Bad Dream Frequency in Older Adults With Generalized Anxiety Disorder: Prevalence, Correlates, and Effect of Cognitive Behavioral Treatment for Anxiety

Abstract

This study investigated the relation between generalized anxiety disorder (GAD) and frequency of bad dreams in older adults. A secondary analysis from a randomized clinical trial comparing cognitive behavioral therapy for anxiety (CBT) to enhanced usual care (EUC), it assessed bad dream frequency at baseline, post-treatment (3 months), and 6, 9, 12 and 15 months. Of 227 participants (mean age = 67.4), 134 met GAD diagnostic criteria (CBT = 70, EUC = 64), with the remaining 93 serving as a comparison group. Patients with GAD had significantly more bad dreams than those without, and bad dream frequency was significantly associated with depression, anxiety, worry, and poor quality of life. CBT for anxiety significantly reduced bad dream frequency at post-treatment and throughout follow-up compared to EUC.

Pain severity, interference, and prescription analgesic use among depressed, low-income homebound older adults

“…Sleep disturbance caused by pain as well as insomnia, muscle spasms, and agitation related to depression may also have necessitated both anxiolytic and analgesic medications. Chest and other bodily pain complaints, sleep disturbance, insomnia, and somatic symptoms are commonly comorbid with anxiety disorders in older adults (Lenze et al, 2005;Nadorff et al, 2014;Wolitzky-Taylor et al, 2010). The presence of significantly higher depressive symptoms among users of both medications than among users of analgesics only also suggest that anxiety may have exacerbated perceptions of both pain and depression (Hanssen et al, 2014;Kroenke et al, 2013).…”

Subjective sleep characteristics associated with anxiety and depression in older adults: a population‐based study

“…In adults with remitted major depressive disorder, residual insomnia and nightmares were associated with anxiety symptoms (Li et al, 2012). In older adults with GAD, cognitive behavioral therapy for GAD and sleep hygiene reduced bad dream frequency (Nadorff et al, 2014). Although the treatment did not address bad dreams, it is not clear whether their lower frequency was attributable to the reduction of anxiety symptoms or because of a better sleep hygiene.…”

Nightmares: Under-Reported, Undetected, and Therefore Untreated

“…The DDNSI assesses the frequency, intensity, and severity of nightmares and bad dreams. The participant is asked about the frequency of nightmares (both number of nights per week with a nightmare and total nightmares per week) as well as the severity and intensity of the nightmare problem utilizing a Likert-type scale ranging from no problem (0) to extremely severe problem/intensity (6). The measure also assesses how often nightmares result in awakenings ranging from never/rarely (0) to always (4).…”

“…3,4 Nightmares are also associated with insomnia symptoms, anxiety, depression, schizophrenia, and even suicidal thoughts and behaviors. 2,[5][6][7][8] Thus, nightmares are clinically relevant and are a primary target for intervention.…”