Overview of approaches to treating dream PTSD

There now exist at least ten specific and probably more than twenty general approaches to dealing with post-traumatic stress disorder in dreams.

Post traumatic stress disorder (PTSD) is defined by the Diagnostic and Statistical Manual, 4th edition (DSM-IV) in terms of five criteria:

  I: The traumatizing event. 

    (1) Death or serious injury has been personally experienced by self or others;

    (2) Response involves intense feelings of horror, fear, or helplessness.

  II: Re-experiencing: 

          nightmares, intrusive thoughts and flashbacks

  III: Avoidance/numbing:

          efforts to avoid memories of the traumatic experience and symptoms of emotional numbing

  IV: Hyper-arousal: 

          sleeplessness, irritability and hyper-vigilance

  V:   Impact and duration of symptoms: 

          minimum of one month distress

There are multiple ways that PTSD affects dreams. It can show up as:

Re-experiencing: Having flashbacks to traumatic events – a hallmark symptom of posttraumatic stress syndrome. 

 For roughly half of PTSD patients, those flashbacks occur at night, while sleeping. 

   These are more common among those who’ve served in the military. 

     53% percent of Vietnam veterans experience vivid nightmares

     Just three percent of civilians experience vivid nightmares

Replicative nightmares: Nightmares that are exact replays of the trauma one has experienced.

 Others have nightmares that are related to the trauma indirectly.

Differences between ordinary and trauma-induced nightmares: 

  – Often happen earlier in the night 

  – Occur during different stages of sleep than typical dreams  

  – Related to sleep-disordered breathing

       (treating underlying breathing problems can help to reduce or even eliminate violent nightmares. Pranayama can be of assistance here.)

Here are ten of the better known approaches to addressing PTSD in dreams, with a short description, links to more information about each, as well as a summation of their strengths and limitations:

Counseling and interpretation

This is the traditional Freudian-Jungian-psychodynamic approach as well as all authoritarian approaches which rely on the interpretations of “experts.”

“the therapist and the client collaborate to establish the meaning of the dream”

Strengths: Faith in respected authority can be intrinsically therapeutic.

Limitations: Projective; there is no necessary correlation between someone‘s interpretation of a dream and a cure for PTSD.

Cognitive-Behavioral Dreamwork

“the therapist and the client collaborate to establish the meaning of the dream”



Hill Cognitive-Experimental Method 


This is a slightly more sophisticated cognitive behavioral therapy-oriented version of counseling and interpretation.

Strengths: Ties the dream to personal biographical information

Limitations: Projective; agreeing on the meaning of a trauma does not imply its neutralization 

Image Rehearsal Therapy 

Detailed, non-frightening endings for repetitive nightmares are created:

  • Write down and rehearse the nightmares with the new endings. This is similar to approaches that coach the subject to attack the threat in dream rehearsal and while dreaming.


Strengths: A form of dream incubation. A response to dealing with a perceived dream threat is being practiced during waking hours. Intervention increases self-confidence for dealing with waking sources of anxiety or for learning new skills by practicing them in an environment in which failure is much less real.

Limitations: Imposing our waking priorities, even for the best of reasons, is a form of colonization of the dream state rather than practicing deep listening to it; we are imposing our preferences on dreams instead of focusing on learning why they are the way they are. Imposes waking priorities instead of listening to the priorities of questioned characters, interviewed either while awake or while dreaming.

Visual Kinesthetic Dissociation (the rewind technique; NLP derived)

  • Evoke the trauma in memory
  • Watch the trauma as a black and white movie from a safe beginning and in an imaginary safe place (like the projection booth in a theater) to a safe place after the movie ends.
  • Repeat until the movie elicits no emotional response.


Strengths: neutral witnessing; desensitization and development of the witness

Limitations: no learning from the experience

Dream Interview Method

Client-centered; phenomenological. That is, the subject is encouraged to arrive at their own meanings.


Strengths: better than therapist-centered approaches because it respects the wisdom of the dreamer.

Limitations: Still projective, but this time, of the interpretations of the dreamer, not of the therapist or “expert.” The assumption is that the dreamer innately knows what balance and integration are. Is that a true, accurate, or realistic assumption???

The Five Star Method

Views dreaming as an interactive process between the perspectives of the dreamer and the “other,” that is, the other characters in the dream as well as objects and general setting. It is therefore process-centered and relational and emphasizes the interaction between dreamer and image.


Strengths: better than therapist or client-centered approaches because it views both dreaming and dreamwork as an interactional growth process

Limitations: Projective, meaning that the therapist and client work together to evolve interpretations based on the patterns of interaction between the dreamer and dream images. Client-centered; the subject is led to conclusions that are personally satisfying and helpful, whether or not they have anything to do with the actual intent behind the dream.

Integral Dreaming Method

Client-centered; phenomenological. Emphasizes multiple perspectives on dreaming.


Strengths: uses non-interpretive methodologies (dream re-entry; creativity-drawing, sculpting, etc.); cultivates lucid witnessing in dreams.

Limitations: The dreamer transforms the nightmare in varieties of lucidity, which means waking colonization of the dream state.  Waking assumptions are not necessarily tabled. For example, “Dreams are a complete expression of the mind,” is an assumption that may or may not reflect  perspectives that are actually invested in the dream (dream characters and objects).

Dream to Freedom Method 

Partially character-centered. Uses Gestalt-based role-playing. It also uses somatic cueing by “tapping” acupressure points.


Strengths: Character identification; physical anchoring

Limitations: Goal is to actualize new waking priorities rather than listen to those intrinsic to the dream; interjection of outcomes desired by the dreamer into the dream; interpretation is primarily by the dreamer. 

 Integral Deep Listening 

  • Enquiry based on alternative embedded alternative perspectives
  • Three important current life issues are identified to increase relevance and value of interview.
  • One or more dream character (or elements of the waking traumatic experience) are identified
  • The subject becomes, or identifies with, the character
  • The character answers a series of questions (This is the IDL Interviewing Protocol)     (Voice, text script, or computer assisted)
  • Relevant recommendations made by interviewed characters are operationalized
  • Daily implementation is charted and monitored weekly by therapist
  • Additional interviews can speed the process as well as reduce any resistances encountered

   (IntegralDeepListening.Com; DreamYoga.Com

Strengths: Respects the dream as the primary source of interpretation; subordinates therapist and subject perspectives/interpretations to dream perspectives/interpretations. Experiential multi-perspectival. (How do you know what the actual intent of the dream is? You don’t – unless you look at the dream from innate alternate perspectives than your own that are embedded in the dream.)  

Limitations: Therapists are taught to support “return to normalcy” or “self-actualization;” most clients/subjects want one or the other. But interviewed emerging potentials have their own priorities. Therefore, IDL does not meet the assumed or expressed needs of many clients and therefore clashes with the assumptions many therapists make about their role.

The above approaches are on several continua:

Who interprets, nature of goals of dreamwork, and personal involvement

Who interprets? Is it:

Therapist/authority centered? (Interpretation by therapist)

Client/subject centered? (Interpretation by subject)

Dream Element centered? (Interpretation by interviewed perspectives)

Therapist/authority centered:

  Pros:  Provides new or different perspectives from respected objective others

  Cons: Objective others are not you and so are not aware of your issues, history, feelings, or other factors intrinsic to the creation of the dream; Interpretations are projective; dependency on answers from objective others encourages passivity.

Client/subject centered:

  Pros:  Allows ownership or responsibility for the dream; there is validation of the client’s own awarenesses; originating helpful information is confidence-building.

  Cons: Dream are not created by the dreamer; otherwise, they would understand them. Therefore, their interpretations of them are projective.

Dream Element centered:

  Pros: Interviewing dream characters and objects accesses perspectives that are closer to the source of the dream; listening to the embedded perspectives within a dream is more respectful of the dream itself; de-centers others and self, meaning that the need to be in control and to pursue one’s own priorities is temporarily set aside; accesses creativity that extends beyond what we want or need.  (Drops the assumption that “The dream is all about me and my needs.”)  Dreamers can still also consult self and authorities.

  Cons: Most life issues ARE self-centered; finding oneself and setting clear personal priorities is most important for many people

Goals are on a continua. Is the goal of dreamwork:

Insight? (“What does this mean?”) 

Remediation? (“I just want to feel well!”)

Reframing? (“My life feels more integrated.”)


  Pros: An antidote to depression; life direction & clarity

  Cons: The meaning may not be yours, or it may be a projection of your hopes or fears


    Pros: It’s hard to feel good/be productive when under stress, and remediation focuses on reducing some source of life distress.

    Cons: Making problems go away without understanding their function does not prepare us to deal any better with future similar problems. (Like taking a pill.)


   Pros: If a misperception or misunderstanding caused the misery, adopting a healthier narrative, script, or story provides both insight and remediation.

   Cons: Scripts have adaptive functions and are deeply rooted in our identity. We don’t easily outgrow them. Repetition is required.

Personal involvement is on a continua: How invested are you in the dream?

Passivity (How withdrawn am I?)

Degrees of lucidity  (How awake am I?)

Assertion/aggression(How engaged/forceful am I?) 

Identification (How present are the perspectives of the dream elements?)


  Pros: Safety, security, comfort, objectivity

  Cons: Much growth in life is due to taking risks, interacting, immersion.

Degrees of lucidity:

  Pros: More wakefulness means more clarity, integration of waking and dreaming

  Cons: Colonization of the dream instead of integral deep listening to emerging potentials


  Pros: More involvement and investment, control and power, less victimization, more choice

  Cons: No learning, only imposition


  Pros: Acceptance; identity expansion; internalization; integration

  Cons: Impermanent state; must be observed and repeated; foreign; can be threatening

How IDL combines and builds on the various approaches to the treatment of trauma in dreams

An integral approach to the treatment of trauma is an inclusive one. That is, it acknowledges the strengths of different approaches, goals, and degrees of personal involvement represented by these different approaches, and then combines them in ways that transcends them individually. 

For example, the strengths of authority-centered, client-centered, and element-centered approaches are recognized and acknowledged and an approach to the treatment of trauma is developed that takes all three approaches into account. In the case of Integral Deep Listening (IDL), this is done by first listening to the interpretations of interviewed elements, then those of the dreamer/subject, and then those of the therapist. 

The strengths of insight, remediation, and reframing as goals of the process are all recognized and an approach developed that utilizes all three. For IDL, this is done by prioritizing the reframing of life provided by a particular interviewed perspective and then looking at what insight and remediation are like within that new, reframed world view. Remediation occurs in the form of operationalizing recommendations, choosing those that resonate, monitoring them daily, and sharing them with an accountability person, such as an IDL Practitioner, once a week.

The strengths of each degree of personal involvement – passivity, degree of lucidity, personal investment, and identification – are all considered. In IDL, identification is given priority because it allows passivity and the cultivation of objectivity, in that the self takes a back seat; lucidity, in the form of hearing and acting on the wake-up call; and personal investment, in the form of identification and application of recommendations is encouraged. 

This is the rationale for viewing IDL as an integral approach to the treatment of trauma.  

For more information, contact joseph.dillard@gmail.com. While IDL does not accept advertising or sponsored postings, we gratefully accept donations of your time, expertise, or financial support.