Are PTSD Nightmares Therapeutic?


This is often a concept offered to trauma survivors:  their terrible dreams are helping them heal.  They need to suffer through the fear and racing heartbeats in order to recover and grow.

Well, let’s unpack this a bit more.  Like a lot of things, there is some truth to this, and a big distinction between recent trauma and trauma from the distant past.

Immediately after a traumatic experience, it is indeed common to have nightmares, and for the theme and meanings to reflect coming to terms with the events that transpired.  The brain will use the dreams generated in REM sleep stages to “work out” recent issues.  In this immediate stage after trauma, the idea that bad dreams have benefit for healing makes sense, and appears to be supported by sleep and brain science.


For chronic nightmares, occurring months and years (sometimes decades!) after the trauma or trauma period, it is more likely that there is no therapeutic benefit to these awful dreams, no valuable healing taking place.  Instead, a sleep disorder has developed.  The brain is stuck in a pattern that it can’t escape on its own.

Sadly, many trauma survivors have incorporated their chronic nightmares into their self-image.  It is part of who they are, as much as they identify as having DID.  They don’t see the possibility of reducing or eliminating their nightmares, much as they don’t anticipate losing a limb or an eye.

What can be done about this?

  • Recognize that you are not your condition.  This is something that isn’t essential to who you are, essential to healing from trauma, and definitely something that can change.
  • Believe that change is possible.  If you can’t let go of the idea that all dreams are purposeful and healing, then you are trapped in them.  That can feel familiar, in the same way that being abused is bad but familiar.  Severe childhood abuse makes terrible feel normal.  Even when you know it is terrible.
  • Try Imagery Rehearsal Therapy (IRT).  This is a very specific treatment for chronic nightmares, and requires you to work with a provider that understands trauma, and particularly DID, well.  Without an understanding of DID, a solid understanding, you can find yourself feeling worse, not better.  You will be consciously re-writing your nightmare.  Your brain will remember because IRT is so specific and powerful.   In order to re-write your dreams, you have to think about them with the ability not to dissociate severely.  This takes some stabilization skills.  Those grounding and self-hypnosis techniques that allow you to know that “now” is now, and “then” was then.  All day.  Every day.  If you are struggling with orienting to the present, then that is a pre-IRT goal.  If you don’t have some communication with your DID system, then that is another goal to do pre-IRT.


Published by Cathy Collyer

I am a licensed occupational therapist and a licensed massage therapist, in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment, with a focus on sensory processing issues and treating the consequences of complex trauma. I am the author of four books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training Your Child With Low Muscle Tone". Over the years I have lectured about trauma treatment and pediatric development.

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