Article Type: Original Articles
Pathological and Nonpathological Worry: Their Relationships with Nightmare Frequency
William E. Kelly
Objective: Both worry and nightmares are relatively common phenomena and both are conceptually related. However, research investigating their relationship has not been reported. The aim of the current study was to investigate the statistical relationship between worry and nightmare frequency.

Methods: Using a cross-sectional design, university students (n=134) completed reliable and validated measures of nightmare frequency using the Schredl’s Nightmare Frequency Scale, trait pathological worry usimg the Three Item Worry Index (TIWI), nonpathological worry using the Worry Domains Questionnaire Short Form (WDQ-SF), and worry related sleep disturbance using the Sleep Disturbance Ascribed to Worry Scale (SAW).

Results: Higher frequency of nightmares was significantly correlated with higher scores on measures of pathological worry, nonpathological worry, and worry-related sleep disturbance. Using ordinal regression, it was determined that pathological worry, but not nonpathological worry or worry-related sleep disturbance, accounted for significant unique variance in nightmare frequency.

Conclusions: The results were consistent with conceptualizations of pathological worry and nightmare frequency as related to ego functioning and psychological distress. Individuals seeking psychotherapy reporting intense, uncontrollable worry might need to be evaluated for frequent nightmares as well. The results were discussed and suggestions for future research were offered.

Key words: Nightmares, dreams, worry, anxiety, sleep disorders
Psychiatry and Behavioral Sciences 2018;8(1):1-6
REFERENCES
1. Kelly WE, Miller MJ. A discussion of worry with suggestions for counselors. Counseling and Values 1999;44(1):55-66.

2. Tallis F, Davey GCL, Capuzzo N. The phenomenology of nonpathological worry: A preliminary investigation. In: Davey GCL, Tallis F, eds. Worrying: Perspectives on theory, assessment and treatment. New York: Wiley; 1994. p. 185-207.

3. Davey GCL. Pathological worrying as exacerbated problem-solving. In: Davey GCL, Tallis F, eds. Worrying: perspectives on theory, assessment and treatment. New York: Wiley; 1994. p. 35-59.

4. Kelly WE. Some evidence for nonpathological and pathological worry as separate constructs: an investigation of worry and boredom. Pers Individ Diff 2002;33(3): 345-54.

5. Kelly WE. Anxiety and stress as contributory factors in pathological and nonpathological worry. Psychology Journal 2008;5(3):147-57.

6. Davey GC. A comparison of three worry questionnaires. Behav Res Ther 1993;31(1): 51-6.

7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Author, 2013.

8. Ehring T, Watkins E. Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy 2008;1(3):192-205.

9. Lee HJ, Lee SH, Kim HS, Kwon SM, Telch MJ. A comparison of autogenous/reactive obsessions and worry in a nonclinical population: a test of the continuum hypothesis. Behav Res Ther 2005;43(8):999-1010.

10. Buck JM, Kelly WE, Silver NC. An investigation of the relationship between depression and worry: A research note. Individual Differences Research 2008;6:120-2.

11. Kertz SJ, Woodruff-Borden J. Human and economic burden of GAD, subthreshold GAD, and worry in a primary care sample. J Clin Psychol Med Settings 2011;18(3):281-90.

12. Kelly WE. The relationship between nonpathological worry and narcissism: A path analytic study investigating the effects of self-esteem and anxiety. Individual Differences Research 2014;12(4):209-18.

13. Borkovec TD, Alcaine O, Behar E. Avoidance theory of worry and generalized anxiety disorder. In Heimberg RG, Turk CL, Mennin DS, eds. Generalized anxiety disorder: Advances in research and practice. New York: Guilford Press; 2004. p. 77-108.

14. Kelly WE, Paolini L. The relationship between worry and family functioning among young adults. Individual Differences Research 2014;12: 31-7.

15. Dugas, MJ, Gosselin P, Ladouceur R. Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognit Ther Res 2001;25(5): 551-8.

16. Muris P, Meesters C, Merckelbach H, Hulsenbeck P. Worry in children is related to perceived parental rearing and attachment. Behav Res Ther 2001;38(5):487-97.

17. Bjorvatn B, Grønli J, Pallesen S. Prevalence of different parasomnias in the general population. Sleep Med 2010;11(10):1031-4.

18. Li SX, Zhang B, Li AM, Wing YK. Prevalence and correlates of frequent nightmares: a community-based 2-phase study. Sleep 2010;33C(6):774-80.

19. Schredl M. Nightmare frequency and nightmare topics in a representative German sample. Eur Arch Psychiatry Clin Neurosci 2010; 260(8): 565-70.

20. Schredl M. Nightmare frequency in a representative German sample. International Journal of Dream Research 2013;6(2):119-22.

21. Schredl M. Continuity in studying the continuity hypothesis of dreaming is needed. International Journal of Dream Research 2012;5(1):1-8.

22. Kráčmarová L, Plháková A. Nightmares and their consequences in relation to state factors, absorption, and boundaries. Dreaming 2015;25(4):312-20.

23. Levin R, Fireman G. Nightmare prevalence, nightmare distress, and self-reported psychological disturbance. Sleep 2002;25(2):205-12.

24. Schredl M. Effects of state and trait factors on nightmare frequency. Eur Arch Psychiatry Clin Neurosci 2003;253(5):241-7.

25. Nadorff MR, Nazem S, Fiske A. Insomnia symptoms, nightmares, and suicidal ideation in a college student sample. Sleep 2011;34(1):93-8.

26. Levin R, Raulin ML. Preliminary evidence for the proposed relationship between nightmares and schizotypal symptomatology. J Pers Disord 1991;5(1):8-14.

27. Belfiore LA, Pietrowsky R. Attachment styles and nightmares in adults. Dreaming 2017;27(1):59-67.

28. Bardeen JR, Fergus TA, Wu KD. The interactive effect of worry and intolerance of uncertainty on posttraumatic stress symptoms. Cognit Ther Res 2013;37(4):742-51.

29. Fresco DM, Frankel AN, Mennin DS, Turk CL, Heimberg RG. Distinct and overlapping features of rumination and worry: The relationship of cognitive production to negative affective states. Cognit Ther Res 2002;26(2);179-88.

30. Muris P, Roelofs J, Rassin E, Franken I, Mayer B. Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Pers Individ Dif 2005;39:1105-11.

31. Caplan G. An approach to community mental health. New York: Grune and Stratton, 1961.

32. Freud S. The interpretation of dreams. In: Strachey J, ed. & trans. The standard ed. of the complete works of Sigmund Freud. London: Hogarth Press. 1900. v. 4-5.

33. Hartmann E. The nightmare. New York: Basic Books, 1984.

34. Kohut H. The restoration of the self. New York: International Universities Press, 1977.

35. Cabaniss DL, Cherry S, Douglas CJ, Schwartz A. Psychodynamic psychotherapy: A clinical manual. West Sussex: Wiley, 2011.

36. Silverstein R. Combat-related trauma as measured by ego developmental indices of defenses and identity achievement. J Genet Psychol 1996;157(2):169-79.

37. Berant E, Wald Y. Self-reported attachment patterns and Rorschach-related scores of ego boundary, defensive processes, and thinking disorders. J Pers Assess 2009;91(4):365-72.

38. Antunes-Alves S, De Koninc J. Pre- and post-sleep stress levels and negative emotions in a sample dream among frequent and non-frequent nightmare sufferers. Archives of Psychiatry and Psychotherapy 2012;2:11-6.

39. Leggett A, Zarit SH, Nguyen NH, Hoang CN, Nguyen HT. The influence of social factors and health on depressive symptoms and worry: a study of older Vietnamese adults. Aging Ment Health 2012;16(6):780-6.

40. Coolidge FL, Segal DL, Coolidge CM, Spinath F, Gottschling J. Do nightmares and generalized anxiety disorder in childhood and adolescence have a common genetic origin? Behav Genet 2010;40(3):349-56.

41. Lancee J, Spoormaker VI, van den Bout J. Nightmare frequency is associated with subjective sleep quality but not with psychopathology. Sleep Biol Rhythms 2010;8(3):187-93.

42. Kelly WE. Some correlates of sleep disturbance ascribed to worry. Individual Differences Research 2003;1(2):137-46.

43. Strumbrys T, Erlacher D, Schredl M. Reliability and stability of lucid dream and nightmare frequency scales. International Journal of Dream Research 2013;6(2):123-6.

44. Kelly WE. A brief measure of general worry: The Three Item Worry Index. N Am J Psychol. 2004;6:219-25.

45. Churchill NW, Cimprich B, Askren MK, Reuter-Lorenz PA, Jung MS, Peltier S, et al. Scale-free brain dynamics under physical and psychological distress: Pre-treatment effects in women diagnosed with breast cancer. Hum Brain Mapp 2015;36(3):1077-92.

46. Stöber J, Joormann J. A short form of the Worry Domains Questionnaire: Construction and factorial validation. Pers Individ Dif 2001;31:591-8.

47. Kelly WE. Worry and sleep length revisited: worry, sleep length, and sleep disturbance ascribed to worry. J Genet Psychol 2002;163(3): 296-304.

48. Kelly WE, Forbes A. Temporal stability of the Sleep Disturbance Ascribed to Worry Scale. Percept Mot Skills 2004;99(2):628.

49. Levin R. Relations among nightmare frequency and ego strength, death anxiety, and sex of college students. Percept Mot Skills 1989;69(3):1107-13.

50. Bradshaw S, Lafrenière A, Amini R, Lortie-Lussier M, De Koninck J. Threats in dreams, emotions and the severity of threatening experiences in waking. International Journal of Dream Research 2016;9(2):102-9.

51. Belicki K. The relationship of nightmare frequency to nightmare suffering with implications for treatment and research. Dreaming 1992;2:143-8.

52. Krakow B. Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: Diagnostic and treatment implications. Sleep 2006;29(10):1313-9.

53. Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 1990;28(6):487-95.

54. Robert G, Zadra A. Measuring nightmare and bad dream frequency: impact of retrospective and prospective instruments. J Sleep Res 2008;17(2):132-9.

55. Nadorff MR, Nadorff DK, Germain A. Nightmares: under-reported, undetected, and therefore untreated. J Clin Sleep Med 2015;11(7):747-50.
Online ISSN: 2636-834X
Creative Commons License This work is licensed under a Creative Commons Attribution 3.0 Unported License