A survey of nightmare frequency and intensity in an Australian University sample and treatment with a Story-Line Alteration Technique (SLAT) Fabian A Elzo Submitted in fulfillment of the requirements for the Doctorate of Philosophy degree at the School of Social Sciences and Psychology at Victoria University August 2011 1 Acknowledgements This project was supervised by Associate Professor Gerard Kennedy. Hence, I would like to extend my sincere gratitude to Gerard for his support and guidance throughout the course of this project, as well as Professor Jill Astbury for her assistance as co-supervisor in the first year of undertaking this research thesis. Acknowledgements are also extended to my lovely wife Sara and children Jacob, Bethany and Liam for their patience during this project; thank-you for your love and support. Now it’s time for a family holiday. 2 Statement of Declaration I, Fabian A. Elzo, declare that the PhD thesis entitled “ A survey of nightmare frequency and intensity in an Australian University sample and treatment of weekly nightmares with a Story-Line Alteration Technique (SLAT)” is no more than 100,000 words in length, exclusive of tables, figures, appendices, and references. This thesis contains no material that has been submitted previously, in whole or in part, for the award of any other academic degree or diploma. Except otherwise indicated, this thesis is my own work. Signature:________________________ Date:____________________ 3 TABLE OF CONTENTS TABLES OF CONTENTS ........................................................................................... 4 LIST OF APPENDICES ............................................................................................ 10 ABSTRACT ................................................................................................................. 11 CHAPTER 1: Introduction ........................................................................................... 12 1.1. Historical Overview .................................................................................... 12 1.2. Literture Overview ...................................................................................... 16 1.3. Australian Research on Nightmares ............................................................ 25 1.4. Statement of Significance ............................................................................ 26 1.5. Contribution to Knowledge ......................................................................... 27 1.6. Thesis Focus ................................................................................................ 29 1.7. Aims for the First Study .............................................................................. 29 1.8. Aims for the Second Study ......................................................................... 30 1.9. Hypotheses for the First Study .................................................................... 30 1.10. Hypotheses for the Second Study ................................................................ 31 1.11. Thesis Structurce ......................................................................................... 31 CHAPTER 2: Dream Theories/Hypotheses ................................................................. 33 2.1. Introduction ................................................................................................. 33 2.2. Wish fulfillment Theory of Dreams ............................................................ 34 2.2.1. Nightmare Experiences - Wish fulfillment Theory of Dreams ................... 37 2.3. The Activation-Synthesis Hypothesis ......................................................... 38 2.3.1. Nightmare Experiences -The Activation-Synthesis Hypothesis.................. 42 2.4. Cognitive-Psychological Analysis of Dreams Model ................................. 44 2.4.1. Nightmare Experiences - Cognitive-Psychological Dreams Model ........... 47 2.5. Neuro-cognitive Model of Dreams .............................................................. 48 2.5.1. Nightmare Experiences - Neuro-cognitive Model of Dreams ..................... 52 2.6. Summary and Conclusion............................................................................ 53 4 CHAPTER 3: Contemporary Nightmare Models and Theories ................................... 56 3.1. Introduction ................................................................................................. 56 3.2. Hartmann’s Nightmare Theory/Hypothesis................................................. 57 3.3. Threat Simulation Theory (TST) ................................................................. 63 3.4. Neuro-Cognitive Model of Dreaming ......................................................... 67 3.5. Cognitive Model of Recurrent Nightmares ................................................. 72 3.6. Summary and Conclusion............................................................................ 77 CHAPTER 4: Contentious Issues associated with Dream and Nightmare Definitions 81 4.1. Introduction ................................................................................................ 81 4.2. Dream definitions ........................................................................................ 81 4.3. Nightmare Definitions ................................................................................. 82 4.4. Physiological/Psychological Distinctions between Sleep Disturbances ...... 83 4.5 Sleep Architecture ....................................................................................... 86 4.6. Physiological Constructs Confounded in Early Nightmare Definitions ...... 88 4.7. Psychological Constructs Confounded in Early Nightmare Definitions ..... 89 4.8. Nightmares Reported in Contemporary Literature ...................................... 91 4.9. Trauma Related Dichotomy ........................................................................ 93 4.9.1. Trauma-Related Nightmares ....................................................................... 93 4.9.2. Non-Trauma Related Nightmares ................................................................ 95 4.10. Psychopathology Related Dichotomy ......................................................... 96 4.10.1. Primary Psychopathology ............................................................................ 96 4.10.2 Secondary Psychopathology ........................................................................ 97 4.11. Clinical/Research related Dichotomy .......................................................... 98 4.11.1. Clinical Definition ..................................................................................... 98 4.11.2. Research Definition ................................................................................... 101 4.12. Definitive Elements of Nightmares ........................................................... 104 4.13. Summary and Conclusion.......................................................................... 105 5 CHAPTER 5: Prevalence Studies and Dilemmas ....................................................... 107 5.1. Introduction ............................................................................................... 107 5.2. Frequency and Prevalence Reports ........................................................... 108 5.3. Healthy Populations .................................................................................. 109 5.3.1. Nightmare frequency estimates in Children .............................................. 109 5.3.2. Nightmare frequency estimates in Adolescents......................................... 110 5.3.3. Nightmare frequency estimates in Young and Middle aged Adults .......... 110 5.3.4. Nightmare frequency estimates in the Elderly .......................................... 111 5.4. Developmental Perspective: Frequency Progression ................................ 111 5.5. Generalisability: Nightmare Frequency Studies ..................................... 112 5.5.1. University Samples .................................................................................... 113 5.6. Gender Difference .................................................................................. 116 5.7. Psychopathological Symptoms .................................................................. 118 5.8. Clinical Populations .................................................................................. 119 5.8.1. Psychopathological Populations ............................................................. 119 5.8.2. Pathological Populations ........................................................................... 123 5.9. Prevalence and Frequency estimate issues ................................................ 124 5.10. Australian Estimates .................................................................................. 126 5.11. Summary and Conclusion.......................................................................... 127 CHAPTER 6: Nightmare Formation Function and Interpretation ............................. 128 6.1. Introduction ............................................................................................... 128 6.2. Nightmare Formation ................................................................................ 130 6.3. Biology/Physiology of Nightmare Formation ........................................... 130 6.3.1. Hartmann ................................................................................................... 130 6.3.2. Solms ........................................................................................................