Bódizs R*, Simor P, Csóka Sz, Bérdi M, Kopp MS : Dreaming and health promotion: A theoretical proposal and some epidemiological establishments. European Journal of Mental Health 3: 35-62. 2008 – 4. Discussion

4. Discussion

Based on the psychobiological aspects of dream formation we consider the empirical investigation of the epidemiological context of dreams and health reasonable. Considering the number of the participants and the examined variables, our investigation is unique in this research field. Our findings serve the starting point for the further investigation of the relationship between dreams and health in the Hungarian population. In sum, we can draw the following conclusions:

• 1. Subjects’ habitual dream qualities derived from the Dream Quality Questionnaire can be grouped into three components. The first is related to the negative emotional aspects of dreaming: frequent expressly oppressive dreams, bad dreams, non-recurrent and recurrent nightmares are parts of this factor. We call this factor Negative Dream Affect. The second component is related to the positive emotional aspects of dreaming. This factor is characterised by frequent experiencing of expressly gratifying and pleasant dreams. We call this factor Positive Dream Affect. The third component consists of neutral dream affect and dream vividness. We call this factor the Neutral Dream Affect factor. Above and further results suggest that dream quality can be tested by relatively simple psychometric instruments which could have a clinical and a research importance in future dream studies.
• 2. There is a reliable connection between the emotional aspects of dreams and the general indicators of health and disease, but not between habitual dream recall frequency and health.
• 3. The relationship between dreams and health is partly explained by illness intrusiveness, but there are several characteristics of dreaming (recurrent nightmares, the high frequency of expressly oppressive dreams) that are related to the general dimension of healthdisease, independently of those effects mediated by illness intrusiveness.
• 4. The relationship between dreams and health indexes is not mediated by the potential direct mood-altering effect of dreams.
• 5. There is a particularly strong relationship between the emotional aspects of dreams and the well-being of the individuals.
• 6. Nightmares and night-terror-like symptoms are potential predictors of health and sick-leave even after the statistical control for well-being. Hence, nightmares and fearful nocturnal awakenings suggest the influence of other factors apart from the lowered level of well-being associated with these phenomena.

On the basis of the theoretical assumptions presented in the introduction we have proposed that dreaming reflects the waking affect of the individuals and hence the investigation of dreaming may shed light on the general psychobiological state of the dreamer. Furthermore, the investigation of the emotional aspects of dreams and the prevalence of dream disturbances (nightmares, recurrent nightmares, fearsome awakenings) could be considered as useful tools for interviewing the subjects’ general state of health, instead of the direct questions concerning the mental state of the subjects. This is because dream reports are less biased by social and communicational expectations. Our results indicate that there is an association between emotional aspects of dreams and general health indexes. This is in concordance with previous findings, showing a relationship between nightmares and certain somatic diseases like cardiac symptoms such as spasmodic chest pain and irregular heart beating (LEVIN & NIELSEN 2007). Furthermore, the association between cardiac symptoms and the prevalence of nightmares seems to be independent of the symptoms of sleep-disordered breathing (ASPLOUND 2003). Since sleep and dream disorders are relevant predictors of the development of depression, the association between dream complaints and lowered levels of well-being may indicate the presence of sub-clinical depressive states. The extremely oppressive dreams may also disrupt sleep, facilitating insomnia, which is shown to be one of the major risk factors for the development of depression (RIEMANN & VODERHOLZER 2003).

Our results indicate that while the relationship between nightmares and health indexes is partly explained by illness intrusiveness, the emotional aspects of dreams, for example the frequency of expressly oppressive and expressly gratifying dreams reflect a general state of mental and physical health, independently from illness intrusiveness. Since this relationship is not the result of the effect that dreams exert on waking mood, our results suggest that the emotional aspects of dreams reflect the waking affect of the dreamer, and not the other way around. Our results cohere with previous findings showing that the investigation of the emotional aspects of dreams, or simply the assessment of the prevalence of disturbing dreams are more appropriate indicators of the mental state of health than the prevalence of nightmares which per definition contain the awakening criterion (BLAGROVE et al. 2004). We found that the frequent experience of disturbing dreams is associated with a lower leve
l of well-being. This is in concordance with previous findings showing a connection between well-being and the emotional aspects of dreams (PESANT & ZADRA 2006; BLAGROVE et al. 2004). Additionally, our findings suggest that general health problems and the days spent on sick-leave are associated with the frequent experience of nightmares and disturbing dreams and this cannot be solely explained by the lowered levels of well-being, therefore the emotional aspects of dreams may reflect something more that we can measure by the self-rated well-being scale. Dreams are metaphorical, visual responses depicting mainly social emotions, waking concerns and self-referential thoughts of the dreamer by using weak and distant associations, and as such may portray the individuals’ mental state from a broader perspective, than self-ratings obtained by common psychometric instruments.

Our study has several limitations, however. Reported associations between dreams and health are usually weak, explaining only a small percent of the variance. The number of subjects varied substantially from one test to another and there was a possibility for an increased Type I statistical error in our analyses. Moreover, we did not yet analyse the relationship between neutral dream affect and health in our preliminary study. However, in spite of the above limitations the hypothesis-based preliminary exploration of this unique large data set suggests that dreams can be analysed in health psychological studies and could convey information on the general mental and physical health of the subjects, which could be useful in medical practice.