{"id":66396,"date":"2019-01-30T10:57:07","date_gmt":"2019-01-30T15:57:07","guid":{"rendered":"http:\/\/www.bumc.bu.edu\/busm\/?p=66396"},"modified":"2019-01-30T10:57:07","modified_gmt":"2019-01-30T15:57:07","slug":"how-virtual-reality-might-help-fight-recurring-nightmares","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/camed\/2019\/01\/30\/how-virtual-reality-might-help-fight-recurring-nightmares\/","title":{"rendered":"How Virtual Reality Might Help Fight Recurring Nightmares"},"content":{"rendered":"

BU researchers: VR could benefit people, particularly children, suffering scary dreams<\/h3>\n
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Two BU professors have teamed up to design a pilot study examining whether virtual reality therapy could help people with recurring nightmares. Photo by Lux Interaction\/Unsplash, eferli\/iStock, bunhill\/iStock<\/figcaption><\/figure>\n

You might say that\u00a0<\/span>Patrick McNamara<\/a>\u00a0<\/span>is in a frightening line of work. As a sleep researcher, he\u2019s hunting for new ways to treat people with nightmare disorder (also known as dream anxiety disorder). Being chased by a malevolent entity, McNamara says, is one of the most common recurring nightmares that patients report experiencing over and over again.<\/p>\n

\u201cVery often, people with chronic nightmares report dreaming about being chased or attacked by supernatural or demonic beings,\u201d says McNamara, a Boston University School of Medicine associate professor of neurology. \u201cThey can\u2019t really see their attackers\u2019 faces, but they know their intent is to harm them. People also report being chased by animals like snakes or bears. Bears are very frequent in these types of dreams, where you\u2019re trying to get safe, throwing up obstacles between you and the attacker, feeling like you\u2019re about to be attacked.\u201d<\/p>\n

A nightmare like that might give anyone a bit of anxiety. But terrifying dreams, if they keep happening, can induce far more than just fleeting fear. McNamara says recurring nightmares can have profound long-term effects, especially for children who experience them. In the United States, between half and two-thirds of children and up to 15 percent of adults have frequent nightmares.<\/p>\n

\u201cRecurring nightmares are really significant predictors,\u201d he says. \u201cThey foretell mental health trouble.\u201d<\/p>\n

For children, that trouble can come in the form of adolescent and adult psychosis, including anxiety, depression, stress, and suicidal ideation. In adults, distressing nightmares can often be a sign of post-traumatic stress disorder (PTSD). Despite the documented clinical effects of nightmares\u2014including distress, loss of sleep, and generalized anxiety\u2014McNamara says we still lack easy-to-use, effective treatments for nightmare disorders.<\/p>\n

Imagery rehearsal therapy, the current gold standard for treatment, attempts to teach patients to replace nightmare imagery with less frightening versions. According to McNamara, the success of the treatment is varied and typically short-term because it relies on a person\u2019s ability and willingness to conjure up realistic nightmare imagery in their mind\u2019s eye, which some patients can do better than others. Naturally, most young children are even less capable of willfully controlling an imagined visual narrative than adolescents or adults.<\/p>\n

How can you stop recurring nightmares?
\n<\/strong>Research in the last decade has hinted that modern technology may enable a more tangible approach to treating nightmare disorders. In 2010, Grant MacEwan University psychologist Jayne Gackenbach found that people who played video games before bed may have better awareness and control in their dreams, which could help prevent distressing nightmares. Then, in 2011, Gackenbach found that soldiers who played warfare-themed video games were less likely than nongamers to suffer from feeling distress and helplessness in their dreams.<\/p>\n

The takeaway from those studies? Platforms like video games that exercise a person\u2019s ability to control and manipulate simulated imagery\u2014rather than imagery conjured up in their mind\u2019s eye\u2014could have therapeutic benefits for people with nightmare disorders. Looking out to the next evolution of visual technology, McNamara became very interested in whether virtual reality could be an even more effective tool.<\/p>\n

\u201cVirtual reality immerses you in a 3-D environment and the imagery is quite intense,\u201d McNamara says. How intense? The sensory inputs can be so all-consuming that \u201ceven for people who do it often, you can get nausea because it destabilizes the inner brain mechanisms about balance.\u201d<\/p>\n

Virtual reality programs place users into artificial environments where they experience and manipulate visuals that seemingly exist right in front of their own eyes. In this way, McNamara says, VR is able to take the burden of imagery generation off of the patient, immersing them in nightmarish imagery through interactive systems like Oculus Rift.<\/p>\n

The hardest thing to grasp is the idea that recurring nightmares never lose their strength. It\u2019s a really painful problem to have nightmares that are just as bad the hundredth time you\u2019ve had them.\u201d\u2014<\/span>Wesley J. Wildman<\/cite><\/h4>\n

Teaming up with Wesley J. Wildman, a BU School of Theology professor of philosophy of religion and an expert in artificial, computer-simulated environments, McNamara designed a pilot study to examine if virtual reality therapy could help people with recurring nightmares. The two are cofounding directors of the Center for Mind and Culture and have previously worked together to explore how religious experiences are processed in the brain.<\/p>\n

When McNamara reached out to Wildman for help with the virtual reality component of the study, Wildman says, the idea struck him as a \u201cgenius-level intervention.\u201d<\/p>\n

For people who don\u2019t experience recurring nightmares, \u201cthe hardest thing to grasp is the idea that recurring nightmares never lose their strength,\u201d he says. \u201cIt\u2019s a really painful problem to have nightmares that are just as bad the hundredth time you\u2019ve had them.\u201d<\/p>\n

Ultimately, Wildman says, unrelenting nightmares can make people truly afraid to go to sleep.<\/p>\n

Teaching control over dream imagery<\/strong>
\nFor the pilot study, McNamara and Wildman designed moderately frightening virtual reality imagery\u2014such as an underwater environment where a great white shark seems to swim closer and closer to the virtual reality user\u2014to illicit a manageable level of fear in participants. \u201cTo treat nightmare disorders, you want to expose the person to arousing and disturbing images, but you don\u2019t want to expose them to very scary images,\u201d McNamara says. The goal is to treat distress rather than inflict more.<\/p>\n

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In a virtual reality environment, study participants were directed to make intense imagery less scary, such as using a drawing tool to cover up this great white shark\u2019s teeth as it swam toward them. Photos courtesy of Dreaming<\/figcaption><\/figure>\n

They enrolled 19 study participants who reported having frequent nightmares. Using joystick and gesture controls, participants were able to modify the threatening visuals to make them less scary. McNamara says they could, for example, use a drawing tool to cover up the shark\u2019s teeth or a sizing tool to shrink it down. Afterward, participants were also asked to write a narrative about their newly edited visual experience.<\/p>\n

Someone might say, \u201cWhen I looked [at the shark] more closely it turned out to be a great white tuna that was going to swim by me,\u201d McNamara says. \u201cSuddenly that tremendous force is not after you and it\u2019s not so threatening.\u201d<\/p>\n

Over the course of a month, participants continued visiting McNamara\u2019s lab twice a week to use an Oculus headset and its joystick controls to alter scary visuals and create new narratives. Each visit, they were monitored for anxiety, nightmare distress, and nightmare effects. By the conclusion of the study, participants reported significantly lower levels of all three.\u00a0<\/span>The results were published in the journal\u00a0<\/span>Dreaming<\/em><\/a>.<\/p>\n

\u201cWe think that they learn these imagery control skills and then over a couple of weeks, those skills get transferred from their conscious state into their dream state,\u201d McNamara says.<\/p>\n

Although the results of the pilot are exciting, McNamara says the next step is to design a double-blind clinical trial to really test the effects of virtual reality therapy. To rule out placebo therapy effects, he says, such a study could involve a group of participants who do virtual reality therapy and another group of participants who do standard imagery rehearsal therapy.<\/p>\n

\u201cThe most exciting thing about this is the potential to bring this to kids suffering from nightmares,\u201d says McNamara. \u201cKids are fantastic with adopting technology, and if we can treat their nightmares earlier, we might slow down or prevent conversion into psychosis. That could save lives.\u201d<\/p>\n

The pilot project was funded by the Center for Mind and Culture and the Virginia Modeling, Analysis & Simulation Center.<\/em><\/p>\n

This <\/em>BU Today Story was written by Kat McAlpine<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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