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Section 3
Dreaming and Nightmares in REM Sleep Behavior Disorder

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Type B Night Terrors - The Anxiety Dreams
In the last section, we discussed ways of treating type ‘A’ night terrors.  Three effective cognitive intervention treatments for children or adolescents suffering from type ‘A’ night terrors are behavior documentation, assisted recall, and associative connections. 

In this section, we will discuss type ‘B’ night terrors. Night terrors are known as a delta sleep parasomnia and anxiety dreams occurring in REM sleep. Thus, according to this definition, in light of sleep level, what we refer to in this course as type 'B' night terrors could be considered "anxiety dreams." Thus you may wish to transpose our use of the term type 'B' night terrors to anxiety dreams when evaluating your clients delta versus REM sleep status. Three factors involved with type ‘B’ night terrors that we will examine on this track are extreme trauma, complications resulting from type ‘B’ night terrors, and personality characteristics.

Type ‘B’ Night Terrors - 3 Factors

#1 - Extreme Trauma
First, let’s discuss extreme trauma. You may already know that Type B night terrors are more rare than type ‘A’, and often they are a lifelong category of night terror. Type B night terrors have been proven to be a persistent consequence of extreme trauma. Therefore, the difference between Type A and Type B night terrors is essentially the cause of the disorder. Have you found, like I have, that, when investigating childhood trauma as the cause for night terrors, some important factors arise? 

These factors may include the severity, depth, meanness, damage, or method of the trauma or abuse. Environmental factors may also play a role in determining the degree of trauma. If the environment was not safe, your client may have experienced intense emotions such as fear, tension, or frustration. Likewise, extreme trauma which occurs in adulthood can lead to night terrors. Clearly, many of the same factors will apply. Think of the client you are treating for night terrors.  Have you identified a specific traumatic experience as a contributing factor? 

#2 - Personality Characteristics
Additionally, certain personality characteristics are common among clients I have treated who suffer from Type B night terrors.  As we discuss common personality characteristics of night terror sufferers, consider your client.  In what ways does he or she exhibit similar characteristics?  How does your client differ? 

Jerry, age 36, was a night terror sufferer. When I began treating Jerry, I conducted an analysis of his personality. Using standard testing and a diagnostic interview, I found that Jerry, like other night terror sufferers, was rather passive. However, Jerry also reported feeling happy and optimistic. Do you find, like I do, that night terror sufferers may engage in defensive emotional blindness? 

Jerry’s emotional blindness toward his childhood trauma had led him  to appearing optimistic.  The result, for Jerry, was a change in perspective which led to an inhibition of outward expressions of aggression. We’ll discuss Jerry’s past trauma more on the next track.

Jerry also exhibited secondary personality characteristics which are common among night terror sufferers. Jerry experienced impaired memory and impaired retention. As we discussed Jerry's night terrors, it became apparent that Jerry’s nightmares were always related to actual circumstances from his past. Therefore, because type B night terrors do not simply go away by themselves as do type A night terrors, Jerry was in a position to benefit from behavioral intervention. 

When you treat clients like Jerry, do you treat the night terror itself or the associated memories repressed from a traumatic experience?  On the next track we will examine behavioral intervention which helped Jerry.  But first, think of your client.  Are his or her night terrors type A or type B? 

#3 - Complications Resulting From Type ‘B’ Night Terrors
In addition to extreme trauma and personality characteristics, a third factor of type ‘B’ night terrors is the resulting complications. Clearly, problems getting adequate sleep is one complication for our clients. However, health and interpersonal problems often arise for clients I treat who are suffering from type ‘B’ night terrors. Health and interpersonal complications are generally the result of rapid eye movement or REM deprivation. 

Though impaired memory and retention can be a secondary personality characteristic, it can also be a resultant complication, because, as you know, REM is essential to learning and memorization. Similarly, REM deprivation can lead to problems with thermoregulation. A study by Dr. Hartmann revealed that REM restores the part of the brain responsible for maintaining body heat.

Therefore, REM deprivation from night terrors can result in the body’s inability to regulate it’s temperature. Clearly, this can make clients susceptible to a number of health problems. Think of the client you are treating who is suffering from night terrors. What complications can you link to the night terrors? Would it be helpful to play this track for client education?

In this section,we have discussed type ‘B’ night terrors.  Three factors involved with type ‘B’ night terrors that we have examined on this track were extreme trauma, complications resulting from type ‘B’ night terrors, and personality characteristics.

In the next section, we will discuss a six step psychotherapeutic approach to treating type B night terrors.  The six steps I used with Jerry were following sleep guidelines, validating trauma and evaluating family ties, exploring present circumstances, addressing resultant health problems, allowing solitude, and implementing the steps simultaneously.

Peer-Reviewed Journal Article References:
Carr, M., Konkoly, K., Mallett, R., Edwards, C., Appel, K., & Blagrove, M. (2020). Combining presleep cognitive training and REM-sleep stimulation in a laboratory morning nap for lucid dream induction. Psychology of Consciousness: Theory, Research, and Practice. Advance online publication.
Godin, I., Montplaisir, J., & Nielsen, T. (2015). Dreaming and nightmares in REM sleep behavior disorder. Dreaming, 25(4), 257–273. 

Klein, S. B. (2019). The phenomenology of REM-sleep dreaming: The contributions of personal and perspectival ownership, subjective temporality, and episodic memory. Psychology of Consciousness: Theory, Research, and Practice, 6(1), 55–66. 

What are three factors involved with type ‘B’ night terrors? To select and enter your answer go to Test.

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