1. Dreams: The Contemporary Theory Ernest Hartmann, M.D. Professor of Psychiatry Tufts University School of Medicine Director, Sleep Disorders Center Newton Wellesley Hospital

2. I was walking along a beach somewhere. It wasn’t exactly like any of the beaches I know, I think my friend Jan was with me. Suddenly, a huge wave reared up out of the ocean and totally engulfed us. I’m not sure what happened after that. I struggled and struggled to get to the surface. There was no one else with me. I’m not sure whether I made it, and I awoke, terrified.

4. Fear, Terror A huge tidal wave is coming at me. A house is burning and no one can get out. A gang of evil men, Nazis maybe, are chasing me.

5. Helplessness, Vulnerability I dreamt about children, dolls — dolls and babies all drowning. He skinned me and threw me in a heap with my sisters; I could feel the pain, I could feel everything. There was a small hurt animal lying in the road.

6. Guilt A shell heads for us (just the way it really did) and blows up, but I can’t tell whether it’s me or my buddy Jack who is blown up. I let my children play by themselves and they get run over by a car. I leave my children in a house somewhere and then I can’t find them.

7. Grief A mountain has split. A large round hill or mountain has split in two pieces, and there are arrangements I have to make to take care of it. A huge tree has fallen down. I’m in this huge barren empty space. There are ashes strewn all about.

8. Dream ID# 1. CI? (Y/N) 2. What is it? 3. Intensity (rate 1-3) 4. What emotion?5. Second emotion? Scoring for the CI (Central Image)

9. I was walking along a beach somewhere. It wasn’t exactly like any of the beaches I know, I think my friend Jan was with me. Suddenly, a huge wave reared up out of the ocean and totally engulfed us. I’m not sure what happened after that. I struggled and struggled to get to the surface. There was no one else with me. I’m not sure whether I made it, and I awoke, terrified.

10. Most Recent Dream Dream that Stands Out Most Recent Daydream Daydream that Stands Out

11. Waking Sleep Onset NREMREM

12. CI Intensity 0.00 0.50 1.00 1.50 2.00 2.50 012345678910 Cases CI Intensity Score Mean of Student Group

13. CI Scores in the Trauma Group (N=10) Versus Matched Student Control Group (N=30) (Mean ± S.E.M.)

14. CI Scores in Students Reporting Abuse or No Abuse 1.12 ± 1.2 0.65 ± 1.0 * t = 2.63, p = 0.01

15. Methods: Participants Complete data sets obtained from 44 persons, living in the US who have recorded their dreams every morning for years. 33 women, 11 men. Mean age about 50. 9/11 STUDY

16. Methods Each participant provided 20 dreams — the last ten recorded before 9/11 and the first ten after 9/11, without any selection or alteration.

17. Methods: Scoring All dreams were scored on a blind basis for CI intensity, emotion pictured by the CI, dreamlikeness, and vividness. Dreams were also scored on three ad-hoc scales of content: 1) attacks 2) buildings like WTC or pentagon 3) airplanes, and on a scale of nightmare-likeness

19. Results: After vs. Before 9/11 Bef Aft Dif t p CI 1.10 1.28.18 3.29.001 one-tailed Length 12.93 11.88 -1.04 1.3 NS D-like 4.50 4.54.04.47 NS Viv 4.22 4.24.02.17 NS

20. Results, continued Bef Aft Dif t p Attacks.034.098.064 2.74 <.01 Bldgs..059.104.045 1.70 NS Planes.045.061 -.016.85 NS NM-like.213.307.094 2.28 <.05

21. Results: Nightmares (16 Ss) Before 9/11After 9/11 Definite nightmares (agreement between two scorers)32 Less definite (one scorer definite/one scorer possible )33

22. Results: Nightmares (cont’d) Before 9/11After 9/11 Total possible nightmares 3033 (by either scorer) All results not significant

23. Conclusions: If we can generalize from these 44 dream journalers, our dream imagery overall was more intense after 9/11/01 than before.

24. Conclusions (continued): However, dreams after 9/11/01 were not significantly longer, more dreamlike or more vivid. They did not contain more references to buildings or airplanes. They did contain slightly more references to attacks and they were scored as slightly more nightmare-like.

25. Conclusions (continued) Consistent with previous studies the intensity of the dream’s central image (CI) appears to be a measure of emotional arousal or emotional power.

26. Creating a “dream” in the laboratory If a dream involves the picturing of emotion (“contextualizing emotion”), could one create a dream or something very dream-like by allowing waking imagery (daydream) to develop under the influence of strong emotion?

29. Where To Look For CIs (Easiest to Hardest) Dreams after trauma Dreams in stressful situations Dreams in special situations, such as pregnancy Dreams in patients in whom a dominant emotion or concern is obvious Dreams in experimental situations (thirst, hunger, external stimuli) Dreams in a patient or client about whom information is available Ordinary dreams from unknown dreamers

35. “Nets of the Mind”

38. CBF in REM Sleep vs. Slow Wave Sleep

39. We do not dream of “reading, writing and arithmetic” Results from 250 good dream recallers

40. RESULTS: Question A (Frequency of the “3 R’s” in dreams) READING 48% of subjects said “never,” and an additional 36% said “hardly ever,” although the group spent 150 ± 94 minutes per day reading. WRITING 56% of S’s said “never” and an additional 36% said “hardly ever,” although this group spent 106 ± 87 minutes per day writing. TYPING 75% of S’s said “never” and an additional 19% said “hardly ever,” although this group spent 98 ± 97 minutes per day typing. CALCULATING 73% of S’s said “never” and an additional 22% said “hardly ever,” although this group spent 23 ± 29 minutes per day calculating.

41. Relative Prominence Scores for Six Activities: X ± S.E.M. 6 5 4 3 2 1 Walking Writing Talking Reading Sexual Typing with Friends Activity Questionnaire study in 250 frequent dreamers. The scale on the left runs from 1: “The activity is far more prominent in my waking life; it hardly occurs in my dreams,” to 7: “The activity is far more prominent in my dreams; it hardly occurs in my waking life.”

43. More powerful emotion leads to more intense dream imagery. Thus the intensity of the dream image is a measure of the power of the dreamer’s emotion.

46. Thick Boundary SubjectsThin Boundary Subjects Most Recent Dream Dream Stands Out Most Recent Daydream Daydream Stands Out Most Recent Dream Dream Stands Out Most Recent Daydream Daydream Stands Out

47. Large portions of the cortex (what we usually think of as “mind”) are basically an image-generator. During focused waking (left-end of the continuum) the cortex can be constrained into acting as a calculator, a reader or filer of texts, a carefully calibrated body- navigator, etc. Towards the right-end of the continuum it relaxes into pure story-imagery, guided by the emotional state (as in dreaming).

48. Underlying Emotional State Imagery of the Dream (Contextualizing Image)

49. Underlying Emotional State Imagery of the Dream (Contextualizing Image) Pathways involving amygdala and other subcortical “limbic” areas The cortex acts as an image- maker

50. Image Generator Focused Waking Memory Emotional State Sensory Input “Task”

51. Image Generator Dreaming Memory Emotional State Sensory Input “Task”

52. CAR IN MOTION TRUCK RELATIONSHIP EngineWheels Metal Gasoline Highways A JourneyMotion Beginnings, ends Goal Brakes Speed Start-stop Obstacles In control, out of control Crash? Exhilaration, danger

53. The functions of dreaming Dreaming connects broadly. It interconnects. It interweaves traumatic (and other) new material. This interconnecting has both an immediate function in “smoothing things out” or “calming a storm” and a longer term function in term of providing broader connections — an increase in connections rather than simply consolidation of memory. Dreaming has a quasi-therapeutic function: dreaming allows the making of connections in a safe place.

54. The functions of dreaming (continued) The cross connections, interconnections, weaving in, etc. all occur whether or not a dream is actually remembered. A remembered dream can, of course, be functional in other ways. A new connection in dreaming can play an essential role in problem solving, science, art, and self-knowledge.

57. Functions of REM sleep 1. REM sleep is necessary for, or at the very least facilitates, certain kinds of learning (based on numerous animal and human studies by Hennevin and Leconte, C. Smith, De Koninck, Stickgold and others, 1960-1998). 2. REM sleep “functions to develop the nervous system,” especially in the immature animal (Roffwarg, Muzio, and Demunt, 1966). 3. REM sleep functions in the “repair, reorganization, and formation of new connections in the cortex…” (Hartmann, 1973). (major theories)