The Client Has Recurring Nightmares About Her Unborn Baby.
Introduction
First pregnancy is an important transitional phase during which a mental reorganization leads to development of a woman's maternal identity and future maternal competencies (Ammaniti and Trentini, 2009; Slade et al., 2009). Through the activation of a caregiving organization reciprocal to attachment (Solomon and George, 1996), this mental reorganization involves the elaboration and integration of maternal mental representations (MMR) of the unborn infant, of the woman as a female parent, of non-maternal self-features, and of other pregnant relationships (Ammaniti and Trentini, 2009; Slade et al., 2009). However, while feelings of connection to and amore for the unborn baby increment throughout pregnancy, the woman's capacity to consider the fetus and herself as two autonomous and carve up individuals is crucial to achieving a reciprocal and intimate relationship with the newborn child (Pines, 1972; Ammaniti and Trentini, 2009; Slade et al., 2009).
To date, empirical inquiry indicates that the nature and qualities of MMR (due east.g., their richness, specificity, and emotional tone) are principally rooted in the woman's internalized representations of the self and the other (Priel and Besser, 2001). They are likewise likely influenced by contextual factors such as actual relationships with her partner and family unit (Pajulo et al., 2001), psychological state (Pajulo et al., 2001; Theran et al., 2005), perceived fetal movements (Zeanah et al., 1990), ultrasound procedures (Viaux-Savelon et al., 2012), and high-hazard environmental factors (Theran et al., 2005; Ammaniti et al., 2013). Time-dependent variations in the quality of MMR have also been described in several studies. Third trimester pregnant women have singled-out, differentiated and emotionally invested MMR (Ammaniti et al., 1992), with a substantial presence of fearful imagery and worries almost the child and the self as a mother (Vizziello et al., 1993; Leckman et al., 2004). These MMR display peak levels of richness and specificity by the 7th month of pregnancy with a subsequent decline up to childbirth (Stern, 1995; Innamorati et al., 2010). Stern (1995) interpreted this late decline equally a need for the adult female to "undo" her representations of the imagined child in lodge to prevent thwarting when finally contiguous with the actual child.
Since the woman lacks information about her real baby, the evolution of MMR is thought to result from her projections, hopes, attributions, witting and unconscious fantasies, and dreams (Stern, 1991, 1995; Ammaniti and Trentini, 2009; Slade et al., 2009). However, studies have principally investigated the more conscious aspects of MMR while giving surprisingly fiddling attending to whether more unconscious processes, such as dreaming, might also contribute to their system.
Dreaming is a course of mental activity occurring during slumber that can exist recalled upon enkindling. It is considered past some to exist responsive to new emotion-evoking situations requiring accommodation, especially situations involving shut friends and family members (Cartwright, 2005, 2010; Nielsen and Lara-Carrasco, 2007). By linking memories and emotions in a less linear fashion than during waking idea (Hartmann, 1996), dreams are believed to connect recent emotional experiences to self-relevant memories and thereby to optimize psychological equilibrium and coherence of the cocky-system (Cartwright, 2005, 2010). In support of this possibility, content analyses have shown dreams to exist highly social in nature, predominantly portraying interpersonal conflicts and concerns (Nielsen et al., 2004; McNamara and Szent-Imrey, 2007). Some clinical studies go further to support a regulatory function for dreaming in showing, for example, that clinically depressed divorcees who dream emotionally about their ex-spouses at intake are more than likely to be psychologically well-adjusted several months after than are divorcees who do not report these types of dreams (Cartwright, 1991; Cartwright et al., 2006). Other studies with good for you subjects find that sadness dissipates across the night, a change that is positively associated with the number of intervening dream characters [for a review, see Kramer (2007)]. Based on such findings, information technology may exist that life transitions involving the breaking or the (re)structure of meaning relationships trigger representations of these relationships and associated emotions during dreaming, and that this socially structured dreaming facilitates the individual's adaptation to his/her new social context (Nielsen and Lara-Carrasco, 2007; Cartwright, 2010).
Accordingly, every bit pregnancy is an important flow of mental reorganization near feelings, cognitions and relationships relating to the self and the unborn baby, pregnant women might well be expected to express these feelings, cognitions and relationships in their dreams. In this respect, a small number of systematic studies (Blake and Reimann, 1993; Van et al., 2004; Nielsen and Paquette, 2007) indicate that the vast bulk of pregnant women (67–88%) study having at least i dream relating to a babe, pregnancy, or childbirth. Some others report that 30–62% of pregnant women'southward dreams refer to at least one of these maternal elements (Gillman, 1968; Van De Castle and Kinder, 1968; Winget and Kapp, 1972; Sered and Abramovitch, 1992) and that such dreams increase in frequency with advancing gestational age (Blake and Reimann, 1993). While such pregnancy dreams typically refer to the mother's physical well-being and to the sex of the unborn baby (Sered and Abramovitch, 1992), they also oftentimes comprise elements of misfortune, injury or threat toward the infant, the mother or the father (Blake and Reimann, 1993; Van et al., 2004), and marital and familial issues (eastward.thou., fear of losing the partner, dependency-independency issues with their own mother) (Van De Castle and Kinder, 1968). Other mutual themes relate to postpartum parental responsibilities and the fear of beingness an inadequate parent (Van De Castle and Kinder, 1968; Van et al., 2004). The few available comparative studies indicate that, relative to non-pregnant controls, pregnant women call back more dreams with pregnancy related themes (e.g., fetus, pregnancy, childbirth, one's own body, the infant'south body) and more than elements of danger toward the fetus and the cocky (Gillman, 1968; Van De Castle and Kinder, 1968; Dagan et al., 2001; Nielsen and Paquette, 2007). The dreams of meaning women are also more negative (Gillman, 1968; Nielsen and Paquette, 2007) and contain more masochistic elements (i.e., misfortune, harm, environmental threats) but not more aggressive acts (Gillman, 1968).
In sum, though limited in number, studies provide ample show that MMR are expressed during dreaming. That MMR are frequently very emotional in nature provides some support for the suggestion that they are remodeled during dreaming and maybe serve a function in regulating emotions associated with this important developmental transition. Masochistic dreams have, in fact, been related to better outcomes, such as shorter labor durations (Mancuso et al., 2008) and less depressed mood 6–ten weeks postpartum (Kron and Brosh, 2003).
Even so, most of the studies reviewed hither contain of import methodological flaws. First, prospective and longitudinal studies are notably lacking; existing studies are based largely on retrospective methods of dream collection that favor the recall of baroque and intense dreams over more than emotionally representative dreams (Schredl, 2010). Also, existing prospective studies exploit very small samples or fail to appraise dream content related specifically to MMR; most none command for potential confounders that might affect dream content or emotions, such equally demographic characteristics and psychological land. To illustrate, masochistic dreams characterize depression-prone subjects and co-vary with the severity of depressed mood (Agargun, 2010); thus, as pregnancy is a period of increased risk for depressive disorders (Marcus, 2009), the finding of more negative dream elements during pregnancy needs to exist replicated with appropriate controls for depressive mood. Finally, no available studies take examined whether dreamed MMR modify in the terminal months of pregnancy as waking MMR do between 7 months and nascence (Stern, 1995; Innamorati et al., 2010). Therefore, in add-on to more prospective and carefully controlled studies, descriptive enquiry is needed to clarify how dream content expresses MMR and how such content varies temporally toward the end of a start pregnancy.
Objectives and Hypotheses of the Report
Objectives
This descriptive comparative study was function of a larger longitudinal study investigating the dream and sleep characteristics of third trimester, nulliparous, pregnant women (i.e., at least 26 weeks or seven months of gestation) and the capacity of these characteristics to predict delivery outcomes and postnatal low.
In the present study, the get-go objective was to compare the prospectively nerveless dreams of nulliparous pregnant women, early on and late 3rd trimester, with those of non-pregnant women on several measures designed to assess MMR in dreams. Several of these measures were based upon Stern's (1991, 1995) comprehensive theoretical conceptualization of mental system specific to the motherhoped-for that he terms the "motherhood constellation." We besides developed measures to assess the quality of representations of babies or children (i.east., the intensity of interaction with the female parent and the level of separateness from the mother) and their valence (i.e., babe depicted negatively and/or as being in danger). Finally, we assessed whether the number of MMR and the quality of baby/child representations changed in the concluding stages of pregnancy (i.e., from the seventh to the eighth and 9th months of pregnancy).
The 2nd objective of the written report was to comparatively assess the frequencies of pregnancy-related dream themes (i.e., fetus, pregnancy, childbirth, human body) in gild to replicate and correct methodological issues of previous studies. Whether these themes changed in frequency in the last stages of pregnancy was also explored.
The third objective was to examine not-MMR dream characteristics to determine whether more than distal dream processes and characteristics are altered during pregnancy. These included dysphoric dream elements, dream interactions, and the capacity to report well-developed dream narratives (i.e., the dreamer's ability to form a dream connected to other memory material). Once again, we explored whether these characteristics were subject to change throughout the last stages of pregnancy.
Hypotheses
(1) Nosotros expected that the dreams of 3rd trimester pregnant women would comprise more MMR, but not more representations of the self as a friend or in a work office. Because mental representations of the family accept been found to gradually replace those of work and the significant adult female'southward wider social context (Smith, 1999), representations related to friendship and work role were expected to be less frequent in their dreams. We also expected that dreamed MMR and representations of the cocky every bit friend or work colleague would be less prevalent amidst late than among early 3rd trimester pregnant women.
(2) On the other hand, we expected that dream images about babies and children would be more specific and more negative amongst pregnant than among non-significant women, and amidst early than among late 3rd trimester meaning women.
(3) Finally, we expected dream characteristics relating to general emotions to differ between groups, with pregnant women having more dysphoric dream elements (due east.one thousand., morbid and masochistic elements), but not necessarily more negative dream interactions (eastward.thou., lack of cooperation and aggressiveness). Also, since some clinical observations and cocky-study studies advise that dream material is more accessible during pregnancy (Raphael-Leff, 1991; Lee and Dejoseph, 1992; Ablon, 1994; Kennedy et al., 2007), nosotros expected that pregnant women would study better developed dream narratives.
Materials and Methods
Participants
One hundred twenty-iii healthy nulliparous women (62 third trimester pregnant women, 61 non-meaning women) aged between 18 and 39 years were recruited by advertising, via health care centers of the province of Québec (Canada), and past discussion of mouth over a 4-month period (August to December 2010). They reported recalling at least one dream per week and being free from astringent sleep and psychiatric disorders. None reported taking medications known to bear on sleep. Pregnant women did not report whatsoever major obstetric complications. Participation in the written report was on a voluntary ground requiring written consent with payment of $25 for expenses.
Two pregnant women and one not-significant adult female were excluded because they failed to complete all questionnaires; one additional pregnant woman was excluded due to insufficient ability to understand and write French. The report sample thus included 59 pregnant and sixty non-pregnant women. Significant women were divided into two groups: early third trimester (seven months or <thirty weeks of gestation; Northward = 37) and late 3rd trimester (8–nine months or ≥30 weeks of gestation; Northward = 22) for dream content comparisons designed to examine the 7-calendar month elevation in MMR richness and specificity described before.
Process
The inquiry was conducted in the Dream and Nightmare Laboratory of the Hôpital du Sacré-Coeur de Montréal (Canada), an affiliate of the Université de Montréal, and was approved by scientific and ethical boards of the ii institutions. Later on screening for inclusion and exclusion criteria on an initial phone interview, both groups of women received a set of questionnaires to complete at home and to return by mail to the laboratory when completed. The gear up included a custom demographics questionnaire, several psychological measures, and a prospective 14-solar day dream log (come across details below).
Demographic and Psychological Measures
Demographic questionnaire
All women completed a cocky-report questionnaire that included demographic information and in which they indicated any personal history of psychiatric problems on a single yep/no question ("I have had a major psychiatric disorder, due east.k., mood disorders, anxiety disorders, schizophrenia, psychosis, etc.").
State feet scale
Both groups completed the Spielberger Country and Trait Anxiety Inventory (STAI) (Spielberger et al., 1970). The STAI is a widely used self-report mensurate of feet with good psychometric qualities in the general population (Spielberger, 1983) and amid childbearing women (Grant et al., 2008). But the land anxiety scale of the STAI was used in the present study. It consists of 20 items rated on 4-point scales evaluating emotional land at the time of the assessment (range 20–80). The scale had adept internal consistency in the present study: Cronbach'due south α = 0.93 for significant women and.87 for non-significant women.
Low scales
Depressive symptoms were assessed using the Edinburgh Postnatal Depression Calibration (EPDS) (Cox et al., 1987) for pregnant women and the Beck Depression Inventory-Brusk Grade (BDI-SF) (Beck et al., 1974) for not-pregnant women. Low screening tools were dissimilar between groups since the EPDS is less reliant on somatic symptoms that are common during pregnancy (e.thousand., tiredness, ambition dysregulation) (Marcus, 2009). Both scales were used to classify women equally having likely depressive disorders using cut-offs specific to each population. The EPDS is a widely used 10-item questionnaire assessing perinatal low symptoms over the past 7 days using 4-point response scales (score range: 0–thirty). A score above 12 indicates probable depressive disorder with an overall sensitivity of 86% and specificity of 78% for all forms of (major and modest) depression (Cox et al., 1987). The questionnaire demonstrated acceptable internal consistency in the present study (Cronbach's α = 0.79). The BDI-SF is a 13-item questionnaire assessing depressive symptoms over the past 7 days using 4-point scales (score range: 0–39). A score higher up viii screens moderate to astringent depression in the general population with a sensitivity of 79% and a specificity of 77% (Nielsen and Williams, 1980). The scale had acceptable internal consistency in the present study (Cronbach's α = 0.77). Additionally, because dream emotions are known to exist affected by pre-slumber mood (Schredl, 2010), both groups answered a 1–five rating scale from the Sleep Disorders Questionnaire (Douglass et al., 1994) evaluating the occurrence of sadness/depressive feelings at bedtime (1 = never to 5 = all the time).
Dream Log
All women completed, for 14 consecutive days, a home dream log in which they were asked to describe upwards to three dreams per night (including naps). They were given a booklet containing 14 blank lined pages, each of which was followed past a 2nd page containing questions assessing sleep and dream characteristics. Participants were instructed to write downward their dreams immediately after awakening in the aforementioned lodge in which they occurred during the night. On the education folio, they were informed that dreams were not always intense or easy to recall and that sometimes they could be uncomplicated sensory experiences, such as auditory, visual, or actual impressions.
Overall, participants reported a total of 1795 dream narratives over the 14-day period (907 for pregnant women vs. 888 for non-significant women). Women indicated if there was no content to recall past checking the "no retrieve" box on the diary page. The number of dreams reported by a participant ranged from iv to 29 for significant women (early third trimester: G = 15.41, SD = six.60; belatedly 3rd trimester: M = 15.32, SD = 5.21) and from iii to 27 for non-significant women (M = 14.eighty, SD = v.63). Groups did non differ in the average number of dream reported per person (all p = ns). The mean number of words per dream was too calculated; a between groups analysis did not reveal any differences (non-significant: M = 94.92, SD = 5.44, early third trimester: Thou = 95.96, SD = 6.93, late 3rd trimester: M = 81.lxxx, p = ns).
Dream Content Assay
Dream reports were transcribed and presented in a randomized order to iii raters (Jessica Lara-Carrasco, Vickie Lamoureux-Tremblay, and Kadia Saint-Onge) who were blind to the dreamer's pregnancy status and other information. To appraise dream content specific to pregnancy, i.due east., dreamed MMR, pregnancy-related themes and the quality of baby or kid representations, dreams were scored using MMR and dream variables reviewed previously; other dream characteristics non specific to the pregnancy were assessed using validated scales for dream content analysis and ane mensurate of psychological functioning applied to the dream narrative (see details in department Materials and Methods beneath). To assess reliability levels between raters, 40% of the dreams were scored past at least 2 raters. Interrater reliability (Cohen Kappa's coefficient, k) is reported for each variable described beneath.
Dream content specific to pregnancy
Dreamed MMR . Dreamed MMR were analyzed following the "motherhood constellation" model adult by Stern (1991, 1995), which was based on numerous theoretical writings and empirical findings in the fields of psychological process in motherhood and female parent-baby attachment (e.1000., Winnicott, 1965; Fraiberg et al., 1975; Bowlby, 1980). These "representations-of-being-with" include internalized sets of relationships concerning the baby (i.e., representation of the babe as a person, as having a type of personality or character), the adult female (i.e., as a mother of this particular infant, as a wife to her husband, as a adult female with a career, every bit a friend, equally a daughter to her ain parents, as a specific fellow member of her original extended family), the babe's male parent, the woman's parents, other parental figures (e.g., k-parents, uncles and aunts, cousins), family groupings (i.e., triads), so on (Stern, 1991, 1995).
Dreams were rated for the presence (1) or absence (0) of each measure of the two following MMR categories: (ane) MMR characters: representations of the dreamer'southward partner, mother, father, family (triads), and/or whatsoever baby or child (k = 0.63–0.95), and (2) Social roles of the dreamer: when the dreamer was represented as a character in her dream, her social attributes were scored (if applicable) every bit being whatsoever of the post-obit: a mother, a spouse, a daughter, a member of her parents' family unit, a friend, and/or a worker/student (k = 0.47–0.85). Density scores were computed as follows: the number of each type of dreamed character was tallied and divided by the number of dreams reported across the 14 days, whereas the number each social role depicted was tallied and divided by the total number of occurrences of the dreamer across the 14 days. Extremely loftier z-scores were identified as univariate outliers on the following measures: occurrences of the dreamer's female parent, begetter, and spouse and occurrences of the dreamer as a mother and as a worker/student; these were replaced by scores at the z = three.29 limit.
Quality of infant or child representations . When a babe or a child image was present, its quality was evaluated on 1–9 Likert scales (i = not at all to nine = a lot) according to the intensity of the dreamer's interaction with the baby/kid (i.e., how much they interacted by gazing at, talking to, or touching each other) and to the specificity and individuality of the personality of the babe/child (i.east., how much the babe/kid was described as having his/her ain personality and as beingness an individual apart from the dreamer) (1000 = 0.lx and 0.52, respectively). Two other ane–9 Likert scales assessed the affective valence of the baby/child representation (i = negatively depicted to 9 = positively depicted) and how much the baby/child was depicted as being in danger (1 = no danger is directed toward the baby at all to ix = a lot of danger is directed toward the infant) (chiliad = 0.59 and 0.66, respectively). Each of these four variables was averaged over the 14 journal days. There were no univariate outliers on these variables.
Pregnancy-related themes . The presence (1) or absence (0) of 4 pregnancy-related themes was evaluated: content relating specifically to pregnancy, childbirth, a fetus and/or the human being trunk, regardless of whether the content fabricated reference to the dreamer herself or to some other dream grapheme (k = 0.l–0.92). Each variable was tallied and divided by the number of dreams reported beyond the 14 days. Extremely high z-scores were identified as univariate outliers on the childbirth and fetus variables and were replaced by scores at the z = 3.29 limit.
Other dream characteristics not specific to pregnancy
Dream characteristics not specific to pregnancy included development of the dream narrative, which classifies each dream into one of v categories derived from the Dream-like Fantasy Scale (see Cartwright et al., 2003, 2006): ane = no retrieve, ii = a thought, three = a single image, 4 = a dream (ii or more images with some connexion between them), and five = a well-developed dream (more than than two images with a well-developed plot) (k = 0.fourscore). Higher scores (4 and 5) are divers to reflect the dreamer'due south power to class a dream and connect it to other memory textile (Cartwright et al., 2006). This scale co-varies with the severity of depressive mood and predicts positive psychological outcomes amid depressed subjects (Cartwright et al., 2003, 2006). The scores for each dream were averaged over the 14 day-catamenia.
Dream masochism was scored using the Masochism scale for dreams [see Winget and Kramer (1979) for an in-depth description of the scale] by assigning a binominal score to each dream as existence either masochistic (ane) or non (0) (k = 0.87; coefficient calculated on ten% of dream reports). A masochistic dream is divers as an unpleasant dream in which the dreamer has negative characteristics and/or the dream'south upshot is negative. The dreamer is either depicted as less fortunate or less attractive than in reality (e.g., defective, ugly, sick), or is subjected to an unpleasant experience (e.g., thwarting, rejection, impecuniousness) (pp. 83–84 in Winget and Kramer, 1979). As mentioned earlier, dream masochism is correlated with current depressive state and vulnerability to depression (Agargun, 2010), simply studies among childbearing women have also found masochistic dreams during pregnancy to predict better postnatal depressive mood (Kron and Brosh, 2003) and delivery outcomes (Mancuso et al., 2008). The number of masochistic dreams was divided past the total number of dreams reported over the 14 days.
Finally, Aggressive (AG) and cooperative (COP) movements and morbid (MOR) dream content were derived from the Special scores categories of the Exner scoring system for the Rorschach Inkblot exam (Exner, 2003). The Exner scoring system has been applied to the scoring of dream narratives; homo movements were found to successfully distinguish female and male adolescents' dream content (Winegar and Levin, 1997). Another study constitute AG, COP, and MOR categories to be reliable measures of psychological operation when assessed in the dream content of children and adolescents living in situations of enduring violence (Kamphuis et al., 2008). For each dream report, the numbers of AG movements (dream action is conspicuously aggressive, including fighting, breaking, arguing, being angry, etc.), COP movements (interactions between two or more dream characters are clearly benevolent, cooperative or mutually supportive), and MOR elements (descriptions of dead, destroyed, damaged, polluted, degraded or broken dream elements, or a dysphoric feeling or character is attributed to a dream chemical element) were tallied and divided by the number of dreams reported across the 14 days (yard = 0.48–0.63).
Data Reduction and Statistical Analyses
To reduce the number of dependent measures and minimize multicollinearity between the dreamed MMR, a Principal Components Assay (PCA) with varimax rotation, using an eigenvalue >1 extraction benchmark with factor loadings >0.xl, was conducted on the density scores for five MMR characters (any baby or child, her partner, her mother, her father, her family) that conceptually matched to the density scores of four social roles of the dreamer (dreamer as female parent, spouse, girl of her parents, member of her own family). The assay yielded a iv-factor solution explaining, altogether, 80.8% of the variance: (1) "equally daughter-parents" (dreamer every bit girl of her parents and dreamer's female parent and male parent representations; 28.5% of explained variance), (2) "as spouse-partner" (dreamer equally spouse and dreamer'due south partner representations; 25.9% of explained variance), (three) "as mother-baby/child" (dreamer as mother and representations of babies and children; xiv.7% of explained variance), and (four) "as office of own family" (dreamer as function of her own family and representations of dreamer's family; 11.seven% of explained variance). Higher scores on each of these four composite scores indicated more frequent dreamed MMR. Other social roles of the dreamer (every bit friend, as worker/student) were converted to z-scores and examined separately; these were not highly correlated with other dreamed MMR (absolute r's ≤ 0.24).
Additionally, to avoid redundancy between the four variables relating to the quality of baby and child dreamed representations, a PCA with varimax rotation, using an eigenvalue >1 extraction criterion with factor loadings >0.40 was conducted, yielding a two-factor solution explaining birthday 70.1% of the variance: (1) "specificity of babe/kid relationships and personality" (intensity of the dreamer'southward interaction with the baby/child, specificity and individuality of the personality of the baby/child; 38.9% of explained variance), and (2) "endangered and negative babe/child representations" (21.8% of explained variance). Higher scores on each of these two factors indicated more specific baby/child representations and greater endangered and negative baby/child representations, respectively. Table 1 summarizes and describes the concluding sets of dream variables.
Table ane. Description of dream variables.
In social club to identify covariates to control in subsequent analyses, a series of one-way analyses of variance and chi-foursquare tests compared groups of women (not-pregnant women, early third trimester pregnant women, belatedly tertiary trimester pregnant women) on demographic and psychological characteristics. Four sets of one-way multivariate analyses of covariance (MANCOVAs) with pregnancy status (not-pregnant women, early 3rd trimester pregnant women, belatedly 3rd trimester meaning women) every bit the between-group factor, and dream variables pertaining to each of the categories listed previously (i.eastward., "Dreamed MMR," "Quality of baby or child representations," "Pregnancy-related themes," and "Other dream characteristics") as multiple dependent variables, were performed controlling for demographic and psychological characteristics previously identified. Univariate furnishings were examined using Bonferroni adjustments (p = 0.05/number of comparisons) to command family-wise Blazon ane errors (Tabachnick and Fidell, 2013). In that location were no multivariate outliers at α = 0.001 and assumptions of normality, linearity, and multicollinearity were all satisfactory. All analyses were performed with SPSS xx (SPSS Inc., Chicago, IL, USA).
Results
Demographic and Psychological Characteristics
Not-pregnant women, early 3rd trimester and belatedly third trimester pregnant women differed significantly in age, relationship status, employment condition, family income, didactics level and STAI state-anxiety score (see details in Table two). However, family income did non remain meaning when relationship condition was controlled (non-significant: M = 4.30, SE = 0.33; early 3rd trimester: M = 5.28, SE = 0.xl; late 3rd trimester: M = 5.59, SE = 0.50; p = 0.1). Thus, all these variables except family income were controlled in subsequent analyses.
Table 2. Non-pregnant and pregnant (early and late tertiary trimester) women characteristics on demographic and psychological variables (mean ± standard departure).
Non-Pregnant and Pregnant Women (Early on and Late 3rd Trimester) Differences on Dream Variables
Univariate analyses for dream content specific and not specific to pregnancy are detailed in Table 3.
Tabular array 3. Not-pregnant and pregnant women (early and late 3rd trimester) differences on dream variables (adapted hateful ± standard error).
Dream content specific to pregnancy
Dreamed MMR . A MANCOVA including the iv dreamed MMR factors ("as daughter-parents," "as spouse-partner," "as mother-baby/kid," "as office of ain family") and the two other social roles z-scores (i.east., "as friend," "as worker/pupil") as dependent measures, the three groups of women (non-pregnant, early third trimester, late tertiary trimester) as a between-group gene, and previously identified demographic and psychological measures as covariates was performed (Bonferroni adjustment for univariate effects, p = 0.008; 0.05/six). Since the assumption of homogeneity of variance-covariance was not met (Box's mean = 95.98, p < 0.001), the more robust Pillai'south criterion was chosen for significance testing.
Groups differed on the combined dependent measure out [Pillai's trace = 0.27; F (12, 214) = 2.73, p = 0.002, fractional ηtwo = 0.13]. The only significant univariate effect was "every bit mother-babe/child" (p < 0.001, partial ηtwo = 0.xviii), which indicated higher scores for both groups of pregnant women than for not-pregnant women (all p = 0.006) (Figure 1A). There was besides a tendency for this score to be lower later in pregnancy; tardily 3rd trimester women had lower scores than did early tertiary trimester women (p = 0.1).
Figure 1. Significant and non-significant women differences (mean ± standard error) on "As mother-infant/child" and "Specificity of infant/child representations" dream factor scores. Early and tardily 3rd trimester pregnant women had more than representations of themselves as female parent and of babies and children (A) than did not-pregnant women in their dreams; late 3rd trimester pregnant women (≥30 weeks of gestation) had less specific babies and children representations in their dreams than did early 3rd trimester (<30 weeks of gestation) and non-pregnant women (B). **p < 0.01, ***p < 0.001.
Quality of baby/kid representations . As reported earlier, meaning women differed from non-pregnant women in having significantly more than babies and/or children depicted in their dreams. A total of 37 (61.7%) not-pregnant women, 29 (78.4%) early on 3rd trimester women and nineteen (86.iv%) late 3rd trimester women, had dreams depicting babies and/or children for which the quality of the representations was scored.
A MANCOVA was conducted amidst this subgroup, with specificity of babe/child relationship and personality and endangered and negative infant/child representations as dependent measures, the three groups of women (non-pregnant, early 3rd trimester, late tertiary trimester) as a betwixt-group cistron, and previously identified demographic and psychological measures as covariates (Bonferroni adjustment for univariate effects at p = 0.025; 0.05/ii). The supposition of homogeneity of variance-covariance was not met (Box's hateful xiv.86, p = 0.03) and the more robust Pillai'due south benchmark was chosen for significance testing.
A marginal between group multivariate deviation was found [Pillai's trace = 0.12; F (iv, 154)= 2.35, p = 0.06, fractional ηii = 0.05], with a univariate effect for the specificity of baby/kid relationship and personality factor (p = 0.01, fractional ηii = 0.11). Equally shown in Effigy 1B, the belatedly 3rd trimester group had less specific baby/child representations than did either the early on third trimester (p = 0.005) or the non-pregnant (p = 0.01) groups. The latter ii groups did non differ (p = 0.vii).
Pregnancy-related themes . A MANCOVA including the four pregnancy themes (pregnancy, childbirth, fetus, homo body) as dependent measures, the three groups (non-meaning, early on 3rd trimester, belatedly 3rd trimester) as the between-group factor, and previously identified demographic and psychological as covariates was performed (Bonferroni adjustment for univariate effects at p = 0.013; 0.05/4). The assumption of homogeneity of variance-covariance was satisfactory (Box's mean = ten.86, p = ns), so the more liberal Wilks λ criterion was chosen for significance testing.
Groups differed on the combined dependent measure out [Wilks λ = 0.66; F (8, 216)= 6.18, p < 0.001, partial ηii = 0.19], and significant univariate effects were found for pregnancy (p < 0.001, partial η2 = 0.26), childbirth (p < 0.001, partial η2 = 0.19) and fetus (p = 0.007, fractional ηii = 0.09), but not for human body (p = 0.i, partial η2 = 0.04). Pairwise comparisons indicated that both pregnant groups had more pregnancy related themes in their dreams than did non-meaning women (all p ≤ 0.01) (Figure 2A). Pregnant groups also differed in the prevalence of childbirth content; the latter was higher in the late than in the early third trimester group (p = 0.01). The 2 pregnancy groups did not differ on pregnancy and fetus themes (p = 0.3 and 0.8, respectively).
Effigy 2. Pregnant and non-significant women differences (mean ± standard error) on pregnancy-related themes and on morbid dream contents. Early and tardily 3rd trimester pregnant women had more than pregnancy, childbirth and fetus dream themes than did not-pregnant women, and belatedly 3rd trimester (≥30 weeks of gestation) had more than childbirth dream themes (A) than did early 3rd trimester (<30 weeks of gestation) women; morbid dream contents were more than frequent in both pregnant groups than in the non-significant group (B). *p < 0.05, **p < 0.01, ***p < 0.001.
Other Dream Characteristic Not Specific to Pregnancy
A MANCOVA including the five dream characteristics non specific to pregnancy ("dream development", "AG movements", "COP movements", "MOR contents", "dream masochism") as dependent measures, the 3 groups of women (non-pregnant, early 3rd trimester, late 3rd trimester) as a between-group factor, and previously identified demographic and psychological measures as covariates, was performed (Bonferroni adjustment for univariate furnishings p = 0.05/5 = 0.01). The assumption of homogeneity of variance-covariance was not met (Box'southward hateful = 52.49, p = 0.02) and the more than robust Pillai's criterion was chosen for significance testing.
Groups differed on the multivariate dependent measure [Pillai'due south trace = 0.xvi; F (ten, 216) = 1.93, p = 0.04, fractional η2 = 0.09], but the only significant univariate outcome was marginal and concerned morbid (MOR) dream content (p = 0.05, partial ηtwo = 0.05). Every bit shown in Figure 2B, there were more morbid elements in dreams of the two pregnancy groups than in the dreams of not-pregnant women (p = 0.04 and 0.02 respectively). Post-hoc Pearson correlations between MOR dream content and STAI-country anxiety scores revealed that these two variables were non correlated for non-meaning women (r = −0.17, p = 0.twenty), but were slightly correlated for early (r = 0.30, p = 0.07) and late third trimester (r = 0.39, p = 0.07) pregnant women.
Further post-hoc analyses indicated that MOR dream content correlated positively with "as daughter-parents" (r = 0.27, p = 0.04) and "as part of family" (r = 0.25, p = 0.05) in non-pregnant women, with "specificity of baby/child representations" (r = 0.45, p = 0.01) and "endangered and negative babe/child representations" (r = 0.49, p = 0.007) in early 3rd trimester women, and with the "childbirth" theme (r = 0.67, p = 0.001) in late 3rd trimester women. MOR dream content was too correlated with "homo torso" themes in non-pregnant (r = 0.27, p = 0.04) and in early on third trimester (r = 0.38, p = 0.02) women.
Discussion
The get-go objective of this study, to compare nulliparous non-pregnant women to early on and late 3rd trimester pregnant women on dreamed MMR frequencies, resulted in relatively few differences. A composite factor that included representations of the woman as a female parent and of babies and children was the only MMR gene to differentiate groups. Equally expected, 3rd trimester women scored higher on this gene than did non-pregnant women, thereby replicating earlier findings (Gillman, 1968; Van De Castle and Kinder, 1968; Winget and Kapp, 1972; Sered and Abramovitch, 1992; Blake and Reimann, 1993; Dagan et al., 2001; Van et al., 2004; Nielsen and Paquette, 2007). This upshot also generally supports the view that, in being focused principally on the maternal part during pregnancy, dreams are continuous with daytime concerns, thoughts, fantasies, and so forth (Schredl, 2012). They appear to mirror the ongoing daytime processes of remodeling MMR of the cocky as a mother and of the fetus as a future babe (Ammaniti and Trentini, 2009; Slade et al., 2009).
Nevertheless, at that place was no prove that meaning women dreamed more about themselves in the office of a spouse, a daughter or a member of her own family, equally might exist expected from an early study reporting that dreams frequently depict marital and familial issues during pregnancy (Van De Castle and Kinder, 1968). At that place were likewise no differences in the frequencies of dreamer'due south representations of themselves in the roles of friend and of worker or student. The lack of differences in dreamed MMR relating to other aspects of the self and to relationships is surprising because the vast clinical and empirical literature suggesting that these representations are also subject to remodeling during pregnancy. First, clinicians consider pregnancy as a major testing bespeak for the mother-daughter relationship during which the adult female begins to identify with her own female parent while existence confronted with the reactivation of unresolved mother-daughter conflicts (Pines, 1972; Raphael-Leff, 1991; Stern, 1998; Slade et al., 2009). The paternal representation is also thought to be reworked through a gradual renunciation of the "internal omniscient father" and the implantation of a human relationship of developed equals betwixt the woman and her begetter (Raphael-Leff, 1991). 2nd, a representational concept of triangular interactions of the woman with her partner and the couple's child is thought to develop even before the nascency of the babe (Bürgin and Von Klitzing, 1995). Finally, the pregnant woman'southward representational earth has been reported to gradually shift from a public world of work and wide social context to a more personal world of family (Smith, 1999). Our findings suggest that none of these changes is paralleled in dream content during pregnancy.
Rather, our results suggest that dream action might be required in late pregnancy to process MMR relating exclusively to the mother-baby human relationship. A small accomplice report yielded results like to ours in showing that tertiary trimester pregnant women dream more than about babies, but not almost the family or the partner, than do non-pregnant women (Dagan et al., 2001).
That we assessed dreams prospectively in a large cohort while simultaneously decision-making many potentially confounding factors boosts our confidence in the accuracy and representativeness of these differences. Further, our statistical controls may account for the fact that we did not replicate some previous findings and clinical impressions. On the other mitt, since it has been suggested that past the end of pregnancy a adult female has mostly reached reconciliation with her internalized relationships, particularly those relating to her own mother (Raphael-Leff, 1991; Trad, 1991), it may be that issues relating to mental representations of other aspects of herself and her relationships have been candy in dreams at earlier stages of pregnancy. This possibility is consistent with our finding that dreams depicting the adult female every bit a daughter and as office of her own family unit along with parents and family representations were not associated with morbid elements amid pregnant women whereas they were among non-pregnant women. Longitudinal studies are clearly needed to appraise this possibility.
Another of import finding of the present written report is that amid those adult female who dreamed about babies or children, the quality of these representations was less specific in the late third than in the early 3rd trimester and the non-pregnant women groups. These results concur with MMR studies showing that 3rd trimester women accept specific and rich images virtually the unborn baby (Ammaniti et al., 1992) and that the quality of these representations declines upward to childbirth (Stern, 1995; Innamorati et al., 2010). As Stern (1991, 1995) has suggested, this pass up might reflect a need for the adult female to "undo" her representations to prevent disappointment when faced with the "real child" afterwards birth. Some other explanation for the nowadays finding is that, around the 30th calendar week of gestation, the number of spontaneous fetal movements (Kurjak et al., 2005) and of nighttime micro-arousals evoked past fetal movements (Nishihara et al., 2008) decrease until birth. In line with the continuity hypothesis of dreaming, the lower quality of dreamed representations of babies and children in late 3rd trimester might parallel the decrease in daytime and nighttime perceived fetal movements.
Opposite to our expectations, however, specific representations of babies and children were not more negative during pregnancy, even though more specific and negative representations correlated with more morbid dream elements in early on 3rd trimester pregnant women. This result partially supports findings that women's concerns during the last trimester are characterized by recurrent thoughts relating to the possibility that something bad may happen to the baby (Vizziello et al., 1993; Leckman et al., 2004) and with earlier studies showing that babies are commonly depicted equally being in danger in pregnant women's dreams (Gillman, 1968; Van De Castle and Kinder, 1968; Blake and Reimann, 1993; Van et al., 2004; Nielsen and Paquette, 2007). The fact that such correlations were not institute in late 3rd trimester might reflect the women'south greater confidence in the bug of pregnancy and the infant's safety, since neonatal and maternal morbidity decrease sharply after 36 completed weeks of gestation (Escobar et al., 2006).
The second objective of this study, to comparatively measure the frequencies of pregnancy-related dream themes (i.e., fetus, pregnancy, childbirth, human trunk) and to assess whether these themes' frequencies were different among the 2 pregnancy groups, resulted in a number of noteworthy differences. Childbirth dream themes, which were more frequent in both pregnancy groups than in not-pregnant women, were also more than prevalent among late than among early 3rd trimester women. In contrast, frequencies of pregnancy and fetus themes, and to a lesser extent human body themes remained loftier and stable amongst the two significant groups. The latter finding supports previous studies showing that pregnant women'southward dreams depict greater pregnancy and childbirth themes (Dagan et al., 2001; Nielsen and Paquette, 2007), only they add to this the notion that mental reorganization in the very last stage of pregnancy becomes more focused on preparations for commitment. This shift in focus might parallel the female parent's reality of enduring more frequent medical appointments during the final weeks of pregnancy and of undergoing an upsurge of intense ambivalent feelings of excitement, fear and feet about the coming effect (Raphael-Leff, 1991; Smith, 1999). In our study, dysphoric feelings toward the delivery in belatedly pregnancy are reflected in the clear clan between the childbirth dream theme and more morbid dream content exclusively in late 3rd trimester pregnant women.
The final objective of the report, to appraise whether more than general dream characteristics are altered during pregnancy, produced surprisingly few differences. Unexpectedly, the results showed that evolution of dream narratives and dream masochism did not differ betwixt groups. However, that cooperative and aggressive interactions in dreams did not differ between groups parallels the findings of an before study (Gillman, 1968). In fact, the just measure not specific to pregnancy that differentiated the groups assessed morbid dream contents, that is, dysphoric feelings and negative characteristics attributed to any dream chemical element. These were more than prevalent and were marginally associated with more state anxiety among both pregnancy groups, fifty-fifty though our pregnant participants were considerably less broken-hearted than our non-pregnant participants. Together, these results suggest that general dream processes not directly related to pregnancy remain relatively stable during pregnancy, but that the psychological challenges of pregnancy may be reflected indirectly in a more than dysphoric emotional tone in dream content.
It is worth noting that our groups showed impressive high dream call back rates: meaning and non-pregnant women reported on average one dream per day. Our dream log instructions might account for this effect: they stated that participants could report upward to three dreams per dark. This may accept biased participants toward reporting an atypically high number of dreams. On the other manus, we too specified in the instructions that dreams are non always an intense or an piece of cake to recollect feel and that sometimes they may be simple sensory experiences such as auditory, visual, or somatic impressions. This definition, based on the inclusive definition of dreams proposed past Nielsen (2003), may also have led to an increased number of dream reports in our report.
Implications for Dream Function During Pregnancy
Altogether, the nowadays results are consistent with the notion that mental reorganization during the tertiary trimester of a starting time pregnancy is focused principally on the futurity mother'due south construction of a new maternal identity and of representations of her unborn baby. This reorganization is probable to be achieved through activation of the caregiving system, a motivational mechanism that guides maternal behaviors and that derives from cognitive and affective representations shaped by the mother's ain first human relationship experiences (Solomon and George, 1996; Ammaniti and Trentini, 2009; Slade et al., 2009). This transitional procedure of change in self-concept during pregnancy might crave the activation of specific representations of the mother-infant relationship during dreaming, mayhap past virtue of dreaming facilitating the integration of recent and remote memories (Cartwright, 2005, 2010).
How dreaming achieves this may reside in its suggested capacity to integrate emotional experiences about life transitions and significant others into the retentivity arrangement defining the cocky-concept. Indeed, every bit dream inquiry has consistently institute that dreams are sensitive to relational bug and changes, transitional periods implicating pregnant new relationships, such equally pregnancy, might trigger the oneiric activation of these relationships and their associated emotions in an adaptive style (Cartwright, 2005, 2010; Nielsen and Lara-Carrasco, 2007). Dreams may even office to selectively influence and promote attachment in unattached or insecurely attached adults by activating the mnemonic processes associated with development and revision of internal working models (Zborowski and McNamara, 1998; McNamara et al., 2001). Nosotros add together to this the proposition that pregnancy is a sufficient condition to activate the caregiving system during dreaming and thereby to consolidate maternal images near both the cocky as a mother and babies and children. In containing more than morbid elements and in being more focused on the commitment process, particularly late in the tertiary trimester, dreams might thus be part of a "working through procedure" that enables meaning women to be more psychologically prepared to face childbirth (Mancuso et al., 2008) and to adapt to the maternal office (Kron and Brosh, 2003). Whether the processing of these representations in dreams is predictive of existent mother-babe interactions after nascency, as was found in studies assessing prenatal waking thoughts, expectations and representations (Zeanah et al., 1994; Benoit et al., 1997; Siddiqui and Hagglof, 2000), needs to be assessed further in longitudinal studies.
Still, as Blagrove (2011) has pointed out, a difficulty in investigating dream function is that electric current experimental designs are correlational rather than experimental. Accordingly, it has non been possible to experimentally manipulate dream incorporations, i.e., to randomly assign participants to incorporator vs. non-incorporator groups. Nosotros thus remain unable to demonstrate dream function in any causal sense. Future studies could assess whether the intentional recall of dreaming promotes insight and personal growth (Hobson and Schredl, 2011), an experimental effect that might be reflected during pregnancy in a ameliorate understanding of a mother's own parental concerns, relational changes, and modifications in self-concept.
Conflict of Interest Statement
The authors declare that the research was conducted in the absenteeism of any commercial or fiscal relationships that could exist construed as a potential conflict of involvement.
Acknowledgments
Thanks are due to the women who participated in this study, to the obstetric units of the Hôpital du Sacré-Coeur de Montréal and the Centre Hospitalier de l'Université de Montréal, to the Jeanne-Mance and de la Montagne Health and Social Services Centres and to doulas for subject recruitment. The authors acknowledge Tyna Paquette for technical and editorial help. This written report was supported past grants from the Canadian Institutes of Health Research of Canada (CIHR; Tore Nielsen), the Natural Sciences and Engineering Research Quango of Canada (NSERC; Tore Nielsen), the International Association for the Study of Dreams (IASD; Jessica Lara-Carrasco, Tore Nielsen and Valérie Simard) and by a scholarship to Jessica Lara-Carrasco from the CIHR.
References
Agargun, G. Y. (2010). "Rapid eye move sleep interruption as a therapy for major low," in Sleep and Mental Disease, eds South. R. Pandi-Perumal and M. Kramer (New York, NY: Cambridge University Press), 222–224.
Ammaniti, M., Baumgartner, Eastward., Candelori, C., Perucchini, P., Pola, One thousand., Tambelli, R., et al. (1992). Representations and narratives during pregnancy. Baby Ment. Health J. thirteen, 167–182.
Ammaniti, Yard., Tambelli, R., and Odorisio, F. (2013). Exploring maternal representations during pregnancy in normal and at-take chances samples: the use of the interview of maternal representations during pregnancy. Infant Ment. Wellness J. 34, 1–ten. doi: 10.1002/imhj.21357
CrossRef Total Text
Ammaniti, M., and Trentini, C. (2009). How new noesis virtually parenting reveals the neurobiological implications of intersubjectivity: a conceptual synthesis of recent research. Psychoanal. Dialogues xix, 537–555. doi: 10.1080/10481880903231951
CrossRef Full Text
Beck, A. T., Rial, Due west. Y., and Rickels, K. (1974). Short grade of depression inventory: cross-validation. Psychol. Rep. 34, 1184–1186.
Pubmed Abstruse | Pubmed Full Text
Benoit, D., Parker, K. C., and Zeanah, C. H. (1997). Mothers' representations of their infants assessed prenatally: stability and association with infants' attachment classifications. J. Child Psychol. Psychiatry 38, 307–313. doi: ten.1111/j.1469-7610.1997.tb01515.x
Pubmed Abstract | Pubmed Total Text | CrossRef Total Text
Blagrove, Thou. (2011). Distinguishing continuity/discontinuity, function, and insight when investigating dream content. Int. J. Dream Res. 4, 45–47.
Blake, R. L. Jr., and Reimann, J. (1993). The pregnancy-related dreams of pregnant women. J. Am. Board Fam. Pract. 6, 117–122.
Pubmed Abstract | Pubmed Full Text
Bowlby, J. (1980). Attachment and Loss. New York, NY: Basic Books.
Bürgin, D., and Von Klitzing, G. (1995). "Prenatal representations and postnatal interactions of a threesome (female parent, male parent, babe)," in Psychosomatic Obstetrics and Gynaecology, eds J. Blitzer and Yard. Stauber (Bologna: Monduzzi Editore), 185–191.
Cartwright, R. (2005). "Dreaming equally a mood-regulation system," in Principles and Practice of Sleep Medicine, 4th Edn., eds M. H. Kryger, T. Roth, and C. D. William (Philadelphia, PA: Elsevier Saunders), 565–572.
Cartwright, R., Baehr, E., Kirkby, J., Pandi-Perumal, South. R., and Kabat, J. (2003). REM slumber reduction, mood regulation and remission in untreated depression. Psychiatry Res. 121, 159–167. doi: ten.1016/S0165-1781(03)00236-ane
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Cartwright, R. D. (1991). Dreams that piece of work: the relation of dream incorporation to adaptation to stressful events. Dreaming ane, 3–9. doi: x.1037/h0094312
CrossRef Full Text
Cartwright, R. D. (2010). The Twenty-4 60 minutes Mind: The Office of Sleep and Dreaming in our Emotional Lives. New York, NY: Oxford University Press; US.
Cox, J., Holden, J., and Sagovsky, R. (1987). Detection of postnatal depression: development of the ten-item Edinburgh postnatal low scale. Br. J. Psychiatry 150, 782–786. doi: 10.1192/bjp.150.six.782
Pubmed Abstruse | Pubmed Total Text | CrossRef Total Text
Douglass, A. B., Bornstein, R., Nino-Murcia, Yard., Keenan, S., Miles, L., Zarcone, Five. P. Jr. et al. (1994). The sleep disorders questionnaire. I: Cosmos and multivariate structure of SDQ. Slumber 17, 160–167.
Pubmed Abstruse | Pubmed Full Text
Escobar, Grand. J., Clark, R. H., and Greene, J. D. (2006). Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin. Perinatol. 30, 28–33. doi: 10.1053/j.semperi.2006.01.005
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Exner, J. East. Jr. (2003). The Rorschach: A Comprehensive System, quaternary Edn. Hoboken, NJ: John Wiley and Sons Inc.
Fraiberg, S., Adelson, East., and Shapiro, V. (1975). Ghosts in the nursery. A psychoanalytic approach to the problems of impaired infant-mother relationships. J. Am. Acad. Child Psychiatry 14, 387–421. doi: 10.1016/S0002-7138(09)61442-4
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Grant, Grand. A., Mcmahon, C., and Austin, M. P. (2008). Maternal anxiety during the transition to parenthood: a prospective written report. J. Bear on. Disord. 108, 101–111. doi: x.1016/j.jad.2007.10.002
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Hartmann, Eastward. (1996). Outline for a theory on the nature and functions of dreaming. Dreaming 6, 147–170. doi: 10.1037/h0094452
CrossRef Total Text
Hobson, J., and Schredl, One thousand. (2011). The continuity and discontinuity between waking and dreaming: a dialogue betwixt Michael Schredl and Allan Hobson concerning the adequacy and completeness of these notions. Int. J. Dream Res. 4, iii–7.
Innamorati, M., Sarracino, D., and Dazzi, N. (2010). Maternity constellation and representational modify in pregnancy. Babe Ment. Health J. 31, 379–396. doi: 10.1002/imhj.20261
CrossRef Full Text
Kamphuis, J. H., Tuin, N., Timmermans, M., and Punamaki, R. Fifty. (2008). Extending the Rorschach trauma content alphabetize and aggression indexes to dream narratives of children exposed to enduring violence: an exploratory study. J. Pers. Assess. 90, 578–584. doi: 10.1080/00223890802388558
Pubmed Abstruse | Pubmed Total Text | CrossRef Full Text
Kennedy, H. P., Gardiner, A., Gay, C., and Lee, K. A. (2007). Negotiating sleep: a qualitative study of new mothers. J. Perinat. Neonatal Nurs. 21, 114–122. doi: ten.1097/01.JPN.0000270628.51122.1d
Pubmed Abstract | Pubmed Total Text | CrossRef Full Text
Kramer, M. (2007). The Dream Experience: A Systematic Exploration. New York, NY: Routledge/Taylor and Francis Group.
Kron, T., and Brosh, A. (2003). Can dreams during pregnancy predict postpartum depression. Dreaming xiii, 67–81. doi: 10.1023/A:1023397908194
CrossRef Full Text
Kurjak, A., Carrera, J., Medic, M., Azumendi, G., Andonotopo, W., and Stanojevic, M. (2005). The antenatal development of fetal behavioral patterns assessed past 4-dimensional sonography. J. Matern. Fetal Neonatal Med. 17, 401–416. doi: 10.1080/14767050400029657
Pubmed Abstract | Pubmed Full Text | CrossRef Total Text
Leckman, J. F., Feldman, R., Beau, J. Eastward., Eicher, 5., Thompson, N., and Mayes, L. C. (2004). Primary parental preoccupation: circuits, genes, and the crucial part of the surroundings. J. Neural Transm. 111, 753–771. doi: 10.1007/s00702-003-0067-10
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Lee, K. A., and Dejoseph, J. F. (1992). Slumber disturbances, vitality, and fatigue among a select group of employed childbearing women. Birth xix, 208–213. doi: 10.1111/j.1523-536X.1992.tb00404.x
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Mancuso, A., De Vivo, A., Fanara, G., Settineri, Southward., Giacobbe, A., and Pizzo, A. (2008). Emotional country and dreams in pregnant women. Psychiatry Res. 160, 380–386. doi: 10.1016/j.psychres.2007.06.005
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Marcus, Due south. M. (2009). Low during pregnancy: rates, risks and consequences–Motherisk Update 2008. Can. J. Clin. Pharmacol. xvi, e15–e22.
Pubmed Abstract | Pubmed Full Text
McNamara, P., Andresen, J., Clark, J., Zborowski, M., and Duffy, C. A. (2001). Impact of attachment styles on dream remember and dream content: a test of the attachment hypothesis of REM sleep. J. Sleep Res. ten, 117–127. doi: x.1046/j.1365-2869.2001.00244.x
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
McNamara, P., and Szent-Imrey, R. (2007). Costly signaling theory of REM slumber and dreams. Evol. Psychol. 5, 28–44.
Nielsen, A. C., and Williams, T. A. (1980). Depression in convalescent medical patients. Arch. Gen. Psychiatry 37, 999–1004. doi: 10.1001/archpsyc.1980.01780220037003
CrossRef Full Text
Nielsen, T. A. (2003). "A review of mentation in REM and NREM slumber:"Covert" REM sleep as a possible reconciliation of ii opposing models," in Sleep and Dreaming: Scientific Advances and Reconsiderations, eds Due east. F. Step-Schott, Thou. Solms, M. Blagrove, and S. Harnad (New York, NY: Cambridge Academy Press), 59–74.
Pubmed Abstract | Pubmed Full Text
Nielsen, T. A., Kuiken, D., Alain, Yard., Stenstrom, P., and Powell, R. A. (2004). Immediate and delayed incorporations of events into dreams: further replication and implications for dream role. J. Sleep Res. 13, 327–336. doi: 10.1111/j.1365-2869.2004.00421.x
Pubmed Abstract | Pubmed Total Text | CrossRef Full Text
Nielsen, T., and Lara-Carrasco, J. (2007). "Nightmares, dreaming, and emotion regulation: a review," in The New Science of Dreaming: Vol. ii Content, Recall, and Personality Correlates, eds D. Barrett and P. McNamara (Westport, CT: Praeger Publishers/Greenwood Publishing Group), 253–284.
Nielsen, T., and Paquette, T. (2007). Dream-associated behaviors affecting pregnant and postpartum women. Sleep 30, 1162–1169.
Pubmed Abstract | Pubmed Full Text
Nishihara, Yard., Horiuchi, South., Eto, H., and Honda, M. (2008). A long-term monitoring of fetal motion at home using a newly developed sensor: an introduction of maternal micro-arousals evoked by fetal move during maternal slumber. Early Hum. Dev. 84, 595–603. doi: 10.1016/j.earlhumdev.2008.03.001
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Pajulo, M., Savonlahti, E., Sourander, A., Piha, J., and Helenius, H. (2001). Prenatal maternal representations: mothers at psychosocial risk. Infant Ment. Health J. 22, 529–544. doi: x.1002/imhj.1016
CrossRef Full Text
Priel, B., and Besser, A. (2001). Bridging the gap betwixt attachment and object relations theories: a report of the transition to motherhood. Br. J. Med. Psychol. 74, 85–100. doi: 10.1348/000711201160821
CrossRef Total Text
Raphael-Leff, J. (1991). Psychological Processes of Childbearing. London; New York: Chapman and Hall.
Schredl, M. (2012). Continuity in studying the continuity hypothesis of dreaming is needed. Int. J. Dream Res. 5, 1–8.
Slade, A., Cohen, L. J., Sadler, 50. Southward., and Miller, M. (2009). "The psychology and psychopathology of pregnancy: reorganization and transformation," in Handbook of Infant Mental Wellness, 3rd Edn., ed C. H. Zeanah (New York, NY: The Gilford Press), 22–39.
Smith, J. A. (1999). Identity evolution during the transition to motherhood: an interpretive phenomenological analysis. J. Reprod. Infant Psychol. 17, 281–299. doi: 10.1080/02646839908404595
CrossRef Full Text
Solomon, J., and George, C. (1996). Defining the caregiving organization: toward a theory of caregiving. Infant Ment. Health J. 17, 183–197.
Spielberger, C. D. (1983). Manual for the Country-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
Spielberger, C. D., Gorsuch, R. L., and Luschene, R. Due east. (1970). Test Manual for the State-Trait Anxiety Inventory (Cocky-Evaluation Questionnaire). Palo Alto, CA: Consulting Psychologists Press.
Stern, D. N. (1991). Maternal representations: a clinical and subjective phenomenological view. Infant Ment. Health J. 12, 174–186.
Stern, D. Due north. (1995). The Motherhood Constellation: A Unified View of Parent-Baby Psychotherapy. New York, NY: Bones Books; US.
Tabachnick, B. G., and Fidell, 50. S. (2013). Using Multivariate Statistics. Boston, MA: Pearson Education.
Theran, Southward. A., Levendosky, A. A., Bogat, G. A., and Huth-Bocks, A. C. (2005). Stability and modify in mothers' internal representations of their infants over fourth dimension. Attach. Hum. Dev. vii, 253–268. doi: 10.1080/14616730500245609
Pubmed Abstract | Pubmed Full Text | CrossRef Total Text
Trad, P. V. (1991). Adaptation to developmental transformations during the various phases of motherhood. J. Am. Acad. Psychoanal. 19, 403–421.
Pubmed Abstract | Pubmed Full Text
Van De Castle, R., and Kinder, P. (1968). Dream content during pregnancy. Psychophysiology 4, 375.
Van, P., Cage, T., and Shannon, G. (2004). Big dreams, little sleep: dreams during pregnancy after prior pregnancy loss. Holist. Nurs. Pract. xviii, 284–292.
Pubmed Abstruse | Pubmed Full Text
Viaux-Savelon, S., Dommergues, Thousand., Rosenblum, O., Bodeau, N., Aidane, E., Philippon, O., et al. (2012). Prenatal ultrasound screening: false positive soft markers may alter maternal representations and female parent-baby interaction. PLoS ONE vii:e30935. doi: x.1371/journal.pone.0030935
Pubmed Abstract | Pubmed Total Text | CrossRef Total Text
Vizziello, G. F., Antonioli, M. East., Cocci, V., and Invernizzi, R. (1993). From pregnancy to motherhood: the structure of representative and narrative modify. Infant Ment. Health J. fourteen, 4–16.
Winegar, R. K., and Levin, R. (1997). Sexual activity differences in the object representations in the dreams of adolescents. Sex Roles 36, 503–516. doi: 10.1007/BF02766687
CrossRef Full Text
Winget, C., and Kapp, F. T. (1972). The relationship of the manifest content of dreams to duration of childbirth in primiparae. Psychosom. Med. 34, 313–320.
Pubmed Abstract | Pubmed Total Text
Winget, C., and Kramer, M. (1979). Dimensions of Dreams. Gainesville: University of Florida Press.
Winnicott, D. (1965). The Maturational Processes and the Facilitating Surroundings: Studies in the Theory of Emotional Development. Oxford, England: International Universities Press.
Zborowski, M. J., and McNamara, P. (1998). Attachment hypothesis of REM slumber: toward an integration of psychoanalysis, neuroscience, and evolutionary psychology and the implications for psychopathology research. Psychoanal. Psychol. fifteen, 115–140. doi: ten.1037/0736-9735.xv.1.115
CrossRef Full Text
Zeanah, C. H., Carr, S., and Wolk, Due south. (1990). Fetal movements and the imagined infant of pregnancy: are they related. J. Rep. Infant Psychol. 8, 23–36. doi: 10.1080/02646839008403605
CrossRef Total Text
Source: https://www.frontiersin.org/articles/10.3389/fpsyg.2013.00551/full
0 Response to "The Client Has Recurring Nightmares About Her Unborn Baby."
Post a Comment