A cognitive model of recurrent nightmares

Abstract

Nightmares are a prevalent mental disorder resulting in disturbed sleep, distress, and impairment in daily functioning. Elaborating on previous theoretical models for anxiety disorders, sleep disorders and dreaming, this study introduces a cognitive model of recurrent nightmares, the central element of which concerns representation of the nightmare’s repetitive storyline in the memory as a script. It is suggested that activation of this script during REM sleep results in a replay of the nightmare, and that activation occurs through perceived similarity between dream elements and the nightmare script. The model proposes a central role for cognitive processes in the persistence of nightmares over time. The success of cognitive-behavioural treatments is explained and clinical implications are discussed.