Dear Allison,

Lucid Dreaming: dream awareness while dreaming.

Trauma alters biological, psychological, physical, social and spiritual domains.

Focus on just symptoms will limit treatment – relates to IPDT Trauma is not integrated to memory. Biological aspect notes memory is stored in affect & non-verbal forms (van der Kolk, 2005).  Social: Disconnect from society as veteran or survivor

experiences are dissimilar to most people.  Psychological: Loss of belief that world is a relatively safe place or similar catastrophic loss in worldview.  Fear-based system stems from trauma w/o integration, assimilation or accommodation of experience creates “what if” filter. Fear-based system overload HPA-axis burnout

 System fatigue and depression.  Isolation and narrowing of ability to cope/problem

solve.  Conflict in universal truths. Dealing w issues of death w resulting guilt, shame,

grief, helplessness (victim/victim maker).

Stages of Treatment

Rapport: Safety a paramount concern for client.  Psycho-education.  Core process to calm the arousal system.  Self-efficacy foster independence from

treatment cente.

PTSD was associated with enhanced cortisol

suppression indicating HPA-Axis burn-out.

Dose-Response

Multiple stressors lead to HPA axis burnout (Lindqvist,

2010) & brain inflammation.

 Depletes tryptophan which lowers monoamines

(serotonin, dopamine and noradrenalin).

 Lowers levels of orexins (a neuropeptide) which help

regulate sleep & arousal were found to be low in

suicidal persons w MDD

 AKA the “Wear and tear” hypothesis…

Research -Neurobiology of Sleep

 Sleeping brain alive w activity

 Dreaming is a sensorimotor process as limbic system

(limbic and paralimbic area) activates (Hobson, 2002) These

areas are associated most closely to the survival process

(fight/flight).

 Somatic memory stored in limbic system (van der Kolk, 2005).

Traumatic memory is a sensorimotor process…. Hello!

 Van der Kolk concluded cognitive therapies less effective

b/c trauma is not stored in cortical areas.

 Trauma & dreaming are sensorimotor. Natural pathway

Research -Neurobiology

 Nightmares tend to wake person at the height of terror

 Nightmares tend to sensitize the sufferer & increase

levels of fear w/o benefit of process

Research - Art

 Morgan and Read (1995) sought a creative route to

address the aspect of trauma not found in words.

 They suggested drawing was a non-invasive method to

process the content of nightmares.

 Art fostered increased awareness while dreaming

Research - Dreaming

 Rothbaum & Mellman (2001) suggest lucid dreaming.

Spadfora and Hunt (1990) found:

 Both Nightmares and Lucid Dreaming can be bridge

to Archetypal dreaming.

 Active nightmares impact spatial-analytic ability

 Lucid and archetypal dreamers highest in imagination.

 Archetypal dreams open dreamer to transformation

dreams.

Research – Lucid Dreaming

 Small study instructed patients to become aware of

dream while in the dream then before terrifying aspect

they could shut down the previous action.

 Half the subjects learned to become lucid in only 1

treatment

 All six were able to weaken “fright”

 Improvements continued after TX stopped

Research – Lucid Dreaming

Benefits:

 Improves rest

 Enhances problem solving skills

 Over all improvements in problem solving can be

tested in Stroop Task Application

Research: Standard VA Therapy

 Prolonged Exposure (PE) and Cognitive Processing

Theory (CPT).

 96% of VA facilities have at least one

 PE shown to reduce SX in general by 33%

 CPT demonstrated a 28% reduction. (Karlin et al 2010)

Drug therapy

 Prazosin is an alpha-1 blocker current drug of choice

(start at 1 mg at bedtime) for PTSD/ASD

 FDA approved: sertraline (Zoloft) and paroxetine

(Paxil) for PTSD

 Fluvoxamine best effect on reducing traumatic dreams

2.9 at baseline to 2.0 @ 10 weeks (150 mg modal dose)

 Risperidone under study (n=400)

Hoping this will be helpful,

Rafik

I compared painting therapy with qigong therapy treating psychotic patients. Both had different effects. Painting therapy reduced the Feeling of anxiousness and anxiety and made ot possible to them to see their Position in the reality and to verbalize this. These results - besides others which are not so interesting for you as you want to look for traumatised patients - might be valuable for you. - And of course qigong therapy would also be fine for your patients, but this is not what you asked for.  (Vol. 12 – Thomas Heise: Qigong und Maltherapie • 2009 • 248 Seiten • 17 x 24 cm • dt • EUR 38,00 • ISBN 978-3-86135-144-3)

Having completed one course in lucid dreaming i could not imagine, that traumatized patients could get a safe enough feeling and benefit from it.

http://vwb-verlag.com/fkat_r.html

I think this is a great question and I remember wondering something similar in relation to people with substance misuse who lived in a context rich with cultural enactment. However I did not investigate, and no longer practice art therapy in a clinical setting. I have a sense that the activity of painting captured really complex mesh of trauma, grief and guilt. In ways made momentarily tangible, and although not articulated, by being their as an accompanying witness, I've experienced the shift in a person when that sequence occurred in safety and through the anonymity of the medium as the vehicle to externalise. Sorry - not much help, but a really interesting question although I don't know about 'lucid dreaming' - only painting,

Rafik, 

Loved your answer.  Very informative!!

Rafik, 

Loved your answer.  Very informative!!

Allison,

You may want to look at Bella's paper on stuckness.

THE TAO OF STUCKNESS: A HEURISTIC ART-BASED INQUIRY INTO

FOLLOWING THE THREAD OF THE STUCK EXPERIENCE by Kim Bella.

I am interested in tying the arts to defining the impact of trauma, to determine progression in trauma care, and for client's to visualize wellness and healthy living.

Reading Bella's paper and seeing the art included in her paper gave me the idea of using art in my clinical practice.  I had already considered using the spoken arts such as poetry and short stories as expressive narratives.  

After read Cattell's longitudinal study on the benefits to education and student long term success.  The benefit were enormous to the students even with a minimal amounts of art in education.  I know that this does not mean a positive correlation of the benefits when transferred to trauma care but I think that it is worth being researched.

Rafik, 

Loved your answer.  Very informative!!

Aswin,

A very interesting reading list.

I remember this book being good on counselling with nightmares and dreams

http://www.amazon.co.uk/Counselling-Dreams-Nightmares-Therapy-Practice/dp/0803986009

Rafik, Thank you so much for your response. So helpful for those of us interested in this topic.

This question fascinates me as I can connect with it on three different levels.  I cannot comment as a trained professional, but as a practicing artist (self-taught in prison) and a former political prisoner dealing with PTSD, I believe a therapeutic approach using both art therapy and lucid dreaming might actually be useful where other therapies usually fall short. (I've tried most of them.)

My academic training was in neuroscience, and I confess an implicit bias when it comes to anything that sounds New Age or quasi-spiritual. However, there are elements to both lucid dreaming and art therapy that resonate with those dealing with PTSD.

While serving thirteen years in the federal system (seven in solitary confinement) I experimented with lucid dreaming. My goals were understandable given the circumstances - to leave the prison for a while and connect with important people in my life for a few moments in my dreams. I was able to achieve this with some success, although the methodology for lucid dreaming was daunting even for someone with little else to attend to. I also became an artist - largely as a way to connect to people in the outside world and to keep the Me in me alive. I was very prolific in those years. I was able to put together a portfolio that got me admitted to an MFA graduate program without ever having taken a formal art course.

What makes sense to me in these approaches is the element of witnessing and story-telling. Ex-convicts (former political prisoners and other ex-cons), as well as veterans and other trauma survivors who I have met all seem to share a need to tell our story to someone who will deeply listen. Not just once, but as long as and as many times as it takes to tell it. Families can't/won't do this, nor friends, and therapists are mostly interested in directing outcomes. I understand the veterans involvement with the VFW or American Legion, or whatever organization they might find with similar survivors where they sit with people who implicitly understand what they've been through. Most trauma survivors are looking for this. In countries that have gone through genocides or human rights abuses, the resulting Truth and Reconciliation Commissions largely serve this function - to let survivors speak their truths and have these experiences acknowledged as having been something that was very, very wrong. This is not something ex-offenders are likely to find. Ever. We are the ones responsible for our own institutional treatment - including solitary confinement and psychological torture.

Art can be way of creating nonlinear narratives in this fashion. One organization that I respect immensely is a group of veterans/artists called Combat Paper. (http://www.printnj.org/combat-paper/)  These vets invite their comrades to make paper out of their old uniforms and create art with them. It's a remarkable process that involves art as well as writing, But story-telling is behind all of it.

One of the hardest parts of surviving trauma is the very mechanism that keeps us from experiencing the pain in the first place. I am amazed at how my brain slammed the door shut on my prison experience so quickly and completely. Until I go to sleep. The story and the characters are there, but they need the unconscious to reactivate.

Where lucid dreaming might be of use is in the redirection of the stories that play in our heads most every night. I have had the same nightmare three times a week or more for the last twelve years. The details change, but the essentials of the narrative are always the same. No form of therapy that I have tried has made a dent in this pattern. Perhaps lucid dreaming - which helped me in solitary might be a way to "finish the story" in a more favorable way. I think it is a very promising avenue to explore.

http://www.printnj.org/combat-paper/

Thank you all so very much for your generosity of sharing your experience, expertise, vulnerability, and resources. 

Dear Allison,

I do agree your question is a good one. How to integrate different techniques which both can enhance intense emotional responses in our patients. Let me suggest a recent paper we have recently published on "active technique in psychodynamic therapy". We offer a theoretical frame explaining why these interventions may work and produce therapeutic change, plus some recommendations on technical issues. In particular, when working with traumatized patients, a secure bond and awareness of patient's ability to deal with emotional intensity or to self-regulate emotional states aré both critical. When using powerful therapeutic weapons such as these, you must keep the risk for iatrogenia always in mind.

I've used myself both dream analysis (though note lucid dreaming) plus working with artística photos in a borderline patient within this model. A clinical vignette is shown in the article. 

For further info please check: de Iceta, Soler, Mendez, Ingelmo & Bleichmar (2015) Active Change in Psychodynamic Therapy: Moments of High Receptiveness. AMERICAN JOURNAL OF PSYCHOTHERAPY 69(1):65-86 ·

I hope you find this useful.

Best regards,

Mariano de Iceta