Aetiology and treatment of nightmare disorder: State of the art and future perspectives

Annika Gieselmann¹, Malik Ait Aoudia², Michelle Carr³, Anne Germain⁴, Robert Gorzka⁵, Brigitte Holzinger⁶, Birgit Kleim⁷, Barry Krakow⁸, Anna E Kunze⁹, Jaap Lancee¹⁰, Michael R Nadorff¹¹, Tore Nielsen¹², Dieter Riemann¹³, Hinuga Sandahl¹⁴, Angelika A Schlarb¹⁵, Carolin Schmid¹⁶, Michael Schredl¹⁷, Victor I Spoormaker¹⁸, Regina Steil¹⁶, Annette M van Schagen¹⁹, Lutz Wittmann²⁰, Maria Zschoche¹⁵, Reinhard Pietrowsky¹

Affiliations

¹ Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
² Centre du Psychotrauma de l'Institut de Victimologie à Paris, Paris, France.
³ Department of Psychology, Swansea University, Swansea, UK.
⁴ Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁵ Central Institute for Mental Health, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany.
⁶ Institut für Bewusstseins- und Traumforschung, Vienna, Austria.
⁷ Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland.
⁸ Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, New Mexico, USA.
⁹ Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany.
¹⁰ Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
¹¹ Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA.
¹² Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
¹³ Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany.
¹⁴ Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.
¹⁵ Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany.
¹⁶ Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany.
¹⁷ Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
¹⁸ Max Planck Institute of Psychiatry, Munich, Germany.
¹⁹ Foundation Centrum '45, Partner in Arq Psychotrauma Expert Group, Oegstgeest, the Netherlands.
²⁰ International Psychoanalytic University Berlin, Berlin, Germany.

PMID: 30697860
PMCID: PMC6850667
DOI: 10.1111/jsr.12820

Review

Aetiology and treatment of nightmare disorder: State of the art and future perspectives

Annika Gieselmann et al. J Sleep Res. 2019 Aug.

. 2019 Aug;28(4):e12820.

doi: 10.1111/jsr.12820. Epub 2019 Jan 29.

Authors

Affiliations

¹ Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
² Centre du Psychotrauma de l'Institut de Victimologie à Paris, Paris, France.
³ Department of Psychology, Swansea University, Swansea, UK.
⁴ Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁵ Central Institute for Mental Health, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany.
⁶ Institut für Bewusstseins- und Traumforschung, Vienna, Austria.
⁷ Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland.
⁸ Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, New Mexico, USA.
⁹ Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany.
¹⁰ Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
¹¹ Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA.
¹² Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
¹³ Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany.
¹⁴ Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.
¹⁵ Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany.
¹⁶ Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany.
¹⁷ Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
¹⁸ Max Planck Institute of Psychiatry, Munich, Germany.
¹⁹ Foundation Centrum '45, Partner in Arq Psychotrauma Expert Group, Oegstgeest, the Netherlands.
²⁰ International Psychoanalytic University Berlin, Berlin, Germany.

PMID: 30697860
PMCID: PMC6850667
DOI: 10.1111/jsr.12820

Abstract

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

Keywords: PTSD; anxiety; evidence-based medicine; exposure; imagery (psychotherapy); nightmare scripts; parasomnias; posttraumatic stress disorders; sleep-disorders.

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Conflict of interest statement

Anne Germain owns equity in and serves as CEO for Rehat, LLC and received a consulting honorarium from Jazz Pharmaceuticals. Barry Krakow sells products and services for the treatment of nightmares via his website and owns and operates the commercial sleep center Maimonides Sleep Arts & Sciences, Ltd. Annika Gieselmann, Malik Ait Aoudia, Michelle Carr, Robert Gorzka, Brigitte Holzinger, Birgit Kleim, Anna E. Kunze, Jaap Lancee, Michael R. Nadorff, Tore Nielsen, Dieter Riemann, Hinuga Sandahl, Angelika A. Schlarb, Carolin Schmid, Michael Schredl, Victor I. Spoormaker, Regina Steil, Annette M. van Schagen, Lutz Wittmann, Maria Zschoche and Reinhard Pietrowsky declare that they do not have any conflict of interests.

Figures

**Figure 1**
Integrative model of nightmare aetiology

**Figure 2**
Frequently applied trauma‐focused interventions and proposed alternative approaches

See this image and copyright information in PMC

Comment in

The pathophysiology of nightmare disorder: Signs of impaired sleep regulation and hyperarousal.
Simor P, Blaskovich B. Simor P, et al. J Sleep Res. 2019 Dec;28(6):e12867. doi: 10.1111/jsr.12867. Epub 2019 May 15. J Sleep Res. 2019. PMID: 31094047 No abstract available.
Sleep, insomnia and neurological and mental disorders.
Riemann D. Riemann D. J Sleep Res. 2019 Aug;28(4):e12892. doi: 10.1111/jsr.12892. J Sleep Res. 2019. PMID: 31297929 No abstract available.

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Aetiology and treatment of nightmare disorder: State of the art and future perspectives

Affiliations

Aetiology and treatment of nightmare disorder: State of the art and future perspectives

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources