Lucid dreaming as a nightmare therapy: promise and limits

A lucid dream is one in which you know, while it is happening, that you are dreaming. For anyone who lives with nightmares, the appeal is obvious: if you could realise mid-nightmare that none of it is real, perhaps you could change the ending, or simply wake. Lucid dreaming therapy is built on that idea. The research behind it is genuinely interesting, and also smaller than its popularity suggests.

What lucid dreaming therapy involves

In the best-known trial, from Utrecht, the therapy combined three elements: exposure to the nightmare, exercises aimed at a sense of mastery over it, and exercises to make lucid dreaming more likely.^[1] The first two will sound familiar if you know imagery rehearsal, which also asks people to revisit a nightmare and give it a new direction while awake.

The pilot trial

Victor Spoormaker and Jan van den Bout randomly assigned 23 people with chronic nightmares to one of three groups: a single two-hour individual session (8 people), a single two-hour group session (8 people), or a waiting list (7 people). Everyone filled in questionnaires on sleep and post-traumatic stress, then again twelve weeks later.^[1]

• Nightmares became less frequent in both treatment groups, and the individual session appeared to help more than the group session.^{[1, 2]}
• Sleep quality and PTSD symptoms did not change significantly.
• Lucidity was not necessary. Nightmares fell even in people who did not become lucid, and the authors concluded that it was unclear whether exposure, mastery or lucidity was doing the work.^[1]

With 23 participants and a single follow-up, this is a pilot: a reason to look further, not a settled answer.

What happened next

Later studies have been mixed. In a trial summarised by the American Academy of Sleep Medicine, 32 people received Gestalt therapy with or without added lucid dreaming training; both groups had fewer nightmares, with no difference between them.^[2]

A larger Dutch trial tested self-help versions with 278 participants: imagery rehearsal alone, imagery rehearsal plus sleep advice, or imagery rehearsal plus sleep advice and a lucid dreaming section, against a waiting list. Against the authors’ expectations, plain imagery rehearsal did best, and it was the only version that clearly beat the waiting list. Many participants dropped out, so the authors urged caution.^[3]

A 2023 systematic review found four randomised trials, two case series and five case reports. Most reported fewer nightmares after lucid dreaming therapy, but the studies were small and limited in quality, and there were none in children.^[4]

What the guidelines say

The AASM’s 2010 guide said lucid dreaming therapy may be considered for nightmare disorder, on low-grade evidence.^[7] Its 2018 position paper lists it among treatments that “may be used” for nightmare disorder, but not among the options for nightmares linked to PTSD. The only treatment it recommends outright, for both, is imagery rehearsal.^[2]

A conversation from inside a dream

In 2021, four independent laboratories reported something remarkable. They studied 36 people during REM sleep, confirmed with full sleep recordings. Some lucid dreamers could hear simple questions from the researchers, such as simple sums, and answer from inside the dream with agreed eye movements or small facial muscle twitches. Correct answers came on 29 occasions, from 6 of the people tested.^[5] You can read more about it in talking from inside a dream.

This shows that two-way communication with a dreamer is possible in a laboratory. It is not a nightmare treatment, only a minority of participants managed it, and it needed full sleep-lab equipment. The authors suggest the channel could have practical uses in future; whether it could ever help with nightmares is a separate question this study did not test.

Possible downsides

Most lucid dreaming research has asked whether lucidity helps. Far less has asked whether trying to induce it can harm. In a 2020 article, psychologist Nirit Soffer-Dudek set out reasons for caution.^[6]

• Some techniques break sleep on purpose. “Wake back to bed”, for example, involves deliberately waking in the night. For someone who already sleeps badly, that is a real cost.
• Effort may matter more than lucidity. In one study, frequent attempts to induce lucid dreams, rather than lucid dreams that happened by themselves, went with more sleep problems, stress and dissociation. This is a correlation, not proof of harm.
• Knowing is not the same as steering. Lucid dreams without control appear to be more common than lucid dreams with it, including in veterans with PTSD.
• Blurring dream and waking may not suit everyone. Clinicians have urged particular caution for people prone to psychosis.

The same article notes that, in the studies it reviewed, lucid dreaming did not show a benefit for PTSD symptoms.^[6]

What this means for you

• If lucid dreams come naturally and help you turn a nightmare around, there is no reason to worry about them.
• If you want a structured method, imagery rehearsal has stronger evidence, needs no lucidity and asks nothing of your sleep. See what imagery rehearsal is.
• Protect your sleep. If you already wake a lot, techniques that interrupt sleep on purpose may not be worth the trade.
• If your nightmares are linked to trauma, work with a professional, and if they come with thoughts of harming yourself, please reach out to a crisis line today.

Baku’s Rewrite studio works entirely while you are awake: you change the dream in daylight and rehearse it, and the night is left for sleeping.