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Trauma, Dream, and Psychic Change in Psychoanalyses

Fischmann, T.; Russ, M.; Baehr, T.; Stirn, A.; Leuzinger-Bohleber, M. (2012): Changes in dreams of chronic depressed patients: the Frankfurt fMRI/EEG study (FRED). In: Fonagy, P.; Kächele, H.; Leuzinger-Bohleber, M.; Taylor, D. (eds.): The significance of dreams: Bridging clinical and extraclinical research in psychoanalysis. London: Karnac Books, 157-181

Fischmann, T.; Leuzinger-Bohleber, M.; Kächele, H. (2012): Traumforschung in der Psychoanalyse: Klinische Studien, Traumserien, extraklinische Forschung im Labor. Psyche - Z Psychoanal 66: 833-861

Fischmann,T; Russ, M; Leuzinger-Bohleber,M. (2013): Trauma, dream, and psychic change in psychoanalyses: a dialogue between psychoanalysis and the neurosciences. In: frontiers in Human Neuroscience, Vol 7, Article 877

Leuzinger-Bohleber, M. (2015): Working with severely traumatized, chronically depressed analysands. In: The International Journal of Psychoanalysis Volume 96, Issue 3, June 2015, Pages: 611–636

Brief summary

To many psychoanalysts dreams are a central source of knowledge of the unconscious—the specific research object of psychoanalysis. The dialogue with the neurosciences, devoted to the testing of hypotheses on human behavior and neurophysiology with objective methods, has added to psychoanalytic conceptualizations on emotion, memory, sleep and dreams, conflict and trauma. To psychoanalysts as well as neuroscientists, the neurological basis of psychic functioning, particularly concerning trauma, is of special interest. In this article, an attempt isto bridge the gap between psychoanalytic findings and neuroscientific findings on trauma and depression.

We then attempt to merge both approaches in one experimental study devoted to the investigation of the neurophysiological changes (fMRI) associated with psychoanalytic treatment in chronically depressed patients in the so called FRED Study (Frankfurt- fMRI EEG- Study of Depression). We also applied a method to quantify psychoanalysis-induced transformation in the manifest content of dreams developed by Moser and von Zeppelin in Zürich in the 1990 and further developed by our research group in Frankfurt (together with Susanne Doell and others). 

In this study focused on some single case studies we used three independent methods. First, dreams reported during the psychoanalysis of chronic depressed analysands were assessed by the treating psychoanalyst. Second, dreams reported in an experimental context in the sleep laboratory of the Sigmund-Freud-Institute were analyzed by an independent evaluator using a standardized method to quantify changes in dream content (Moser method).  

Thirdly, we also investigated the analysands by fMRI. The fMRI results regarding changes in brain activation patterns when confronted with conflictladen dream material (dream-words) elucidate the brain areas involved. These preliminary results point to the Precuneus and Left Parietal Lobe when conflict is still acute. The changes found clinically have thus found their neurobiological resonance and validate them furthermore. This is further supported by the finding that the MFC – usually involved when conflictladen information and control of affective signals is being processed – is no longer contrastingly active after one year of treatment.

In combination these results give impressive evidence in a psychoanalytical treatment on an empirical, clinical and neurobiological base.

We  also illustrated the differences between the clinical use of dreams as an indicator for changes in the inner (traumatic) object world in psychoanalyses and the systematic, „scientific“ investigation of laboratory dreams by the so-called „Moser-method“ and by showing that these changes are also evident on a neurobiological level. The case report focused on the importance of the psychoanalytic context of dreams, the observation of transference and countertransference reactions, the associations of the patient and the analysand etc. necessary to unravel the unconscious meaning of the dream (Leuzinger-Bohleber, 2012). One great advantage of the psychoanalytical clinical „research“ on dreams continues to be the understanding of the meaning of a dream in cooperation with the dreamer—the patient. His association, and conscious and unconscious reactions to a dream interpretation still are the criteria in order to evaluate the „truth“ of the interpretation (see. e. g. Leuzinger-Bohleber, 1987, 1989, 2008). To make a long story short: the transformation of the unconscious world (like dreams) – and as products of it the maladaptive emotions, cognitions and behaviours („symptoms“) of the patient – still remain the final psychoanalytical criteria for a therapeutic „success“ based on „true insights“ of the patient in his unconscious functioning.

  Evaluation

Ongoing studies at the Sigmund-Freud-Institut, Frankfurt, show promising results combining clinical and experimental dream studies. The careful investigation of dreams in the psychoanalytical situation as well as of dreams reported in the sleep laboratory show parallel findings concerning the transformation of dreams in psychoanalyses. The preliminary results suggest that psychoanalysis-induced transformation can be assessed in an objective way.

Contact

Tamara Fischmann  dr.fischmann@sigmund-freud-institut.de

Marianne Leuzinger-Bohleber m.leuzinger-bohleber@gmx.de

Michael Russ m.russ@em.uni-frankfurt.de

The Zürich-Ulm Study of dreams: Aggregating single cases (USD)

Leuzinger-Bohleber, M. (1989). Veränderung kognitiver Prozesse in Psychoanalysen. Bd 2: Eine gruppen-statistische Untersuchung (Change of Cognitive Processes in Psychoanalyses. Vol. 2 A Group-statistical Study). Berlin: Springer.

Kächele, H., & Leuzinger-Bohleber, M. (2009). Dream series as process tool. In H. Kächele, J. Schachter & H. Thomä (Eds.), From Psychoanalytic Narrative to Empirical Single Case Research (pp. 266-278). New York: Routledge.

Summary

This study initially described and analysed changes in the problem-solving cognitive processes of five patients during their long-term psychoanalyses. Modifi­cations of the way the patients themselves handled their dreams during psychoanalytic sessions were focused upon.

In the first phase of the study, hypotheses were derived by exploring dream associations as recorded in a patient's diary during the first and last hundred hours of his psychoanalysis (Leuzinger-Bohleber, 1987). In the second phase, the hypotheses were tested by studying the verbatim materials of four psycho­analytic cases from the Ulm Textbank (Leuzinger-Bohleber, 1989). Using two kinds of theory-guided content analysis, the dream reports taken from the first hundred along with those from the last hundred psycho­analytic sessions were evaluated case by case. At this point, the clinical outcome assessments - provided by independent clinicians - were compared to the findings on the cognitive changes. Across the five cases the estimation of clinical change corresponded very well to the changes in the cognitive functions measured by the patients' handling of dreams supporting the study hypotheses.

An extension study was performed on material from one of the patients (Kächele & Leuzinger-Bohleber, 2009). In this study, all dreams were subjected to an analysis of changes in relationship pattern, dream atmosphere and problem solving. There was an impressive change of the dream atmosphere from negative to more positive affects and to more variation in affects and an impressive change in a variety of problem-solving activities.

Evaluation

This is an innovative approach to the process-outcome problem. Changes in dream quality would not be predicted by any theory other than the psychoanalytic. The methods developed here need validating by other centres but the use of replicative single case design is one with many possible applications in this field. The careful investigation of transformations of dreams has also been one major tool for studying changes in psychoanalyses and psychoanalytic longterm therapies in the frame of the LAC depression study (main investigator: M. Leuzinger-Bohleber).

Contact

Marianne Leuzinger-Bohleber

Email: M. Leuzinger-Bohleber@sigmund-freud-institut.de

Horst Kaechele

Email: horst.kaechele@ipu-berlin.de

Posttraumatic dreams and symbolisation

Varvin, S., Fischmann, T., Jovic, V., Rosenbaum, B., & Hau, S. (2012). Traumatic dreams: symbolization gone astray. In: P. Fonagy, H. Kächele, M. Leuzinger-Bohleber & D. Taylor (Eds.): The Significance of Dreams. Bridging Clinical and Extraclinical Research in Psychoanalysis (pp. 182-211). London: Karnac.

Varvin, S., Jovic, V., Fischmann, T., Rosenbaum, B, & Hau, S. (2012) Traumatische Träume: Streben nach Beziehung{Traumatic dreams: quest for relations}. Psyche – Zeitschrift für Psychoanalyse, 66, 937-967

Jovic, V., Hau, S., Varvin, S., Fischmann, T., & Rosenbaum, B. (2018). Sleep and dream studies in Serbian victims of torture. In E. Vermetten, T. Neylan, S. R. Pandi-Perumal & M. Kramer (Eds.), Sleep and Combat-related Post-Traumatic Stress Disorders (pp. 395-409). New York: Springer.

Aim

The study aims to combine the investigation of the content of the dreams, the dream work process and trauma. With a better understanding of the influence of trauma on dream work we hope to further develop psychoanalytic understanding of dreams and the clinical work with dreams.

Methods

In the frame of a larger study on psychological and physiological parameters of PTSD (financed by the EU during 2005-2008) a group of 25 war veterans with PTSD related to traumatic war experiences during the last Balkan war were investigated in the sleep laboratory. They were selected from the larger group (N=100) as they all reported having repetitive war-related dreams at least twice per week. More than 70 spontaneous dream reports were collected under laboratory conditions. The standardized interviews – performed by psychoanalysts in Belgrade - were tape recorded, transcribed and translated into English. Two research groups, consisting of psychoanalysts from Germany, Norway, Denmark, and Sweden are in the process of investigating the manifest dream narratives with two sophisticated evaluation methods in order to describe symbolizing activity and relational interactions in the dreams. At the same time, psychoanalysts from Belgrade will compare these results with psychological measures such as: clinical symptomatology, personality structure, stressful life events (prior to war and war-related), pre-war adjustment, and cognitive and neuropsychological parameters. 

Contact

Stephan Hau, Prof., Ph.D.

Department of Psychology, Stockholm University, Stockholm, Sweden.

Vladimir Jović, MD, PhD

IAN Center for Rehabilitation of Torture Victims, Belgrade, Serbia.

Sverre Varvin. MD, Dr. Philos.

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

E-mail: sverre.varvin@nkvts.unirand.no

Bent Rosenbaum, MD, DMSci

Psychiatric University Centre Copenhagen, Psychiatry of the Capital Region of Denmark. Professor, Institute of Psychology, University of Copenhagen.

Posttraumatic dreams and symbolisation: A follow up study

Purpose and objective

The study aims to combine the investigation of the content of the dreams, the dream work process and trauma. So far we were able to gather abundance of data (including narratives of dreams) from two groups of subjects, and we were able to provide some evidence that their dreaming process differs in respect to several dimensions (symbolization, affect regulation, attachment to others etc.). With a better understanding of the influence of trauma on dream work we hope to further develop psychoanalytic understanding of dreams and the clinical work with dreams.

In this moment we have an access to the first group of subjects, i.e. individuals who were exposed to severe war-related stressors (torture, imprisonment, severe combat, injury, etc.), and to assess their psychological and physiological state seven or eight years after the initial assessment. In that sense we will be able to have a longitudinal perspective of their psychological status (development of posttraumatic sequela, possible changes in the clinical picture), social variables that could have impact on the outcome of the disorder, and more importantly, we will have a chance to analyze elements of their dream processes (indirectly via dream narratives) and to compare them with the results of analyses almost one decade before. It is reasonable to assume that we will have dispersion of possible outcomes of the posttraumatic processes (from the resolution to the chronic form) and that these differences would be recognizable at the level of dream structures. 

This research started as a sub-component of the research project entitled “Psychobiology of PTSD” (PPTSD), that is approved and financed by European Commission (Contract number: FP6-509213) and has been implemented through international cooperation of research centers in Serbia, Croatia, Holland, Italy and England. PPTSD Project’s general objective is to better understand the biological basis of psychophysical profiles of PTSD patients. The study is focused on establishing multiple correlations of different PTSD subtypes with relevant psychological, biochemical, endocrinological, genetic, physiological and anthropometric parameter. Our subjects were 25 men, exposed to various war related stressors (combat, imprisonment, torture), with the current diagnosis of PTSD and with the specific characteristic – frequent nightmares related to war experiences (established criteria was at least two nightmares during the two week period prior to psychological assessment). Objectives of our study were to: 1) perform polysomnographic identification of two parasomnic events - nightmares and night terrors in subjects and to 2) record narratives of dreams during the night and upon awakening, and to record narratives on recurrent war-related dreams that will subsequently be submitted to psychoanalytical analyses.

Second part of the research was entitled „Posttraumatic dreams and symbolisation“ and was supported by the IPA Research Advisory Board. The main purpose of that second part was to investigate referential group of men, who were exposed to war-related stressors but who did not have PTSD at the time of assessment. They were selected to match the experimental group according to age, education and level of exposure to war-related stressors.

With both groups, procedure of collecting the narratives in the morning was similar: in the early morning subject was interviewed by one of two of Serbian colleagues, both psychoanalytic researchers, and interviews were recorded, transcribed, and translated into English. Material has been analyzed by two different methods: Psychoanalytical Enunciation Analysis (PEA) and by a method introduced by Moser & v. Zeppelin. Both methods and their utilization for the analysis of traumatic dream narratives have been presented in conferences and papers published so far.

Currently two research groups are in the process of evaluating the dream reports.

Methods of analysis

We used two different methods for qualitative analysis of narratives of dreams that are related to two different theoretical backgrounds and have relatively strict rules for application which limit possible subjective interpretations. Both methods have earlier been applied for analyzing different clinical phenomena (e.g. psychosis, suicide, depression). They proved to be useful for the systematic evaluation of traumatic dreams as well as for evaluating processing of memories and affects with intrusive re-experiencing and reactive avoidance – observable in dream narratives – phenomena that can be understood as the core of the clinical dynamics of the posttraumatic stress disorder.

„Replica dreams“. Most of our subjects did report dreams and all those dreams were at some extent related to traumatic (war-related) experiences. This was the case for subjects from the experimental group (individuals with current PTSD at the time of assessment) as well as for the referential group (healthy individuals who were exposed to war-related stressors). But one of important results was that in all narratives (except one, which could be understood as an artifact) traumatic material was transformed by the dream work. This speaks against the view of traumatic dreams as „pure replicas” of the past presenting un-integrated memories and brings us closer to the understanding of traumatic dreams as complex processes which more or less successfully aim at integrating traumatic experience into the mind’s normal communicative and problem-solving way of working.

Positive and negative outcome. One of the aims of our research was to explore the differences in the structure of dreaming of two groups (subjects with and without current PTSD). We are in the process of finalizing analysis of all dreams collected during the research. By the April 2013 we will be able to report the summary of main differences and probably will be able to describe main trends, qualitatively and quantitatively. Currently, we were able to demonstrate (19) that the referential group dream specimen is characterized by higher level of symbolic and relational quality than the dream specimen of the experimental group, and that they differ in security regulation, capacity to solve problems, and involvement with others (good feelings, positive relations).

Affect regulation and involvement with others. By looking at the dreams of the traumatized subjects in light of the results of the Moser method, disturbances of affect-regulation become apparent. Those disturbances reflect the dreamer’s inability to get involved with others in the dream scenario because of anxieties, especially annihilation anxiety, evoked by such involvement. The Moser dream coding method reveals that, the security principle overrules the involvement principle in these dreams. This finding could be further elaborated to help us understand one of the basic features of PTSD – detachment from others, as a defensive strategy to avoid overwhelming affects.

Contact

Vladimir Jović, MD, PhD

IAN Center for Rehabilitation of Torture Victims, Belgrade, Serbia.

Sverre Varvin. MD, Dr. Philos.

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

Bent Rosenbaum, MD, DMSci

Psychiatric University Centre Copenhagen, Psychiatry of the Capital Region of Denmark. Professor, Institute of Psychology, University of Copenhagen.