Survival after severe burns has improved in recent decades, but there is limited information on the course of recovery after surviving a burn and on factors that can affect recovery. The aims of this thesis were to investigate the occurrence of physical and psychological problems after burns, and to examine the consequences of psychological problems for the clinical management of burn patients. Three groups of consecutive patients who were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2005 were included in the studies. The Burn Specific Health Scale (BSHS) was used for self-report of burn-specific aspects of health. Personality traits and coping strategies as psychological factors during recovery were examined with the Swedish universities Scales of Personality (SSP) and the Coping with Burns Questionnaire (CBQ). Presence of symptoms of posttraumatic stress were assessed with the Impact of Event Scale-Revised (IES-R), and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to determine the concurrent validity of the IES-R as a measure of Posttraumatic Stress Disorder (PTSD). Furthermore, the effect of pre-injury psychiatric morbidity on perceived health one year after injury was assessed. Both pruritus and nightmares were common problems after burns; 59% of the individuals in the study reported pruritus and 43% reported nightmares. Neuroticism-related personality traits and avoidant coping strategies were associated with an increased risk of having pruritus or nightmares. The presence of nightmares could be used as a screening tool for high scores in the IES-R. The IES-R was in turn shown to be a good, although overly inclusive, test for the diagnosis of PTSD. Pre-injury psychiatric morbidity predicted perceived outcome in six out of nine burn-specific health domains. These studies show that psychological factors and psychiatric morbidity affect outcome after burns.

In my work as speech and language pathologist I often meet people emerging from coma andtheir experiences intrigue me. Coma is an eluding human condition that offers a challenge formodern science and our view on body and mind. In my Master project in Creative Writing Iwanted to try to enter this zone that is so hard for a clinician to reach: the personal experienceof being in a coma. By writing HUSK MIDAS I have tried to create a realistic fiction based onresearch on coma state and real-life stories of people waking up from coma.In my exploration of the coma state I found that lucid dreaming is common apart fromdreaming, many patients experience sensory inputs like sound and touch which aremisinterpreted and woven into dreams and creating a feeling of confusion and fear.Coma is a frequent theme in literature and film but is often depicted unrealistically andmisleadingly. A few works like Artur Lundkvist’s Journeys in Dream and Imagination andthe film The Descendents by Alexander Payne show a more reality based fiction. While themedical care has the responsibility to provide accurate information and make important healthcare decisions regardless of possible public misconceptions, fiction helps us to dramatize thecoma experience and bring to life this marginalized and otherwise non-communicable state ofthe human condition.

Cette thèse avait pour objectif général d’approfondir nos connaissances sur les rêves dysphoriques (mauvais rêves et cauchemars), selon deux axes. Premièrement, nous avons voulu éclaircir les implications méthodologiques reliées aux différentes mesures de la fréquence de rappel de rêves (articles 1 et 2). Deuxièmement, nous avons voulu étudier un aspect encore peu exploré des rêves dysphoriques : leur contenu (article 3). Dans la première étude, nous avons comparé systématiquement différentes méthodes rétrospectives et prospectives utilisées pour mesurer la fréquence des cauchemars et des mauvais rêves chez 411 participants. En plus de reproduire les résultats d’études antérieures selon lesquelles les mesure rétrospectives sous-estiment la fréquence des rêves dysphoriques, nous avons démontré que ces fréquences n’étaient pas affectées de manière différentielle par le format de la mesure prospective (journaux de rêves narratifs ou à choix de réponse). Dans la deuxième étude, nous nous sommes intéressés à la fréquence de rappel onirique en général (i.e. de tous les rêves) auprès d'un échantillon de 358 participants pour approfondir les résultats relatifs à la comparaison entre les deux types de journaux de rêves obtenus dans la première étude. Nos résultats soulignent que la fréquence de rappel obtenue par un journal à choix de réponse est plus élevée que celle obtenue d’un journal narratif, et que le présumé effet d’augmentation de rappel attribué aux mesures prospectives est limité dans le temps. Ces résultats suggèrent que des facteurs motivationnels sont impliqués dans la tenue d’un journal de rêves, et que dans le cas des journaux narratifs, ces facteurs outrepasseraient les facteurs attentionnels favorisant le rappel onirique. Dans la troisième étude, nous avons comparé le contenu de 253 cauchemars et 431 mauvais rêves obtenus prospectivement auprès de 331 participants, offrant ainsi l’une des descriptions de ce type des plus détaillées à ce jour. Nos résultats démontrent que cauchemars et mauvais rêves partagent de nombreuses caractéristiques mais se différencient en plusieurs points : le contenu des cauchemars est davantage caractérisé par des menaces physiques, et celui des mauvais rêves par des menaces psychologiques. De plus, les cauchemars ont plus souvent la peur comme émotion principale, ont une intensité émotionnelle plus forte, se terminent plus souvent de façon négative et sont plus bizarres que les mauvais rêves. Ces différences de contenu entre mauvais rêves et cauchemars suggèrent que ces deux types de rêves sont des manifestations d’un même phénomène variant en termes d’intensité, et que cette intensité est multidimensionnelle. Les résultats de l’étude 3 sont discutés en lien avec différentes théories sur l’étiologie et la fonction des rêves. / The overall goal of this thesis was to further our understanding on disturbed dreaming (bad dreams and nightmares) along two main lines of inquiry. First, we examined the methodological implications associated with the different instruments used to measure dream recall frequency (articles 1 and 2). Second, we investigated the actual content of disturbing dreams, a dimension for which empirical data remain surprisingly scarce (article 3). Study 1 compared the frequency of nightmares and bad dreams obtained with retrospective methods and with two types of prospective instruments (narrative and checklist logs) in 411 participants. In addition to replicating findings showing that when compared to daily logs, retrospective self-reports underestimate current nightmare and bad dream frequency, we showed that these frequencies were not differentially affected by the type of prospective log. Our second study extended these findings by comparing the differential effects of narrative and checklist logs on general dream recall in 358 participants. The results indicate that checklist logs yield higher prospective dream recall frequency than narrative logs, and that prospectively measured dream recall frequency tends to peak at the beginning of the log and then remains stable over time. Thus, improved dream recall arising from subjects' increased attention towards their dreams is short-lived and the effect quickly offset by motivational factors. Our third article presents a comprehensive and comparative description of the content of 431 bad dreams and 253 nightmares collected prospectively from 331 participants. The results indicate that although nightmares and bad dreams share many content characteristics and features, they also differ along several dimensions: nightmares tend to involve physical threats whereas psychological threats predominate in bad dreams; nightmares are more likely than bad dreams to contain fear as their principal emotion as well as being significantly more emotionally intense; and when compared to bad dreams, nightmares are more bizarre and contain significantly more aggressions, failures, and unfortunate endings. Taken together these findings support the view that nightmares represent a more intense expression of the same basic phenomenon and that this intensity manifests itself along a number of content dimensions. These results are discussed in relation to different theories on the etiology and function of dreams.

Thesis (MA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: The stories and histories of the human race are littered with the remnants of utopia. These utopias always exist in some "far away" place, whether this place be removed in terms of time (either as a nostalgically remembered past, or an idealistically projected future), or in terms of space (as a place that one must arrive at). In our attempts to attain these utopias, we construct our worlddefinitions in accordance with our projections of these ideal places and ways of "being". Our discourses come to embody and perpetuate these ideals, which are maintained by excluding any definitions of the world that run counter to these ideals. The continued existence of utopia relies on the subjects of that utopia continuing their belief in its ideals, and not questioning its construction. Counter-discourse to utopia manifests in the same space as the original utopia and gives rise to questions that threaten the stability of the ideal. Questions challenge belief, and therefore the discourse of the ideal must neutralise those who question and challenge it. This process of neutralisation requires that more definitions be constructed within utopian discourse - definitions that allow the subjects of the discourse to objectify the questioner. However, as these new definitions arise, they create yet more counter-definitions, thereby increasing the fragmentation of the aforementioned space. A subject of any "dominant" discourse, removed from that discourse, is exposed to the questions inherent in counter-discourse. In such circumstances, the definitions of the questioner - the "other" - that have previously enabled the subject to disregard the questioner's existence and/or point of view are no longer reinforced, and the subject begins to question those definitions. Once this questioning process starts, the utopia of the subject is re-defined as dystopia, for the questioning highlights the (often violent) methods of exclusion needed to maintain that utopia. Foucault's theory of heterotopia, used as the basis for the analysis of the three texts in question, suggests a space in which several conflicting and contradictory discourses which seemingly bear no relation to each other are found grouped together. Whereas utopia sustains myth in discourse, running with the grain of language, heterotopias run against the grain, undermining the order that we create through language, because they destroy the syntax that holds words and things together. The narrators in the three texts dealt with are all subjects of dominant discourses sustained by exclusive definitions and informed by ideals that require this exclusion in order to exist. Displaced into spaces that subvert the definitions within their discourses, the narrators experience a sense of "madness", resulting from the disintegration of their perception of "order". However, through embracing and perpetuating that which challenged their established sense of identity, the narrators can regain their sense of agency, and so their narratives become vehicles for the reconstitution of the subject-status of the narrators, as well as a means of perpetuating the counter-discourse. / AFRIKAANSE OPSOMMING: Utopias spikkel die landskap van menseheugenis as plekke in "lank lank gelede" of "eendag", in "n land baie ver van hier", en is dus altyd verwyderd van die huidige, óf in ruimte, óf in tyd. In ons strewe na die ideale, skep ons definisies van die wêreld wat in voeling is met hierdie idealistiese plekke en bestaanswyses. Sulke definisies sypel deur die diskoers, of taal, waarmee ons ons omgewing beskryf. Die ideale wat dan in die diskoers omvat word, word onderhou deur die uitsluiting van enige definisie wat teenstrydig is met dié in die idealistiese diskoers. Die volgehoue bestaan van utopie berus daarop dat die subjekte van daardie utopie voortdurend glo in die ideale voorgehou in en onderhou deur die diskoers, en dus nie die diskoers se konstruksie bevraagteken nie. Die manifestering van teen-diskoers in dieselfde ruimte as die utopie, gee aanleiding tot vrae wat die bestaan van die ideaal bedreig omdat geloof in die ideaal noodsaaklik is vir die ideaal se voortbestaan. Aangesien bevraagtekening dikwels geloof uitdaag en ontwrig, lei dit daartoe dat die diskoers wat die ideaal onderhou, diegene wat dit bevraagteken, neutraliseer. Hierdie neutraliseringsproses behels die vorming van nog definisies binne die diskoers wat die vraagsteller objektiveer. Die vorming van nuwe definisies loop op sy beurt uit op die vorming van teen-definisies wat bloot verdere verbrokkeling van die voorgenoemde ruimte veroorsaak. "n Subjek van die "dominante" diskoers van die utopie wat hom- /haarself buite die spergebiede van sy/haar diskoers bevind, word blootgestel aan vrae wat in teen-diskoers omvat word. In sulke omstandighede is die subjek verwyder van die versterking van daardie definisies wat die vraagsteller - die "ander" - se opinies of bestaan as nietig voorgestel het, en die subjek mag dan hierdie definisies bevraagteken. Sodra hierdie proses begin, vind "n herdefinisie van ruimte plaas, en utopie word distopie soos die vrae (soms geweldadige) uitsluitingsmetodes wat die onderhoud van die ideaal behels, aan die lig bring en, in sommige gevalle, aan die kaak stel. Hierdie tesis gebruik Foucault se teorie van "heterotopia" om die drie tekste te analiseer. Dié teorie veronderstel "n ruimte waarin die oorvleueling van verskeie teenstrydighede (diskoerse) plaasvind. Waar utopie die bestaan van fabels en diskoerse akkommodeer, ondermyn heterotopia die orde wat ons deur taal en definisie skep omdat dit die sintaks vernietig wat woorde aan konsepte koppel. Die drie vertellers is elkeen "n subjek van "n "dominante diskoers" wat onderhou word deur uitsluitende definisies in "n utopia waar die voortgesette bestaan van die ideale wat in die diskoers omvat word op eksklusiwiteit staatmaak. Omdat die vertellers verplaas is na ruimtes wat hulle eksklusiewe definisies omverwerp, vind hulle dat hulle aan "n soort waansin grens wat veroorsaak is deur die verbrokkeling van hul sin van "orde". Deur die teen-diskoers in hul stories in te bou as verteltaal, of te implementeer as die meganisme van oordrag, kan die vertellers hul "selfsin" herwin. Deur vertelling hervestig die vertellers dus hul status as subjek, en verseker hulle hul plek in die opkomende diskoers deur middel van hulle voortsetting daarvan.

Les troubles du sommeil en général et les cauchemars en particulier sont souvent associés aux troubles psychopathologiques et physiques. Ils font partie des plus importantes et fréquentes plaintes rapportées par les patients souffrant de trouble stress post-traumatique et leurs liens avec la sévérité de ce dernier se précisent de plus en plus. L’objectif général de notre thèse est d’apporter des précisions sur les aspects cliniques, psychopathologiques et psychophysiologiques concernant les cauchemars dans le contexte particulier et spécifique du trouble stress post-traumatique, et de préciser les apports thérapeutiques d’un traitement centré sur les cauchemars à travers une étude de cas. Pour ce faire, nous avons choisi de procéder à des évaluations psychopathologiques au moyen d’auto-questionnaires (IES-R, HAD, PSQI, PSQI-A, NDQ et DES), d’entretiens structurés (MINI et CAPS) et d’enregistrements psychophysiologiques sur un échantillon de 21 patients souffrant de cauchemars dans un contexte de TSPT, hospitalisés dans une unité de soins spécialisés en psychotraumatologie et une évaluation d’un suivi thérapeutique d'un patient reçu dans un centre de soin spécialisé à Paris. Les principaux résultats de notre recherche montrent que la sévérité du TSPT est très fortement et positivement associée à la sévérité des cauchemars post-traumatiques et soulignent que la détresse liée aux cauchemars explique mieux la sévérité du TSPT que la fréquence des cauchemars. Nos résultats ont également permis de vérifier ce qui a été rapporté dans la littérature scientifique, à savoir la présence d’importantes comorbidités. En revanche, pour ce qui est des évaluations psychophysiologiques du sommeil, aucun élément pertinent ne ressort de l’analyse des enregistrements polysomnographiques, et aucun des paramètres étudiés n’a été corrélé ni avec la fréquence des cauchemars, ni avec la détresse liée aux cauchemars. Enfin, l’étude de cas a permis d’évaluer les bénéfices thérapeutiques attendus d’un nouveau traitement psychothérapeutique centré sur les cauchemars, dont les résultats montrent une réduction significative de la sévérité des cauchemars, accompagnée d’une réduction de la sévérité du TSPT ainsi qu’une amélioration proportionnelle de la qualité du sommeil. En conclusion, les résultats de notre recherche convergent avec ceux retrouvés dans des études antérieures et soulignent l’importance clinique et psychopathologiques des cauchemars et leur implication dans la sévérité du trouble stress post-traumatique. / Sleep disorders in general and nightmares in particular are often associated with psychopathological and physical disorders. They are among the largest and the most frequent complaints reported by patients with PTSD and their links with the severity are now more specified. The overall objectives of this thesis are to shed light on the clinical, psychopathological and psychophysiological aspects of nightmares in the specific context of PTSD, and also to clarify the therapeutic contributions of nightmares centered treatment through a case study. In order to achieve these objectives, a sample of 21 patients suffering from posttraumatic nightmares and hospitalized in a specialized psychotraumatology unit of care were assessed using self-administered questionnaires (IES-R, HAD, PSQI, PSQI-A, NDQ and DES), structured interviews (MINI and the CAPS) and psychophysiological recordings. In parallel, another patient coming from a specialized psychotraumatology center in Paris was carefully monitored in regards of his therapeutic evolution while receiving the Imagery Rehearsal Therapy program on an individual basis. The main results of this research show that the severity of PTSD is strongly and positively associated with the severity of post-traumatic nightmares and that the distress related to nightmares better explains the severity of PTSD that the frequency of nightmares does. The results also confirmed what has been reported in the scientific literature, namely the presence of significant comorbidities. However and in terms of psychophysiological assessments of sleep, no significant results were found in the analysis of polysomnographic recordings, and none of the studied parameters were correlated with the frequency and/or the distress related to nightmares. Finally, the case study was successfully used to evaluate the expected therapeutic benefits of a relatively new psychotherapeutic treatment focusing on nightmares and the results show a significant reduction in the severity of nightmares, accompanied by a reduction in the severity of PTSD and a proportional improvement in sleep quality. In conclusion, the results of this research are consistent with those found in previous studies and underscore the clinical and psychopathological importance nightmares and their involvement in the severity of PTSD

No description available.

Made available in DSpace on 2014-12-17T15:36:38Z (GMT). No. of bitstreams: 1 SergioAMR_TESE_1-152.pdf: 4687573 bytes, checksum: d13791598d6a440077f9a5703901fe3b (MD5) Previous issue date: 2012-06-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Lucid dreaming (LD) is a mental state in which the subject is aware of being dreaming while dreaming. The prevalence of LD among Europeans, North Americans and Asians is quite variable (between 26 and 92%) (Stepansky et al., 1998; Schredl & Erlacher, 2011; Yu, 2008); in Latin Americans it is yet to be investigated. Furthermore, the neural bases of LD remain controversial. Different studies have observed that LD presents power increases in the alpha frequency band (Tyson et al., 1984), in beta oscillations recorded from the parietal cortex (Holzinger et al., 2006) and in gamma rhythm recorded from the frontal cortex (Voss et al., 2009), in comparison with non-lucid dreaming. In this thesis we report epidemiological and neurophysiological investigations of LD. To investigate the epidemiology of LD (Study 1), we developed an online questionnaire about dreams that was answered by 3,427 volunteers. In this sample, 56% were women, 24% were men and 20% did not inform their gender (the median age was 25 years). A total of 76.5% of the subjects reported recalling dreams at least once a week, and about two-thirds of them reported dreaming always in the first person, i.e. when the dreamer observes the dream from within itself, not as another dream character. Dream reports typically depicted actions (93.3%), known people (92.9%), sounds/voices (78.5%), and colored images (76.3%). The oneiric content was related to plans for upcoming days (37.8%), and memories of the previous day (13.8%). Nightmares were characterized by general anxiety/fear (65.5%), feeling of being chased (48.5%), and non-painful unpleasant sensations (47.6%). With regard to LD, 77.2% of the subjects reported having experienced LD at least once in their lifetime (44.9% reported up to 10 episodes ever). LD frequency was weakly correlated with dream recall frequency (r = 0.20, p <0.001) and was higher in men (?2=10.2, p=0.001). The control of LD was rare (29.7%) and inversely correlated with LD duration (r=-0.38, p <0.001), which is usually short: to 48.5% of the subjects, LD takes less than 1 minute. LD occurrence is mainly associated with having sleep without a fixed time to wake up (38.3%), which increases the chance of having REM sleep (REMS). LD is also associated with stress (30.1%), which increases REMS transitions into wakefulness. Overall, the data suggest that dreams and nightmares can be evolutionarily understood as a simulation of the common situations that happen in life, and that are related to our social, psychological and biological integrity. The results also indicate that LD is a relatively common experience (but not recurrent), often elusive and difficult to control, suggesting that LD is an incomplete stationary stage (or phase transition) between REMS and wake state. Moreover, despite the variability of LD prevalence among North Americans, Europeans and Asians, our data from Latin Americans strengthens the notion that LD is a general phenomenon of the human species. To further investigate the neural bases of LD (Study 2), we performed sleep recordings of 32 non-frequent lucid dreamers (sample 1) and 6 frequent lucid dreamers (sample 2). In sample 1, we applied two cognitive-behavioral techniques to induce LD: presleep LD suggestion (n=8) and light pulses applied during REMS (n=8); in a control group we made no attempt to influence dreaming (n=16). The results indicate that it is quite difficult but still possible to induce LD, since we could induce LD in a single subject, using the suggestion technique. EEG signals from this one subject exhibited alpha (7-14 Hz) bursts prior to LD. These bursts were brief (about 3s), without significant change in muscle tone, and independent of the presence of rapid eye movements. No such bursts were observed in the remaining 31 subjects. In addition, LD exhibited significantly higher occipital alpha and right temporo-parietal gamma (30-50 Hz) power, in comparison with non-lucid REMS. In sample 2, LD presented increased frontal high-gamma (50-100 Hz) power on average, in comparison with non-lucid REMS; however, this was not consistent across all subjects, being a clear phenomenon in just one subject. We also observed that four of these volunteers showed an increase in alpha rhythm power over the occipital region, immediately before or during LD. Altogether, our preliminary results suggest that LD presents neurophysiological characteristics that make it different from both waking and the typical REMS. To the extent that the right temporo-parietal and frontal regions are related to the formation of selfconsciousness and body internal image, we suggest that an increased activity in these regions during sleep may be the neurobiological mechanism underlying LD. The alpha rhythm bursts, as well as the alpha power increase over the occipital region, may represent micro-arousals, which facilitate the contact of the brain during sleep with the external environment, favoring the occurrence of LD. This also strengthens the notion that LD is an intermediary state between sleep and wakefulness / O sonho l?cido (SL) ? um estado mental no qual o sujeito est? consciente de estar sonhando durante o sonho. A preval?ncia do SL em Europeus, Norte-Americanos e Asi?ticos ? bastante vari?vel (entre 26 e 92%) (Stepansky et al., 1998; Erlacher & Schredl, 2011; Yu, 2008) e em Latino-Americanos ainda n?o foi investigada. Al?m disso, as bases neurais do SL permanecem controversas. Diferentes estudos observaram um aumento da pot?ncia na frequ?ncia alfa (Tyson et al., 1984), na oscila??o beta na ?rea parietal (Holzinger et al., 2006) e no ritmo gama na regi?o frontal (Voss et al., 2009) durante o SL em rela??o ao n?o l?cido. Assim, para investigar a quest?o epidemiol?gica (Estudo 1), elaboramos um question?rio online sobre sonhos que foi respondido por 3427 volunt?rios. Em nossa amostra, 56% s?o mulheres, 24% s?o homens e 20% n?o responderam o g?nero; a mediana de idade foi de 25 anos. Um total de 76,5% dos indiv?duos refere que lembra dos sonhos pelo menos uma vez por semana. Cerca de dois ter?os dos sujeitos observam o sonho em primeira pessoa, ou seja, vendo o sonho da pr?pria perspectiva e n?o como mais um dos personagens do sonho. Os elementos mais comuns nos sonhos s?o movimentos/a??es (93,3%), pessoas conhecidas (92,9%), sons/vozes (78,5%) e imagens coloridas (76,3%). O conte?do on?rico se relaciona principalmente com planos para o dia seguinte (37,8%) e mem?rias do dia anterior (13,8%). Os pesadelos apresentam principalmente ansiedade/medo (65,5%), ser perseguido (48,5%) e sensa??es desagrad?veis que n?o envolvem dor (47,6%). Assim, sonhos e pesadelos podem ser evolutivamente entendidos como uma simula??o das situa??es frequentes que acontecem na vida e que se relacionam com a nossa integridade social, psicol?gica e biol?gica. Observamos tamb?m que a maioria dos indiv?duos (77,2%) relata ter tido pelo menos um SL, tendo experimentado na sua maior parte at? 10 epis?dios (44,9%). A frequ?ncia do SL foi fracamente correlacionada com a frequ?ncia de lembran?a dos sonhos (r=0,20, p<0,001) e foi tamb?m maior em homens (?2=10,2, p= 0,001). O controle do SL ? raro (29,7%) e inversamente correlacionado com o tempo de dura??o do SL (r=- 0,38, p<0,001), que normalmente ? curto: para 48,5% dos sujeitos o SL dura menos que 1 minuto. A ocorr?ncia do SL ? principalmente facilitada pela possibilidade de dormir sem hora para acordar (38,3%) que aumenta a chance de ter sono REM (SREM), e estresse (30,1%) que aumenta tamb?m as transi??es do SREM para a vig?lia. Como conclus?o, nossos resultados indicam que o SL ? uma experi?ncia relativamente comum (mas n?o recorrente), geralmente fugaz e dif?cil de controlar, o que sugere que o SL ? um est?gio intermedi?rio, incompleto e estacion?rio (ou fase de transi??o) entre o SREM e a vig?lia. Al?m disso, apesar das popula??es Europeias, Norte-Americanas e Asi?ticas terem uma preval?ncia de SL bastante vari?vel, nossos dados de uma amostra de Latino-Americanos fortalecem a no??o de que o SL ? um fen?meno universal da esp?cie humana. Para investigar as bases neurais do SL (Estudo 2), realizamos registros de sono em 32 sujeitos que n?o apresentam SL de forma frequente, e investigamos 6 sujeitos que apresentam SL recorrentemente. A primeira amostra foi submetida a duas t?cnicas cognitivo-comportamentais para induzir o SL: sugest?o pr?- sono (n = 8) e incuba??o de est?mulos do ambiente (pulsos de luz) no sonho durante o SREM (n = 8). Um grupo controle n?o foi submetido a nenhuma das duas t?cnicas (n = 16). Os resultados indicam que ? muito dif?cil induzir SL em laborat?rio, uma vez que conseguimos obter apenas um SL em um sujeito, que era do grupo em que aplicamos a t?cnica de sugest?o pr?-sono. O sinal eletroencefalogr?fico deste volunt?rio apresentou pulsos de ritmo alfa (7-14Hz) anteriores ao SL, de forma breve (aproximadamente 3s), sem altera??o significativa do t?nus muscular e independente da presen?a de movimentos oculares r?pidos. O SL desse sujeito apresentou tamb?m uma maior pot?ncia do ritmo alfa (7-14Hz) na regi?o occipital e um aumento de atividade gama (20- 50Hz) na regi?o temporo-parietal direita. Nos 6 sujeitos que frequentemente t?m SL, o mesmo apresentou em m?dia um aumento de pot?ncia em gama alto (50-100Hz) na regi?o frontal em compara??o com o SREM n?o-l?cido; no entanto, isso aconteceu de forma clara para apenas um dos indiv?duos. Observamos tamb?m que quatro desses volunt?rios apresentaram um aumento da pot?ncia do ritmo alfa na regi?o occipital, pouco antes do SL, ou durante o mesmo. Dessa forma, nossos resultados preliminares sugerem que o SL apresenta diferentes caracter?sticas neurofisiol?gicas dos estados t?picos de SREM e vig?lia: 1) Os pulsos de ritmo alfa, bem como o aumento da pot?ncia dessa oscila??o na regi?o occipital, podem ser micro-despertares. Estes facilitam o contato do c?rebro durante o sono com o meio externo, favorecendo a ocorr?ncia do SL e fortalecendo a ideia de que o SL seria um estado intermedi?rio entre o sono e a vig?lia. 2) Como as regi?es temporoparietal direita e frontal se relacionam com a forma??o da auto-consci?ncia e da imagem corporal, sugerimos que um aumento de atividade nessas regi?es durante o sono pode ser o mecanismo neurobiol?gico subjacente ao SL

La littérature suggère que le sommeil paradoxal joue un rôle dans l'intégration associative de la mémoire émotionnelle. De plus, les rêves en sommeil paradoxal, en particulier leur nature bizarre et émotionnelle, semblent refléter cette fonction associative et émotionnelle du sommeil paradoxal. La conséquence des cauchemars fréquents sur ce processus est inconnue, bien que le réveil provoqué par un cauchemar semble interférer avec les fonctions du sommeil paradoxal. Le premier objectif de cette thèse était de reproduire conceptuellement des recherches antérieures démontrant que le sommeil paradoxal permet un accès hyper-associatif à la mémoire. L'utilisation d'une sieste diurne nous a permis d'évaluer les effets du sommeil paradoxal, comparativement au sommeil lent et à l’éveil, sur la performance des participants à une tâche sémantique mesurant « associational breadth » (AB). Les résultats ont montré que seuls les sujets réveillés en sommeil paradoxal ont répondu avec des associations atypiques, ce qui suggère que le sommeil paradoxal est spécifique dans sa capacité à intégrer les traces de la mémoire émotionnelle (article 1). En outre, les rapports de rêve en sommeil paradoxal étaient plus bizarres que ceux en sommeil lent, et plus intenses émotionnellement ; ces attributs semblent refléter la nature associative et émotionnelle du sommeil paradoxal (article 2). Le deuxième objectif de la thèse était de préciser si et comment le traitement de la mémoire émotionnelle en sommeil paradoxal est altéré dans le Trouble de cauchemars fréquents (NM). En utilisant le même protocole, nos résultats ont montré que les participants NM avaient des résultats plus élevés avant une sieste, ce qui correspond aux observations antérieures voulant que les personnes souffrant de cauchemars soient plus créatives. Après le sommeil paradoxal, les deux groupes, NM et CTL, ont montré des changements similaires dans leur accès associatif, avec des résultats AB-négatif plus bas et AB-positif plus grands. Une semaine plus tard, seul les participants NM a maintenu ce changement dans leur réseau sémantique (article 3). Ces résultats suggèrent qu’au fil du temps, les cauchemars peuvent interférer avec l'intégration de la mémoire émotionnelle pendant le sommeil paradoxal. En ce qui concerne l'imagerie, les participants NM avaient plus de bizarrerie et plus d’émotion positive, mais pas négative, dans leurs rêveries (article 4). Ces attributs intensifiés suggèrent à nouveau que les participants NM sont plus imaginatifs et créatifs à l’éveil. Dans l'ensemble, les résultats confirment le rôle du sommeil paradoxal dans l'intégration associative de la mémoire émotionnelle. Cependant, nos résultats concernant le Trouble de cauchemars ne sont pas entièrement en accord avec les théories suggérant que les cauchemars sont dysfonctionnels. Le groupe NM a montré plus d’associativité émotionnelle, de même que plus d'imagerie positive et bizarre à l’éveil. Nous proposons donc une nouvelle théorie de sensibilité environnementale associée au Trouble de cauchemar, suggérant qu'une sensibilité accrue à une gamme de contextes environnementaux sous-tendrait les symptômes uniques et la richesse imaginative observés chez les personnes souffrant de cauchemars fréquents. Bien que davantage de recherches doivent être faites, il est possible que ces personnes puissent bénéficier e milieux favorables, et qu’elles puissent avoir un avantage adaptatif à l'égard de l'expression créative, ce qui est particulièrement pertinent lorsque l'on considère leur pronostic et les différents types de traitements. / Existing literature suggests that REM sleep plays a role in the associative integration of emotional memory, and that attributes of dreams during REM sleep, particularly their bizarre and emotional nature, either reflect or even influence this associative and emotional function. The consequence of frequent nightmares on this process is unknown, although, the experience of a nightmare suggests an associative restriction imposed by intense negative emotion, consistent with research showing that negative affect tends to restrict cognitive flexibility in wake. This is consistent with existing theories of nightmare function, largely purporting that nightmares reflect temporary failures in emotion regulation. The first objective of the thesis was to conceptually replicate prior research portraying REM sleep as enabling increased associative access to emotional memory. The use of a daytime nap allowed us to assess the effects of REM sleep, compared to both NREM sleep and waking, on participant performance on a novel task measuring Associational Breadth (AB). Results showed that only those subjects awakened from REM sleep responded with atypical emotional word associations, suggesting that REM is specific in its capacity to broadly integrate emotional memory traces (article 1). Further, REM dream reports were more bizarre than both NREM dreams and waking daydreams, and more emotionally intense than NREM dreams; these attributes are thought to reflect the hyper-associative and emotional nature of REM sleep (article 2). The second objective was to clarify whether and how REM sleep-dependent emotional memory processing is altered in frequent nightmares sufferers. Using a similar nap protocol, our results showed that NM participants had higher baseline AB in response to emotional cue-words, contrary to predictions, but nonetheless corresponding with anecdotal reports of heightened creativity. Following REM sleep, both NM and CTL groups showed similar changes in associative access to emotional cue-words, with negative AB being restricted and positive AB being broadened; one week later, the NM group alone maintained this altered pattern of emotional semantic access (article 3). This finding suggests that, over time, nightmares may interfere with REM sleep-dependent emotional memory integration. Regarding imagery, the NM participants had heightened bizarreness, and positive, but not negative, imagery in their daydreams, but not their dreams (article 4), mirroring our AB finding that the NM group had significantly higher emotional associativity in wake, although patterns of associativity following a REM sleep nap did not differ between groups. Overall, findings support a role of REM sleep in the associative integration of emotional memory. However, our findings regarding nightmare sufferers are not entirely consistent with views that nightmares are associated with dysfunctional emotional memory processing. Although they did show a prolonged priming effect suggestive of inadequate emotion regulation, they also showed heightened semantic associativity and vivid positive imagery in wake. We therefore propose a novel Environmental Sensitivity framework for the study of nightmare sufferers, claiming that an increased sensitivity to a range of environmental contexts, not only negative contexts, underlies the unique symptoms and imaginative richness seen in frequent nightmare sufferers. Although further empirical research exploring potentially adaptive traits or sensitivity to positive contexts in nightmare sufferers is needed, the possibility that these individuals may benefit especially from supportive environments, and may have heightened creativity and semantic associativity, is particularly relevant when considering prognosis and treatment approaches.

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Studien undersöker användningen av Goyas etsning När förnuftet sover kommer monstren och Fuselis oljemålning Nattmaran som förekommer i slasherfilmen Terror på Elm Street (2010). Konstverken är placerade i en scen där konstverken bland annat får en självrefererande roll eftersom det som sker i konstverken även sker i filmen. Syftet med studien är att undersöka vad konstverken fyller för funktion i filmen och att undersöka om det finns stilistiska och tematiska likheter mellan konstverken och filmen trots att det skiljer ungefär 200 år mellan dem. De båda konstverken analyseras semiotiskt och filmen analyseras främst utifrån studiens teoretiska perspektiv: intermedialitet, transmediering och intertextualitet.   Resultatet visar att slasherfilmer och skräckfilmer är väldigt flitiga med användandet av intertextuella referenser och självrefererande uttryck men att det är svårt att veta exakt vad konstverken har för betydelse. Tidigare forskning visar att tidig skräckfilm inspirerades av gotiska romaner och romantiska konstverk vilka transmedierades till filmmediet när det var tekniskt möjligt. Mellan konstverken och filmen går det att hitta flera stilmässiga och tematiska likheter som är typiska för det som började framhävas under romantiken. Terror på Elm Street (2010) bär på flera postmoderna drag, bland annat eftersom filmen kombinerar uttryck från det förflutna och berör gränsen för vad som ses som fin- respektive populärkultur. / This study examines Goya’s etching The Sleep of Reason Produces Monsters and Fuseli’s The Nightmare and how they are used in the slasher movie A Nightmare on Elm Street (2010). The purpose of this study is to explore the artworks and their role within the movie and examine if it is possible to distinguish stylistic and thematic similarities between the works despite being separated by approximately 200 years. The artworks are analyzed according to a semiotic method, while the movie is analyzed mainly using the study’s theoretical aspects: intermediality, transmediality and intertextuality. The result shows that intertextual references and self-referential expressions are frequently used in slasher movies. However, the specific role which these artworks play in the movie is often hard to decipher. There are several similarities between the artworks and the movie and previous studies shows that early horror movies were influenced by gothic novels and romantic paintings which were transmediated to fit the film medium. The art works used in A Nightmare on Elm Street (2010) have the same motifs as part of the film’s story and are also part of a postmodern trend of mixing between so called high culture and popular culture.