创伤幸存者的痛苦梦境：使用睡眠日记移动应用程序揭示创伤暴露成年人的痛苦梦境特征及其与症状和自杀意念的关系。
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.
作者信息
Richards Anne, Santistevan Anthony, Kovnick Miles, Orlova Polina, Yack Leslie, Berg Emily, Pracar Shane, Metzler Thomas, Neylan Thomas, Woodward Steven
机构信息
Psychiatry, University of California San Francisco, San Francisco, CA, USA.
Mental Health, San Francisco VA Medical Center, San Francisco, CA, USA.
出版信息
Sleep Adv. 2025 Jan 2;6(1):zpae099. doi: 10.1093/sleepadvances/zpae099. eCollection 2025.
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.
研究目的
创伤噩梦是创伤后应激障碍（PTSD）的核心特征，对心理健康结果可能产生毁灭性影响。目前的治疗效果仍不尽人意，而且无论是从生物学还是现象学角度，人们对噩梦的了解都很有限；测量方法也很有限。当前分析的目的是：（1）描述创伤幸存者的痛苦梦境；（2）研究梦境特征与次日症状及自杀意念之间的关系；（3）验证睡眠日记移动应用程序项目用于测量临床相关梦境特征的有效性。
方法
招募有PTSD标准创伤史且每周至少做1次噩梦的成年男性和女性退伍军人及非退伍军人。参与者完成3周的睡眠日记，包括就寝时间和早晨的调查以及每周评估。他们还完成了临床医生管理的PTSD量表（CAPS）-5 PTSD评估。采用重复测量的多变量混合模型和标准回归来研究梦境特征与次日症状及自杀意念之间的关系。
结果
梦境特征和梦境困扰各自独立预测临床相关结果；没有单一特征足以预测所有感兴趣的结果。特别是，创伤噩梦的复制质量在与次日症状、CAPS严重程度和自杀意念的关联方面表现突出。主观梦境持续时间、梦后觉醒程度和主观困扰严重程度也各自独立预测日间症状。
结论
结果强调了检查梦境特征对于理解噩梦影响以及与自杀意念关联的重要性。这些发现还强调了移动应用程序技术以吸引人且用户友好的方式获取具有高时间分辨率的信息性数据的实用性。
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