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In the midnight hour: Cancer and nightmares. A review of theories and interventions in psycho-oncology

Published online by Cambridge University Press:  04 May 2011

David K. Wellisch  and
Marie Cohen
David K. Wellisch*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
Marie Cohen
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
*
Address correspondence and reprint requests to: David K. Wellisch, 760 Westwood Plaza, C8-849, Los Angeles, CA 90095. E-mail: dwellisch@mednet.ucla.edu
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Abstract

Objectives:

The purposes of this study were: (1) to explore cancer patients' complaints of poor sleep, which often involve a combination of somatic symptoms and nightmares; and (2) to understand these sleep disturbances in the light of modern dream theories and intervention modalities.

Method:

 The literature search originated with several major articles (Revonsuo, 2000; Krakow & Zadra, 2006; Hobson, 2009) which then opened up the search through their references.  We also used the database PubMed, and employed the following key words:  cancer, nightmares/dreams, sleep disturbances, and dream theory. The literature search covered the interval between 1900 (Freud, 1900) and 2009. Our criteria for selecting studies included the most recent major review articles on the neuroscience of sleep and dreams; articles reviewing sleep disturbances in cancer patients and relevant treatments; and articles reviewing interventions for traumatic dreams.  Approximately 30 articles were deemed worthy of inclusion.

Results:

Thirty article/books/chapters met the criteria for relevance related to key theories and clinical interventions related to nightmares and traumatic dreams of cancer patients. Key concepts involve threat simulation theory and imagery rehearsal therapy in regard to theoretical and interventional paradigms significantly generalizable to cancer patients. The dream material included in this article presents patients' attempts to deal with complex threats such as intense dependency/ loss of self-sufficiency, disfigurement, and death. This is especially true with regard to the doctor–patient relationship at all stages of the illness and disease. Imagery rehearsal can facilitate empowerment in light of highly threatening and conflictual cancer-related dreams in which the patient feels helpless and victimized.

Significance of results:

This review offers a new lens on current dream theories and understanding of sleep disturbance in cancer patients as well as their familes and medical caregivers. Modern theories lead to opportunities for intervention that can both relieve symptoms and improve communication between medical caregivers and patients and families.

Keywords

CancerNightmaresThreat assessmentImage rehearsal therapy (IRT)
Type
Review Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 2 , June 2011 , pp. 191 - 200
Copyright
Copyright © Cambridge University Press 2011

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