Search Results (113)

Background: The nursing profession is recognized as a high-risk occupation, with the emotional toll on healthcare workers reaching a critical point. A complex interplay of anger and cynicism, often stemming from systemic pressures and chronic moral injury, seems to increasingly affect nurses’ professional and personal lives. This psychological strain does not end when the shift ends; rather, it often manifests as insomnia and nightmare distress, creating a vicious cycle of exhaustion and emotional instability. This article explores how anger, cynical distrust, nightmare distress and insomnia are interrelated and jeopardize the well-being of nursing staff and what these “invisible” symptoms reveal about the current state of healthcare by confirming their prevalence rates. Methods: This cross-sectional study was conducted online in October 2025 and included 441 hospital nurses who completed the Dimensions of Anger Reactions-5 (DAR-5), the 8-item Cynical Distrust scale (CDS-8), the Nightmare Distress Questionnaire (NDQ) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of anger, nightmare distress and insomnia were 41.5%, 6.6%, and 62.1%, respectively. Based on the CDS-8 scores, a notable proportion (20.9%) of nurses fell within the highest quartile of CDS-8 scores (CDS-8 > 29), indicating relatively elevated cynical distrust within this sample; this threshold is sample-derived and does not correspond to a validated clinical cut-off. Hierarchical multiple regression analysis indicated that the DAR-5 explained 22.1% of the variance in AIS, while an additional 10.2% was explained by NDQ and another 1.5% by the CDS-8. Both cynical distrust and nightmare distress displayed a chain mediation pattern in the association between anger and insomnia; however, given the cross-sectional design, the temporal order of these variables cannot be confirmed. Conclusions: Anger exhibited significant direct and indirect associations with insomnia, with cynical distrust and nightmare distress acting as serial mediators in this cross-sectional model. Findings from this cross-sectional study tentatively suggest that future intervention efforts targeting insomnia in nurses might benefit from addressing anger alongside nightmare distress and cynical attitudes; however, experimental studies are needed to confirm whether such interventions would be effective. Full article

Generative AI has been used in higher education in teaching and learning. The purpose of this study is to compare the marks generated by GenAI and human educators in essay assignments. The feedback made by GenAI and educators is also examined. A total of 126 submitted assignments from business students in a university were marked by GenAI and by an educator, respectively. It was found that there were small differences in the marks, recorded using a paired sample t test, and there was a moderate correlation between educator and GenAI markings. GenAI feedback follows the rubrics closely, and educators are more likely to give a holistic view of the scripts. GenAI marking might be useful in a large class with specific guidelines for an essay format assignment. Full article

Suicide remains one of the leading causes of death worldwide, yet psychiatry continues to assess risk primarily through suicidal ideation. This narrow focus overlooks a critical factor: sleep. A growing body of evidence demonstrates that insomnia, nightmares, and circadian disruption are consistent and potentially modifiable correlates of suicidal behavior across various diagnoses and age groups, supported primarily by longitudinal and prospective studies. Despite this, structured sleep assessment is seldom integrated into routine psychiatric care, predominantly due to cultural inertia and inadequate training. This perspective necessitates a shift: sleep assessment should be regarded alongside mood and cognition in every evaluation of suicide risk. Brief questionnaires and targeted interventions are readily accessible and feasible for implementation, thereby presenting concrete opportunities for prevention. By incorporating sleep evaluation into standard practice and future predictive models, psychiatry can advance toward more precise, actionable, and timely suicide prevention. To continue neglecting sleep is to overlook one of the most accessible and effective means of saving lives. Full article

Traumatic experiences are among the strongest predictors of suicidal thoughts and behaviors, but the mechanisms that account for this association are still debated. Sleep disturbances, particularly insomnia, nightmares, and fragmented sleep, are highly prevalent after trauma and have been shown to predict suicidality independently of depression and other psychiatric comorbidities. This narrative mini-review synthesizes evidence from epidemiological, clinical, and experimental studies to examine whether sleep may represent a pathway linking trauma and suicidality. Among the proposed mechanisms, alterations in REM sleep regulation, dysregulation of the hypothalamic–pituitary–adrenal axis, and impaired prefrontal control of emotional reactivity have received empirical support, although findings remain inconsistent across populations. Importantly, trauma-related nightmares and persistent insomnia appear to be especially strong markers of elevated suicide risk. Clinically, these observations suggest that routine sleep assessment could add value to suicide risk evaluation in trauma-exposed individuals. Interventions such as cognitive behavioral therapy for insomnia, imagery rehearsal therapy, and REM-modulating pharmacological treatments have shown promise, but their specific impact on suicidality requires further testing in controlled trials. Future research should prioritize longitudinal designs, incorporate both subjective and objective sleep measures, and include culturally diverse samples to clarify causal mechanisms and refine prevention strategies. Full article

Fear of sleep may drive the development of trauma-related sleep disturbances but may differ across potentially traumatic events (PTEs). This study tested whether the factor structure of the Fear of Sleep Inventory-Short Form (FOSI-SF) differed between women with a history of sexual traumas (ST: including sexual assault and other sexual traumas) and women reporting other Non-ST PTEs. Two samples of undergraduate women who endorsed a history of PTEs (n = 339 and n = 318) completed a battery of questionnaires including the FOSI-SF, as well as other psychological and sleep screening measures. We conducted an exploratory factor analysis in Sample 1 and a confirmatory analysis in Sample 2. In the sample of women endorsing a history of ST, but not those with Non-ST PTEs, four latent factors adequately fit the data: vigilance, fear of the dark, fear of nightmares, and vulnerability. This structure was replicated in the second sample that included only women with a history of ST and showed appropriate convergent and discriminant validity with other study measures. This study illustrates that fear of sleep may differ across PTE, and that for those with a history of ST, the fear of nightmares appears to be distinct from other facets of the fear of sleep construct. Full article

Background: Nightmares are a type of sleep disorder characterised by vivid and distressing dreams that cause abrupt awakenings, leading to significant discomfort. In adults, recurrent nightmares can negatively impact quality of life, daytime functioning, and overall mental health. In this context, it is essential to have valid, reliable, and culturally appropriate psychological instruments that allow for an accurate assessment of this phenomenon. The aim of the present study was to translate and validate the Nightmare Disorder Index (NDI) into Spanish for use with Peruvian adults. Methods: A total of 507 adults (66.7% women) participated by completing a sociodemographic questionnaire and psychological instruments. Statistical analyses were conducted using structural equation modelling and item response theory. Results: The NDI demonstrated adequate content validity (V > 0.70), a unidimensional structure (CFI = 0.99, RMSEA = 0.06 [90% CI: 0.030, 0.102], SRMR = 0.03), and reliability (ω = 0.84, H = 0.94, r_xx = 0.79). In addition, invariance was observed across sex, and significant associations were found with depressive symptoms, generalised anxiety, and suicidal ideation. Item 3 showed the highest discrimination and information, and the scale proved to be accurate at higher levels of nightmare severity. Conclusions: The NDI presents adequate psychometric properties for the inference and interpretation of scores in the assessment of nightmares. Its use is recommended in both professional practice and research with the adult general population. Full article

Background: Displaced individuals endure challenges, including conflict, forced migration, family separation, human rights violations, limited access to essential services, and increased exposure to violence and abuse. These hardships significantly impact their mental health, often leading to heightened trauma-related symptoms. Methods: We used a cross-sectional correlational design in refugee camps, homes, and centers across Jordan and Spain. 200 refugees with confirmed status in the past ten years were recruited. Demographic data were collected via a demographic form, the PTSD-8 Inventory assessed traumatic symptoms, and data analysis included descriptive statistics, independent t-tests, one-way ANOVA, and Chi-square tests. Results: Most participants had a secondary education, were unemployed, and had low incomes. PTSD symptoms were prevalent, with rates of recurrent thoughts (63.5%), re-experiencing events (57.5%), nightmares (50.5%), sudden reactions (56.5%), activity avoidance (53.5%), avoidance of specific thoughts or feelings (56.5%), jumpiness (53.5%), hypervigilance (53.5%), feeling on guard (41.5%), and general avoidance (43.5%) rated from rarely to most of the time. All symptoms were significantly more frequent among refugees in Jordan than in Spain. Conclusions and Recommendations: Intrusive thoughts were more frequent among females, urban residents, and unemployed individuals. Avoidance behaviors were higher in married and unemployed individuals. Hypervigilance was more prevalent among females, married individuals, and those with lower incomes. Regionally, females and married individuals in Jordan exhibited more intrusive thoughts and avoidance. In Spain, intrusive thoughts and hypervigilance were more common among females and the unemployed. The findings highlight the urgent need for targeted mental health interventions, particularly in refugee camps like those in Jordan, where PTSD symptom rates were significantly higher. Programs should prioritize trauma-focused therapies, such as Cognitive Behavioral Therapy, while adopting gender-sensitive approaches to address the heightened vulnerability of women and unemployed individuals. Given the strong link between unemployment and symptom severity, livelihood support and vocational training should be integrated into psychosocial care. Policymakers in host countries like Jordan could benefit from adopting integration strategies similar to Spain’s, which may contribute to lower PTSD prevalence. Additionally, community-based awareness initiatives could improve early symptom recognition and access to care. Future research should explore longitudinal outcomes to assess the long-term impact of displacement and resettlement conditions on mental health. Full article

Background and Objectives: While sleep paralysis (SP) is a well-defined disorder, its pathophysiology and causes remain elusive. We aimed to assess the prevalence of sleep paralysis among higher education students and determine factors associated with SP with a focus on psychoactive substance and medication use. Materials and Methods: We conducted a cross-sectional online survey across higher education institutions in Lithuania, asking students to report the occurrence and frequency of SP as well as its characteristics and self-rated sleep quality alongside demographic data and history of medication and psychoactive substance use. Subgroup comparisons and correlation analyses were performed in search of factors associated with reported SP. Results: The study sample consisted of 275 respondents aged 22.9 ± 4.7 years (240, 87.3% female), 119 (43.3%) of whom reported having experienced SP (average age at first episode 16.4 ± 4.2 years), with 87 (73.1%) more than once. The phenomenology of SP episodes included mostly visual, auditory, sensory, or olfactory hallucinations (73, 61.3%), feelings of fear or anxiety (56, 47.1%), incubus-like phenomena (17, 14.3%), and autonomic symptoms (6, 5.0%). Having experienced SP was associated with the use of antidepressants or recreational stimulant use (χ² = 5.258, p = 0.022) as well as higher alcohol intake (Z = −3.568, p < 0.001) and lower self-rated sleep quality (Z = −2.413, p = 0.016). Earlier age of onset, hallucinations during paralysis, specific time of manifestation during the night, and overall nightmare frequency were related to the recurrence of SP. Respondents tied SP episodes mostly to stress or anxiety (55, 46.2%), the supine sleeping position (31, 26.1%), disturbed sleep cycles (28, 23.5%), and emotional or traumatic experiences (28, 23.5%). Conclusions: Our study suggests that SP is prevalent among students with a tendency to recur. We report a correlational association between SP and the use of antidepressants or stimulant drugs, suggesting the need to further explore the possible role of psychoactive agents in this disorder. Full article

Emerging evidence highlights oxidative stress and its biomarkers as potential factors in the onset and maintenance of Post-Traumatic Stress Disorder (PTSD) and co-occurring sleep disturbances. The study concerns the profile of biomarkers including glutamine, glutathione (GSH), caspase-1 and Brain-Derived Neurotrophic Factor (BDNF) levels in three groups (PTSD with a current diagnosis lasting ≤ 5 years, PTSD with a current diagnosis lasting > 5 years, and no PTSD), classified into two age groups. In addition, sleep disturbances were analyzed using the Pittsburgh Sleep Quality Index Addendum (PSQI-A). The study revealed mutual correlations between the examined biomarkers, which may confirm a coordinated antioxidant response. Furthermore, a relationship was observed between biomarkers and PSQI-A; trauma-related domains (e.g., Trauma Nightmares with Terror Episodes) were more pronounced in the case of PTSD ≤ 5 years, while PTSD > 5 years emphasized trauma-unrelated anxiety. The study results suggest that individuals with PTSD exhibit increased sensitivity to trauma, which may manifest through immune system activation and sleep disturbances. Patients with a longer history of PTSD and co-occurring dysfunctions require a personalized approach to trauma treatment and prevention of recurrence. Full article

This article commences by noting that most accounts of Spiritualism during World War One and its aftermath consider that it was harnessed to assist either with the war effort, or to provide comfort for those on the Home Front who were grieving for the dead or missing. However, as this article uncovers and elaborates, there was a brand of Spiritualism which looked beyond this nationalism to provide a form of universalism which sought to heal the wound of both current and past conflicts, instead to provide a world of harmony in the post war world. The population of England was to be reunited culturally with its dead through a rewriting of the history of the Reformation, informed by Spiritualist contact with the Tudor World and individuals within it. By looking at the wartime and immediately post wartime careers of three individuals (Edward Bligh Bond, William Packenham-Walsh and Margaret Murray) the article demonstrates the work of this area of Spiritualism to suggest collective approaches to reconciliation and the writing of past historical wrongs. These individuals also provide evidence of a commitment to creating a shared psychological, anthropological and cultural heritage that would bring Europeans together to transcend the rationalist nightmare created during the war years. Full article

Background/Objectives: Lucid dreaming (LD), during which the dreamer becomes aware of the dream state, offers a unique opportunity for a variety of applications, including motor practice, personal well-being, and nightmare therapy. However, these applications largely depend on the dreamer’s ability to control their dreams. While LD research has traditionally focused on induction techniques to increase dream frequency, the equally important skill of dream control remains largely underexplored. This study provides an exploration into the mechanisms of LD motor practice, dream control, and its potential influencing factors. We specifically examined whether a complex motor skill—juggling—could be performed during LD, calling for relatively high levels of dream control and access to procedural memory. Methods: Four healthy participants underwent overnight polysomnography (PSG), provided detailed dream reports, and completed questionnaires assessing dream control and self-efficacy. Dream-task success was assessed using predefined in-dream motor performance criteria. Differences between high and low LD control participants were examined, and two detailed case reports of lucid dream juggling attempts provide insight into the challenges of executing complex motor tasks during LD. Results: Dream control varied between and within participants. Both dream control and self-efficacy seemed to predict participants’ ability to execute the LD motor task. Conclusions: Despite the low sample size, this study highlights the potential roles of individual traits like self-efficacy in shaping dream control abilities and motor performance during LD. By using empirical, task-based measures, this study helps build the foundation for future research aimed at optimizing LD applications in clinical and non-clinical fields. Full article

Background/Objectives: Individuals with posttraumatic stress disorder (PTSD) tend to show patterns of elevated cardiovascular disease (CVD) risk earlier in life than the general population. The need for effective interventions for CVD risk-reduction in PTSD is increasingly evident. In this paper we present preliminary results from a longitudinal study of a health behavior intervention, as an adjunct to standard trauma therapy in PTSD. The health behavior intervention addresses CVD-related heath behaviors (physical activity, nutrition, sleep, and stress) in a 12-week program delivered individually in 90-min sessions. Behavior change recommendations included: increased aerobic activity; establishing a balanced diet, enhancing consumption of fruits and vegetables and reducing sugars and fat/saturated fat; incorporating strategies to enhance sleep and lower PTSD-related disruptions (e.g., nightmares); and relaxation and cognitive coping skills to reduce general stress. Methods: Participants were randomized to the health behavior intervention plus standard trauma therapy experimental condition or a standard trauma therapy control group. Outcomes were measured at baseline and after the 12-week intervention phase. Sleep efficiency was measured from actigraphy watches. Physical activity was assessed by self-report and blood pressure was measured using an automated device. The preliminary outcomes are for 29 participants to date who have pre-post data. Results: Sleep efficiency was improved in the intervention group compared to controls (p < 0.05). The intervention group also evidenced significant pre-post increases in moderate physical activity compared to the control group (p < 0.05). Changes in vigorous physical activity did not reach statistical significance in this preliminary sample but the pattern of results are similar to those for moderate activity. Trends toward significance were also observed for pre-post changes in systolic (p = 0.06) and diastolic blood pressure (p = 0.07), with small reductions for the intervention group and increases for the control group. Conclusions: These findings provide preliminary information about the effectiveness of the health behavior intervention on multiple parameters for adults with PTSD. The findings suggest that focusing on health behavior change in multidisciplinary treatments for PTSD may enhance outcomes such as sleep and physical activity and potentially result in greater quality of life. However, the small preliminary sample size reported here should be considered when interpreting the outcomes. Further research may also determine how improvements in health parameters impact other indices of long-term cardiovascular health. Full article

Refugees experience disproportionately high rates of sleep disturbances due to trauma, displacement, and resettlement stressors. Sleep health is critically linked to both physical and mental well-being, yet remains an underexplored area of intervention for refugee populations. This systematic review aimed to (1) identify interventions implemented to improve sleep health among refugees, (2) assess their effectiveness, and (3) evaluate the extent of cultural adaptation in their design and implementation. A comprehensive search of peer-reviewed literature from 2004 to 2024 identified nine studies focused on adult refugees in high-income countries. Interventions included psychoeducation, music-assisted relaxation, guided imagery, and nightmare-focused therapies. Several demonstrated improvements in sleep quality, insomnia severity, and nightmare frequency. Music-based interventions and sleep health education stood out as accessible, non-stigmatizing strategies that may be particularly well suited to refugee contexts. However, cultural adaptation emerged as the most significant gap. Using the 4-Domain Cultural Adaptation Model (CAM4)—which assesses adaptation across context, content, delivery, and engagement—most studies showed only surface-level modifications. Few incorporated community voices, and none validated sleep assessment tools for cultural relevance. Future research should prioritize co-creation with refugee communities to ensure interventions are not only evidence-based, but also culturally grounded, trusted, and sustainable across diverse refugee populations. Full article

Background/Objectives: Providing appropriate treatment for pediatric patients after traffic accidents remains a significant challenge. Furthermore, limited studies have validated the long-term effectiveness and safety of integrative Korean medicine treatment (IKMT) based on follow-up periods of 6 months or longer for pediatric patients. Methods: A retrospective chart review was conducted, focused on children aged 0–6 years who visited one of seven Korean medicine hospitals after traffic accident injuries and received IKMT between 1 January 2019 and 30 June 2023. The primary outcome was the Numeric Rating Scale (NRS) scores of chief complaints, and the secondary outcomes were quality of life, adverse events, and satisfaction with IKMT. Statistical analyses were conducted using paired t-tests and descriptive statistics, with a significance level of 5%. Results: Sixty-four participants were included in the retrospective chart review, and fifty-seven guardians responded to the surveys (mean age: 4.84 ± 1.26 years; mean duration of treatment: 19.20 ± 25.38 days). Among the immediate symptoms after the accidents, flashbacks and intrusive symptoms as well as nightmares and crying were the most common (50.9%). Following treatment, the NRS scores for flashbacks and intrusive symptoms and for nightmares and crying showed meaningful improvements from the time right after the accidents to the survey period. Follow-up confirmed that quality of life scores on all dimensions corresponded with those of healthy children. Nine adverse events were reported, and the participants fully recovered without the need for additional treatment. Furthermore, 91.2% of the survey respondents were satisfied with IKMT. Conclusions: IKMT was effective and safe for alleviating the post-accident symptoms in infants and young children aged 0–6 years involved in traffic accidents. Full article

Sleep paralysis (SP), an REM parasomnia, can be characterized as one of the symptoms of narcolepsy. The SP phenomenon involves regaining meta-consciousness by the dreamer during REM, when the physiological atonia of skeletal muscles is accompanied by visual and auditory hallucinations that are perceived as vivid and distressing nightmares. Sensory impressions include personification of an unknown presence, strong chest pressure sensation, and intense fear resulting from subjective interaction with the unfolding nightmare. While the mechanism underlying skeletal muscle atonia is known, the physiology of hallucinations remains unclear. Their complex etiology involves interactions among various membrane receptor systems and neurotransmitters, which leads to altered neuronal functionality and disruptions in sensory perception. According to current knowledge, serotonergic activation of 5-hydroxytryptamine-receptor-2A (5-HT2A)-associated pathways plays a critical role in promoting hallucinogenesis during SP. Furthermore, they share similarities with psychedelic-substance-induced ones (i.e., LSD, psilocybin, and 2,5-dimethoxy-4-iodoamphetamine). These compounds also target the 5-HT2A receptor; however, their molecular mechanism varies from serotonin-induced ones. The current review discusses the intracellular signaling pathways responsible for promoting hallucinations in SP, highlighting the critical role of β-arrestin-2. We propose that the β-arrestin-2 signaling pathway does not directly induce hallucinations but creates a state of network susceptibility that facilitates their abrupt emergence in sensory areas. Understanding the molecular basis of serotonergic hallucinations and gaining better insight into 5-HT2A-receptor-dependent pathways may prove crucial in the treatment of multifactorial neuropsychiatric disorders associated with the dysfunctional activity of serotonin receptors. Full article