PTSD Dreaming, Part 1

For the past three years, I’ve been living with post-traumatic stress disorder from experiences that occurred before, during and after spinal surgery. Trauma-related issues have become commonplace these days as uncertainty about the future is causing unprecedented levels of stress and crisis in many people’s lives all over the world. Our dream experiences reflect and influence our waking experiences, and in difficult times this dynamic relationship becomes especially significant. Drawing upon current therapeutic models for trauma care, I’d like to explore some of the healing possibilities of trauma-informed dreamwork.

First, a brief primer on trauma. Not everyone who has traumatizing experiences gets PTSD. Usually, we are able to literally “shake off” (through releases like trembling or crying) the physical shock of such experiences and go forward integrating the changes that traumatic events can cause in our lives. But PTSD occurs when the body’s natural threat responses and recovery processes are acutely or chronically thwarted or distorted. In PTSD, we feel trapped, and therefore can’t stop reacting, can’t return to equilibrium, after the crisis has passed. When this happens, virtually every subsequent life experience is perceived as a potential threat, especially experiences that remind us of the initial trauma. The body is numbed and disoriented by internal alarms, overwhelmed and confused by external stimuli, perpetually mobilized to fight or run away, or locked into paralyzing dissociation. 

When all of the body’s resources are going toward threat readiness, some internal systems are charged up, while others are switched off. When we’re gripped by “fight-flight” (a sympathetic nervous system response) or “freeze” (a parasympathetic response), no energy is available for everyday essential functions like digestion, sleep or socializing. We can’t think creatively or systematically, can’t make decisions or feel joy. We aren’t motivated by anything but the emergency that never ends, so exhaustion is inevitable, relationships can break down, and secondary illnesses or injuries are likely. PTSD has profound physical, mental and emotional consequences, diminishing our sense of ourselves as whole beings with full lives; we become nothing but a set of reflex reactions to circumstances beyond our control. Even if diagnosable PTSD is not present, anyone with a trauma history may experience some of these symptoms when stressed. In troubled times, we all need support from one another, and from practices that help regulate our nervous systems and restore balance. Though dreams can be part of the problem (PTSD often brings repetitive nightmares and sleep disorders), they can also contribute greatly to healing. 

Because traumas impair cognitive function, many forms of talk therapy are unhelpful, but if a traumatized person is able to recall dreams and has some capacity for self-reflection, dreamwork may be a tremendous resource because dream imagery offers a perspective on disturbing experiences that includes the body as well as the mind. Although PTSD dreams are often filled with repetitious problem and threat scenarios, these scenarios can be emotionally cathartic, and may include fresh details and connections essential to restoring equilibrium. Except in the case of PTSD nightmares (which are more like inescapable flashbacks than like dreams), dreaming can refresh our range of options, helping us recognize possibilities we can’t see when our emotions and cognitive minds are on automatic pilot, stuck in threat reaction patterns. 

Dream scenarios usually diverge from literal memories of traumatic events in ways that create alternative neural pathways in the brain. Just having dreams helps, and then telling them to an attentive and caring person helps even more. If that other person has dreamwork skills and can provide fresh insights, all the better, though this isn’t essential. A listening ear and an open mind may be exactly what is lacking for a person with PTSD, and dreams provide an opportunity to connect with others in ways that are intimate and authentic yet potentially non-threatening. Just telling or hearing dreams non-judgmentally may be meaningful, because when interesting dream content is being shared, the social pressure of making conversation is reduced.

Generally, PTSD dreamwork that involves talking should emphasize sensations and impressions rather than analysis—allowing the dream itself to provide the healing. I’ll give some examples of this in part 2, but for now I’ll just say that an important aspect of PTSD healing is restoring trust in one’s own body, so paying attention to direct physical dream experiences in all five senses is extremely powerful medicine, provided there is a safe context. Even if someone does not recall any dreams of their own, or if their dreams are too disturbing to share, indirectly experiencing the imagery in others’ dreams may be meaningful, inviting physical impressions and responses without overwhelming personal associations. A person with PTSD should not be expected to offer insights, but should be welcomed to do so if it comes naturally. Above all, a vulnerable person needs permission to simply experience dreams without the imperative to make sense of them. This helps reinforce trust in self and others, so when potentially triggering dream content comes up, it can be felt with the confidence that it will pass, making room for new possibilities rather than an endless recycling of traumatic events.

If PTSD is acute, however, a more body-oriented approach may be necessary, since thinking and talking, even about neutral topics, can be too threatening. In some cases, flashback nightmares reinforce traumatic events, and more positive dream memory may be entirely absent. Yet dreams can still be the path of healing for the psyche, even if this process isn’t conscious. During REM sleep (perhaps also during other sleep stages) dreams integrate scattered memory fragments and sense impressions to create the coherence and meaning that are absent in severe PTSD. Unfortunately, it is often not just the capacity to remember dreams that is impaired by trauma, but the dreaming process itself: people with PTSD (like those with certain forms of depression or anxiety) tend to have less REM sleep and poor sleep quality overall, which deprives them of integration when they need it most. Therapies such as EMDR, tapping, and neurofeedback seem to carry out some of the same functions as dreaming, and may be helpful in reestablishing healthy dream sleep.

In part 2, I’ll give some examples of PTSD dreams, and also discuss how tools like theater and bodywork with dreams can be effective for those of us with disregulated nervous systems who might have difficulty with analytical dreamwork. In the meantime, if you are having PTSD symptoms, take heart! Even if you can’t immediately feel it, your dreams are working within you, and others’ dreams are working around you (as Jeremy Taylor would say) “in the service of healing and wholeness.”

[This article was originally published in in the Fall, 2022 issue of DreamTime Magazine. If you enjoyed it, please consider subscribing to DreamTime by joining the International Association for the Study of Dreams ]