- The Washington Times - Sunday, December 9, 2001

The planes. The smoke. The fire. The terror.

Many Americans' waking hours have been a jumble of these horrible images since September 11. The images are there in some people's dreams, too, as they try and make sense of and move forward after the tragedies.

"I think people have been undergoing an epidemic of nightmares," says Alan Siegel, a clinical psychologist and past president of the Association for the Study of Dreams. "There has never really been anything like this in our history. I was 12 when Kennedy was assassinated, and that might have been similar, except it was a smooth transition to a new administration. In this case, we have a loss of security, world conflict and fear of the unknown. We are experiencing a sense of invasion [on American soil] not seen since the Civil War."

While there is no data confirming how many people have had their sleep disturbed by the events of September 11, the anecdotal evidence can be found in bedrooms from coast to coast.

"I had a dream I was a spy in Afghanistan," says Beth Hodgson, 24, of Centreville. "The people there said they were going to kill me."

Says Laurie, a Northern Virginia mother of three who asked that her last name not be used: "I dreamed I was in a crowd of people and I told another woman I didn't feel well. She said she didn't either, and we realized then we had been victims of bioterrorism."

Even the mental health professionals who are listening to clients talk about how their feelings and fears are not immune.

"I was a flight attendant many years ago," says Gigi Stowe, a licensed clinical social worker with the Women's Center in Vienna. "I've dreamed that I was on one of the airplanes. But in the end, it was a happy ending, I saved the plane."

A bad dream is disturbing or unpleasant, but doesn't wake the sleeper, Mr. Siegel says. A nightmare is a bad dream intense enough to rouse the sleeper, leading to daytime sleepiness and increased anxiety.

At any given time, about 5 percent to 7 percent of adults report having a problem with nightmares. And nightmares are quite common among those who have been victims of trauma, such as war veterans, Mr. Siegel says.

But nightmares also are a healthy part of the healing process, he says.

"Nightmares are basically a normal response to the coping process," Mr. Siegel says. "Having nightmares suggest that the dreamer is actively engaged in working out the most upsetting part of the trauma [he has] suffered. Instead of looking at nightmares as a poison, we should look at them as a vaccine, one that will help us develop antibodies to fight off and resist and overcome a disease. Recalling our nightmares activates our ability to cope and helps us discover creative solutions to upset feelings."

Indeed, nightmares usually resolve themselves by evolving into dreams with better endings, says Patricia Garfield, author of eight books about dreams.

"The people most affected by a tragedy may stop dreaming all together," she says. "And sometimes trauma will bring up past traumatic experiences all over again. But the way we know we are healing is when the dreams start to shift into a normal pattern."

Ms. Garfield, who is based in Northern California, tells of one patient who, after living through the 1989 earthquake there, had recurrent nightmares about another earthquake. Eventually, though, she dreamt she made a wall out of pieces of pottery broken in the earthquake. "That was a sign of healing."

Changing the ending

We cannot alter what has happened in reality. We do, however, have control over our subconscious.

"We can't change the outcome of the World Trade Center," Ms. Garfield says. "But we can change the outcome of a dream."

And by changing dreams, not only will nightmare sufferers sleep better, they will feel better during the day, too.

"Strange as it may seem, you can influence your dreams by planning your behavior in them and changing how you act during them," Ms. Garfield says. "You can shift from the role of passive victim to one of active participant. If we program ourselves in the dream to save ourselves and others, we will be changing our confidence level."

For those who cannot picture defeating their nighttime monsters, there is imagery rehearsal, a therapeutic process used by therapists who treat trauma victims.

Dr. Barry Krakow, a psychiatrist and medical director of the Sleep and Human Health Institute in Albuquerque, N.M., has used imagery rehearsal on groups of sexual assault survivors.

A paper published in the Journal of the American Medical Association in August explained how patients met in groups, talked about their nightmares and came up with alternate endings. They then practiced the new ending in 20-minute sessions. Dr. Krakow reported that severity of nightmares and post-traumatic stress disorder (PTSD) symptoms decreased in 65 percent of the 114 patients in the study.

In another study, Dr. Krakow followed 62 crime victims who had similar image rehearsal therapy and found 79 percent of them had a decrease in PTSD symptoms. Thirty-three of the participants decreased their PTSD ratings by one clinical severity level.

"More than half the people we see have been having nightmares since childhood," Dr. Krakow says. "They may have had early trauma and abuse and have undergone successful therapy, but were still having nightmares. Imagery can help transform the dream. This technique has really been used for hundreds of years by parents, who tell their children after a bad dream to make up a new one."

When will we wake up?

In the three months since the attacks, the nation has begun to heal. So have most individuals. For those directly affected a Pentagon employee who survived or the spouse of someone who was killed the healing will, of course, take much longer.

Ms. Stowe has counseled several people more directly affected by the Pentagon crash. "It is an incomprehensible loss," she says. "People who have been directly affected by the tragedies may question what the last minutes of their loved one's life were like. These are people who might eventually benefit from professional help."

For those indirectly affected, the nightmares' ending should evolve within a few months, Mr. Siegel says. Meanwhile, talking about nightmares with friends, loved ones or a mental health professional can aid the process.

"Sharing dreams is a gift," he says. "It points you to understanding of what specifically is troubling you."

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