PubMed · 4165088
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1965-04-10. Dreaming.. https://pubmed.ncbi.nlm.nih.gov/4165088/
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Exposure therapy is a well-established treatment for PTSD that requires the patient to focus on and describe the details of a traumatic experience. Nightmares that refer to or replicate traumatic experiences are prominent and distressing symptoms of PTSD and appear to exacerbate the disorder. With this apparent paradox in mind, exposure therapy and the literature on sleep and PTSD are reviewed in the context of the relationship between therapeutic exposure and exposure to trauma-related stimuli that occurs in dreams. It is concluded that nightmares that replay the trauma and disrupt sleep do not meet requirements for therapeutic exposure, whereas other dreaming may aid in the recovery from trauma.
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Recent studies have shown that the ventral tegmental pathway stimulates both dreaming and drug craving. To investigate a possible clinical link between these two psychic phenomena, psychotherapy notes from the first six months of an addicted patient's treatment were reviewed, together with verbatim notes from the four years of psychoanalysis that followed. Of 240 dreams reported by the patient,58 had manifest content involving the seeking or using of drugs. There was no particular temporal or emotional thematic pattern to these "drug dreams,"which persisted through four and a half years of sobriety. Drug dreams are observable phenomena that reflect both the innate structure of the brain and neural changes produced by exposure to addictive drugs. In some addicted persons, exposure to drugs produces a fixed change in neurological functioning with which they must contend for years, possibly the rest of their lives. Drug craving meets Freud's defining characteristics for a drive: it is a constant pressure, originating from within the organism, to do work, and it constantly demands satisfaction. Because ego and libidinal drives share a common neural pathway, they should not be separated conceptually. Solms's finding (in press) that the activating systems for dreaming and for craving are identical, a finding based on observations of tumor- or stroke-provoked brain lesions, is confirmed by observation of the dreams of a patient whose brain changes were created by drug exposure. This study provides further evidence that the origin of the dream is a wish.