• Michael Schredl


Nightmares are defined as very negatively toned dreams and have been experienced by many from time to time. If they occur very often and cause clinically significant distress, a nightmare disorder should be diagnosed. The etiology of nightmares is explained by a disposition-stress model; in addition, traumata and psychoactive drugs might play a role. Interestingly, research has provided evidence that simple cognitive interventions like the imagery rehearsal therapy are very effective for coping with nightmares.


  1. American Academy of Sleep Medicine. (2014). The international classification of sleep disorders (ICSD-3). Darien: AASM.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  3. Augedal, A. W., Hansen, K. S., Kronhaug, C. R., Harvey, A. G., & Pallesen, S. (2013). Randomized controlled trials of psychological and pharmacological treatments for nightmares: A meta-analysis. Sleep Medicine Reviews, 7, 143–152.CrossRefGoogle Scholar
  4. Belicki, K. (1992a). Nightmare frequency versus nightmare distress: Relation to psychopathology and cognitive style. Journal of Abnormal Psychology, 101, 592–597.CrossRefGoogle Scholar
  5. Belicki, K. (1992b). The relationship of nightmare frequency to nightmare suffering with implications for treatment and research. Dreaming, 2, 143–148.CrossRefGoogle Scholar
  6. Bixler, E. O., Kales, A., Soldatos, C. R., Kales, J. D., & Healey, S. (1979). Prevalence of sleep disorders in the Los Angeles metropolitan area. American Journal of Psychiatry, 136, 1257–1262.CrossRefGoogle Scholar
  7. Boerner, J. (1855). Das Alpdrücken: Seine Begründung und Verhütung. Würzburg: Carl Joseph Becker.Google Scholar
  8. Carr, M., & Nielsen, T. (2017). A novel differential susceptibility framework for the study of nightmares: Evidence for trait sensory processing sensitivity. Clinical Psychology Review, 58, 86–96.CrossRefGoogle Scholar
  9. Casement, M. D., & Swanson, L. M. (2012). A meta-analysis of imagery rehearsal for post-trauma nightmares: Effects on nightmare frequency, sleep quality, and posttraumatic stress. Clinical Psychology Review, 32(6), 566–574.CrossRefGoogle Scholar
  10. Cuddy, M. A., & Belicki, K. (1992). Nightmare frequency and related sleep disturbance as indicators of a history of sexual abuse. Dreaming, 2, 15–22.CrossRefGoogle Scholar
  11. Faraday, A. (1990). The dream game. New York: Harper & Row.Google Scholar
  12. Germain, A., Krakow, B., Faucher, B., Zadra, A. L., Nielsen, T. A., Hollifield, M., Warner, T. D., & Koss, M. (2004). Increased mastery elements associated with imagery rehearsal treatment for nightmares in sexual assault survivors with PTSD. Dreaming, 14, 195–206.CrossRefGoogle Scholar
  13. Gieselmann, A., Böckermann, M., Sorbi, M., & Pietrowsky, R. (2017). The effects of an internet-based imagery rehearsal intervention: A randomized controlled trial. Psychotherapy and Psychosomatics, 86(4), 231–240.CrossRefGoogle Scholar
  14. Hansen, K., Höfling, V., Kröner-Borowik, T., Stangier, U., & Steil, R. (2013). Efficacy of psychological interventions aiming to reduce chronic nightmares: A meta-analysis. Clinical Psychology Review, 33(1), 146–155.CrossRefGoogle Scholar
  15. Harb, G. C., Brownlow, J. A., & Ross, R. J. (2016). Posttraumatic nightmares and imagery rehearsal: The possible role of lucid dreaming. Dreaming, 26(3), 238–249.CrossRefGoogle Scholar
  16. Hartmann, E. (1984). The nightmare: The psychology and biology of terrifying dreams. New York: Basic Books.Google Scholar
  17. Hartmann, E. (1991). Boundaries in the mind. New York: Basic Books.Google Scholar
  18. Hublin, C., Kaprio, J., Partinen, M., & Koskenvuo, M. (1999). Nightmares: Familial aggregation and association with psychiatric disorders in a nationwide twin cohort. American Journal of Medical Genetics (Neuropsychiatric Genetics), 88, 329–336.CrossRefGoogle Scholar
  19. Janson, C., Gislason, T., De Backer, W., Plaschke, P., Björnsson, E., Hetta, J., & Kristbjarnason, H. (1995). Prevalence of sleep disturbances among young adults in three European countries. Sleep, 18, 589–597.PubMedGoogle Scholar
  20. Krakow, B. (2006). Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: Diagnostic and treatment implications. Sleep, 29, 1313–1319.CrossRefGoogle Scholar
  21. Krakow, B., & Zadra, A. L. (2006). Clinical management of chronic nightmares: Imagery rehearsal therapy. Behavioral Sleep Medicine, 4, 45–70.CrossRefGoogle Scholar
  22. Krakow, B., & Zadra, A. L. (2010). Imagery rehearsal therapy: Principles and practice. Sleep Medicine Clinics, 5, 289–298.CrossRefGoogle Scholar
  23. Krakow, B., Kellner, R., Pathak, D., & Lambert, L. (1995). Imagery rehearsal treatment for chronic nightmares. Behavior Research and Therapy, 33, 837–843.CrossRefGoogle Scholar
  24. Krakow, B., Hollifield, M., Johnston, L., Koss, M. R., Schrader, R., Warner, T. D., Tandberg, D., Lauriello, J., McBride, L., Cutchen, L., & Cheng, D. T. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 286, 537–545.CrossRefGoogle Scholar
  25. Kunze, A. E., Arntz, A., Morina, N., Kindt, M., & Lancee, J. (2017). Efficacy of imagery rescripting and imaginal exposure for nightmares: A randomized wait-list controlled trial. Behaviour Research and Therapy, 97(Supplement C), 14–25.CrossRefGoogle Scholar
  26. Lancee, J., & Schrijnemaekers, N. C. M. L. (2013). The association between nightmares and daily distress. Sleep and Biological Rhythms, 11(1), 14–19.CrossRefGoogle Scholar
  27. Lancee, J., Spoormaker, V. I., & van den Bout, J. (2010). Cognitive-behavioral self-help treatment for nightmares: A randomized controlled trial. Psychotherapy and Psychosomatics, 79, 371–377.CrossRefGoogle Scholar
  28. Levin, R., & Fireman, G. (2002). Nightmare prevalence, nightmare distress, and self-reported psychological disturbance. Sleep, 25, 205–212.PubMedGoogle Scholar
  29. Levin, R., & Nielsen, T. A. (2007). Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model. Psychological Bulletin, 133, 482–528.CrossRefGoogle Scholar
  30. Levin, R., Fireman, G., Spendlove, S., & Pope, A. (2011). The relative contribution of affect load and affect distress as predictors of disturbed dreaming. Behavioral Sleep Medicine, 9(3), 173–183.CrossRefGoogle Scholar
  31. Li, S. X., Zhang, B., Li, A. M., & Wing, Y. K. (2010). Prevalence and correlates of frequent nightmares: A community-based 2-phase study. Sleep, 33, 774–780.CrossRefGoogle Scholar
  32. Michels, F., Schilling, C., Rausch, F., Eifler, S., Zink, M., Meyer-Lindenberg, A., & Schredl, M. (2014). Nightmare frequency in schizophrenic patients, healthy relatives of schizophrenic patients, patients at high risk states for psychosis, and healthy controls. International Journal of Dream Research, 5, 9–13.Google Scholar
  33. Nadorff, M. R., Nadorff, D. K., & Germain, A. (2015). Nightmares: Under-reported, undetected, and therefore untreated. Journal of Clinical Sleep Medicine, 11(7), 747–750.PubMedPubMedCentralGoogle Scholar
  34. Nielsen, T. A. (2017). The stress acceleration hypothesis of nightmares. Frontiers in Neurology, 8, 201. Scholar
  35. Nielsen, T. A., & Powell, R. A. (2015). Dreams of the rarebit fiend: Food and diet as instigators of bizarre and disturbing dreams. Frontiers in Psychology, 6.
  36. Pagel, J. F., & Helfter, P. (2003). Drug induced nightmares – An etiology based review. Human Psychopharmacology, 18, 59–67.CrossRefGoogle Scholar
  37. Paul, F., Schredl, M., & Alpers, G. W. (2015). Nightmares affect the experience of sleep quality but not sleep architecture: An ambulatory polysomnographic study. Borderline Personality Disorder and Emotion Dysregulation, 2(3), 1–9.Google Scholar
  38. Robert, G., & Zadra, A. L. (2008). Measuring nightmare and bad dream frequency: Impact of retrospective and prospective instruments. Journal of Sleep Research, 17, 132–139.CrossRefGoogle Scholar
  39. Robert, G., & Zadra, A. L. (2014). Thematic and content analysis of idiopathic nightmares and bad dreams. Sleep: Journal of Sleep and Sleep Disorders Research, 37(2), 409–417.CrossRefGoogle Scholar
  40. Sandman, N., Valli, K., Kronholm, E., Ollila, H. M., Revonsuo, A., Laatikainen, T., & Paunio, T. (2013). Nightmares: Prevalence among the Finnish general adult population and war veterans during 1972–2007. Sleep, 36, 1041–1050.CrossRefGoogle Scholar
  41. Schredl, M. (2003a). Continuity between waking and dreaming: A proposal for a mathematical model. Sleep and Hypnosis, 5, 38–52.Google Scholar
  42. Schredl, M. (2003b). Effects of state and trait factors on nightmare frequency. European Archives of Psychiatry and Clinical Neuroscience, 253, 241–247.CrossRefGoogle Scholar
  43. Schredl, M. (2010a). Nightmare frequency and nightmare topics in a representative German sample. European Archives of Psychiatry and Clinical Neuroscience, 260, 565–570.CrossRefGoogle Scholar
  44. Schredl, M. (2010b). Nightmares: An under-diagnosed and undertreated condition? Commentary on Li et al. prevalence and correlates of frequent nightmares: A community-based 2-phase study. Sleep, 33, 733–734.CrossRefGoogle Scholar
  45. Schredl, M. (2013a). Nightmare disorder. In C. Kushida (Ed.), The encyclopedia of sleep (Vol. 4, pp. 219–224). Waltham: Academic.CrossRefGoogle Scholar
  46. Schredl, M. (2013b). Nightmare frequency in a representative German sample. International Journal of Dream Research, 6, 119–122.Google Scholar
  47. Schredl, M. (2013c). Seeking professional help for nightmares: A representative study. European Journal of Psychiatry, 27, 259–264.CrossRefGoogle Scholar
  48. Schredl, M., & Göritz, A. S. (2014). Umgang mit Alpträumen in der Allgemeinbevölkerung: Eine Online-Studie. [Coping with nightmares in the general population: An online study]. Psychotherapie, Psychosomatik und Medizinische Psychologie, 64(5), 192–196.Google Scholar
  49. Schredl, M., & Göritz, A. S. (2015). Changes in dream recall frequency, nightmare frequency, and lucid dream frequency over a 3-year period. Dreaming, 25(2), 81–87.CrossRefGoogle Scholar
  50. Schredl, M., & Göritz, A. S. (2018). Nightmare themes: An online study of most recent nightmares and childhood nightmares. Journal of Clinical Sleep Medicine, 14(3), 465–471.Google Scholar
  51. Schredl, M., & Piel, E. (2006). War-related dream themes in Germany from 1956 to 2000. Political Psychology, 27, 299–307.CrossRefGoogle Scholar
  52. Schredl, M., & Reinhard, I. (2011). Gender differences in nightmare frequency: A meta-analysis. Sleep Medicine Reviews, 15, 115–121.CrossRefGoogle Scholar
  53. Schredl, M., Kronenberg, G., Nonell, P., & Heuser, I. (2001). Dream recall, nightmare frequency, and nocturnal panic attacks in patients with panic disorder: Their relationship to nocturnal panic attacks. Journal of Nervous and Mental Disease, 189, 559–562.CrossRefGoogle Scholar
  54. Schredl, M., Landgraf, C., & Zeiler, O. (2003). Nightmare frequency, nightmare distress and neuroticism. North American Journal of Psychology, 5, 345–350.Google Scholar
  55. Schredl, M., Bocklage, A., Engelhardt, J., & Mingebach, T. (2009). Psychological boundaries, dream recall, and nightmare frequency: A new Boundary Personality Questionnaire (BPQ). International Journal of Dream Research, 2, 12–19.Google Scholar
  56. Schredl, M., Binder, R., Feldmann, S., Göder, R., Hoppe, J., Schmitt, J., Schweitzer, M., Specht, M., & Steinig, J. (2012). Dreaming in patients with sleep disorders: A multicenter study. Somnologie, 16, 32–42.CrossRefGoogle Scholar
  57. Schredl, M., Berres, S., Klingauf, A., Schellhaas, S., & Göritz, A. S. (2014). The Mannheim Dream questionnaire (MADRE): Retest reliability, age and gender effects. International Journal of Dream Research, 7, 141–147.Google Scholar
  58. Seda, G., Sanchez-Ortuno, M. M., Welsh, C. H., Halbower, A. C., & Edinger, J. D. (2015). Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmare frequency, sleep quality, and posttraumatic stress. Journal of Clinical Sleep Medicine, 11(1), 11–22.PubMedPubMedCentralGoogle Scholar
  59. Steine, I. M., Krystal, J. H., Nordhus, I. H., Bjorvatn, B., Harvey, A. G., Eid, J., Grønli, J., Milde, A. M., & Pallesen, S. (2012). Insomnia, nightmare frequency, and nightmare distress in victims of sexual abuse: The role of perceived social support and abuse characteristics. Journal of Interpersonal Violence, 27(9), 1827–1843.CrossRefGoogle Scholar
  60. Stepansky, R., Holzinger, B., Schmeiser-Rieder, A., Saletu, B., Kunze, M., & Zeitlhofer, J. (1998). Austrian dream behavior: Results of a representative population survey. Dreaming, 8, 23–30.CrossRefGoogle Scholar
  61. St-Onge, M., Mercier, P., & De Koninck, J. (2009). Imagery rehearsal therapy for frequent nightmares in children. Behavioral Sleep Medicine, 7, 81–98.CrossRefGoogle Scholar
  62. Stumbrys, T., Erlacher, D., & Schredl, M. (2013). Reliability and stability of lucid dream and nightmare frequency scales. International Journal of Dream Research, 6, 123–126.Google Scholar
  63. Swart, M. L., van Schagen, A. M., Lancee, J., & van den Bout, J. (2013). Prevalence of nightmare disorder in psychiatric outpatients. Psychotherapy and Psychosomatics, 82(4), 267–268.CrossRefGoogle Scholar
  64. Thünker, J., & Pietrowsky, R. (2012). Effectiveness of a manualized imagery rehearsal therapy for patients suffering from nightmare disorders with and without a comorbidity of depression or PTSD. Behaviour Research and Therapy, 50(9), 558–564.CrossRefGoogle Scholar
  65. Thünker, J., Norpoth, M., von Aspern, M., Özcan, T., & Pietrowsky, R. (2014). Nightmares: Knowledge and attitudes in health care providers and nightmare sufferers. Journal of Public Health and Epidemiology, 6, 223–228.CrossRefGoogle Scholar
  66. Tribl, G. G., Wetter, T. C., & Schredl, M. (2013). Dreaming under antidepressants: A systematic review on evidence in depressive patients and healthy volunteers. Sleep Medicine Reviews, 17, 133–142.CrossRefGoogle Scholar
  67. van Schagen, A. M., Lancee, J., Spoormaker, V. I., & van den Bout, J. (2016). Long-term treatment effects of imagery rehearsal therapy for nightmares in a population with diverse psychiatric disorders. International Journal of Dream Research, 9, 67–70.Google Scholar
  68. van Schagen, A. M., Lancee, J., Swart, M., Spoormaker, V., & van den Bout, J. (2017). Nightmare disorder, psychopathology levels, and coping in a diverse psychiatric sample. Journal of Clinical Psychology, 73(1), 65–75.CrossRefGoogle Scholar
  69. Wittmann, L., Schredl, M., & Kramer, M. (2007). The role of dreaming in posttraumatic stress disorder. Psychotherapy and Psychosomatics, 76, 25–39.CrossRefGoogle Scholar
  70. Wood, J. M., & Bootzin, R. R. (1990). The prevalence of nightmares and their independence from anxiety. Journal of Abnormal Psychology, 99, 64–68.CrossRefGoogle Scholar
  71. Zadra, A. L., & Donderi, D. C. (2000). Nightmares and bad dreams: Their prevalence and relationship to well-being. Journal of Abnormal Psychology, 109, 273–281.CrossRefGoogle Scholar
  72. Zunker, M., Althoff, H. K., Apel, J., Lässig, H. S., Schültke, L., & Schredl, M. (2015). Comparing questionnaire and diary measures for eliciting nightmare frequency. International Journal of Dream Research, 8, 129–134.Google Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Michael Schredl
    • 1
  1. 1.Central Institute of Mental HealthMannheimGermany

Personalised recommendations