The Distressing Dream Content Inventory: Development and Initial Validation in Acute Trauma Patients

Distressing dreams shortly after trauma may reflect attempts at emotional processing that, if unsuccessful, could heighten the risk of posttraumatic stress disorder (PTSD). However, no measures are designed to assess the emotional content of dreams after trauma. The current studies aimed to develop and validate a clinician-rated inventory for assessing emotional dream content after trauma. In Study 1, we created 77 items targeting seven emotions in dreams: fear, anger, sadness, seeking, care, play, and lust. Two independent raters scored 100 randomly selected dreams using these items. In Study 2, we applied the most reliable items to 42 dreams of patients within 1 week following trauma (T1), with follow-ups 1 month later (T2). An 18-item negative dream inventory (fear + anger + sadness) correlated with trauma patients' self-reported dream negativity (r = 0.54, p < 0.001) and inversely with positivity (r = -0.37, p = 0.017). Negative dreams were associated with increased odds of being exposed to interpersonal violence (OR = 1.45, p = 0.014) and more severe acute stress at T1 (β = 0.36, p = 0.021). More negative dreams at T1 prospectively predicted trauma-related nightmares (OR = 1.62, p = 0.045) and PTSD at T2 (OR = 1.50, p = 0.049). Patients who developed PTSD at T2 had significantly more negative dreams at T1 (p = 0.034, ${\eta }_p^2$  = 0.20). These studies provide preliminary support for a novel clinician-rated tool, the Distressing Dream Content Inventory, for identifying negative emotional dream content immediately after trauma that is predictive of future PTSD risk.