The nature of posttraumatic nightmares and school functioning in war-affected youth

Abstract

Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.

Characterizing veterans’ dreams applying the Zurich dream process coding system.

“…It may be plausible to attribute this finding to the instruction to briefly describe the dream content in combination with a possible tendency toward underreporting of emotional experiences in military personnel (Green et al, 2010). The finding of a passive-sustaining position of the dream ego and failing interactions or trajectories is in line with results regarding a lack of self-efficacy, lack of control, strong feelings of helplessness, or a less active role of the dream ego by several previous studies (Harb & Schultz, 2020; Harb et al, 2012; Miller et al, 2021; Valli et al, 2006). However, presence or absence of these dream report features was not related to PTSD severity.…”

“…Furthermore, they describe sensory details, death scenes, life threat, their perpetration of violence, and related emotions in these nightmares. Similar results were reported by Harb and Schultz (2020) and by Dale et al (2013). Elevated threat content and negative emotions as well as a less active role of the dream ego have also been described in dreams of trauma-exposed children as compared to control groups (Helminen & Punamäki, 2008; Punamäki et al, 2005; Valli et al, 2005; Valli et al, 2006).…”

Validation of an instrument in Latin America to measure fear perception of the consequences of a large-scale war (war-effect)

“…On the other hand, this questionnaire could be used along with other instruments and scales that allow the evaluation of other components of the population's mental health, as well as other changes influenced by the war context. [22][23][24] We have included questions that permit us to assess fear of the economic consequences of the conflict between Ukraine and Russia in the Latin American population. This is important because the economic and product exchange was stagnated between America and the conflict zone.…”

Prevalence and Characteristics of Posttraumatic Nightmares in War- and Conflict-Affected Students

“…However, the available literature suggests significantly more sleep problems and nightmares among children and adolescents exposed to trauma than in non-trauma-exposed samples. 7 A recent study 14 of 58 treatment-seeking students (12–16 years old) in Gaza found evidence of disturbed sleep as indicated by approximately five weekly posttraumatic nightmares for an average of 3.1 years, an average 50 minutes of nightly sleep latency, waking after sleep onset (several times a week to almost every night), and only once per week feeling rested in the morning. This suggests that recurrent posttraumatic nightmares are likely associated with reduced daily functioning which can lead to impaired academic development.…”

“… 7 However, there is considerable variation in these studies, with the prevalence of children’s nightmares following exposure to traumatic events ranging from 20% to 81%. Recent smaller studies of dreams in Palestinian youths have demonstrated signs of nightmare disturbance: adolescents reported five nightmares per week that had lasted for an average of three years; 14 75% had dreams with an unpleasant atmosphere, 66.8% unhappy endings, with fear the most common emotion; 15 and 38.1% of students (primary school), 28.8% (preparatory), 25.6% (secondary) and 13.6% (university level) reported “bad dreams” most nights. 16…”