Distressing dreams in trauma survivors: using a sleep diary mobile app to reveal distressing dream characteristics and their relationship to symptoms and suicidal ideation in trauma-exposed adults.

Study objectives: Trauma nightmares are a core feature of PTSD, with potentially devastating implications for mental health outcomes. Treatments remain unsatisfactory and nightmares are poorly understood, both biologically and phenomenologically; measurement methods are limited. The aims of the current analyses were to (1) characterize distressing dreams in trauma survivors, (2) examine the relationships of dream features to next-day symptoms and to suicidal ideation, and (3) validate sleep diary mobile app items for the measurement of clinically relevant dream characteristics.

Methods: Adult male and female veterans and nonveterans with a history of PTSD criterion trauma and at least 1 nightmare weekly were enrolled. Participants completed 3 weeks of sleep diary, including bedtime and morning surveys and weekly assessments. They also completed a Clinician-Administered PTSD Scale (CAPS)-5 PTSD assessment. Multivariable mixed models with repeated measures and standard regression were utilized to examine relationships between dream features and next-day symptoms and suicidal ideation.

Results: Dream features and dream distress independently predict clinically relevant outcomes; no single feature was sufficient for predicting all outcomes of interest. In particular, the replicative quality of trauma nightmares stood out in terms of associations with next-day symptoms, CAPS severity, and suicidal ideation. Subjective dream duration, extent of postdream arousal, and subjective distress severity also independently predicted daytime symptoms.

Conclusions: Results underscore the importance of examining dream characteristics to understand nightmare effects and associations with suicidal ideation. These findings also underscore the utility of mobile app technology for obtaining informative data with high temporal resolution in an appealing and user-friendly manner.