Dreams and psychosis share overlapping features in symptoms and brain activity, offering a testable model for conditions like schizophrenia and delirium. This review examines two key concepts: insight and dissociation. Insight in dreams is central to lucid dreaming, where dreamers become aware they are dreaming and often try to control the narrative, alongside dissociative experiences similar to depersonalization and derealization. These concepts also apply to psychotic illness. While insight may be harmless in lucid dreaming and even beneficial in psychosis, dissociation remains poorly understood. Comparing these phenomena helps clarify their psychological and neurophysiological roles.
During the COVID-19 pandemic, pandemic-related themes were incorporated into dreams, but such incorporation was rare. Psychiatric outpatients and healthy controls did not differ in how often their dreams included pandemic content, and incorporation was unrelated to psychiatric symptoms or loneliness. Loneliness was, however, linked to threat-related dream content, suggesting it is a risk factor for bad dreams but not for crisis-specific incorporation. Lucid dreaming core dimensions—insight, control, and dissociation—were similar between outpatients and controls during lockdowns. Compared to a pre-pandemic sample, scores for control and dissociation were lower, while insight was not. The authors propose that REM sleep intensified during lockdowns for emotional consolidation, making the mental state less hybrid and thus less lucid.