Frankfurt, Germany. Similarities in human brain activity during periods of lucid dreaming and psychosis suggest that an updated form of dream therapy may be useful in psychiatric treatment, according to new findings. This is strengthened by the potential evolutionary relationship between dreams and psychosis.

Lucid dreaming – when you are aware you are dreaming – is a hybrid state between sleeping and being awake. It creates distinct patterns of electrical activity in the brain that have similarities to the patterns made by psychotic conditions such as schizophrenia.

Confirming links between lucid dreaming and psychotic conditions offers potential for new therapeutic routes based on understanding how healthy dreaming differs from the unstable states associated with neurological and psychiatric disorders.

Counterfactual thinking occurs when we think about a past that did not happen. Typically, the thoughts are of an option that was not selected, usually with regret (if only... we had or had not done something). We can change our own memories, adjusting the facts and creating new memories.

Humans are predisposed to ask what if questions, regarding both real and imaginary alternatives. A person may imagine the opposite of a given event and contemplate the consequences. The effects of such thinking depend on the consequences the person imagines, and whether the consequences are better or worse than reality.

This can happen to cover up trauma or may be just excuses to avoid facing uncomfortable truths. It can also be to explain what is otherwise unexplainable.

Counterfactual thinking often happens around situations of perceived 'luck'.

The overall effect can be enhanced by a variety of factors:

• Replication. If we reconstruct events as happened or as wished for.

• Closeness. If the unwanted event is close (such as just missing the winning lottery number or a taxi).

• Exception. If the event occurred because of omitting a non-routine action ("if only I had ...").

• Controllability. If something could have been done to avoid the event.

• Action. If, in the short term, we regret actions that cause problems more than inaction that might have the same effect (although in the longer term, this effect is reversed).  

We can also do the reverse, thinking about bad things that did not happen, such as when we narrowly avoid being in an accident.

Ordinarily, this type of thinking is a healthy part of adjustment to circumstances. When obsessive, counterfactual thinking can lead to detriorating mental health.

Dissociation involves losing conscious control over mental processes, such as logical thinking or emotional reaction. In some psychiatric conditions this state is also known to occur while people are awake. The findings were a focus for discussion at a workshop sponsired by the European Science Foundation (ESF).

“In the field of psychiatry, the interest in patients’ dreams has progressively fallen out of both clinical practice and research. But this new work seems to show that we may be able to make comparisons between lucid dreaming and some psychiatric conditions that involve an abnormal dissociation of consciousness while awake, such as psychosis, depersonalisation and pseudoseizures.” said the workshop’s convenor Silvio Scarone, from the Università degli Studi di Milano in Milan, Italy.

Meanwhile, the previously discredited idea of treating some conditions with dream therapy has attracted interest from clinicians. An example is people suffering from nightmares can sometimes be treated by training them to dream lucidly so they can consciously wake up.

“On the one hand, basic dream researchers could now apply their knowledge to psychiatric patients with the aim of building a useful tool for psychiatry, reviving interest in patients’ dreams,” continues Scarone.

“On the other hand, neuroscience investigators could explore how to extend their work to psychiatric conditions, using approaches from sleep research to interpret data from acute psychotic and dissociated states of the brain-mind.”

The existence of such psychotic conditions may be rooted in the evolutionary role of dreams, where dreaming is thought to have emerged to enable early humans to rehearse responses to the many dangerous events they faced in real life.

Developed by Antti Revonsuo at University of Turku in Finland, if this threat simulation theory is correct, it may have origins even further back in evolution, given that other mammals such as dogs also exhibit the characteristic electrical activity of dreaming.

Researcher also looked at the idea that paranoid delusions and other hallucinatory phenomena occur when the dissociative dreaming state involving replay of threatening situations is carried through into wakefulness.

“Exposure to real threatening events supposedly activates the dream system, so that it produces simulations that are realistic rehearsals of threatening events in terms of perception and behaviour,” said Scarone. “This theory works on the basis that the environment in which the human brain evolved included frequent dangerous events that posed threats to human reproduction. These would have been a serious selection pressure on ancestral human populations and would have fully activated the threat simulation mechanisms.”

However, dreaming is unlikely to have evolved purely to recreate threats. It may also have a role in the learning process, according to Allan Hobson, a psychiatrist and dream researcher recently retired from Harvard University in the US.

Contents are added while you are awake and integrated with the automatic program of dream consciousness during sleep. This works with observations that daytime learning is consolidated by night-time sleeping, leading to the phenomenon where people remember facts better the day after they have learnt them than at the time.

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TS-Si is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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