good research questions about dreams

74 Dreaming Essay Topic Ideas & Examples

🏆 best dreaming topic ideas & essay examples, ✍️ interesting topics to write about dreaming, 🔖 good essay topics on dreaming, ❓ research questions about dreams.

• The Importance of Sleeping and Dreaming Finally, I would not take this pill since I love seeing dreams and realize that this “miracle medicine” will cause too many negative consequences.
• Dreaming in Christianity and Islam Indeed, I was influenced mainly by the studies that explained this phenomenon from the point of continuous activity of people’s minds that processes daily routine during the night. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Dreaming, Consciousness and Cognition For instance, the behaviorist supposition that the brain is always awakened and only from the external by sense organ procedures cannot define daydreams; likewise, for the statement that consciousness is the straight or restricted product […]
• Dreams and the Process of Dreaming Analysis Dreams are said to be like opening a door to the rest of the mind, all of one’s friends, fears, phobias, hopes, wishes, good times, and bad times are there.
• Lucid Dreaming in Science Fiction and Technology The author provides an interesting and intriguing article about the phenomenon of lucid dreaming and its representation in culture and media.
• Impoverished and Excessive Dreaming Many patients saw a dog in their dreams that tried to bite them; they began to defend themselves or hit the dog, and, in reality, they hit their spouses or walls/beds.
• Nature and Functions of Dreaming Still, other researchers argue that one of the key functions of dreams is to maintain our bodily and psychological health. To conclude, it is obvious that many suggestions have been put forward by researchers about […]
• Kertha Gosa Ceiling vs. “Dreaming” paintings by Aborigines of Australia Over a long period, Aborigine’s paintings have advanced to the point of intertwining with the public dissertation, with a great recognition in Australia and the rest of the world.
• Concept of Dreaming Theories in Psychology One of the theories that are common is the belief that dreams occur as a result of the human mind trying to incorporate external stimuli while one is sleeping.
• The Use of Illusion Argument, Dreaming Argument, and Evil Genius Argument by Descartes
• The Centrality of the Dreaming and Its Importance for Aboriginal Spirituality
• An Overview of the Dream State and the Concept of Human Dreaming
• Animal Dreaming And Substantiation A Connection To Humanity
• Understanding the Unconcious Dreaming
• How Is the Power of Dreams and Dreaming in the Novel of Mice and Men
• Dreams, Dreaming and Phases of Sleep
• Phenomenology of Dreaming
• The Beauty Of Dreaming: How Dreams Drive The Individual
• The Dreaming and Traditional Aboriginal Spirituality
• Freud’s Theory of Dreaming and Repression
• Sleeping and Dreaming and Theories of Sleep
• Gender And Dreaming In Mapuche Shamanistic Practices
• The Benefits Of Lucid Dreaming
• An Overview of the Controversy of Dreaming, a Cognitive Activity During Sleep
• The Importance of Dreaming and Sleeping
• Procrastination and Day Dreaming
• The Psychological Theories Of The Function Of Dreaming
• Difference Between Astral Projection And Lucid Dreaming
• Dreaming as Significant Process in Human Life Experience
• Exploring Causes of Sleep Difficulty and Dreaming Problems
• Dreams and Dreaming Nightmares in Children
• Dreaming Can Bring Misery in the Great Gatsby By F. Scott
• Varieties of Lucid Dreaming Experience, by Stephen Laberge
• The Significance of Land to the Dreaming for Aboriginal People and the Impact of the Land Rights Movement
• Dreaming And Post Traumatic Stress Disorder
• Understanding the Science of Dreaming Through Oneirology
• The Importance of Dreaming and the Sub-Conscious
• Descartes’ Meditations: Dreaming and Evil Demon Arguments
• Dreaming Various Amount Of People Experiences Different Effects
• Comparing and Contrasting Psychological Theories of Dreaming
• The Skeptical Dreaming Argument of Rene Descartes, and the Priori and the Posteriori
• Dreaming Is Known As The Journey Your Mind
• Day Dreaming in the Middle of the Summer Heat
• Synchroncities in the History of Paranormal Dreaming
• What Dreams May Come True?
• What Every Athlete Dreams, of but Few Achieve?
• What Makes Your Friend’s Dreams Come True?
• What Does the Bible Say About Dreams?
• When Dreams and Reality Collide?
• Why Do We Forget Dreams?
• Why Are Dreams Interesting for Philosophers?
• What Makes a Nightmare a Nightmare?
• What’s the Most Common Nightmare?
• What Are the Most Typical Nightmare Themes and What Do They Mean?
• Why Are Dreams Important to Duddy Kravitz?
• Why Do People Dream and What the Dreams Mean?
• What Are Dreams, and Do They Affect Us in a Good Way or a Bad Way?
• What Are the Key Similarities and Differences Between Freud and Jung’s Theories of Dreams?
• What Are You Doing to Achieve Your Dreams?
• How Dreams Affect Our Personalities?
• How Dreams and Omens Support the Theme of Interconnection?
• How Can Dreams Sustain People Through Life, or Can Break Them Down When It Doesn’t Come True?
• How Do Dreams Have Symbolic Meaning?
• How Women Follow Their Dreams Without Embarrassment?
• How Do Different People Use Different Things to Escape Life Problems or Find Motivation to Dreams?
• Can Dreams Tell the Future?
• Are Dreams Messages From Our Subconscious Mind or Insignificant Manifest?
• Are Dreams the Reason for Mythology?
• Can Blind Person See Dreams?
• What Are the Most Rare Dreams?
• How Long Do Dreams Last?
• Can You Learn From Your Dreams?
• Do We Dream Differently Across the World?
• Do We Know When We Are Dreaming?
• Chicago (A-D)
• Chicago (N-B)

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177 Dream Research Topics & How to Write a Research Paper on Dreams

People have dreams every night. Dreams are different – sweet dreams and nightmares, colored and colorless. However, every psychologist knows that people need to sleep. Why? Well, let us give you the right to answer this question in your research paper on dreams.

A research paper on dreams is a serious research project. That is why you cannot simply write how dreams can be interpreted or describe your dreams in the research paper on dreams. Research papers on dreams require more serious topics and approach.

Below you will find several possible ideas for research papers on dreams.

• 🔎 Dreams Research Topics
• 💤 Dreams Definition
• ✍️ How to Write about Dreams

😴 Easy Research Topics on Dreams

🛌 essay about dreams topics, 😪 topics for a research paper on sleep and dreams, ✏️ importance of sleep essay topics, 👻 nightmare essay topics.

• 📝 My Dreams Essay – Example

✅ Interesting Facts about Dreams

🔎 dreams research topics – 2024.

• The link between our dreams and emotions.
• What is the role of dreaming in creativity development?
• The gender-based patterns in dreaming experience.
• Sigmund Freud and his theory of dreams.
• The key mechanisms that underlie dreaming.
• What knowledge can you gain from your dreams?
• The impact of eating patterns on the quality of dreams.
• How do different cultures perceive and interpret dreams?
• The advantages and disadvantages of dreaming.
• How can people control their dreams?
• The role of dreams in processing emotions.
• How do bizarre and emotionally intense dreams occur?

💤 What Are Dreams?

Psychologists are sure that dreams are the result of what we wish or think about when we are awake. For example, Freud, a famous psychologist, considered that if a man did not have sexual relations for a long time, he would dream about them. If you think about someone, you may also dream about him/her. This is what you may write about in the research paper on dreams if you want to consider this aspect.

Nightmares can also be a very interesting issue to discuss in research papers on dreams. Psychologists relate nightmares to the field of “unconscious”. Very often, people forget about the stressful situations they once had. However, those situations are reflected in their minds and they can appear in dreams. You may also find other points of view on nightmares and discuss them in your research paper on dreams.

✍️ How to Write a Research Paper about Dreams

A research paper about dreams generally includes an introduction, body paragraphs, and a conclusion. First, it is crucial to choose a relevant and exciting topic to write on and decide on the type of research paper (analytical, argumentative, etc.).

Choosing a Topic

Pick a topic that corresponds to your interests and expertise. It will help you stay more motivated throughout the research process. In addition, ensure that your topic is specific, relevant, and follows the assignment instructions.

If you need help choosing a good topic for your paper, try our free research title generator .

Finding Sources

After you have found a perfect topic on dreams, it is time to look for sources for your research. You can look up information in books, similar research papers, or online sources. Communicating with professionals related to dreams , like psychologists or neurologists, is also a good idea since it is an effective method to gain new knowledge or advice.

Writing a Research Paper

The format of your research paper on dreams should consist of the following elements:

• The relation between dreaming and the role of deep-brain structures.
• Dreaming capacity to repeatedly simulate potential threatening events.
• The role of amygdala and hippocampus in the dreaming process.
• The spiritual significance of dreams in different cultures.
• Dream interpretation and its value in self-understanding.
• How does dream recall reflect social relationships?
• The positive impact of dreams on our physical health.
• Dreams and their role in predicting the future.
• The peculiarities of dreams in pregnant women.
• Why does Charcot-Wilbrand syndrome cause the loss of the ability to dream?
• The role of dreaming in developing cognitive capabilities.
• How can dreams reflect the aging process?
• The repetitive character of some dreams and their meaning.
• Why are young people more likely to dream in color?
• The benefits and cautions of lucid dreaming.
• The influence of smartphones on the content of dreams.
• Why do people forget their dreams after waking up?
• The impact of suppressing intrusive thoughts on dream content.
• What is the role of dreams in developing long-term memory?
• The key causes and types of dreams.
• The peculiarities of dreaming during the COVID-19 pandemic.
• Everything you need to know about lucid dreams.
• The role of melatonin in determining the dream content.
• What can we learn from our dreams?
• The psychotomimetic nature of dreams.
• The terrors of sleep paralysis.
• Does screen time affect people’s dreams?
• Dreams and the future of sleep technology.
• Are AI technologies capable of generating dreams?
• The hidden cost of insufficient sleep.
• How can nap breaks improve your productivity at work?
• The main facts and myths about sleep and dreams.
• How can our understanding of dreams shape our worldview?
• The link between dreams and telepathy.
• The process of dreaming in animals.
• Why do some people wake up in the middle of the night?
• The impact of mental illnesses on dream content.
• The role of dreams in art as a source of inspiration.
• How do different societies interpret dreams?
• The power of dreaming in everyday life.
• How to become a morning person: the key strategies.
• The impact of sleep time on life length.
• Ways to decode the language of sleep.
• Using cannabis as a method to cope with nightmares.
• The impact of the daily schedule on improving the quality of sleep.
• How to get a good night’s sleep in a new place?
• Methods to combat morning grogginess.
• Taking care of your sleep as one of the pillars of health.
• The use of dreams in filmmaking and book writing.
• The phenomenon of dreaming during sleep.
• The main phases of sleep in a sleep cycle.
• How is alpha activity measured during sleep?
• The use of oneirology in uncovering the dreaming process.
• Dreaming in Christianity and Islam.
• What is the connection between race and sleep disorders?
• The theory of astral projection during sleep.
• The effect of sleep on pain thresholds and sensitivity.
• The consequences of chronic daytime sleepiness.
• Why is dreaming a key part of a sleep cycle?
• The natural patterns of sleeping in children and teenagers.
• REM and non-REM sleep : the difference.
• What is biphasic sleep, and how does it work?
• The influence of dreams on musical creativity.
• The cultural significance of dream symbols.
• How do moon phases affect your sleep?
• The nature and functions of dreaming.
• The use of dream content during expressive arts therapy.
• What are the possible functions of REM sleep and dreaming?
• The value of dreaming and sleep tracking.
• The analysis of mental activity of sleep and disturbing dreams.
• How do sleep disturbances impact skin health?
• The impact of age on our circadian rhythm.
• The phenomenon of conscious control in dreams.
• How do sleep patterns change across different life stages?
• The influence of sleep quality on academic performance.
• The psychological theories of dreaming purpose.
• The disadvantages of oversleeping for adults.
• How does your body use calories while you sleep?
• Factors influencing the memory of dreams.
• What impact does alcohol have on the sleep cycle and dreaming?
• How can dreams contribute to the healing process?
• The role of sleep in underlying psychological issues.
• The benefits of daytime napping for young people.
• Why does sleep deprivation increase the risk of substance abuse?
• The use of daytime naps to increase imagination.
• The value of bedtime routine for toddlers.
• The benefits of a good night’s sleep.
• What is the role of sleeping in achieving life goals?
• Lack of sleep as a key cause of hormonal imbalance.
• The damaging effect of shift work on sleep patterns and health.
• The link between sleep and the immune system.
• What impact does a change of clocks by an hour have on public health?
• The value of sleep for children’s physical, cognitive, and emotional development.
• What would happen if you did not sleep?
• The importance of sleep for children’s development and growth.
• The connection between good mood and quality sleep.
• Why does the lack of sleep increase aggression?
• The role of sleeping in cancer prevention and treatment.
• The value of sleep for the recovery process of athletes.
• How does the quality of sleep impact metabolism?

Essay about Sleep Deprivation

• The economic impact of sleep deprivation in the workplace.
• How can sleep deprivation lead to anxiety and depression?
• The role of sleep deprivation in worsening obesity and diabetes.
• The use of sleeping pills in sleep deprivation treatment.
• How is sleep deprivation diagnosed?
• The prevalence of sleep deprivation among shift workers.
• What is the difference between sleep deprivation and insomnia?
• The key stages of sleep deprivation.
• The role of DNA in the development of sleep deprivation.
• The unique challenges in diagnosing obstructive sleep deprivation.
• How does sleep deprivation affect the human body?
• The issue of sleep deprivation in teenagers due to exams.
• The role of medications in managing sleep deprivation.
• Ways of reducing the risk of developing sleep deprivation.
• What are the key symptoms of sleep deprivation?

Why Is Sleep Important? Essay Topics

• The efficiency of sleeping in losing weight.
• How can sleep improve concentration and productivity?
• Sleep as essential component of healthy aging.
• Why can a lack of sleep be dangerous?
• Sleep satisfaction and its impact on energy level.
• How is poor sleep linked to depression?
• The impact of sleep on emotional intelligence.
• How does sleep help to repair and restore tissues?
• The role of sleeping in removing toxins from the brain.
• Why can the lack of sleep be lethal?
• The link between sleep quality and mental resilience.
• Sleep loss and its impact on reducing the ability to regulate emotions.
• The role of sleep in the regulation of the central nervous system.
• How can the quality of sleep strengthen your heart?
• Sleeping as a method to maximize athletic performance.

Sleeping Disorders Essay Topics

• The connection between sleep disorders and dreaming.
• Do congenitally blind people have visual dreams?
• The effective ways of coping with insomnia.
• Sleep difficulties and their physical and emotional consequences.
• How does weight affect sleep apnea in adults?
• Breathing practices and their efficiency in overcoming sleep disorders.
• The key symptoms of sleep-related hypoventilation .
• What are the risk factors for sleep disorders?
• Minimizing stress as a method to cope with obstructive sleep apnea.
• The side effects of sleep disorder treatment.
• What are the major categories of sleep disorders, and how do they differ?
• Restless legs syndrome as one of the sleep disorder types.
• The effectiveness of light therapy in sleep disorder treatment.
• The peculiarities of sleep disorder diagnosis.
• How to deal with rapid eye movement sleep behavior disorder?
• Nightmare disorder and its impact on sleep quality.
• The role of negative thinking, stress, and anxiety in worsening nightmares.
• How may nightmares help to express unresolved emotions?
• The influence of nightmares on interpersonal relationships.
• The use of cognitive behavioral therapy in nightmare treatment.
• Are nightmares a possible consequence of drug abuse?
• The key symptoms of experiencing nightmares.
• The health effects of nightmares in adults.
• How are nightmares connected to waking activity?
• The possible consequences of nightmares.
• The efficiency of psychotherapy in nightmare treatment.
• The main causes of nightmares and methods to cope with them.
• How are nightmares different from sleep terrors?
• The role of sleep hygiene practices in preventing nightmares.
• How do nightmares affect the daily life of teenagers?
• Nightmares as a result of trauma-related experience.
• The link between nightmares and sleep paralysis.
• How does genetics impact the occurrence of nightmares?
• The neurobiological aspects of nightmares in children.
• The risk factors of having nightmare disorder.

📝 My Dreams Essay – Example

We have prepared a dream essay example to show you how everything works in practice!

How Do Different Societies Interpret Dreams?

Throughout history, dreams have been a mysterious experience for people worldwide, receiving various interpretations in many different countries and cultures. From ancient times to the present, people have believed that dreams provide crucial insights into our inner being and may even impact our perception of the universe.

For example, in ancient Egypt, snakes were often associated with danger, deceit, and the underworld. At the same time, seeing calm water in a dream was a good sign that meant peace and tranquility. If people were flying while asleep, it symbolized spiritual growth and escape from mortal concerns.

In ancient Mesopotamia, animals were frequently seen as symbols of the dreamer's personality traits. For instance, a lion might symbolize strength and power, while a sheep could represent humility and submission. Numbers also had a special meaning. People believed their appearance in dreams could be interpreted as messages from the gods.

Nowadays, people still interpret dreams in various ways based on their personal beliefs and traditions. However, it is crucial to understand that there is no correct or incorrect approach to interpreting dreams. The essential thing is to discover a method that resonates with you, allowing you to obtain insights into your subconscious mind. The use of the internet in academic contexts is on the rise, and its role in learning is hotly debated. For many teachers who did not grow up with this technology, its effects seem alarming and potentially harmful. The use of the internet in academic contexts is on the rise, and its role in learning is hotly debated. For many teachers who did not grow up with this technology, its effects seem alarming and potentially harmful.

Do you want to make your research paper on dreams interesting? Then, include a couple of facts into your research paper on dreams:

• Blind people dream;
• You forget 90% of your dreams;
• Dreams prevent psychosis;
• Not everyone sees colorful dreams;
• When you are snoring, you are not dreaming.

Who knows, maybe you will manage to interpret one of these facts from the psychological point of view in your research paper on dreams.

On our blog, useful information on how to write a good research paper and make a cover page for research papers can also be found.

Argumentative Bioethics Essays

Psychologywriting review: free essay samples for students of all levels.

July 26, 2011

The Science Behind Dreaming

New research sheds light on how and why we remember dreams--and what purpose they are likely to serve

By Sander van der Linden

Getty Images

For centuries people have pondered the meaning of dreams. Early civilizations thought of dreams as a medium between our earthly world and that of the gods. In fact, the Greeks and Romans were convinced that dreams had certain prophetic powers. While there has always been a great interest in the interpretation of human dreams, it wasn’t until the end of the nineteenth century that Sigmund Freud and Carl Jung put forth some of the most widely-known modern theories of dreaming. Freud’s theory centred around the notion of repressed longing -- the idea that dreaming allows us to sort through unresolved, repressed wishes. Carl Jung (who studied under Freud) also believed that dreams had psychological importance, but proposed different theories about their meaning.

Since then, technological advancements have allowed for the development of other theories. One prominent neurobiological theory of dreaming is the “activation-synthesis hypothesis,” which states that dreams don’t actually mean anything: they are merely electrical brain impulses that pull random thoughts and imagery from our memories. Humans, the theory goes, construct dream stories after they wake up, in a natural attempt to make sense of it all. Yet, given the vast documentation of realistic aspects to human dreaming as well as indirect experimental evidence that other mammals such as cats also dream, evolutionary psychologists have theorized that dreaming really does serve a purpose. In particular, the “threat simulation theory” suggests that dreaming should be seen as an ancient biological defence mechanism that provided an evolutionary advantage because of  its capacity to repeatedly simulate potential threatening events – enhancing the neuro-cognitive mechanisms required for efficient threat perception and avoidance.

So, over the years, numerous theories have been put forth in an attempt to illuminate the mystery behind human dreams, but, until recently, strong tangible evidence has remained largely elusive.

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Yet, new research published in the Journal of Neuroscience provides compelling insights into the mechanisms that underlie dreaming and the strong relationship our dreams have with our memories. Cristina Marzano and her colleagues at the University of Rome have succeeded, for the first time, in explaining how humans remember their dreams. The scientists predicted the likelihood of successful dream recall based on a signature pattern of brain waves. In order to do this, the Italian research team invited 65 students to spend two consecutive nights in their research laboratory.

During the first night, the students were left to sleep, allowing them to get used to the sound-proofed and temperature-controlled rooms. During the second night the researchers measured the student’s brain waves while they slept. Our brain experiences four types of electrical brain waves: “delta,” “theta,” “alpha,” and “beta.” Each represents a different speed of oscillating electrical voltages and together they form the electroencephalography (EEG). The Italian research team used this technology to measure the participant’s brain waves during various sleep-stages. (There are five stages of sleep; most dreaming and our most intense dreams occur during the REM stage.) The students were woken at various times and asked to fill out a diary detailing whether or not they dreamt, how often they dreamt and whether they could remember the content of their dreams.

While previous studies have already indicated that people are more likely to remember their dreams when woken directly after REM sleep, the current study explains why. Those participants who exhibited more low frequency theta waves in the frontal lobes were also more likely to remember their dreams.

This finding is interesting because the increased frontal theta activity the researchers observed looks just like the successful encoding and retrieval of autobiographical memories seen while we are awake. That is, it is the same electrical oscillations in the frontal cortex that make the recollection of episodic memories (e.g., things that happened to you) possible. Thus, these findings suggest that the neurophysiological mechanisms that we employ while dreaming (and recalling dreams) are the same as when we construct and retrieve memories while we are awake.

In another recent study conducted by the same research team, the authors used the latest MRI techniques to investigate the relation between dreaming and the role of deep-brain structures. In their study, the researchers found that vivid, bizarre and emotionally intense dreams (the dreams that people usually remember) are linked to parts of the amygdala and hippocampus. While the amygdala plays a primary role in the processing and memory of emotional reactions, the hippocampus has been implicated in important memory functions, such as the consolidation of information from short-term to long-term memory.

The proposed link between our dreams and emotions is also highlighted in another recent study published by Matthew Walker and colleagues at the Sleep and Neuroimaging Lab at UC Berkeley, who found that a reduction in REM sleep (or less “dreaming”) influences our ability to understand complex emotions in daily life – an essential feature of human social functioning.  Scientists have also recently identified where dreaming is likely to occur in the brain.  A very rare clinical condition known as “Charcot-Wilbrand Syndrome” has been known to cause (among other neurological symptoms) loss of the ability to dream.  However, it was not until a few years ago that a patient reported to have lost her ability to dream while having virtually no other permanent neurological symptoms. The patient suffered a lesion in a part of the brain known as the right inferior lingual gyrus (located in the visual cortex). Thus, we know that dreams are generated in, or transmitted through this particular area of the brain, which is associated with visual processing, emotion and visual memories.

Taken together, these recent findings tell an important story about the underlying mechanism and possible purpose of dreaming.

Dreams seem to help us process emotions by encoding and constructing memories of them. What we see and experience in our dreams might not necessarily be real, but the emotions attached to these experiences certainly are. Our dream stories essentially try to strip the emotion out of a certain experience by creating a memory of it. This way, the emotion itself is no longer active.  This mechanism fulfils an important role because when we don’t process our emotions, especially negative ones, this increases personal worry and anxiety. In fact, severe REM sleep-deprivation is increasingly correlated to the development of mental disorders. In short, dreams help regulate traffic on that fragile bridge which connects our experiences with our emotions and memories.

Are you a scientist who specializes in neuroscience, cognitive science, or psychology? And have you read a recent peer-reviewed paper that you would like to write about? Please send suggestions to Mind Matters editor Gareth Cook, a Pulitzer prize-winning journalist at the Boston Globe. He can be reached at garethideas AT gmail.com or Twitter @garethideas .

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• Open access
• Published: 02 October 2023

Evidence for an emotional adaptive function of dreams: a cross-cultural study

• David R. Samson 1 , 2 ,
• Alice Clerget 3 ,
• Noor Abbas 1 ,
• Jeffrey Senese 1 ,
• Mallika S. Sarma 4 ,
• Sheina Lew-Levy 5 ,
• Ibrahim A. Mabulla 6 ,
• Audax Z. P. Mabulla 6 ,
• Valchy Miegakanda 7 ,
• Francesca Borghese 3 ,
• Pauline Henckaerts 3 ,
• Sophie Schwartz 3 ,
• Virginie Sterpenich 3 ,
• Lee T. Gettler 8 ,
• Adam Boyette 5 ,
• Alyssa N. Crittenden 9 &
• Lampros Perogamvros 3 , 10 , 11  

Scientific Reports volume  13 , Article number:  16530 ( 2023 ) Cite this article

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• Anthropology

The function of dreams is a longstanding scientific research question. Simulation theories of dream function, which are based on the premise that dreams represent evolutionary past selective pressures and fitness improvement through modified states of consciousness, have yet to be tested in cross-cultural populations that include small-scale forager societies. Here, we analyze dream content with cross-cultural comparisons between the BaYaka (Rep. of Congo) and Hadza (Tanzania) foraging groups and Global North populations, to test the hypothesis that dreams in forager groups serve a more effective emotion regulation function due to their strong social norms and high interpersonal support. Using a linear mixed effects model we analyzed 896 dreams from 234 individuals across these populations, recorded using dream diaries. Dream texts were processed into four psychosocial constructs using the Linguistic Inquiry and Word Count (LIWC-22) dictionary. The BaYaka displayed greater community-oriented dream content. Both the BaYaka and Hadza exhibited heightened threat dream content, while, at the same time, the Hadza demonstrated low negative emotions in their dreams. The Global North Nightmare Disorder group had increased negative emotion content, and the Canadian student sample during the COVID-19 pandemic displayed the highest anxiety dream content. In conclusion, this study supports the notion that dreams in non-clinical populations can effectively regulate emotions by linking potential threats with non-fearful contexts, reducing anxiety and negative emotions through emotional release or catharsis. Overall, this work contributes to our understanding of the evolutionary significance of this altered state of consciousness.

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Introduction

Why do humans dream? As a product of the brain’s neurophysiology, our species can produce hallucinatory experiences during sleep. These dream experiences represent an altered state of consciousness. Why is it that we exhibit this altered state of consciousness rather than experiencing sleep in total perception quiescence? Research investigating dream content reveals that the dream state of consciousness, which is most often expressed in rapid-eye movement (REM), appears to be preoccupied with world simulation with content often reflecting the self’s social realities 1 , 2 , social networks 3 , 4 , and dangers 5 . Yet, whether dreams could enhance cognitive, affective, or social adaptation has been a question of active debate for decades.

A common framework for explaining the function of dreams is provided by simulation theories , which are based on the premise that dreams have a biological function and reflect selective pressures and fitness enhancement in the evolutionary past via altered states of consciousness 6 . Accordingly, dreams are credible real-world analogs 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 that prime the individual for corresponding contexts encountered in waking life. From this perspective, it has been argued that the phenotypic expression of dreaming could meet the necessary criteria for evolution by natural selection 15 .

Dream simulation and emotion regulation

Emerging work integrating neuroscience and dream content analysis suggests that emotional experiences are a crucial part of the virtual-world simulation of dreams and support an adaptive process that contributes to the resolution of emotional distress and preparation for future affective reactions 6 , 16 , 17 , 18 , 19 . In this context, the threat simulation theory 6 and social simulation theory 9 posit that dreams are biased to simulate threatening and social situations respectively. Such a mechanism would, in turn, promote adjusted behavioral responses in real-life situations 5 , 9 . Other studies have also supported the idea that past negative memories are reprocessed and combined in dreams with new, realistic, and safe contexts, suggesting the possibility of desensitization 20 , 21 or extinction 17 functions for dreaming. Functional dreams could thus expose us to threatening situations while providing us with efficient solutions to these situations. Such a process may facilitate the resolution of current social and emotional internal conflict 16 , 22 , a process also called emotional catharsis 23 , and the reduction of next-day negative mood 24 .

Together, these proposals and empirical observations suggest a potential core function of dreams via simulating distress in a safe environment to help process threats in beneficial ways; as such, functional dreams would strongly contribute to efficient emotion regulation in wakefulness 18 . These mechanisms seem to be impaired in clinical populations, such as patients with nightmare disorder 17 , 25 and anxiety disorders 26 —two pathologies characterized by less efficient fear extinction 17 , 27 .

Indeed, anxiety is considered a maladaptive emotional response implicating dysfunction of inhibitory (extinction) learning 27 , and the persistence of the fear response across time. We would thus expect that dreams with high levels of anxiety and negative emotions in the presence of a threat, as those found in clinical populations, would not serve the emotional processing function of dreams, as no emotional resolution is achieved. Critically, Revonsuo posited that the adaptive emotional function of dreams may be particularly relevant to contemporary small-scale societies facing routine ecological risks such as infectious disease and predation, as the emotional simulating mechanism would be fully activated in the face of the kinds of challenges within their environment 6 . Although there is some preliminary evidence for this argument 5 , 28 , 29 , such arguments have yet to be comparatively tested with large, multicultural datasets.

The importance of cross-cultural testing of dream content

The major challenge to the scientific investigation of dream function remains a sampling problem. To date, most dream studies have been conducted in the Global North—and primarily in the U.S. and European settings with samples of limited socio-economic and racial/ethnic breadth. Thus, one critical challenge to overcome limitations in past dream-based research, is to test the function of dreams by generating dream content variation among diverse populations’ socio-ecological experiences. This may be due in part to the interest of sleep researchers in pairing such work with sleep-based physiological techniques (i.e. polysomnography) that have been historically limited to lab settings (but see 30 for field-based methods in human biology and sleep research that are gaining momentum). While historically dreams have been the subject of anthropological investigation 28 , 31 , 32 , 33 , this ethnographic work is largely descriptive. Hence, much of the dream data are generated from studies that represent a very narrow range of human experiences for select populations (e.g., college undergraduates) at specific historical moments (e.g., between 1970 and 1990) in particular locations (e.g., U.S., Europe) and under similar societal and economic contexts (e.g., educated, high income).

There is a dearth of direct empirical tests of the evolutionary function of dreams, including comparative perspectives that would enable us to assess variation across cultural and ecological contexts in relation to dream content 9 . For example, smaller-scale societies that engage in mixed-subsistence foraging (i.e., hunt and gather for a large part of their diet), often differ from other smaller-scale societies in important ways. The depth and breadth of egalitarianism (i.e., cultural values and practices aimed at the treatment of all individuals as equal, often with norms around avoidance of prestige and hierarchy) in many sub-tropical foraging populations is intertwined with norms of cooperative pooling of time and energetic resources, such as to help provision and care for children 34 , 35 , 36 , 37 , 38 , 39 . Such forms of egalitarianism and extensive cooperation in resource sharing and family life are thought to be critical to survival and reproduction.

In contemporary populations, including the Hadza of Tanzania and BaYaka of the Republic of the Congo forager communities we focus on here, these cooperative subsistence and social dynamics necessarily place a strong emphasis on the importance of face-to-face supportive relationships for day-to-day health, well-being, and even survival 35 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 . These communities share some broad socioecological similarities in terms of (i) continuous environmental exposure to key stimuli—such as ambient light and temperature cues—known to drive circadian entrainment (e.g., circadian driven fluctuations have been shown to influence central characteristics of dream reports 50 ), (ii) gender divisions of foraging and household labor (though varying in their intensity between the BaYaka and Hadza), (iii) ecological risk in the form of predation exposure by way of large animals, pathogens and parasites, and (iv) norms regarding egalitarianism and generous resource sharing behaviors 39 , 40 , 41 , 42 , 43 , 44 , 51 , 52 .

The community-oriented interpersonal behaviors characteristic of BaYaka and Hadza and their maintenance require high degrees of emotion regulation and social problem solving. Unlike the experience of many individuals in populations from the Global North, these foragers’ daily interactions are repeated with the same network of cooperative partners throughout their lives. Additionally, although precise estimates are difficult to assess, mortality rates are relatively higher in subsistence-level societies compared to populations with better access to emergency care and biomedical treatment 41 —a factor that may be relevant in evaluating the possible threat simulation function of dreams. Thus, foragers may experience greater threat and community oriented responses to threat in their dreams. If an adaptive function of dreams is to reinforce or rehearse such day-to-day, prosocial (i.e., community-oriented) interactions, particularly with trusted kin, then people in BaYaka and Hadza communities will have a higher representation of those interactions and family members in their dreams than would typical populations in the Global North who reside in more individualistic societies.

Hypotheses and predictions

Here, we compare the dreams of two foraging communities—the BaYaka and Hadza—to non-clinical and clinical (i.e., with nightmares and social anxiety) populations from the Global North. First, because of their strong egalitarian social norms and high levels of daily face-to-face interpersonal support from trusted family and friends, we predict that the dream content of both forager groups will have a greater frequency of community-oriented behaviors when compared to dreamers in the Global North. Second, given that both forager groups experience greater early-to-midlife mortality—subsequently leading to a greater chance of an individual losing their own life, the life of offspring, kin, or friends—we predict a greater frequency of threat related dream content relevant to mortality. Third, we expect that foragers’ dreams will serve an efficient emotion regulation function, where threats are associated with new, non-fearful contexts/efficient solutions 17 , and, thus, with lower anxiety/negative emotions in dreams. Finally, we predict that the Nightmare group will have greater levels of negative emotions in dreams and that the student group, associated with COVID-19 pandemic, as well as the social anxiety group, will be characterized by greater anxiety in dream content. By comparing these groups, we can better understand the role of culture and environment in shaping the human experience of dreaming.

Material and methods

Participants.

In all, individuals from two sub-Saharan foraging egalitarian communities with low degrees of market integration, the Hadza and BaYaka and from three high income capitalistic populations (including non-clinical and clinical populations) totaling 234 participants contributed 896 dreams (see Table 1 for summary details).

Global North data collection and characteristics

Data from the Global North populations were drawn from previously published studies done in Switzerland, Belgium, and Canada. The Switzerland and Belgium samples were generated between 2014 and 2022 25 , 26 , 53 , 54 , 55 and included data from three groups: a non-patient group of young healthy participants, patients suffering from social anxiety disorder (SAD), and patients suffering from nightmare disorder. Participants in these studies all kept the same sleep and dream diary (for details see 18 ). During the night or every morning, upon spontaneous awakening, the participants were asked to report whether they had a dream with or without recall or no dream at all. They also reported the presence of specific emotions thanks to dichotomous questions (presence/absence); in total, eleven emotions could be reported. A twelfth choice was reserved to the “absence of emotions”. In the last section of the dream diary, they were also asked to freely write down the dreams they had experienced during their sleep.

The non-clinical reference control group in the Global North includes 219 participants (123 females). A subset of 103 participants, aged between 16 and 40 years old (M = 22.1, SD = 7.9), had dream word counts equal to or greater than 20 words and were included in the dream analysis (word average per dream = 78.2, SD = 66.0). All participants followed a constant sleep schedule during the days preceding the experiment to assess the mean sleep duration and exclude any circadian disturbance or sleep disorder. People suffering from mental disorders were excluded. Ethical approval was granted by the committee of the Faculty of Medicine of the University of Liege and by the Ethical Committee of the Canton of Geneva.

Dreams were also collected from patients suffering from social anxiety disorder (SAD) according to The Diagnostic and Statistical Manual of Mental Disorders (DSM5) 26 , 56 . SAD is characterized by a persistent amount of fear when confronted with social situations 57 . Forty-eight subjects (32 females) were included in the final sample, after assessment of their social anxiety disorder level. The dream diary was filled every morning upon awakening for 2 weeks. Three hundred twenty-four (324) dream reports were collected (6.75 dreams per participant). A subset of 37 participants, aged between 16 and 40 years old (M = 24.4, SD =7.9), had dream word counts equal to or greater than 20 words and were included in the dream analysis (word average per dream = 76.9, SD = 56.7). Ethical approval was granted by the Ethical Committee of the Canton of Geneva, Switzerland (“Commission Cantonale d’Ethique de la Recherche sur l’être humain”).

Additionally, dreams were collected in individuals suffering from nightmare disorder 25 . In total, 36 patients (27 females) were included. All of them suffered from nightmare disorder according to DSM5 with at least moderate severity (> 1 episode per week). Every morning upon awakening participants filled in a dream diary for 2 weeks. One hundred thirty-four (134) dream reports were collected (3.72 dreams per participant). A subset of 33 participants, aged from 20 to 35 years old (M = 26.3, SD = 8.4), had dream word counts equal to or greater than 20 words and were included in the dream analysis (word average per dream = 43.5, SD = 23.8). Ethical approval was granted by the Ethical Committee of the Canton of Geneva, Switzerland (“Commission Cantonale d’Ethique de la Recherche sur l’être humain”).

Altogether, the Belgian and Swiss studies had 924 dream reports collected from the dream diary over 397 nights (4.2 dreams per participant on average). Of those dreams the number that were included in the final analysis with words counts equal to or above 20 are as follows: control N  = 356, Nightmare Disorder N  = 113, and SAD  = 184.

Students at the University of Toronto contributed dream reports ( N  = 184) collected during the fourth wave of the COVID-19 pandemic, where the proliferation of COVID-19 variants was of major concern in Ontario, Canada, as announced by the Public Health Agency of Canada (Statistics Canada, 2021). In total, 24 students (21 females) aged from 19 to 25 years old (M = 21.9, SD = 5.5) were included. Ethics was approved and attained by the University of Toronto REB (RIS Human Protocol Number 39768). During this time, self-rated mental health was below national average (< 50%), and 82% of the Canadian population that were eligible for vaccination were fully vaccinated, however restrictions were still imposed in most areas, including mask-wearing, and limiting contacts. Thus, explorations of evolutionary theories on dream functions may have special relevance during the COVID-19 pandemic 58 , 59 . The final number of dreams equal to or above 20 words and included in the analysis was N  = 168 (word average per dream = 120.6, SD = 44.4).

Global South data collection and characteristics

Data were collected over different time periods by different experimenters. Hadza participants ( N  = 18) were surveyed by DRS in January and February of 2016 and BaYaka participants ( N  = 19) by AHB, SLL, VM, and MSS in June and July 2017. Hadza participants were aged between 18 and 68 years old (M = 42.7, SD = 8.5) and BaYaka participants were aged between 27 and 70 years old (M = 42.3, SD = 10). Combined, we collected a total of 101 dream reports (2.16 dreams per participant and a word average per dream = 38.7, SD = 18.9). The Hadza contributed 48 dream reports (female dreams = 12, male dreams = 36; word average per dream = 44.4, SD = 20.6); all Hadza dreams were equal to or greater than 20 words and were included in the analysis. The BaYaka ( N  = 19) contributed 53 dream reports (females dreams = 26, male dreams = 27); twenty-seven BaYaka dreams were equal to or greater than 20 words (word average per dream = 28.7, SD = 9.1) and were included in the analysis.

Dream reports were collected in the field using a modified Most Recent Dream (MRD) method 60 as a template for questionnaires, and in practice (as the indigenous populations could not write) were a daily verbally administered dream diary. The instructions, given by field researchers in morning after a sleep period, requested the participant to recall whether they dreamt the previous night. If subjects answered in the affirmative, they were then asked to recount the details of the dream using the MRD method template. The report was expected to be detailed, including a description of the dream's setting, the people involved (their age, sex, and relationship to the participant), and any animals present in the dream. Participants were also instructed to describe their emotions during the dream and whether it was a positive or negative experience. This method is ideal for use in small-scale societies because it is a fast, inexpensive, and reliable way to obtain large samples of dream reports. For both forager groups, dream content was translated by the aid of a multilingual field assistant at the time the dream was recorded. Importantly, it is essential to note that, as both the MRD modified and verbally administered dream diary (Global South) and the classic Dream Diary method (Global North) recorded dreams of the previous night, they shared a similar approach and were directly comparable. Additionally, both were administered shortly after awakening from sleep on the same day as the dream, thereby minimizing potential memory biases 61 .

For work with the Hadza, IRB approval was granted from the University of Nevada, Las Vegas (2014) and verbal consent for participation was asked to each participant in Swahili, the second language of the Hadza community. All research was performed with approval of the government of Tanzania, via the Tanzanian Commission for Science and Technology (COSTECH) and the Tanzanian National Institute for Medical Research (NIMR). For the BaYaka, village council consent for this study was obtained at a community meeting in 2015. Subsequently, community consent was annually renewed. Verbal consent was provided by each participant following recruitment into this study. Approval to conduct research in the Republic of the Congo was given by The Centre de Recherche et D’Edudes en Sciences Sociales et Humaines. Ethics approval was obtained from Duke University (2017), the University of Notre Dame (2017), and the University of Cambridge (2017).

All methods were performed in accordance with the relevant guidelines and regulations, and informed consent was obtained from all participants.

Dream text analysis

LIWC-22 is an acronym for Linguistic Inquiry and Word Count, and it is a text analysis software program that can return results for up to 90 different variables or categories 62 . The English text analysis strategy employed the LIWC-22 Dictionary. This internal dictionary is comprised of over 12,000 words, phrases, and emoticons, which have been carefully selected and categorized into sub-dictionaries to assess various psychosocial constructs. Essentially, the LIWC-22 software program is designed to map linguistic constructions to important psychosocial theories and constructs, and thus, target words contained in texts that are read and analyzed by LIWC-22 are used for this purpose.

In this study, the dream texts were translated and transcribed into English, and preprocessed into four super-categories— Community-oriented (by grouping the LIWC categories: social, family, moral, friend, and prosocial) , Threat (by grouping the LIWC categories: conflict and death) , Negative emotions (encompassing the category: negative emotions), and Anxiety (encompassing the category: anxiety). To create an outcome variable for statistical models (see section ‘Modelling' ), we summed the number of words of each category in each dream text. Examples of the Community-oriented target words were: care, help, thank, please, parent, mother, father, baby, honor, deserve, judge, you, we, he, she. Examples of the Threat target words were: fight, killed, attack, death, dead, die, kill. Examples of the Negative emotions target words were: bad, hate, hurt, tired. Examples of the Anxiety target words were: worry, fear, afraid, nervous. The LIWC-22 Dictionary provides a systematic and reliable approach to text analysis 63 and has been widely used in other word-based dream content analyses 25 , 64 , 65 .

To assess the predictors of the four response variable categories ( Community-oriented, Threat, Negative emotions, Anxiety dream content) by population (BaYaka, Hadza, Nightmare, SAD, Students, and Control) we used a linear mixed effects model, built using the lme4 package and model averaged using the MuMin package 66 . To normalize the count data for each category, we square root transformed the response variable 67 , 68 . Finally, we made statistical inferences using a combination of standardized coefficients, confidence intervals, and p-values. We controlled for the fixed effects of age, number of dream reports, word count and sex as well as subject ID (to control for repeated measures) as a random effect. After assessing information criterion, models including the number of dream reports and age as fixed effects differed little from models without them, and so we removed them from final analysis. To increase the power of the model to identify the predicted patterns in the data, we obtained coefficients based on optimization of the log-likelihood using shrinkage, which incorporates measurement error into the regression model and improves less certain estimates by pooling information from more certain estimates 69 .

The non-patient sample from the Global North was used as a model reference category (i.e., a group that is used as a point of comparison for other groups in a statistical analysis) so effect-size estimates for each population are predicted differences in counts of dream content compared to this sample.

The dream content models were fit as follows:

The full dataset, along with all meta-data and more detail of each variable, is available in the Open Science Framework (OSF) data repository:  https://osf.io/7n6kf/ .

Community-oriented’ dream content is greatest in BaYaka

Amongst all sampled populations, the BaYaka showed greater community-oriented dream content than all group samples from Global North populations and Hadza population, after adjusting for sex, word count, and subject ID. As shown in Table 2 , and displayed in Fig.  1 , after factor correction, the BaYaka sample positively drives community-oriented dream content. Additionally, women’s dream reports and word count were drivers of the response variable (Table 2 ). As ethnographic data, we present a few such examples here:

‘I was walking in the forest with my two adult daughters and found a porcupine in a trap and brought it back to the village to eat it. It was a good dream’ ‘I was net hunting with my family (including extended family camp) and we caught many animals so he had to make a smoker "bota" to smoke all of them’

Prosocial dream estimates plot.

‘Threat’ dream content is greatest in BaYaka and Hadza

After adjusting for sex, word count, and controlling for repeated measures of the subject ID, both the BaYaka and Hadza samples had higher levels of threat dream content compared to the Global North groups. This is shown in Table 3 and depicted in Fig.  2 . Thus, belonging to the BaYaka or Hadza community is associated with a greater probability of experiencing threatening dream content. No other factors were found to significantly influence threat dream content.

Threat dream estimates plot.

Importantly, several dream reports gathered among the Hadza community demonstrated high threat situation to which a positive, emotionally cathartic resolution was found. For example:

‘I dreamt I was being chased by a herd of elephants; I was in Nyanza, which is open flat savanna land. I ran and found a small cave which was too small for the elephants to follow. I escaped’. ‘I was chased by an elephant in the bush around camp. I was with four unfamiliar women. I escaped by running into the mountains’. ‘I dreamt I was in the forest and the military was chasing me with guns and he climbed a tree to get away.’ ‘I was chased by a leopard in nearby mountains. I began by hunting but realized that I was the hunted. I was alone but I escaped’.

Moreover, in some Hadza dream reports, a solution to a threat was found through social support:

'I dreamt I fell into a well that is near the Hukumako area by the Dtoga people. I was with two others and one of my friends helped me get out of the well.' ‘I dreamt a buffalo hit me. I was in Numbeya bushland where we look for honey. I was looking for the "small honey". There was another man called January and he came and helped me’ ‘I dreamt a Toga not from this camp (who) took a knife and a person he didn't know from another camp. After I told the guy to stop, he left our Sengele camp.’

'Negative emotion’ dream content is greatest in Nightmare disorder sample

After adjusting for sex, word count, and subject ID, the sample of patients from the Global North in the Nightmare Disorder group had higher levels of dream content with negative emotions compared to the reference group (Table 4 and Fig.  3 ). Conversely, the Hadza exhibited significantly fewer negative emotion words in their dream content than the reference group. No other groups differed from the reference group, as shown in Table 4 and depicted in Fig.  3 . The following dream reports demonstrate high fear without resolution in the Nightmare Disorder group:

‘My mom would call me on my phone and ask me to put it on speakerphone so my sister and cousin could hear. Crying she announced to us that my little brother was dead. I was screaming in sadness and crying in pain.’ ‘I was with my boyfriend, our relationship was perfect and I felt completely fulfilled. Then he decided to abandon me, which awoke in me a deep feeling of despair and anguish.’ ‘I remember in my dream is that I was sitting at a table, in one of the secret rooms, across from a middle-aged man who said he was my uncle (he did not look like any of my uncles), and he was over 100 years old but looked like he was in his 50s. He looked like evil characters from movies. He said he was going to kill me after he went to speak with other people in the other room to admit his secret and then come to kill me. After he left the room, I got up and saw that the door was not fully closed. My thought was that I had to go fight him and then I woke up before I could approach the door.

Negative emotions dream estimates plot.

‘Anxiety’ dream content is greatest in the Canadian (COVID-19 pandemic era) student sample

After accounting for sex, the word count and participant repeated measures by subject ID, it was found that the student group had more anxiety dream content compared to the reference group. Table 5 and Fig.  4 indicate that no other groups demonstrated a significant difference from the control group. In the following two examples, the dream scenario illustrates the level of anxiety that the subject experiences as he needs to confront challenges alone:

‘The dream I remember relates to a game that I play. As it only involved myself, there was no one that I knew around, and I remember feeling anxious. I was doing a very difficult mini-game in the game where a bunch of non-player characters were all around me and I needed to hide behind obstacles to stay safe. I remember waking up once I died inside the mini-game’

Anxiety dream estimates plot.

Contrary to one of our predictions, no significant differences between the non-clinical group and the Social Anxiety Disorder group were found about the level of anxiety experienced in dreams. However, some dreams illustrate the social isolation these patients are experiencing in their real life, translated by a lack of social support when dangers arise:

‘I was in an elevator, stuck, alone. I pressed the down button, and then the elevator sped down. I was very scared, I tried to set off the emergency bell. I arrived at the bottom, it was dark and a sheet or blanket fell from the ceiling of the elevator to cover me.’

In other dreams of this group, people are regarded as hostile, which eventually increases the anxiety level:

‘I dreamed that I ran into someone I knew at the supermarket. We collided without excusing each other which led to an open conflict. The person in question threatens me, I go to the manager of the store accusing the person of having stolen something (it's not true). Then we walk out of the store and the other begs me to drop my charge of theft. I tell him that I won't go any further and that the newspapers won't know anything because I'm a journalist. The person's mother picks him up. I walk a bit until we go to their place. I explain to the person that I have the feeling of being followed by a man who looks like a shadow, and who watches over me and waits for the moment to seize me. I then understand that this man is death himself!’ ‘In my dream, I was at my high school. I went into the classroom by myself and two friends (female, 18) that I thought were close to me started isolating me during group work. I worked by myself the entire class while they acted aggressively towards me, at least verbally. I pulled out my chair to go submit my assignment and it hit a person behind me (male, 18). This person is a friend from my primary school. He shouted at me even though I tried to explain to him what happened was just an accident. I used the washroom, and my phone was water-damaged by one of the two girls (may or may not be an accident). I asked her to pay me back, but subconsciously I did not want the refund but instead to have an excuse to hold a conversation with her. It was an unpleasant dream because I thought I was close to them.’

In the present study, we tested the hypothesis that dreams serve an emotional function that is potentially adaptive by examining dream content from Hadza and BaYaka foragers, who belong to communities characterized by high levels of interpersonal support coupled with greater early-to-midlife mortality (due to predation, resource stress, food and water insecurity, and disease) in comparison to populations in the Global North. We found partial support to the first prediction, that forager dreams exhibit greater community-oriented dream content. Of all the populations examined, only BaYaka reported dreams with significantly more frequent content related to community-orientation and social support amongst family and friends (Table 2 and Fig.  1 ).

The second prediction, that foragers’ dreams contain more threat related content was supported. Both the BaYaka and Hadza samples demonstrated a greater frequency of mortality and conflict associated dream content compared to the reference group, whereas the other groups did not show such difference (Table 3 and Fig.  2 ). The prediction that dreams may augment the processing of high threat levels, yet also be characterized by low levels of both anxiety and negative emotions—was supported. The BaYaka exhibited levels of negative emotions in dreams that did not differ from the reference group, while the Hadza exhibited significantly less dream content with negative emotions compared to the reference. As expected, the Nightmare Disorder group also exhibited significantly greater levels of negative emotions in dreams (Table 4 and Fig.  3 ). A similar pattern was found with anxiety dream content, where the student group during the COVID-19 pandemic was characterized by significantly greater anxiety dream content compared to the reference group, while the BaYaka and Hadza did not differ compared to the reference group (Table 5 and Fig.  4 ).

Evidence for an emotional function of dreams in small-scale forager populations

BaYaka and Hadza foragers face several specific hazards. BaYaka communities reside in a rainforest ecology in the Congo Basin, where routine hazards (i.e., specific sources of danger include: (i) intergroup conflict with Bantu fisher-farmers due to perceived trade and labor related debt, (ii) illnesses (malaria, tuberculosis, intestinal parasites), and (iii) extrinsic risks (i.e., broader factors that can increase a person’s overall risk of harm or negative outcomes) of everyday life, including encounters with dangerous animals like snakes, elephants, crocodiles, and gorillas while hunting, fishing, and foraging as well as other hazardous aspects of the forest such as falling limbs/trees and falls while climbing 70 . The BaYaka infant mortality rate in the study region is unknown, but (as measured elsewhere in the region) can be inferred to be around 20 percent 41 . Adult and juvenile mortality is generally relatively high compared to populations with better access to emergency care and biomedical treatment, though precise estimates are currently unknown 41 . A study of death among the Aka in the Central African Republic found that infections and parasitic diseases were the most common causes of death across ages, causing 22 percent of 669 deaths, and diarrhea causing another 21 percent of deaths 71 .

The Hadza reside in a diverse ecological region characterized by rolling hills, grasslands, and acacia commiphora woodland. Hazards for the Hadza include (i) intergroup conflict with the Datoga pastoralists who co-reside in some areas of the landscape and keep large herds of cattle and goats that drink the scare water in the water holes during the dry season and eat much of the vegetation needed to support wildlife, (ii) illnesses (e.g. tuberculosis, malaria, viral diarrhea) that are faced with little access to biomedical treatment, and (iii) extrinsic risks of everyday life that include falling from trees when collecting honey, snakebites, and encounters with predators when hunting or scavenging meat 48 . One study showed that out of 75 deaths, a third of deaths were attributed to illness, with age, childbirth, poisoning or bewitching and homicide, and falling from trees as other causes of death 72 . With respect to mortality, 21% of infants die in the first year of life and 46% of juvenile children die by age 15 72 , 73 .

Comparatively, populations of the Global North face other types of threats and share different sociocultural values than individuals from small-scale societies. In contrast to collectivistic cultures, like BaYaka and Hadza, most societies of the Global North are strongly individualistic and competitive 74 . People in these societies have less routine face-to-face contact with and imperative cooperative reliance on broad kin networks. At the same time, this individualism shapes many common threats, which are mostly connected to social life (e.g., ostracism and exclusion, loss of status, shame, failure in an exam, etc.), and which are mostly experienced at an individual rather at a collective level. Although recent austerity plans resulted in the reemergence of unemployment, poverty, homelessness, and food insecurity in European and American countries 75 , economic development, public health infrastructure, and access to biomedical care have been linked to comparatively greater life expectancies in the Global North (e.g. 77 years in the U.S. and 80 years in the E.U.), with a larger proportion of deaths occurring in older age from chronic conditions 76 , 76 , 78 .

The present findings provide evidence that when compared to populations in the Global North, foragers disclose a prevalence of community-orientation in their waking life as well as the socially connected themes in their dreams, which may support emotional health. Specifically, our analysis suggests that even in the context of threat, community-orientation—expressed by strong social networks that rely daily on mutual assistance in the context of strong egalitarian social norms—may also play an important role in providing strategies to overcome threats and ultimately achieve emotion regulation. Importantly, an interpretation of BaYaka and Hadza dreams is that foragers activate both the threat simulation and extinction functions of dreaming, which may result in resolution of these threats within their dreams.

The dysfunctional nature of nightmares

We claim here, in line with other theoretical concepts 17 , that increased threat in dreams (as compared to dreams from healthy controls) does not seem to be functional without a subsequent emotional resolution. For example, patients with nightmare disorder have dreams characterized by recurrent, intense, and highly threatening content that cause significant distress and impairment in social, occupational, or other areas of functioning 56 . Nightmares are dreams with high threat but insufficient emotional resolution. The dreamer cannot find effective solutions for threats, therefore high fear and anxiety impedes emotion regulation and catharsis. According to the threat simulation theory, individuals possess a threat simulation system by which multiple factors (such as, inherited personality traits, threat input throughout adolescent development, current stress levels and recent threat input) regulate dream phenotypes. These inputs can also be attenuated by strong social support networks and egalitarian norms. Previous work has suggested that threatening content in dreams ultimately serve to strengthen waking threat perception skills and threat avoidance behaviors that help to self-cope with the challenging realities of waking life 6 , 8 , 79 , 80 .

The forager data further supports the idea that overcoming threat by way of adaptive emotional responses (in wake or sleep) is a crucial component of an efficient emotion regulation in the face of stressful events. When the presence of threats in dreams is not associated with subsequent emotional resolution, as in recurrent nightmares, dreams seem to lose their emotional processing function. Our results, along with others 81 , 82 , 83 suggest that nightmares are dysfunctional dreams with high threat simulation coupled with lack of fear extinction.

Dreams in situations of social isolation or social anxiety

Contrary to the community-oriented character of the BaYaka population, and similar to the increased negative emotions found in nightmares, the dream reports collected from students during the pandemic era were characterized by high levels of anxiety, and sometimes these manifested with themes of isolation and having to confront challenges alone (as depicted in the dream text examples in the “ Results ” section). For example, dreamers experienced high anxiety because of the presence of hostile people in the narrative, without finding any positive way to deal with such a threat. Our results suggest that dreams of individuals in situations of social isolation or social anxiety do not seem to achieve a sufficient degree of emotional resolution (see also 26 ). Whether there is a causal relationship between such a deficient extinction function of dreaming and the symptomatology of anxiety disorders is not clearly elucidated and should be further tested in the future.

Limitations

There are several limitations to the current study, particularly in regard to the dream content collection among the BaYaka and Hadza populations. Future dream research in such small-scale societies should emphasize not only generating dream data but also including daily reports of activity or evidence of daytime emotion regulation or performance 18 . Accounts for waking life experiences enable a direct analysis of dreams to experiences encountered during the day, which would then allow to test threat or social simulation hypotheses or to make claims related to these hypotheses in general 60 . Correlational studies, such as the one conducted by Sterpenich and colleagues 18 , or interventional studies (i.e., manipulating dream content and observing its effect in wakefulness 25 ) offer a closer approximation of the relationship between wake and dream functions. Importantly, observational dream research, including the present study, cannot claim to provide strong evidence for causality between wakefulness and dreams, nor for the directionality of such relationship regarding emotion regulation functions. Finally, as both a point of originality for this work and in distinction from previous work, this study did not test for the daytime emotional state-response, as emotional resolution was assessed in the dream itself.

Dream reports with greater length are more likely to contain sufficient information to accurately describe a dream 29 . Yet, some dream reports from both of these communities were relatively short in length. This can be attributed to dream recounting having to be translated and transcribed into English. Although we made efforts to recount as much detail as possible, dream descriptions could only be paraphrased summaries of dreams distilled through the translator. In addition, it is difficult to assess whether the participant recounting his/her dream was motivated and/or had sufficient practice formulating accurate long-term memories of the dream. Often, inexperienced dream recounters simply answer the questionnaire as is presented to them, which can attribute to dream report bias 80 . Despite the short dream descriptions and less formalized training in dream recounting, the BaYaka and Hadza communities are characterized by a rich storytelling culture and were typically highly motivated to discuss dreams and their interpretations. We also note that these samples are characterized by a stark lack of sexually related activity in dreams. It may well be that for these groups, the lack of recounting dreams of a sexual nature may reflect a taboo placed on descriptions of sexuality in general.

Here we provide support for the idea that in non-clinical populations with real and perceived threats, dreams may process high threat levels, yet also be characterized by low anxiety and negative emotions. Our results suggest indirectly that dreams can effectively regulate emotions by linking potential dangers with novel, non-fearful dream contexts and can lead to a reduction in feelings of anxiety and other negative emotions, as a form of emotional release or catharsis. In addition, in at least one such community (the BaYaka), emotional catharsis is often achieved by strong social support. Ultimately, if dreaming prepares human beings to face likely challenges and dangers in waking life, then our results are among the first to show these potential functions under evolutionarily relevant socio-ecological conditions.

Data availability

The data that support the findings of this study are publicly available on OSF ( https://osf.io/7n6kf/ ). 

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Acknowledgements

We would like to thank both the Hadza and BaYaka for participating in this study. We would like to thank Dambo Justin and Mékouno Paul for assistance with data collection in Congo. We would like to thank Jarno Tuominien for useful discussions and Audrey Theux for technical assistance. This project was funded by the National Geographic Society (no. 9665-15 to DS), the Jacobs Foundation (to LG and AB), the Medical Direction of University Hospitals of Geneva (PRD 18-2019-I to LP) and the Swiss National Science Foundation (CRSK-3_190722 to LP).

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David R. Samson, Noor Abbas & Jeffrey Senese

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David R. Samson

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Alice Clerget, Francesca Borghese, Pauline Henckaerts, Sophie Schwartz, Virginie Sterpenich & Lampros Perogamvros

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Mallika S. Sarma

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Conceptualization: D.S. and L.P. Methodology, software: D.S., A.C., L.P. Data curation: D.S., A.C., N.A., J.S., M.S.S., S. L-L., F.B., P.H., V.S., L.T.G., A.B., A.N.C., L.P. Writing—original draft preparation: D.S. and L.P. Visualization, investigation: D.S., S. L-L., S.S., V.S., L.T.G., A.B., A.N.C., L.P. Supervision: D.S. and L.P. Funding acquisition: D.S., S. L-L., L.T.G., A.B., A.N.C., L.P. Writing—reviewing and editing: D.S., A.C., N.A., J.S., M.S.S., S. L-L., F.B., P.H., S.S., V.S., L.T.G., A.B., A.N.C., L.P.

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Samson, D.R., Clerget, A., Abbas, N. et al. Evidence for an emotional adaptive function of dreams: a cross-cultural study. Sci Rep 13 , 16530 (2023). https://doi.org/10.1038/s41598-023-43319-z

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Untangling dreams and our waking lives: Latest findings in cognitive neuroscience

by Cognitive Neuroscience Society

"Dreams are messages from the deep." (Dune Part 1) Musings about dreams abound throughout society, from movies to TV to books. But despite being a constant source of fascination, the role of dreams in our lives still remains elusive.

As recently noted in the TV show Grey's Anatomy, "Honestly, no one knows why we dream or why we have nightmares." While true, neuroscientists are finding innovative new ways to study dreams and how they influence our cognition.

"Understanding how dreams are generated and what their function might be—if any—is one of science's biggest open questions right now," says Remington Mallett of University of Montréal, who is chairing a session today at the annual meeting of the Cognitive Neuroscience Society (CNS) in Toronto .

"Because we don't know much about dreams, it is hard to estimate their full impact on our waking lives. But current results suggest that indeed dreams influence our waking experiences."

As presented at CNS 2024, researchers are finding not only novel approaches to exploring dreams and the architecture of sleep, but also ways to engineer dreams to help people suffering from sleep disorders . In the process, scientists are seeing how perceptions of dreams and sleep quality often differ greatly from the objective measures traditionally used to evaluate them.

Perceptions versus reality

Claudia Picard-Deland posits that dreams are a window into understanding sleep quality. She and colleagues at the University of Montréal design studies that wake sleepers many times in the night to determine how the participants perceive their sleep.

"Dreams are not studied a lot in the context of sleep quality. The focus is more often on objective measures like brain activity or sleep stage, but I think we need to look closer at dream activity and its impact on how we perceive sleep." For people who suffer from insomnia and related disorders, perception of sleep is reality, and their dreams could offer possible ways to help shape those perceptions.

In their latest, unpublished study, Picard-Deland and colleagues woke 20 "good sleepers" some 12 times in the night, representing all four classic sleep stages at three different times in the night. At each awakening, the researchers would ask whether they had been awake or asleep, how deeply they were sleeping, what was last in their minds, and how immersed they felt in their dreams.

They found that sleep misperception—feeling awake even when electrodes measured they were asleep—was common among participants, especially in the early, dreamless stages of sleep. Likewise, they found that when the participants were able to recall their dreams, they perceived their sleep as deeper.

"And when they are more immersed in their dreams, feel more physically present, or have more vivid dreams, they wake up feeling their sleep was deeper compared to when they have no, or light, dream activity," Picard-Deland says.

The researchers were surprised to see how frequently participants thought they had been awake when they were actually sleeping ("paradoxical insomnia") and in the deeper, slow-wave phase of sleep. This work builds upon similar previous findings and has important implications for how scientists understand the architecture of sleep, as well as for people who report insomnia.

As someone who has experienced insomnia her whole life, Picard-Deland thinks it is crucial for people to realize that they may be sleeping more than they think. "It helped me to see it with my own eyes, happening in front of me, that participants were sleeping yet still felt awake."

Beyond that understanding, this work could have future applications for sleep rehabilitation based on dreams. For example, Picard-Deland would love to explore whether dream training, such as teaching people how to experience more immersive lucid dreams, could lead to better perceived sleep quality.

Lucid dreams as a tool

Lucid dreams are an important part of the work of Saba Al-Youssef whose team at Sorbonne Université leverages the ability of lucid dreamers to use facial muscles during sleep as a new tool for gathering data. "Dreams are a hidden world to which we have no direct access," she says.

"We mostly rely on dream reports no matter what study method we use. The capacity of lucid dreamers to communicate with us in real time gives us side door access to dreams, at least knowing when a specific event is happening."

In a new study with researchers at Northwestern University published in Current Biology , Al-Youssef and colleagues aim to better understand how the brain acts during dreams in comparison to its behavior when awake.

When people are awake and close their eyes, visual content disappears and specific electrical signals occur. Researchers therefore wondered what happens in the brain when someone closes their eyes in a dream. They hope to better understand the neural correlates of visual perception during dreams.

The researchers recruited participants who included lucid dreamers with narcolepsy. Over the course of five naps, the researchers instructed participants to close and open their "dream eyes" and signal so by sniffing once or twice. They then asked those with narcolepsy to report whether they had visual content in each condition by frowning or smiling.

"Surprisingly, we've found that closing our 'dream eyes' is not always accompanied by a loss of vision, as is the case when we're awake," Al-Youssef says. "I hope this work would help show how using lucid dreams can be helpful in studying dreams and even understanding their function."

Mallett is excited to see work like this to develop new methodology for studying dreams. "I think most scientists are skeptical that dreams can be studied, so before I tell them about what we found, I need to convince them that we can find something," Mallett says, "that we have the methods and tools to make discoveries about dreams."

Both Picard-Deland's and Al-Youssef's work open new avenues of research in manipulating dreams through new technology and with immediate clinical benefits. "You need to manipulate dreams for good experimentation, and you need to manipulate dreams to reduce nightmares," he says.

"Nightmares are incredibly frustrating for a variety of clinical populations, and there is great need for approaches to reducing them. Understanding how dreams are formed, and how to change them, is already laying paths forward for efficient nightmare reduction protocols."

Overall, the body of work presented at CNS 2024 is showing the myriad ways dreams affect our waking lives. "This is rather unsurprising when you consider that dreams are experiences, and your prior experience is always going to impact your experiences going forward."

The work also echoes a fundamental lesson from cognitive neuroscience, that whether awake or asleep, our perceptions of the world are but imperfect creations in our minds.

The symposium " Into the Night: The Cognitive Neuroscience of Dreaming " is taking place at 1:30pmEDT on Sunday, April 14, as part of the CNS 2024 annual meeting from April 13-16, 2024 in Toronto, Canada.

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Why your brain needs to dream, research shows that dreaming is not just a byproduct of sleep, but serves its own important functions in our well-being..

We often hear stories of people who’ve learned from their dreams or been inspired by them. Think of Paul McCartney’s story of how his hit song “Yesterday” came to him in a dream or of Mendeleev’s dream-inspired construction of the periodic table of elements.

But, while many of us may feel that our dreams have special meaning or a useful purpose, science has been more skeptical of that claim. Instead of being harbingers of creativity or some kind of message from our unconscious, some scientists have considered dreaming to be an unintended consequence of sleep—a byproduct of evolution without benefit.

Sleep itself is a different story. Scientists have known for a while now that shorter sleep is tied to dangerous diseases, like heart disease and stroke . There is mounting evidence that sleep deprivation leads to a higher risk of obesity and Alzheimer’s disease . Large population studies reflect a saddening truth—the shorter your sleep, the shorter your life . Not only that, sleep helps us to hold onto our memories and to learn facts and skills faster, making it important for everyone including infants, students, athletes, pilots, and doctors.

Much of this I outline in my new book, Why We Sleep: Unlocking the Power of Sleep and Dreams , which summarizes the many findings we have about sleep and its function in our lives.

But what about dreaming? Does it also have a purpose?

Recent work in my neuroscience lab and the work of other scientists has shown that dreams may have a very particular function important to our well-being. Here are the two main ways dreams help us.

Dreaming is like overnight therapy

It’s said that time heals all wounds, but my research suggests that time spent in dream sleep is what heals. REM-sleep dreaming appears to take the painful sting out of difficult, even traumatic, emotional episodes experienced during the day, offering emotional resolution when you awake the next morning.

REM sleep is the only time when our brain is completely devoid of the anxiety-triggering molecule noradrenaline. At the same time, key emotional and memory-related structures of the brain are reactivated during REM sleep as we dream. This means that emotional memory reactivation is occurring in a brain free of a key stress chemical, which allows us to re-process upsetting memories in a safer, calmer environment.

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How do we know this is so? In one study in my sleep center, healthy young adult participants were divided into two groups to watch a set of emotion-inducing images while inside an MRI scanner. Twelve hours later, they were shown the same emotional images—but for half the participants, the twelve hours were in the same day, while for the other half the twelve hours were separated by an evening of sleep.

Those who slept in between the two sessions reported a significant decrease in how emotional they felt in response to seeing those images again, and their MRI scans showed a significant reduction in reactivity in the amygdala, the emotional center of the brain that creates painful feelings. Moreover, there was a reengagement of the rational prefrontal cortex of the brain after sleep that helped maintain a dampening influence on emotional reactivity. In contrast, those who remained awake across the day showed no such dissolving of emotional reactivity over time.

That in itself doesn’t say anything about the role of dreaming. But we had recorded each participant’s sleep during the intervening night between the two test sessions, and we found that specific brain activity that reflected a drop in stress-related brain chemistry during the dream state determined the success of overnight therapy from one individual to the next.

Dreaming has the potential to help people de-escalate emotional reactivity, probably because the emotional content of dreams is paired with a decrease in brain noradrenaline. Support for this idea came from a study done by Murray Raskind on vets with PTSD, who often suffer debilitating nightmares. When given the drug Prazosin—a medication that lowers blood pressure and also acts as a blocker of the brain stress chemical noradrenaline—the vets in his study had fewer nightmares and fewer PTSD symptoms than those given a placebo. Newer studies suggest this effect can be shown in children and adolescents with nightmares, as well, though the research on this is still in its infancy.

The evidence points toward an important function of dreams: to help us take the sting out of our painful emotional experiences during the hours we are asleep, so that we can learn from them and carry on with our lives.

Dreaming enhances creativity and problem-solving

It’s been shown that deep non-REM sleep strengthens individual memories. But REM sleep is when those memories can be fused and blended together in abstract and highly novel ways. During the dreaming state, your brain will cogitate vast swaths of acquired knowledge and then extract overarching rules and commonalties, creating a mindset that can help us divine solutions to previously impenetrable problems.

How do we know dreaming and not just sleep is important to this process?

In one study , we tested this by waking up participants during the night—during both non-REM sleep and dreaming sleep—and gave them very short tests: solving anagram puzzles, where you try to unscramble letters to form a word (e.g., OSEOG = GOOSE). First, participants were tested beforehand, just to familiarize them with the test. Then, we monitored their sleep and woke them up at different points of the night to perform the test. When woken during non-REM sleep, they were not particularly creative—they could solve very few puzzles. But, when we woke up participants during REM sleep, they were able to solve 15-35 percent more puzzles than when they were awake. Not only that, participants woken while dreaming reported that the solution just “popped” into their heads, as if it were effortless.

In another study , I and my colleagues taught participants a series of relational facts—such as, A>B, B>C, C>D, and so on—and tested their understanding by asking them questions (e.g., Is B>D or not? ). Afterwards, we compared their performance on this test before and after a full night’s sleep, and also after they’d had a 60- to 90-minute nap that included REM sleep. Those who’d slept or had a long nap performed much better on this test than when they were awake, as if they’d put together disparate pieces of a jigsaw puzzle in their sleep.

Some may consider this trivial, but it is one of the key operations differentiating your brain from your computer. It also underlies the difference between knowledge (retention of individual facts) and wisdom (knowing what they all mean when you fit them together). The latter seems to be the work of REM-sleep dreaming.

“It’s said that time heals all wounds, but my research suggests that time spent in dream sleep is what heals”

Dreaming improves creative problem solving, too, according to another study . Participants learned to navigate a virtual maze using trial and error and aided by the placement of unique objects—like Christmas trees—at certain junctions in the maze. After this learning session, the group was split in two, with half napping and half watching a video for 90 minutes. Nappers were occasionally awoken to ask about the content of their dreams; those watching a video were also asked about thoughts going through their minds.

Afterwards, the participants again tried to solve the maze, and those who napped were significantly better at it than those who didn’t, as expected. But the nappers who reported dreaming about the maze were 10 times better at the task than those who napped and didn’t dream about the maze. There’s a reason you’ve never been told to stay awake on a problem.

Looking at the content of these dreams, it was clear that the participants didn’t dream a precise replay of the learning experience while awake. Instead, they were cherry-picking salient fragments of the learning experience and attempting to place them within the catalog of preexisting knowledge. This is how dreaming helps us be more creative.

While the benefits of dreaming are real, too many of us have problems getting a full eight hours of sleep and lose out on these advantages. Alternatively, we may think we’re the exception to the rule—that we’re one of those people who doesn’t happen to need a lot of sleep. But nothing could be further from the truth. Research clearly shows that people who overestimate their ability to get by on less sleep are sadly wrong.

Five ways to enhance your sleep

So how can we be sure to get enough sleep and experience a dream state? While we may be tempted to use sleeping pills to get to sleep, this has been shown to be detrimental to dreaming. Instead of taking pills, here are some simple ways to enhance your sleep:

1. Make sure your room is dark and that you are not looking at bright light sources—i.e., computer screens and cell phones—in the last hour or two before going to bed. You may even want to start dimming lights in your house in the earlier parts of the evening, which helps to stimulate sleepiness.

2. Go to bed and wake up at approximately the same time every day. This helps signal to your body a regular time for sleeping. It’s no use trying to sleep in a lot on weekends. There is no way to make up for regular sleep loss during the week.

3. Keep the temperature in your house cool at night—maybe even cooler than you think it should be, like around 65 degrees. Your body temperature needs to drop at night for sleep, and a lower room temperature helps signal your brain that it’s time to sleep.

4. If you have trouble falling asleep, or wake in the night feeling restless, don’t stay in bed awake. That trains the brain that your bed is not a place for sleeping. Instead, get up and read a book under dim light in a different room. Don’t look at your computer or cell phone. When sleepiness returns, then go back to bed. Or if you don’t want to get out of bed, try meditating. Studies suggest it helps individuals fall asleep faster, and also improves sleep quality.

5. Don’t have caffeine late in the day or an alcohol-infused nightcap. Both of these interfere with sleep—either keeping you awake or stimulating frequent wake-ups during the night.

Sleep is the single most effective thing we can do to rest our brain and physical health each day. Atop of sleep, dreaming provides essential emotional first aid and a unique form of informational alchemy. If we wish to be as healthy, happy, and creative as possible, these are facts well worth waking up to.

About the Author

Matthew Walker

Matthew Walker is a professor of psychology and neuroscience at the University of California, Berkeley, and the director of the university’s Center for Human Sleep Science .

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12 Most Commonly Asked Questions About Dreams, Answered

What are your dreams trying to tell you and what if you can't remember them.

Posted June 14, 2015 | Reviewed by Ekua Hagan

1. What are dreams?

Dreams are mental experiences that occur while we are asleep. We know of the existence of dreams because most of us report having mental experiences such as thoughts, images, and emotions while asleep—and we can see consistent areas of the brain become activated during dream-sleep.

2. Why do we dream?

There are many theories, but nobody truly knows. Some researchers believe dreams have no function. Others believe that they serve to process intense emotions, or that they facilitate consolidation of emotional memories.

Still others believe that they protect sleep via hallucinatory fulfillment of a libidinal wish. And some believe that dreams simulate daytime threats so that we become better at avoiding them. (This latter theory appears to predict opposite dream content effects from those of the libidinal wish fulfillment theory.)

Some believe dreams function to run counterfactual simulations to daytime events (or possible daytime events) so that we learn from them. And some believe that dream content functions to promote emotional attachment patterns with others. There are many other theories of dream function but all of those mentioned here do have some limited empirical support.

3. Does everyone dream?

No. There appears to be a very small number of people who can recall very few dreams, if any. The fact that such people can function perfectly well without recalling any dreams suggests that conscious recall of dreams may not be required for normal brain function—unless these people (who appear not to dream) have developed some compensatory brain processes that perform whatever functions dreams normally perform, such as consolidation of emotional memories. The idea would be that if the vast majority of people consolidate their emotional memories via dreams, a small number of people who do not dream would have to have developed alternative means for consolidation of emotional memories.

4. How long do dreams last?

Nobody knows for sure. Rapid eye movement, or "REM" sleep, the form of sleep associated with vivid dreaming , can last up to about 45 minutes but we really have no definitive method for timing dreams.

Subjective estimates of dream length, however, are proportional to length of dream reports. This is consistent with the theory that dreams can last a long time rather than flash by in an instant as some early dream theorists conjectured.

The fact that dreams have substantial duration suggests that the events in dreams should be densely populated with events, people, happenings, and other elements common to normal daytime experiences. Our dream reports , however, typically lack the extensive details normally associated with dense real-life experiential episodes.

5. Are dreams meaningless?

It is unlikely that dreams are meaningless—very few, if any, are random assemblages of images. Instead, most dreams are structured into narratives . Some dreams (dreams that tend to be associated with N3 NREM sleep) can lack narrative action and instead are just presentations of a visual scene or a single set of thoughts. Still, even these non-narrative dreams are not meaningless to the dreamer .

6. What are most dreams about?

Various types of dreams cannot be reduced to this formula, but nevertheless, content analyses of thousands of dream reports from people of all ages and walks of life substantiate this basic claim: Most dreams depict people familiar to the dreamer interacting in various ways with the dreamer.

7. What are lucid dreams?

Lucid dreams are dreams during which the dreamer is aware that he or she is dreaming. Not surprisingly, properties of lucid dreams differ significantly from ordinary dreams. Most importantly, some prefrontal neural networks exhibit higher activation levels in lucid dreams relative to ordinary non-lucid dreams.

8. What are nightmares?

Nightmares are scary or terrifying dreams that typically occur in REM sleep and leave the dreamer shaken or disturbed to some extent upon awakening. Some researchers maintain that for a dream to be a nightmare it has to be disturbing enough to awaken the dreamer. Other experts point out that many non-scary dreams (erotic, sad-nostalgic, creative, spiritual ) can be intense enough to awaken the dreamer, so the awakening criterion is not empirically adequate for nightmares.

9. What are the most common dream disorders?

The most common dream disorders are:

• Anxiety dreams (often associated with slight sleep in insomnia )
• Recurrent nightmares
• Repetitive dream themes
• REM Behavior Disorder (wherein the dreamer acts out his dreams)
• Dreams of depression (empty emotional content)
• Vivid fantastic dreams that may portend illness of some kind, occasionally including psychosis .

10. How can I remember more of my dreams?

Keep a dream diary handy next to your bed and get in the habit of recording dreams upon awakening. Online dream posting websites can also make regular dream recording easy.

11. Do animals dream?

There is no scientific consensus on whether animals dream. Animals do experience REM sleep and sometimes it appears that their bodies react as though they are dreaming while asleep. Given that mental simulations automatically occur when higher cortical centers are activated in humans, it seems plausible that animals also “experience” mental simulations when their brains are activated, as in REM.

12. What part of the brain lights up when we dream?

Neuroimaging studies of people in REM suggest that the limbic system is especially active during REM, with the amygdala undergoing intense activation during REM.

Patrick McNamara, Ph.D. , is Associate Professor of Neurology at Boston University School of Medicine and the author of numerous books and articles on the science of dreams.

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Common Questions About Dreams Answered

From dream interpretation to dream journals — get all of your dream-related questions answered.

Chances are you’ve woken up from a dream where you were falling or late for something. Maybe you’ve even dreamt of your teeth falling out, flying, or being inside water and wondered what it means.

Perhaps you’ve also questioned the very purpose of dreams or the purpose of dream journals — all of which are common questions many people have about dreams. The average person spends 229,961 hours asleep in their lifetime, so it’s natural to wonder about your sleep state.

For all of your dream-related questions, PsychCentral has your dream answers.

8 Common Questions About Dreams  

Do humans always dream.

“Because the brain remains active even during sleep, it is believed that humans dream every night,” says Po-Chang Hsu , a medical doctor and medical content expert at SleepingOcean . “However, people often forget their dreams right after waking up, which has to do with how the brain works during sleep.”

“Studies show that the [part of the] brain responsible for memory formation (the frontal lobe) is inactive during the REM stage when we typically dream, which is why people often don’t recall dreaming.”

Do dreams mean good sleep?

Not necessarily, according to Hsu. “The human brain can dream during any sleep stage ,” he says. “Therefore, a person can see dreams without entering the deep, most restorative sleep.”

With that said, we do know that research shows good sleep is vital for wellbeing. Several studies link the extraordinary importance of sleep for a thriving, healthy life.

What do dreams tell us about our mental state?

According to research, dreams may provide insight into your mental state, including your emotional well-being.

For example, one study from the NIH found that nightmares were more than two-fold more frequent in individuals with mood or psychotic disorders than those without.

Another NIH study also shows that those with post-traumatic stress disorder (PTSD) often have recurring nightmares about their trauma. “This suggests that dreams may play a role in processing and coping with traumatic events ,” explains Aúgusta.

What are common symbols in dreams?

“Most people mention dreaming of falling , running away from someone, flying, reliving childhood memories, working, dying, and seeing people they know,” explains Hsu.

“The meaning behind these symbols has to be discovered individually, as it’s largely based on the person’s current mental state and life circumstances.”

Can you control your dreams?

According to Dr. Nathan Brandon , a licensed psychologist, it is possible to influence dreams and have some control over their content through lucid dreaming.

“Lucid dreaming is a process where you become aware you are dreaming while still asleep,” explains Brandon. “Once you’re aware that you are dreaming, you can attempt to control the dream by changing the dreamscape or influencing the characters in the dream.”

How do you interpret dreams?

“Dreams are made up of a combination of images, thoughts, feelings, and sensations that occur during sleep and can be influenced by factors such as your mood, memories, and experiences,” explains Brandon. Yet, according to Brandon, interpreting dreams is highly personal and doesn’t have a one-size-fits-all answer.

“Often, the symbols and emotions in a dream are related to events or situations in the dreamer’s waking life,” explains Brandon. “In general, you can interpret your dreams by looking at the symbols and images in the dream and exploring your association with them.”

What’s the purpose of a dream journal?

“Dream journals are often used as a tool for self-reflection and understanding dreams,” explains Brandon. “By keeping a journal, you can track patterns in your dreams over time and gain insight into the symbolism and meanings of your dreams.”

You can use your journal to explore deep questions that arise from your dreams in a space you know is safe.

Dream journals can also be helpful during therapy . According to Hsu, “writing the dreams down often helps people process their emotions or dig deeper, for example, to discover what causes nightmares or recurring dreams.”

You could, in turn, consider bringing your dream journal to your next therapy session to discuss your dreams with your therapist.

What are some techniques for better dream recall?

On top of keeping a dream journal, Aúgusta offers a few techniques to help you with dream recall:

• Keep your dream journal by your bed and write down your dreams as soon as you wake up.
• Set the alarm for a few hours before you usually wake up and try to remember your dreams when you wake up.
• Make a habit of thinking about your dreams before you go to bed.
• Practice relaxation techniques before bed, such as deep breathing .

Let’s Recap

While more research on dreams is required, your dreams can still give you a lot of insight into your waking life right now.

Start noting and recalling dreams, and consider what they’re trying to tell you — either in your journal or with a trusted friend or therapist. You never know what insight you may find in your mind.

And whatever you do, don’t stop dreaming.

Other FAQs About Dreams

How do you improve sleep quality and get more REM sleep? Consider sticking to a consistent sleep schedule and adopting healthier habits (more exercise, less caffeine, limit screen time before bed, etc.).

How many times do you dream a night? Researchers have discovered that the average person goes through four to six sleep cycles each night, so it is thought that we dream around that number. However, experts are not fully sure.

How can you practice lucid dreaming? Practicing mindfulness meditation , especially a few hours before your regular wake-up time (and then go back to sleep), can help you get better at lucid dreaming. It can also help to keep a dream journal.

What stage of sleep do you dream the most? Dreaming occurs most during the Rapid Eye Movement (REM) stage, considered the deepest and the most restorative sleep stage.

Last medically reviewed on October 27, 2022

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Why Do We Dream?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva University’s clinical psychology doctoral program.

Verywell / Madelyn Goodnight

What Is a Dream?

The role of dreams.

• Reflect the Unconscious
• Process Information
• Aid In Memory
• Spur Creativity
• Reflect Your Life
• Prepare and Protect
• Process Emotions
• Other Theories

Lucid Dreaming

Stress dreams.

Despite scientific inquiry, we still don't have a solid answer for why people dream. Some of the most notable theories are that dreaming helps us process memories and better understand our emotions , also providing a way to express what we want or to practice facing our challenges.

7 Theories on Why We Dream

A dream includes the images, thoughts, and emotions that are experienced during sleep. Dreams can range from extraordinarily intense or emotional to very vague, fleeting, confusing, or even boring. Some dreams are joyful, while others are frightening or sad. Sometimes dreams seem to have a clear narrative, while many others appear to make no sense at all.

There are many unknowns about dreaming and sleep, but what scientists do know is that just about everyone dreams every time they sleep, for a total of around two hours per night, whether they remember it upon waking or not .

Beyond what's in a particular dream, there is the question of why we dream at all. Below, we detail the most prominent theories on the purpose of dreaming and how these explanations can be applied to specific dreams.

How Do Scientists Study Dreams?

The question of why we dream has fascinated philosophers and scientists for thousands of years. Traditionally, dream content is measured by the subjective recollections of the dreamer upon waking. However, observation is also accomplished through objective evaluation in a lab.

In one study, researchers even created a rudimentary dream content map that was able to track what people dreamed about in real time using magnetic resonance imaging (MRI) patterns. The map was then backed up by the dreamers' reports upon waking.

Some of the more prominent dream theories contend that the function of dreaming is to:

• Consolidate memories
• Process emotions
• Express our deepest desires
• Gain practice confronting potential dangers

Many experts believe that we dream due to a combination of these reasons rather than any one particular theory. Additionally, while many researchers believe that dreaming is essential to mental, emotional, and physical well-being, some scientists suggest that dreams serve no real purpose at all.

The bottom line is, while many theories have been proposed, no single consensus has emerged on why we dream.

Dreaming during different phases of sleep may also serve unique purposes. The most vivid dreams happen during rapid eye movement (REM) sleep , and these are the dreams that we're most likely to recall. We also dream during non-rapid eye movement (non-REM) sleep, but those dreams are known to be remembered less often and have more mundane content.

Dreams May Reflect the Unconscious

Sigmund Freud’s theory of dreams suggests that dreams represent  unconscious desires, thoughts, wish fulfillment, and motivations. According to Freud, people are driven by repressed and unconscious longings, such as aggressive and sexual instincts .

While many of Freud's assertions have been debunked, research suggests there is a dream rebound effect, also known as dream rebound theory, in which suppression of a thought tends to result in dreaming about it.

What Causes Dreams to Happen?

In " The Interpretation of Dreams ," Freud wrote that dreams are "disguised fulfillments of repressed wishes." He also described two different components of dreams: manifest content (actual images) and latent content (hidden meaning).

Freud’s theory contributed to the rise and popularity of dream interpretation . While research has failed to demonstrate that the manifest content disguises the psychological significance of a dream, some experts believe that dreams play an important role in processing emotions and stressful experiences.

Dreams Process Information

According to the activation-synthesis model of dreaming , which was first proposed by J. Allan Hobson and Robert McCarley, circuits in the brain become activated during REM sleep, which triggers the amygdala and hippocampus to create an array of electrical impulses. This results in a compilation of random thoughts, images, and memories that appear while dreaming.

When we wake, our active minds pull together the various images and memory fragments of the dream to create a cohesive narrative.  

In the activation-synthesis hypothesis, dreams are a compilation of randomness that appear to the sleeping mind and are brought together in a meaningful way when we wake. In this sense, dreams may provoke the dreamer to make new connections, inspire useful ideas, or have creative epiphanies in their waking lives.

Dreams Aid In Memory

According to the information-processing theory, sleep allows us to consolidate and process all of the information and memories that we have collected during the previous day. Some dream experts suggest that dreaming is a byproduct, or even an active part, of this experience processing.  

This model, known as the self-organization theory of dreaming , explains that dreaming is a side effect of brain neural activity as memories are consolidated during sleep. During this process of unconscious information redistribution, it is suggested that memories are either strengthened or weakened. According to the self-organization theory of dreaming, while we dream, helpful memories are made stronger, while less useful ones fade away.

Research supports this theory, finding improvement in complex tasks when a person dreams about doing them. Studies also show that during REM sleep, low-frequency theta waves were more active in the frontal lobe, just like they are when people are learning, storing, and remembering information when awake.

Dreams Spur Creativity

Another theory about dreams says that their purpose is to help us solve problems. In this creativity theory of dreaming, the unconstrained, unconscious mind is free to wander its limitless potential while unburdened by the often stifling realities of the conscious world. In fact, research has shown dreaming to be an effective promoter of creative thinking.

Scientific research and anecdotal evidence back up the fact that many people do successfully mine their dreams for inspiration and credit their dreams for their big "aha" moments.

The ability to make unexpected connections between memories and ideas that appear in your dreams often proves to be an especially fertile ground for creativity.

Dreams Reflect Your Life

Under the continuity hypothesis, dreams function as a reflection of a person's real life, incorporating conscious experiences into their dreams. Rather than a straightforward replay of waking life, dreams show up as a patchwork of memory fragments.

Still, studies show that non-REM sleep may be more involved with declarative memory (the more routine stuff), while REM dreams include more emotional and instructive memories. In general, REM dreams tend to be easier to recall compared to non-REM dreams.

Under the continuity hypothesis, memories may be fragmented purposefully in our dreams as part of incorporating new learning and experiences into long-term memory . Still, there are many unanswered questions as to why some aspects of memories are featured more or less prominently in our dreams.

Dreams Prepare and Protect

The primitive instinct rehearsal and adaptive strategy theories of dreaming propose that we dream to better prepare ourselves to confront dangers in the real world. The dream as a social simulation function or threat simulation provides the dreamer a safe environment to practice important survival skills.

While dreaming, we hone our fight-or-flight instincts and build mental capability for handling threatening scenarios. Under the threat simulation theory, our sleeping brains focus on the fight-or-flight mechanism to prep us for life-threatening and/or emotionally intense scenarios including:

• Running away from a pursuer
• Falling over a cliff
• Showing up somewhere naked
• Going to the bathroom in public
• Forgetting to study for a final exam

This theory suggests that practicing or rehearsing these skills in our dreams gives us an evolutionary advantage in that we can better cope with or avoid threatening scenarios in the real world. This helps explain why so many dreams contain scary, dramatic, or intense content.

Dreams Help Process Emotions

The emotional regulation dream theory says that the function of dreams is to help us process and cope with our emotions or trauma in the safe space of slumber.

Research shows that the amygdala, which is involved in processing emotions, and the hippocampus, which plays a vital role in condensing information and moving it from short-term to long-term memory storage, are active during vivid, intense dreaming. This illustrates a strong link between dreaming, memory storage, and emotional processing.

This theory suggests that REM sleep plays a vital role in emotional brain regulation. It also helps explain why so many dreams are emotionally vivid and why emotional or traumatic experiences tend to show up on repeat. Research has shown a connection between the ability to process emotions and the amount of REM sleep a person gets.

Content similarities and common dreams shared among dreamers may help promote connection. Research also notes heightened empathy among people who share their dreams with others, pointing to another way dreams can help us cope by promoting community and interpersonal support.

Other Theories About Why We Dream

Many other theories have been suggested to account for why we dream.

• One theory contends that dreams are the result of our brains trying to interpret external stimuli (such as a dog's bark, music, or a baby's cry) during sleep.
• Another theory uses a computer metaphor to account for dreams, noting that dreams serve to "clean up" clutter from the mind, refreshing the brain for the next day.
• The reverse-learning theory suggests that we dream to forget. Our brains have thousands of neural connections between memories—too many to remember them all—and that dreaming is part of "pruning" those connections.
• In the continual-activation theory, we dream to keep the brain active while we sleep, in order to keep it functioning properly.

Lucid dreams are relatively rare dreams where the dreamer has awareness of being in their dream and often has some control over the dream content. Research indicates that around 50% of people recall having had at least one lucid dream in their lifetime and just over 10% report having them two or more times per month.

It is unknown why certain people experience lucid dreams more frequently than others. While experts are unclear as to why or how lucid dreaming occurs, preliminary research signals that the prefrontal and parietal regions of the brain play a significant role.

How to Lucid Dream

Many people covet lucid dreaming and seek to experience it more often. Lucid dreaming has been compared to virtual reality and hyper-realistic video games, giving lucid dreamers the ultimate self-directed dreamscape experience.

Potential training methods for inducing lucid dreaming include cognitive training, external stimulation during sleep, and medications. While these methods may show some promise, none have been rigorously tested or shown to be effective.

A strong link has been found between lucid dreaming and highly imaginative thinking and creative output. Research has shown that lucid dreamers perform better on creative tasks than those who do not experience lucid dreaming.

Stressful experiences tend to show up with great frequency in our dreams. Stress dreams may be described as sad, scary, and nightmarish .

Experts do not fully understand how or why specific stressful content ends up in our dreams, but many point to a variety of theories, including the continuity hypothesis, adaptive strategy, and emotional regulation dream theories to explain these occurrences. Stress dreams and mental health seem to go hand-in-hand.

• Daily stress shows up in dreams : Research has shown that those who experience greater levels of worry in their waking lives and people diagnosed with post-traumatic stress disorder (PTSD) report higher frequency and intensity of nightmares.
• Mental health disorders may contribute to stress dreams : Those with mental health disorders such as anxiety, bipolar disorder , and depression tend to have more distressing dreams, as well as more difficulty sleeping in general.
• Anxiety is linked to stress dreams : Research indicates a strong connection between anxiety and stressful dream content. These dreams may be the brain's attempt to help us cope with and make sense of these stressful experiences.

A Word From Verywell

While there are many theories for why we dream, more research is needed to fully understand their purpose. Rather than assuming only one hypothesis is correct, dreams likely serve a variety of purposes.

Knowing that so much is left uncertain about why we dream, we can feel free to view our own dreams in the light that resonates best with us.

If you are concerned about your dreams and/or are having frequent nightmares, consider speaking to your doctor or consulting a sleep specialist.

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Eichenlaub JB, Van Rijn E, Gaskell MG, et al. Incorporation of recent waking-life experiences in dreams correlates with frontal theta activity in REM sleep . Soc Cogn Affect Neurosci . 2018;13(6):637-647. doi:10.1093/scan/nsy041

Zhang W. A supplement to self-organization theory of dreaming .  Front Psychol . 2016;7. doi:10.3389/fpsyg.2016.00332

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Blagrove M, Hale S, Lockheart J, Carr M, Jones A, Valli K. Testing the empathy theory of dreaming: The relationships between dream sharing and trait and state empathy . Front Psychol . 2019;10:1351. doi:10.3389/fpsyg.2019.01351

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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• 10 Research Question Examples to Guide Your Research Project

10 Research Question Examples to Guide your Research Project

Published on October 30, 2022 by Shona McCombes . Revised on October 19, 2023.

The research question is one of the most important parts of your research paper , thesis or dissertation . It’s important to spend some time assessing and refining your question before you get started.

The exact form of your question will depend on a few things, such as the length of your project, the type of research you’re conducting, the topic , and the research problem . However, all research questions should be focused, specific, and relevant to a timely social or scholarly issue.

Once you’ve read our guide on how to write a research question , you can use these examples to craft your own.

Note that the design of your research question can depend on what method you are pursuing. Here are a few options for qualitative, quantitative, and statistical research questions.

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What Do You Think About Your Dreams? The Construction of a Belief About Dreams Questionnaire

1 Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, People’s Republic of China

Feilong Yang

2 Psychosomatic Health Institute, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, People’s Republic of China

3 Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China

4 Center for Psychological Development and Service, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People’s Republic of China

5 Mental Health Education Center, Hunan University of Technology and Business, Changsha, Hunan, 410205, People’s Republic of China

Yunlong Deng

Background and purpose.

Nightmare distress (ND) is associated with a broad spectrum of psychopathological conditions such as anxiety, depression and bipolar disorder. Some studies have indicated that dream beliefs play an important role in the occurrence and treatment of nightmare distress. However, existing instruments used to assess dream beliefs either fail to satisfy the requirements of the psychometrics or fail to capture the essence of dream beliefs. This research pursued two objectives: (1) to develop a questionnaire, called the Beliefs About Dreams Questionnaire (BADQ), to measure beliefs people hold about their dreams and (2) to describe the dream beliefs of Chinese college students.

The structure and items on the BADQ were based on the previous literature and were the result of an open questionnaire. Some items were deleted through expert review and the result of predict test. To evaluate its validity and reliability, a sample of 1408 Chinese college students from two universities answered the BADQ, the Chinese version of Van Dream Anxiety Scale (CVDAS), the Dream Survey Questionnaire (DSQ), the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7(GAD-7) Questionnaire. After two weeks, 95 of them answered the BADQ again. Exploratory factor analysis (n=704) and confirmatory factor analysis (n=704) were conducted to explore and verify the structure of BADQ. The correlation between the CVDAS and the BADQ was calculated to evaluate the divergent validity.

The BADQ contains 26 items. Exploratory factor analysis indicated a five-factor structure: Dream omen and health, Dream superstitions, Dream meaninglessness, Dream reality, and Dream attitude. The result of the confirmatory factor analysis also supported the five-factors structure. Acceptable internal consistency (Cronbach’s α of all subscales exceeded 0.80) and ordinary to moderate test-retest reliability (the intraclass correlation coefficient of all subscales ranged from 0.467 to 0.713) of the BADQ were presented. Low degree correlation between the CVDAS and the BADQ (ranged from to −0.052 to 0.219) showed that they were two different variables, indicating a good divergent validity.

The present investigation revealed moderate to high construct validity and reliability of the BADQ.

Introduction

Nightmares are disturbing dreams that involve unpleasant emotions such as anxiety, fear, sadness, anger, and desperation and result in abrupt awakenings. 1 , 2 A number of studies have suggested that the frequency and distress of nightmares are related to a broad spectrum of mental health disorders. 3 – 7 Nightmare distress (ND) refers to the waking suffering or distress associated with nightmares, 8 , 9 which mainly consists of sleep-related complaints and daytime dysfunction. 10 With the deepening of the research, numerous researchers have pointed out that compared with nightmare frequency (NF), ND is more closely related to psychopathology, 8 , 9 , 11 , 12 especially for psychological disorders marked by a high level of negative affect (eg, anxiety and depression). 13 , 14

In the field of ND, Belicki believes that ND partly arises from the people’s views and their evaluation of their dreams after they wake up. 9 In one of his studies, he interviewed people with frequent nightmare but different level of ND, and he found that high-distress people regarded their nightmares more seriously, paid more attention to their nightmares, and were less likely to dismiss their nightmare as merely dreams (e.g., they see nightmares as a sign that something bad will happen). 9 Furthermore, researchers also found that in the treatment of nightmares, ND can be effectively reduced by modifying the beliefs about dreams (e.g., that what happens in dreams will come true). In a treatment study for Posttraumatic Stress Disorder (PTSD), nightmare distress was reduced by psychoeducation, which allowed beliefs about dreams to be corrected. 15 In a clinical treatment of nightmares, Belicki taught nightmare sufferers to modify their beliefs about nightmares (instead of attempting to reduce nightmare frequency) and found that ND was alleviated. 16 As mentioned above, we know that people’s beliefs about dreams play an important role in the occurrence and treatment of nightmare distress.

Besides, the associations between dream beliefs and other variables (e.g., dream recall frequency, dream content, physical health, personality, and treatment effect) also indicated the importance of dream beliefs. Some researchers suggested that those who regarded dreams as meaningful and valuable reported a higher dream recall frequency. 17 – 19 Hall’s study suggested that people who deemed dreams have no meaning tended to be creative and think independently. 20 King and Decicco found that individuals who hold the belief that dreams reflect their physical health reported more body parts in their dreams and showed significantly lower physical functioning, and people who were indifferent to their dreams actually reported higher levels of well-being. 21 Furthermore, people who believed that dreams contained information about spiritual beliefs reported fewer misfortunes in their dreams, and they scored higher on meta-personal self-construal. 21 A therapy patient who views dreams as symbolic and psychological will gain more useful information from his or her dream during psycho-analytical treatment. 22 Several studies have found gender differences concerning dream beliefs; usually, females have a more positive attitude toward their dreams than males, and they are more likely to believe that dreams have some special functions, such as reflecting our daily life or carrying a message from God or the devil. 19 , 23 – 25 In conclusion, dream beliefs are important, and it is necessary for us to be concerned with them.

Nowadays, several questionnaires and scales are used to study dream beliefs. Hall developed a 35-items Dream Belief Questionnaire (DBQ), which contained eight types of dream beliefs. 20 However, in this scale, two subscales (mystical and religious) had a similar meaning. For example, “I believe that a dream can carry a message from the spirit world (mystical)” and “I believe that a dream can contain a spiritual or religious message (religious)”. It is inappropriate that two similar dimensions appear in one scale. Dominic et al developed the Inventory of Dream Experiences & Attitude (IDEA) to assess dream beliefs. 26 Some of the 50 items measured dream beliefs, and other items measured dream content and dream recall. It is known that dream recall and content do not figure into dream beliefs; therefore, this questionnaire cannot accurately capture the importance of dream beliefs. Mazandarani et al developed the Iranian version of the Dream Belief Questionnaire, called My Beliefs About Dream Questionnaire (MBDQ). 27 MBDQ contained 25 items and identified six subscales. However, the last subscale “Dreams as essential to health,” only had two items, which does not meet the requirements of psychometrics. 28 Furthermore, except for “Dream as carrying a message”, the internal consistency coefficient for the other five subscales were found to be 0.65 or lower, suggesting that these factors are somewhat heterogeneous. 29 At present, only one dream attitude scale has been used in China, but this scale has not been standardized. 30 As mentioned above, the existing instruments are subject to shortcomings. Since ancient times, China has a keen interest and a unique view about dreams. It is worthwhile to develop a new questionnaire that combines the existing achievements with Chinese native culture to measure Chinese people’s beliefs about dreams.

This research pursued two main objectives: (1) to develop a questionnaire, the Beliefs about Dreams Questionnaire (BADQ), to measure beliefs people hold about their dreams. (2) to describe the dream beliefs of Chinese college students. For the purposes of this study, dream beliefs are defined as people’s views on dreams, including whether dreams having meanings, and what these meanings are.

Scale Design and Development

In formulating the dimensions of dream beliefs, we made use of existing measures of dream beliefs. We excluded the dimensions that are not related to the dream beliefs, and added dimensions based on the literature to create our preset dimensions: Dream omen (e.g., I believe that what I have dreamed may happen), Dream reality (e.g., I believe that dream contents are linked with my experiences), Dream creativity (e.g., I believe that a dream can inspire me), Dream health (e.g., I believe that dreams are related to a dreamer’s health and mood state), Dream superstition (e.g., I believe that we can communicate with people who have passed away through dreams), Dream learn (e.g., I believe that dreams can consolidate memories), and Dream attitude (e.g., I like dreaming).

Items were compiled in three ways. First, many the items are based on previous scales measuring beliefs about dreams, such as the BDQ, the IDEA and the MADQ. Second, we reviewed Chinese classical literature, refined the description of dreams in Chinese culture, and then compiled some items. Third, we developed an open questionnaire and surveyed 150 college students, and some items were added using the results of the open questionnaire. This led to the original version of the Beliefs about Dreams Questionnaire, which included 52 items describing different beliefs about dreams.

To ensure the content validity of the questionnaire, 14 psychologists were invited to evaluate the questionnaire. They modified the wording of some items, deleted the duplicated items, and ensured that the sentences are simple and easy to understand. Finally, 29 items were left. These 29 items were tested by 128 college students, and none of the items were deleted after the item analysis. There were no any sentences that were difficult to understand.

The instructions were

Some attitudes and beliefs about dreams follow. Please read them carefully and state your opinion (to what extent you agree or disagree) on each sentence. Please answer the question according to your general attitude and opinion in most cases.

The response format entailed a five-point Likert-type scale reflecting similarity ratings (1=strongly disagree, 2= disagree, 3=neutral or do not know, 4=agree, 5=strongly agree).

Participants

The cluster stratified random sampling method was used to conduct a collective survey in two universities (Hunan Business University and Hunan University of Chinese Medicine). The participants included 1600 undergraduate students: 1408 (606 males, 802 females) fully completed the questionnaires. The effective return ration was 88%. The mean age of the sample was 19.39 (SD=1.63), with ages ranging from 16 to 25. We randomly divided the subjects into two equal groups using the SPSS algorithm. The first group, for exploratory analysis, consisted of 704 people, and the second group, for confirmatory analysis, consisted of 704 people. In order to examine the test-retest reliability of the BADQ, 110 students were randomly chosen for a second round of testing after two weeks, and 95 completed the BADQ. Participants under the age of 18 years not required parental content to join in this research. The research protocol was approved by the local ethics committee. The study was conducted in accordance with the Declaration of Helsinki.

All participants were informed of the purpose and content of the study, and informed consent was obtained. Participants used their break time or elective course time to complete the questionnaire. The questionnaire takes 15–20 mins to complete. All materials were collected within two weeks.

Dream Survey Questionnaire

An original Dream Survey Questionnaire (see Appendix ) was developed and utilized; items were selected from the Mannheim Dream Questionnaire 31 and Sleep and Dream Questionnaire. 4 Dream recall frequency was measured with a question requiring participants to estimate the number of dreams typically recalled per week. To determine nightmare and bad dream frequency, two seven-point scales (1=never, 2=less than once a month, 3=about once a month, 4=about two to three times a month, 5=about once a week, 6=several times a week, 7=almost every morning) were used.

The Chinese Version of Van Dream Anxiety Scale (CVDAS)

We used the Chinese version of Van Dream Anxiety Scale (CVDAS) to measure ND. The CVDAS is an assessment instrument that can evaluate dream anxiety caused by nightmare. Wang et al tested its reliability and validity in a Chinese population. 14 The contents of CVDAS include most impacts of nightmares on health, such as sleep problems, morning anxiety, psychological problems, impairment of daytime functioning, and autonomic symptoms. The CVDAS consists of 17 items, among which four items (items 7–10) are used to collect clinical information and are not included in the total scores, and the remaining 12 items are rated on a five-point Likert scale ranging from 0 (never) to 4 (often). Item 5 is related to autonomic hyperactivity and consists of 12 symptoms. Each of the 12 symptoms is also rated on a 0–4 scale. If the total score obtained for the 12 symptom scores is between 0 and 10, the sum score of this item is 0; if it is between 11 and 20, it is 1; if it is between 21 and 30, it is 2; if it is between 31 and 40, it is 3; and if it is between 41 and 48, it is 4. Thus, the scores for the 13 items are summed up to yield a global CVDAS score of 0–52. The CVDAS showed excellent internal consistency (Cronbach’s α coefficient was 0.926) and good test-retest reliability (the intraclass correlation coefficient was 0.942).

The Patient Health Questionnaire-9 (PHQ-9)

Depression will be assessed using the patient health questionnaire (PHQ-9). The PHQ-9 consists of nine items. All items are rated on a four-point scale (ranging from 0 to 3), with higher total scores indicating more severe depression (scores of 5–9, 10–14, 15–19 and ≥20 indicate mild, moderately severe, and severe depression, respectively). 32 The PHQ-9 demonstrates high internal consistency (Cronbach’s α between 0.86 and 0.89) and high test-rest reliability (ICC between 0.84 and 0.95). 32 – 34 The Chinese version of the PHQ-9 is a nine-items, self-reported inventory that has shown good reliability and validity (Cronbach’s α=0.86). 33

The Generalized Anxiety Disorder-7 (GAD-7) Questionnaire

Anxiety will be assessed using the generalized anxiety disorder-7 questionnaire (GAD-7). It is a seven-item self-reported scale which is used to measure the severity of generalized anxiety disorders. 35 All items are rated on a four-point scale; the total score ranges from 0 to 21. Scores of 5–9, 10–14 and ≥15 indicate mild, moderate, and severe anxiety, respectively. 35 The GAD-7 has shown good validity and reliability in several languages (Cronbach’s α between 0.89 and 0.92). 35 – 37 The Chinese version of GAD-7 showed an excellent internal consistency (Cronbach’s α coefficient was 0.898) and good test-retest reliability (the intraclass correlation coefficient was 0.856). 37

Data Analysis

SPSS24.0 and Amos23.0 were used to analyze data. The exploratory factor analysis (EFA), using principal axis factoring (PAF) and Promax rotation, was employed to explore the factor structure. Meanwhile, Amos 23.0 was used to perform confirmatory factor analysis (CFA) to verify the structural validity of the questionnaire. Means and standard deviations of the BADQ and the correlation between the factors were calculated. To study the internal consistency of the BADQ, the Cronbach’ α was calculated. Intra-class correlation coefficient (ICC) was used to analysis the test-retest reliability. The correlation between the CVDAS and of the BADQ was calculated to test the divergent validity of BADQ.

In addition to the basic reliability and validity analysis, we also did some auxiliary analysis. In order to verify if there were gender differences between participants on dream beliefs, an independent-samples t -test was computed. To better understand the variation and variability of BADQ, a hierarchical cluster analysis was used. The cluster analysis, which allows for the systematic identification, organization, and description of behavioral patterns observed within a group of individuals, 38 was performed on group participants based on similarities in the types of dream beliefs. The Ward method and Euclidean distance were used for computing cluster analysis. 38 The final clusters were identified based on interpretability of clusters and also based on the significant difference between two clusters. Next, an independent-samples t -test or analyses of variance (ANOVAs) were used to compare the difference between dream beliefs and various variables (e.g., nightmare distress, nightmare and bad dream frequency, dream recall frequency, and psychopathology).

Item Analyses

There were no items that produced an extreme means, and there were not any items that showed a 75% endorsement of a single Likert response. Items 11, 12, and 14 were dropped due to redundancy (they were correlated 0.612, 0.630, 0.721 with other items). The total scores of all items in the questionnaire were ranked from low to high. The first 27% were selected as the low group and the last 27% as the high group. The mean values of the two groups on the same question were tested for differences, and all items reached a significant level.

Structure Validity

The EFA was performed on scores from a randomly selected subsample (n=704). The significance of Bartlett’s test of sphericity was observed (χ 2 =9680.23, p<0.001). The KMO value was 0.914, which was considered perfect. 39 These results suggested that the factor analysis was appropriate. The final analysis, which produced the best solution, was comprised of 26 items. As is seen in Table 1 , five factors were extracted (based on an eigenvalue>1 and scree criterion). In totally, these factors accounted for a total of 63.88% of the variance in item responses (Factor 1=32.24%, Factor 2 =13.08%, Factor 3=8.78%, Factor 4=5.26% and Factor 5=4.51%). According to the results of the EFA and the content of the five factors, the five factors were labeled as follows: Factor 1 (7 items): Dream omen and health, Factor 2 (6 items): Dream superstition, Factor 3 (5 items): Dream meaninglessness, Factor 4 (4 items): Dream reality, Factor 5 (4 items): Dream attitude.

Factor Loadings for BADQ Items in Pattern Matrix

Note: Bold data indicates which factor the items belong to.

The CFA was conducted on the remaining members of the sample (n=704) using maximum likelihood estimation to evaluate the fitness of the EFA identified five-factor model. Generally, the cut-offs for acceptable fit are χ 2 /df≤5, RMSEA≤0.08 and GFI, CFI and IFI≥0.9. 40 As is shown in Table 2 , the five-factor model (model 1) did not fit the data well. We therefore modified the model according to the item contents and modification index. Both item 17 (“I believe that dreams can affect mental health”) and item 18 (“I believe that dreams are related to a dreamer’s health and mood state”) belonged to Factor 1: Dream omen and health. Both of the two items were associated with health, so the error correlation between item 17 and 18 was acceptable. After setting the error of these two items as free estimation, model 2 was established, and the CFA was conducted again. As is seen in Table 2 , model 2 fitted the data well.

Comparison of Fitting Indexed for Models 1 and 2 (N=704)

Pearson correlations between the factors of the BADQ were calculated ( Table 3 ), ranging from −0.251 (Dream meaninglessness and Dream attitude) to 0.656 (Dream omen & health and Dream attitude). Just as we expected, Dream meaninglessness was negatively correlated with the other four factors.

Pearson Intercorrelations Between BADQ Factors, Reliability and Divergent Validity

Notes: *p<0.05, **p<0.01

Abbreviations: CVDAS, the Chinese version of Van Dream Anxiety Scale; ICC, interclass correlation coefficient.

Divergent Validity

The divergent validity of the scale was evaluated through the examination of correlations between the BADQ and the CVDAS (see Table 3 ). Both the BADQ and then CVDAS are used to measure dreams, but the former focuses on beliefs and the latter focuses on subjective distress. A low correlation with other confounding variables indicates good divergent validity. 41 The four factors of BADQ were found to show consistently positive correlations of low magnitude with the ND measure of the CVDAS (r=0.150 for Dream omen and health, r=0.219 for Dream superstitions, r=0.050 for Dream reality and r=0.125 for Dream attitude). Dream meaninglessness was negatively correlated with CVDAS (r=−0.052) in a low magnitude. These findings indicated that the BADQ had good divergent validity.

Reliability

Internal consistency was evaluated by Cronbach’s α. The alpha reliabilities of all BADQ factors were high, they ranging from 0.821 to 0.902, which was acceptable 29 (Dream omen and health: α=0.848, Dream superstition: α=0.902, Dream meaninglessness: α=0.821, Dream reality: α=0.836, and Dream attitude: α=0.868) (see Table 3 ).

The test-retest reliability was tested by ICC. 42 The reliability coefficients for the Dream omen and health, Dream superstition, Dream meaninglessness, Dream reality and Dream attitude were 0.713, 0.467, 0.521, 0.497 and 0.505, respectively, reflecting ordinary to moderate stability for these factors 43 (see Table 3 ).

Gender Differences

An independent-samples t -test was used to examine the beliefs about dream across genders. As is seen in Table 4 , except for Dream attitude, females obtained significantly higher scores than males across the rest of the four factors.

Mean Score for Males and Females and Gender Difference for Each Factor of BADQ

Notes: *p<0.05, **p<0.01.

Dreamer Profiles Differences

Two distinct profiles were elucidated. In total, 412 participants (29.3% of the sample) are Indifferent Dreamers: they believe that dreams have no real meaning. The remaining 996 participants (70.3% of the sample) are Interested Dreamers: they consider dreams to be meaningful. As can be seen in Table 5 , except for Dream meaninglessness, Interested Dreamers obtained significantly higher scores than Indifferent Dreamers across the other four factors. The t -test showed a significant difference between the two profiles on DRF and in the frequency of bad dreams/nightmares. The Indifferent Dreamers showed lower level of nightmare distress, depression and anxiety than Interested Dreamers, as measured by the CVDAS, PHQ-9 and GAD-7, respectively.

Comparison Between Different Dreamers Profiles

Notes: *p<0.05, ** p<0.01.

Abbreviations: DRF, dream recall frequency; BDF, bad dream frequency; NF, nightmare frequency; CVDAS, the Chinese version of Van Dream Anxiety Scale; PHQ-9, the Patient Health Questionnaire-9; GAD-7, the Generalized Anxiety Disorder-7 Questionnaire.

In the present study, a multidimensional scale of belief about dreams was developed. The BADQ consisted of five factors and assessed beliefs about dreams. The hypothesized Dream creativity did not emerge in this analysis. The final factors, which included Dream omen and health, Dream superstition, Dream meaninglessness, Dream reality and Dream attitude all showed adequate internal consistency, two-weeks test-retest reliability, and divergent validity. The differences in beliefs about dreams between males and females were examined. A hierarchical cluster analysis was used to divide the participants into two categories, and the Indifferent Dreamers showed higher levels of well-being than the Interested Dreamers.

Factor Interpretations

The results of the EFA and CFA provided support to the allocation of the items to the five factors. We titled Factor 1 as Dream omen and health, and it had 15% variance. This factor consisted of seven items expressing the underlying idea that dreams can foretell the future and can reflect upon one’s health. This is in line with the views of ancient Chinese thinkers and medical experts on dreams: medical experts believed that the main function of dreams was to reflect people’s health, and thinkers believed that the function of dreams was mainly to predict good or bad luck. 44 In ancient China, most people believed that dreams could foretell the future. There were professional dream interpreters and specialized books (such as the Duke of Zhou) that helped people to interpret the meaning of their dreams. Even today, there are still many people who explain their dreams using the book above. In addition, the earliest Chinese medical classics (such as Huangdi’s Classic on Medicine) explained the relationship between dreams and physical health: for example, if a person was weak, he/she would dream of water; and if the person was strong, he/she would dream of fire. 45 In Western dream theory, dreams also have these two functions. 46 , 47

The second factor was Dream superstition with six items. This factor was related to people’s beliefs that dream are closely connected to spiritual dimensions. People who scored high on this factor usually believed that dreams could reflect their previous lives and the activity of their soul. At the same time, they agreed that they could communicate with Bodhisattva, ghosts, and the dead through dreams. This factor was similar to both “Dream Guidance” in IDEA and “Carrying message” in MBAD. In ancient China, there were many literary works describing the dream superstitions. Ghosts, Bodhisattva and deceased people enter people’s dreams, make confessions, reveal the truth to clear up injustices, warn, and persuade people to be good. 48 In the famous Chinese story “Injustice to Dou E”, Dou appeared to her father in a dream and said, “I was wrongfully killed, please find out the truth”. Her father investigated and was able to wash away the grievances of Dou E. 49 Western prescientific dream theories saw dreams as messages coming from outside the individual, mostly from god-like creatures. 46

Factor 3 (Dream meaninglessness) comprised five items. Meaninglessness was similar to Hobson’s view on dreams: he asserted that dreams are the result of limbic activity and have no meaning. 50 People who scored high in this factor tended to believe that dreams had no impact on their life; consequently, they did not pay attention to their dreams. No research regarding this belief has been conducted in China. A Canadian study showed that only 6.5% of the participants thought that dreams are meaningless. 21

We named the Factor 4 as Dream reality, which was analogous to the Dream Continuity of IDEA. The four items in this factor assessed people’s beliefs that the content of their dreams is related to waking-life experiences and that dreams could reflect conscious and unconscious desires. 21 , 51 A number of patients believed that daytime problems played an important role in their dreams. 52 There is a saying in China that men do not dream of giving birth and women do not dream of bows and arrows. This is because that they have not experienced these events and, therefore, did not dream about them. 45 At present, some research supports the “continuity hypothesis”, that is, that the content of dreams reflects waking activities. 53 , 54

The last factor is Dream attitude with four items concerning people’s attitude about dreams. This factor contains items about whether participants are willing to remember their dreams, whether they are willing to share their dreams, and whether they like or dislike dreams. Only one study in China focused on the attitude towards dreams, and it found that the positive attitudes towards dreams can predict individuals’ willingness to engage in psychoanalytic interpretation therapy. 30

The result of the current study indicated that the BADQ was a reliable test for the measurement of dream beliefs. According to Cuieford, alpha coefficients greater than 0.70 are acceptable. 29 The alpha coefficients in this study for all factors were good to excellent (0.821–0.902). As all alpha coefficients in the current study were greater than 0.80, the BADQ possessed stronger internal consistency than the MADQ, which had yielded factor alphas below 0.50.

The retest results after two weeks showed that the retest correlation of the five factors of BADQ ranged from 0.467 to 0.713. A phenomenon that may affect retest reliability in the fact that we often have different views about different dreams. For example, if I dream of being rich, I hope it will come true. However, if I lose money in a dream, I will decide that the dream is fake. It is likely that participants had different dreams between the two tests, leading to ordinary(0.41<ICC<0.60) retest reliability.

The results of the current study suggest that the BADQ exhibited high levels of factorial validity. First, the degree of intercorrelation observed among the five factors ranged from weak (Dream meaninglessness/Dream superstition: −0.045) to moderate (Dream omen and health/Dream attitude: 0.656) suggesting that the factors were related but distinct. Dream meaninglessness was significantly negatively correlated with the other four factors. Second, the results of the confirmatory factor analysis indicated that the BADQ five-factor model provided a good fit of the data.

For the divergent validity, we calculated the Pearson correlation between dream beliefs and CVDAS. A Low degree of correlation showed that they were two different variables, indicating good divergent validity.

Gender Difference

When compared with males, females elicited higher scores in Dream omen and health, Dream superstition, Dream meaninglessness, and Dream reality; males and female showed similar scores in Dream Attitude. Females were more likely to agree that dreams had special functions, such as foretelling the future and reflecting mental and physical health, 27 , 46 , 55 which was the exact was the content of the Dream omen and health dimension. This study observed the same phenomenon. In the present study, females scored higher than males in Dream superstition, which was consistent with the previous result. 26 , 27 , 46 We also found that females scored higher than males in Dream meaninglessness. It was interesting that on the one hand, females agreed that dreams were meaningless, but on the other hand, they agreed that dreams had special functions as well. However, in previous studies, males generally found that dreams have no particular meaning. In Dominic’s study, he suggested that females were more likely to agree that dreams reflected our daily lives than males, 26 and we got the same result. Among the five factors, Dream attitude are the most studied. A lot of research has focused on attitudes towards dreams, and it has suggested that females generally have a more positive attitude towards dreams than males. 19 , 23 – 25 In this study, although females scored higher than males, the difference was insignificant.

Dream Profiles

As shown in the results, most of the participants (70.3%) are Interested Dreamers. The MADQ and this questionnaire have a similar structure: Mazandarani et al divided the Iranian participants into two groups using the same method (Convinced Dreamers and Unconvinced Dreamers). However, the Convinced Dreamers, who held the view that dreams are meaningful, only accounted for 57.0%. 27 Perhaps it is the strong culture of dream interpretation atmosphere in China that makes most people consider their dreams are meaningful. In future research, we can compare the differences in dream belief questionnaires (eg, BADQ and MADQ) between different regions and countries to explore cultural differences.

Furthermore, the results suggested that Interested Dreamers have a higher dream frequency (both bad dreams and nightmares) and a lower level of psychological health. What is the relationship between the frequency of nightmares/bad dreams, the belief about dreams and well-being? Maybe, as Dominic speculated, psychological distress makes people pay attention to all aspects of themselves, increasing people’s sensitivity and interest in their dream experiences. 26 Or, as well as affecting health, maybe frequent bad dreams and nightmares give people more insight into the dream itself and its content. In any case, we can know that the beliefs about dreams can reflect people’s health status.

Limitations and Directions for Future Research

The primary limitation of this research is the employment of a student sample. Such a sample may not be representative of individuals within the community or patients who suffer from nightmares, thus affecting the generalizability of our results. Besides, participants in this sample are of similar age and education; however, previous research has shown that people of different ages and education levels had different beliefs about dreams. Further research should examine the psychometric properties of the BADQ in samples more representative of the general population. Second, the design was cross-sectional, making it impossible to draw conclusions about the causality of the relationship between dream beliefs and psychological health. Does pre-existing dream beliefs influence psychological health or psychological health contribute to people’s increased sensitivity and interest in their dream? In order to figure out this question, longitudinal studies are needed.

Acknowledgments

We would like to thank Miss Yin Meng and Miss Li Siya for their help in data collection.

Ethical Approval

The Institutional Review Board (IRB) of The Third Xiangya Hospital in Hunan approved the study (2019-S255).

The authors declared no conflicts of interests in this work.