Dream Patterns in Patients with Acute Myocardial Infarction: Data from the STEP-IN-AMI Trial

Background: Studies on the organization and structure of dreams before and after acute myocardial infarction (AMI) are lacking. Methods: We retrospectively studied dream patterns before and after AMI in the STEP-IN-AMI trial (Short-TErm Psychotherapy IN Acute Myocardial Infarction). We also performed an analysis to describe how this pattern may change during ontopsychological short-term psychotherapy (STP) performed after AMI. Forty-seven patients (pts) aged 31-70 were studied. Results: At baseline, 21/47 (45%) pts remembered dreams, which increased to 43/47 (91%) with psychotherapy (p < 0.0001). Recurring dreams, described as a state of anguish, despair, perceived inability to complete an action, or grief over one's mother's early death, occurred before AMI in 16/47 pts (24%). After the third psychotherapy session, no pts reported recurring dreams (p < 0.001). In dreams that occurred during the year before AMI, 12 of 25 symbols referred to people known to pts and who had died of a cardiac disease; 9 of 25 symbols referred to an accident, danger, or distressing events. Overall, 21 of 25 symbols were associated with danger to an individual's life (84%). The incidence of "negative" symbols was sharply reduced during psychotherapy, from 84% to 32% during the first three psychotherapy sessions and to 9% in the last phase of psychotherapy (p < 0.0001). Conclusions: Our study is the very first on dreams in pts with AMI, and it also examines how STP may change dream patterns in this cohort of pts. AMI pts frequently do not remember dreams that occurred before AMI or report distressing dreams. STP after AMI significantly increased their ability to remember dreams and sharply reduced the incidence of negative/distressing dreams. The results suggest that (1) dream symbols may be connected to the biological status of the dreamer, warning the dreamer of their cardiac condition; (2) ontopsychological STP may act as a stimulus for inner personal change for AMI pts.