Evaluating the Relationship Between Emotion Regulation, Mood and Distressing Dreams Using Daily Sleep Diary Reports in Trauma Survivors

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric condition that affects approximately 6% of the US population, with even higher rates among veterans. Sleep disturbances (e.g., distressing dreams) are among the most reported symptoms in individuals with PTSD. Distressing dreams (sometimes referred to as nightmares) have been associated with significant negative mental health outcomes, such as suicide. Therefore, understanding factors that contribute to or mitigate the risk of experiencing distressing dreams is critical for improving mental health in people with PTSD. The current study uses data on twice daily mood ratings from a mobile phone application across 3 weeks of follow-up to assess the bidirectional relationship between mood and distressing dreams. Additionally, we investigate how emotion regulation difficulties contribute to the incidence of distressing dreams and to their impact on overall mood. Participants were veterans (N = 90) and civilians (N = 13) enrolled as part of a larger study of distressing dream physiology in trauma-exposed individuals. Our results suggest that among individuals with poor mood before bed, the risk of having at least one distressing dream increases, resulting in poor mood the following morning. This negative mood state carried over into the evening on the next day, thereby further increasing the risk of having another distressing dream. Adjusting for sex, age and PTSD severity, we find that individuals with better emotion regulation have a lower incidence of distressing dreams and better mood on average. Future research on novel interventions targeting emotion regulation, mood and/or sleep disturbances is warranted.