Journal of Qualitative Research in Health Sciences
Journal of Qualitative Research in Health Sciences

The Effectiveness of Dream Analysis in Reducing Idiopathic Nightmares by Hermeneutic Single Case Efficacy Design (HSCED)

Document Type : Original Article

Authors

Masoud Bagheri 1
Maryam Arabnejad khanuki 2

1 Associate Professor, Department of Psychology, Faculty of Literature and Humanities, Shahid Bahonar University of Kerman, Kerman, Iran

2 Ph.D. Student, Department of Psychology, Faculty of Literature and Humanities, Shahid Bahonar University of Kerman, Kerman, Ira

10.34172/jqr.2022.07
Abstract
Introduction: Nightmares are prevalent parasomnia associated with various forms of psychological distress in both the clinical and general population. The aim of the current study was to explain the experiences of the client regarding the effects of nightmares and the process of dream analysis treatment on idiopathic nightmares.
Methods: In this qualitative study, the client was a 34-year-old woman who participated in 8 sessions of dream analysis treatment. Based on DSM-5, she had the criteria of a nightmare. Rich data were collected from her. The hermeneutic method was used to collect and analyze quantitative and qualitative data. This study used a simple method to perform the hermeneutic analysis that requires only one person while maintaining its validity.
Results: The findings showed that the frequency of nightmares decreased during the treatment. The client changed significantly during the treatment, and the dream analysis was also responsible for this change. According to Bohart’s criteria, the client changed with at least 72% confidence and with 87% confidence this change in relation to external factors happened as a result of the treatment. Useful therapeutic factors included examining the hidden meaning of nightmares, expressing emotions, self-awareness, and reducing helplessness.
Conclusion: The results of the interventions showed that treatment processes made changes in the client that were unexpected and important to her and these changes would not have happened without the treatment. This method, in addition to exposing the person to the content of the nightmare, leads to the discovery and decoding of the content of the nightmare and understanding of its message to resolve conflicts.

Keywords

Idiopathic nightmare
Dream analysis
Case study
Hermeneutic
  1. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. APA; 2013.
  2. Eiser AS. Abnormal dreams and nightmare disorders. In: Montagna P, Chokroverty S, eds. Handbook of Clinical Neurology. Vol 98. Elsevier; 2011. p. 545-56. doi: 1016/b978-0-444-52006-7.00035-6.
  3. Schubert CC, Punamäki RL. Posttraumatic nightmares of traumatized refugees: dream work integrating cultural values. Dreaming. 2016;26(1):10-28. doi: 1037/drm0000021.
  4. Sandman N, Valli K, Kronholm E, Ollila HM, Revonsuo A, Laatikainen T, et al. Nightmares: prevalence among the Finnish general adult population and war veterans during 1972-2007. Sleep. 2013;36(7):1041-50. doi: 5665/sleep.2806.
  5. Swart ML, van Schagen AM, Lancee J, van den Bout J. Prevalence of nightmare disorder in psychiatric outpatients. Psychother Psychosom. 2013;82(4):267-8. doi: 1159/000343590.
  6. Hublin C, Kaprio J, Partinen M, Koskenvuo M. Nightmares: familial aggregation and association with psychiatric disorders in a nationwide twin cohort. Am J Med Genet. 1999;88(4):329-36. doi: 1002/(sici)1096-8628(19990820)88:4 < 329::aid-ajmg8 > 3.0.co;2-e.
  7. Zadra A, Donderi DC. Nightmares and bad dreams: their prevalence and relationship to well-being. J Abnorm Psychol. 2000;109(2):273-81. doi: 1037/0021-843x.109.2.273.
  8. Hartmann E. Dreams and Nightmares: The New Theory on the Origin and Meaning of Dreams. Plenum Trade; 1998.
  9. Ellis LA. Qualitative changes in recurrent PTSD nightmares after focusing-oriented dreamwork. Dreaming. 2016;26(3):185-201. doi: 1037/drm0000031.
  10. Lemyre A, St-Onge M, Vallières A. The perceptions of nightmare sufferers regarding the functions, causes, and consequences of their nightmares, and their coping strategies. Int J Dream Res. 2019;12(2):35-48. doi: 11588/ijodr.2019.2.62396.
  11. Nielsen T. The stress acceleration hypothesis of nightmares. Front Neurol. 2017;8:201. doi: 3389/fneur.2017.00201.
  12. Krakow B, Zadra A. Clinical management of chronic nightmares: imagery rehearsal therapy. Behav Sleep Med. 2006;4(1):45-70. doi: 1207/s15402010bsm0401_4.
  13. Ellis TE, Rufino KA, Nadorff MR. Treatment of nightmares in psychiatric inpatients with imagery rehearsal therapy: an open trial and case series. Behav Sleep Med. 2019;17(2):112-23. doi: 1080/15402002.2017.1299738.
  14. Kunze AE, Arntz A, Morina N, Kindt M, Lancee J. Efficacy of imagery rescripting and imaginal exposure for nightmares: a randomized wait-list controlled trial. Behav Res Ther. 2017;97:14-25. doi: 1016/j.brat.2017.06.005.
  15. Kellett S, Beail N. The treatment of chronic post-traumatic nightmares using psychodynamic-interpersonal psychotherapy: a single-case study. Br J Med Psychol. 1997;70(Pt 1):35-49. doi: 1111/j.2044-8341.1997.tb01884.x.
  16. Tarkhan M. The Effectiveness of Imagery Rescripting and Reprocessing Therapy on Nightmeres and Suicidal Ideations of Girls with Sexual Abuse. Journal of Modern Psychological Researches. 2016;11(43):21-40.
  17. Hill CE, Zack JS, Wonnell TL, Hoffman MA, Rochlen AB, Goldberg JL, et al. Structured brief therapy with a focus on dreams or loss for clients with troubling dreams and recent loss. J Couns Psychol. 2000;47(1):90-101.
  18. Hill CE. Working with Dreams in Psychotherapy. Guilford Press; 1996.
  19. Weiss L. Dream Analysis in Psychotherapy. Translated by Sahebi A, Hakim Javadi M. Pergamon Press; 1986.
  20. Hill CE, Knox S. The use of dreams in modern psychotherapy. Int Rev Neurobiol. 2010;92:291-317. doi: 1016/s0074-7742(10)92013-8.
  21. Roesler C. Structural dream analysis: a narrative research method for investigating the meaning of dream series in analytical psychotherapies. Int J Dream Res. 2018;11(1):21-9. doi: 11588/ijodr.2018.1.41330.
  22. Gupta S, Hill CE. The outcome of dream sessions: the influence of dream recency, emotional intensity, and salience. Dreaming. 2014;24(2):89-103. doi: 1037/a0036391.
  23. Elliott R, Slatick E, Urman M. Qualitative change process research on psychotherapy: alternative strategies. Psychol Test Assess Model. 2001;43(3):69.
  24. Benelli E, Biffi D, De Carlo AL, McLeod J. Hermeneutic single case efficacy design: a systematic review of published research and current standards. TPM Test Psychom Methodol Appl Psychol. 2015;22(1):97-103. doi: 4473/tpm22.1.7.
  25. De Smet MM, Meganck R, Truijens F, De Geest R, Cornelis S, Norman UA, et al. Change processes underlying “good outcome”: a qualitative study on recovered and improved patients’ experiences in psychotherapy for major depression. Psychother Res. 2020;30(7):948-64. doi: 1080/10503307.2020.1722329.
  26. Elliott R. Hermeneutic single-case efficacy design. Psychother Res. 2002;12(1):1-21. doi: 1080/713869614.
  27. Abolhassani S, Taleghani F, Yazdannik A. The use of qualitative case study in nursing. J Qual Res Health Sci. 2017;6(1):103-11. [Persian].
  28. Mohebbi Z, Sharif F, Peyrovi H, Rakhshan M, Alizade Naini M, Zarshenas L. Patients’ experience of living with irritable bowel syndrome (IBS): a hermeneutic phenomenology. J Qual Res Health Sci. 2020;9(1):28-37. doi: 22062/jqr.2020.91000.
  29. Atashzadeh Shoorideh F, Pazargadi M, Zagheri Tafreshi M. The concept of nursing care quality from the perspective of stakeholders: a phenomenological study. J Qual Res Health Sci. 2012;1(3):214-28. [Persian].
  30. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7. doi: 1037//0022-006x.56.6.893.
  31. Derogatis LR, Lipman RS, Covi L. SCL-90. Administration, Scoring and Procedures Manual-I for the R (Revised) Version and Other Instruments of the Psychopathology Rating Scales Series. Chicago: Johns Hopkins University School of Medicine; 1977.
  32. Llewelyn SP. Psychological therapy as viewed by clients and therapists. Br J Clin Psychol. 1988;27(3):223-37. doi: 1111/j.2044-8260.1988.tb00779.x.
  33. Bohart AC, Berry MC, Wicks CL. Developing a systematic framework for utilizing discrete types of qualitative data as therapy research evidence. Pragmat Case Stud Psychother. 2011;7(1):145-55. doi: 14713/pcsp.v7i1.1076.
  34. Hossein Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J 2. 2008;66(2):136-40. [Persian].
  35. Derogatis LR, Rickels K, Rock AF. The SCL-90 and the MMPI: a step in the validation of a new self-report scale. Br J Psychiatry. 1976;128:280-9. doi: 1192/bjp.128.3.280.
  36. Mosavyan E, Nejati SF. The investigation of facial affect recognition in people with psychological symptoms based on SCL-90-R scale. Soc Cogn. 2016;5(1):113-29.
  37. Barlow D, Nock M, Hersen M. Single Case Experimental Designs: Strategies for Studying Behavior Change. ‎Pearson; 2009.
  38. Ogles BM, Lunnen KM, Bonesteel K. Clinical significance: history, application, and current practice. Clin Psychol Rev. 2001;21(3):421-46. doi: 1016/s0272-7358(99)00058-6.
  39. Schofield W. Psychotherapy: The purchase of Friendship. Transaction Publishers; 1986.
  40. van Schagen AM, Lancee J, de Groot IW, Spoormaker VI, van den Bout J. Imagery rehearsal therapy in addition to treatment as usual for patients with diverse psychiatric diagnoses suffering from nightmares: a randomized controlled trial. J Clin Psychiatry. 2015;76(9):e1105-13. doi: 4088/JCP.14m09216.
  41. Rousseau A, Belleville G. The mechanisms of action underlying the efficacy of psychological nightmare treatments: a systematic review and thematic analysis of discussed hypotheses. Sleep Med Rev. 2018;39:122-33. doi: 1016/j.smrv.2017.08.004.
  42. Pesant N, Zadra A. Working with dreams in therapy: what do we know and what should we do? Clin Psychol Rev. 2004;24(5):489-512. doi: 1016/j.cpr.2004.05.002.
  43. Leijssen M. Focusing-oriented dream work. In: Rosner RI, Lyddon WJ, Freeman A, eds. Cognitive Therapy and Dreams. Springer; 2004. p. 137-60.
  44. Ebrahimi Meymand HA, Askarizadeh G, Bagheri M, Arabnejad M. The role of spiritual intelligence, sense of coherence, and cognitive flexibility as internal resources in predicting perceived stress in patients with multiple sclerosis. Intern Med Today. 2020;27(1):114-29. doi: 32598/hms.27.1.2986.2. [Persian].
  45. Hartley J. Case study research. In: Cassell C, Symon G, eds. Essential Guide to Qualitative Methods in Organizational Research. SAGE Publications; 2004. p. 323-33.

 

 

Journal of Qualitative Research in Health Sciences
Volume 11, Issue 3
Summer 2022
Pages 196-205

  • Receive Date 05 November 2018
  • Revise Date 03 December 2021
  • Accept Date 12 December 2021

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