Psychosis and the Control of Lucid Dreaming

People with psychosis report more control over their lucid dreams than non-psychotic individuals, contrary to the hypothesis that lucid dreaming might be therapeutically beneficial for psychotic patients. Among 45 subjects with psychotic symptoms (25 with schizophrenia, 20 with bipolar disorder) and 28 non-psychotic controls, psychotic lucid dreamers reported controlling their dreams more frequently (67% of schizophrenia and 73% of bipolar patients) than non-psychotic lucid dreamers (23% of controls). However, lucid dreamers with psychosis showed no clinical advantage, even on measures of judgment and insight. The findings suggest psychosis may enhance the ability to control internal reality, and that training lucid dreaming in psychotic populations could potentially strengthen delusions and hallucinations rather than provide therapeutic benefit.

Study at a glance

Abstract

Dreaming and psychosis share important features, such as intrinsic sense perceptions independent of external stimulation, and a general lack of criticism that is associated with reduced frontal cerebral activity. Awareness of dreaming while a dream is happening defines lucid dreaming (LD), a state in which the prefrontal cortex is more active than during regular dreaming. For this reason, LD has been proposed to be potentially therapeutic for psychotic patients. According to this view, psychotic patients would be expected to report LD less frequently, and with lower control ability, than healthy subjects. Furthermore, psychotic patients able to experience LD should present milder psychiatric symptoms, in comparison with psychotic patients unable to experience LD. To test these hypotheses, we investigated LD features (occurrence, control abilities, frequency, and affective valence) and psychiatric symptoms (measure by PANSS, BPRS, and automated speech analysis) in 45 subjects with psychotic symptoms [25 with Schizophrenia (S) and 20 with Bipolar Disorder (B) diagnosis] versus 28 non-psychotic control (C) subjects. Psychotic lucid dreamers reported control of their dreams more frequently (67% of S and 73% of B) than non-psychotic lucid dreamers (only 23% of C; S > C with p = 0.0283, B > C with p = 0.0150). Importantly, there was no clinical advantage for lucid dreamers among psychotic patients, even for the diagnostic question specifically related to lack of judgment and insight. Despite some limitations (e.g., transversal design, large variation of medications), these preliminary results support the notion that LD is associated with psychosis, but falsify the hypotheses that we set out to test. A possible explanation is that psychosis enhances the experience of internal reality in detriment of external reality, and therefore lucid dreamers with psychotic symptoms would be more able to control their internal reality than non-psychotic lucid dreamers. Training dream lucidity is likely to produce safe psychological strengthening in a non-psychotic population, but in a psychotic population LD practice may further empower deliria and hallucinations, giving internal reality the appearance of external reality.