The interpretation of dreams has been a topic of interest for many centuries, dating back to 350 BC (Aristoteles, 2001). Specific considerations of the meaning of nightmares have not been as richly developed as they have been for dreams. One way dream researchers have analyzed dreams is through examining the use of language in dream reports. However, this method is in its infant stages regarding its approach to understanding nightmares. Psychological constructs can be measured using a form of quantitative text analysis called Linguistic Inquiry and Word Count (Pennebaker, Boyd, Jordan, & Blackburn, 2015). This study aims to contribute to the understanding of nightmare content, specifically how nightmare content differs from that of dreams in areas of emotion, social, and perceptual processing. Transcripts of posttrauma nightmare (PTNM) reports were collected from individuals participating in a cognitive-behavioral therapy for nightmares, the exposure, relaxation, and rescripting therapy (Davis, 2008). Language use within PTNMs was compared with established norms of language use in dreams (Bulkeley & Graves, 2018). Results indicated that PTNMs differed from dreams significantly. PTNMs demonstrated increased use of negative emotion words, hearing and feeling words, and risk words. PTNMs showed decreased use of words related to friends and leisure, decreased analytical thinking, and clout. There were no differences in positive emotion words, family, death, visual and motion words. These results support the theory that PTNMs are different than dreams in important ways. The information gleaned from these PTNM reports may be used to inform treatment of trauma-related disorders.

Introduction Studying language use in dreams and nightmares has become an increasingly used tool to understand underlying emotional and cognitive processes. Specifically, in regards to post-trauma nightmares (PTNMs), nightmare transcriptions can offer a lens to understand a survivor’s interpretation of their trauma. The current study will utilize a method of quantitative text analysis to analyze the relationship between specific psychological constructs and symptoms of posttraumatic stress disorder (PTSD) and nightmare qualities. It is hypothesized that there will be a positive correlation between words related to perceptual processes and negative emotions in nightmares and PTSD symptom and nightmare severity. There will be a negative correlation between cognitive processes and positive emotion words, and PTSD symptom and nightmare severity. Methods Fifty-three nightmares were collected from participants that were recruited from the community in a Midwestern city as part of an ongoing investigation of the effectiveness of a brief cognitive-behavioral intervention for PTNM, Exposure, Relaxation, and Rescripting Therapy (ERRT). All participants were over the age of 18, have experienced a criterion A trauma, and have nightmares at least once weekly. Linguistic Inquiry and Word Count (LIWC) was utilized to analyze the nightmare transcriptions. The Posttraumatic Stress Disorder Checklist for the DSM-5 (PCL-5) and the Trauma-related Nightmare Survey (TRNS) were used to measure symptom severity. A Pearson’s correlation analysis was used for this exploratory study. Results Words related to perceptual processes were significantly positively correlated with PTSD symptom and nightmare severity (p<.05) Neither negative nor positive emotion words were significantly related to PTSD and nightmare symptoms (p>.05). Cognitive processing words were significantly negatively correlated with PTSD and nightmare symptoms (p<.05). Conclusion The results of this study support the hypothesis that language use in nightmares reveals important information about underlying cognitive and emotional functioning. The results of this study may have an important impact on treatment considerations for those who have experienced trauma. Analyzing language use in PTNM may help to understand the etiology and maintenance of PTSD symptoms. Support Support for this study comes from the University of Tulsa Institute of Trauma, Adversity, and Injustice.

In adult populations, bipolar disorders (BDs) and posttraumatic stress disorder (PTSD) have overlapping symptoms, potentially leading to misdiagnosis. This misdiagnosis or failure to diagnose both co‐occurring disorders can result in individuals not receiving the proper treatment to address their symptoms. This article highlights how trauma‐informed psychological assessment can assist in differential diagnosis and improve the timely delivery of appropriate treatments. The overlapping symptoms of PTSD and BD are discussed to assist in differential diagnosis, and we suggest guidelines for conducting trauma‐informed, evidence‐based assessments to help clarify these diagnoses.

Objective: The current study sought to understand how language use in posttrauma nightmare (PTNM) reports may be related to psychological symptoms over the course of treatment. Method: Multiple regression analyses were conducted to examine the relationship between language use in PTNMs and psychological symptoms. Specifically, cognitive processing words (CPW) and emotional tone (ET) measured in PTNMs were analyzed in their relationship to posttraumatic stress disorder (PTSD) and depression symptom severity, as well as nightmare frequency and distress measured at the midtreatment and last treatment sessions. Follow-up hierarchical regressions were used to assess the relationship of language to nightmare severity when controlling for both PTSD and depression severity. The sample consisted of treatment-seeking predominately Caucasian females from the community with a history of criterion A trauma and weekly nightmares. Results: CPW in the nightmare were negatively associated with PTSD and depression symptom severity, as well as nightmare frequency, at the time of the exposure session. Decreased CPW and negative ET within the nightmare remained significantly associated with nightmare frequency at the time of the exposure session, when controlling for PTSD and depression symptom severity. CPW in the rescripted PTNM were negatively associated with PTSD and depression symptom severity at the time of the last treatment session. Conclusions: These results suggest that language use in nightmares may reveal important information about underlying cognitive and emotional processes that may help understand the etiology and maintenance of PTSD symptoms, as well as support PTNMs as co-occurring symptoms requiring targeted treatment, and not merely secondary symptoms of PTSD.

Introduction While nightmares are well known to be associated with greater sleep disturbance and psychopathology relative to insomnia, this has primarily been observed in experimental samples and not well-studied in outpatient clinical samples. Several theories for the etiology and maintenance of nightmares have identified the roles of both hyperarousal and emotion dysregulation in explaining the association of nightmares to adverse psychiatric outcomes. Given that insomnia is also associated with similar predisposing and perpetuating factors such as greater trait arousability and sleep reactivity, it is important to understand how these factors compare between nightmares and insomnia. Methods A total of 445 patients (45.6±18.4 years old, 66.5% female, 13.0% minority) with diagnoses of nightmare disorder (n=32), insomnia disorder (n=274) and any other sleep disorder (n=139) were evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Health Sleep Research & Treatment Center. To measure symptoms of depression, anxiety, stress, hyperarousal, sleep reactivity, and dysfunctional beliefs about sleep, all patients completed the Depression Anxiety Stress Scale (DASS), Arousal Predisposition Scale (APS), Ford Insomnia Response to Stress Test (FIRST), Pre-sleep Arousal Scale, and Dysfunctional Beliefs and Attitudes about Sleep (DBAS), respectively. Analysis of variance (ANOVA) examined between-group differences in patient-reported outcomes. Results There were no significant between-group differences on sleep reactivity, pre-sleep cognitive arousal, dysfunctional beliefs and attitudes about sleep or depression scores (all ps>0.12). However, patients with nightmare disorder showed greater arousability, in both trait anxiety and emotional reactivity, pre-sleep somatic symptoms, anxiety and perceived stress than patients with insomnia disorder or with any other sleep disorder (all ps< 0.05). Conclusion While patients with nightmare disorder share predisposing and perpetuating factors common to patients with insomnia disorder, they do present with more severe forms of cognitive-emotional arousability, trait-anxiety, and somatic symptoms of anxiety that impact nighttime sleep. These data suggest that clinical evaluations for sleep disruption should include a thorough gathering of history to include the onset, course, and perpetuating factors. Cognitive-behavioral therapies for nightmares and insomnia should be tailored to target these specific factors in order to prevent relapses. Support (if any)