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Defender of Dreams

New therapy may help traumatized children conquer nightmares

Nightmares play a powerful role in popular culture for obvious reasons. Bad dreams embody some of our greatest fears and, under the spell of sleep, we often feel like we don’t have control over them. All that fear and anxiety makes for interesting television and movie plotlines — it’s exactly why the “Nightmare on Elm Street” franchise is so popular, for instance.

But in real life, for people with post-traumatic stress disorder, frequent nightmares can take a serious toll. In her 2009 book “Treating Post-Trauma Nightmares: A Cognitive Behavioral Approach,” clinical psychologist Joanne Davis of the University of Tulsa writes, “Initiated or exacerbated by a traumatic event, these nighttime horrors may have a haunting impact on the dreamer, affecting not only the quality and quantity of sleep the individual experiences, but also the cognitive, emotional, behavioral and physiological functioning of the individual during the day.”

UM psychology researcher Cameo Stanick studies a new therapy for kids exposed to trauma that switches their worst nightmares to more positive outcomes.In other words, a severe case of nightmares can turn into one giant living nightmare.

Cameo Stanick, a former student of Davis’ and a UM assistant professor of psychology, has spearheaded a study that could help extinguish chronic nightmares for children. The treatment, based on some of Davis’ work with adults, focuses on “rescription,” in which kids between ages 8 and 13 learn how to rewrite their dreams with a positive spin.

The study is small-scale and in its beginning stages, but the results have been promising. It’s being run simultaneously with another study at TU conducted by Lisa Cromer. Stanick and Cromer hope to use the pilot data they gather to launch an expanded, federally funded trial that could benefit multitudes of kids with trauma-induced sleep problems.

Stanick’s journey into nightmare treatment began when she was a graduate student at TU. Davis, her adviser, had been working as an intern at the University of South Carolina National Crime Victims Center, and she was treating a 16-year-old client for PTSD. They were wrapping up the treatment that had been effective for her other PTSD symptoms when the young woman explained that she was still having nightmares that greatly affected her sleep.

“So Joanne, being a scientist-practitioner, started reviewing the literature that was available at that time on treatments,” Stanick says. “She pieced together what eventually became the adult version of this treatment.”

After Davis published her case study, Stanick helped her conduct trials, using the rescription technique with everyone from war veterans to survivors of domestic violence and childhood abuse. The therapy went through three randomized control trials and some quasi-experimental trials before Davis published “Treating Post-Trauma Nightmares,” which has been well-received in the psychology field.

One of Stanick’s colleagues, Shantel Fernandez, developed the children’s version of the therapy for her dissertation and published a case series, and Stanick and Cromer are applying it in their studies.

The treatment requires children and families to meet with with a clinician from Stanick’s research team for a mere five sessions, during which time the kids and their caregivers address their sleep patterns, learn relaxation techniques and, finally, the kids tackle their most vivid nightmares with a simple rewrite. Addressing general sleep issues is important, Stanick says.

“When there are stresses related to sleep, families start to develop bad habits pretty quickly,” Stanick says. “We actually know that when people avoid sleep by engaging in negative habits — drinking caffeine, watching TV, getting up and doing things at night to prevent sleep because they’re afraid of the nightmares — that increases the stress. That increases the daytime sleepiness and actually sets them up for an increasing likelihood that they’ll have nightmares.

It becomes a vicious cycle really quickly.”

Throughout the treatment, Stanick monitors the child’s progress by having them rate their feelings on a fear meter or “scary scale.” All these techniques and preparations lead up to the fourth week, in which the kids finally address their biggest nightmares.

“The main mechanism of the treatment is taking the original nightmare and keeping it basically the same with the exception of changing one major part of it so that the outcome is different and more positive,” Stanick says. “If they felt powerless in the original nightmare, then whatever has changed in the rescription puts them in a powerful position. They take that rescripted nightmare and re-read it before bed every night for that week.”

When the child returns to Stanick, they discuss how the rescription impacted their dreams. They review more relaxation techniques and talk about how to maintain the healthy sleep habits they have begun to develop. At that point the treatment is over, though the child is asked to return for a few post-treatment sessions during the next six months.

“So far it’s been as good as what we’ve seen in the adult trials, which is kind of amazing for such a short treatment,” Stanick says. “Sometimes people dream the rescripted nightmare; sometimes they see their nightmare frequency go down or the distress go down. For the kids we’ve treated so far, the nightmares go away entirely.”

One of the kids, a school-age boy, was so sleep-deprived that he nodded off during the sessions. He was having trouble in school and at home, and his extreme exhaustion led to him to act out and not focus on anything. After Stanick taught him relaxation and sleep techniques, she had him rewrite a part of one of his nightmares. And so in his new version of the dream, Gandalf the wizard from “The Lord of the Rings” shows up and saves him.

|After that, Stanick says, the boy’s nightmare no longer had such a grip on him, and it eventually disappeared altogether. Though alleviating the nightmare was the primary goal, the ripple effect into the boy’s daily life was equally impressive.

“He’d been through multiple sleep studies and had been treated for a variety of things, but after this treatment he looked like a different kid, physically,” Stanick says. “He’s listening better, his schoolwork is better, and he’s not needing as much supervision at school.”

Stanick says the boy has even helped another child with nightmares. “He thinks of himself as a dream ambassador now,” she says, smiling. “He calls himself a defender of dreams.”

Right now, Stanick has funding for 60 kids, but it hasn’t been easy to find them.

“It’s not exactly been a windfall,” she says. “There are a lot of myths and beliefs that people, including clinicians, develop around trauma. They worry that asking kids about trauma is going to re-traumatize them.”

A recent large-scale study has debunked that idea, showing that children and adults who go through PTSD treatments tend to come out of the experience without regret. What makes Stanick’s treatment so interesting is that it doesn’t delve into the trauma itself. Instead, nightmares become the entryway to healing. By adding a plot twist to their dreams, kids get to be in control — even if it’s in their own imagination and inspired by a fantasy book. And that small slice of control can be life changing.

“It doesn’t seem to matter how realistic or not realistic the rescription is,” Stanick says. “Nightmares and dreams often have aspects that aren’t realistic. At the end of the day, what matters is that it’s empowering them.”

— By Erika Fredrickson

If you have a child age 8 to 13 who may be struggling with nightmares and sleep disturbance, call Stanick’s lab at 406-243-6684.

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