Le traitement cognitivocomportemental des cauchemars et le cas particulier de l'état de stress post-traumatique

Almost 60 years of scientific study supports the hypothesis of continuity between mental activity during dreaming and waking. The sources of dreams span from recent to remote waking experiences. They are transformed in images and scenarios that tend to be negative, particularly in dreams arising from REM sleep. Notably, negative emotions prevail. Recent studies using electrophysiological and imaging techniques suggest that this is linked to the alteration in the levels of activations of brain structures such as the amygdala, the hippocampus and the prefrontal cortex. The impact of dreams on waking life which tend to be minimal in normal conditions can be significant in the case of nightmares which are common in childhood but become problematic in adulthood. While the etiology of nightmares is still not well understood, they can be treated effectively with cognitive behavioral techniques such as imagery rehearsal therapy. Nightmares associated with post-traumatic stress disorder present a challenge because of their origin, intensity and the significant sleep disruptions that characterise this condition. The treatments are outlined and reviewed along with studies attempting to validate them.