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Dear Raija-Leena Punamaki, (and all) Some of the list subscribers are using text only readers, so I have taken the liberty of distributing the ascii version of your message - Richard Wilkerson, technical support manager. Dear Colleagues, Helsinki, 19 May 1998 Hereunder are my (Punamaki - the author) responses to your comments on the Article: "Determinants and mental health effect of dream recall among children living in traumatic conditions". First let me apologize for the delay for my response, due accumulation of deadlines. Now I would like thank you all for having devoted your time to comment the article. Getting feedback is a luxury to any researcher. As a beginner in dream research (although not in developmental psychology and stress research), I felt like a student when "all the big names were commenting my article!". In this communication I will concentrate on your critical comments on methodological problems and respond to each of you separately. Later, it would be intriguing to discusses specific themes, exchange ideas about the problems and develop some dynamic hypotheses for forthcoming research. MICHAEL SCHREDL WRITES: >I personally do not like the mood congruency hypothesis since >it is not testable. How should it be possible to measure dream >emotions independently from mood after awakening. I would like >to name it carry over effect. It seems more plausible to me >that dreams influence morning mood. My study setting was entirely based on one-source information concerning the morning mood and dream content. I fully agree that a setting involving separate, more objective and independent measures of dream content (across the night and various REM), and morning recall and emotion reporting would have allowed us to test some of the hypotheses. Also the contemporary emotion theories would brovide much more sophisticated tools to depict the emotional dynamics than the one I used. You are right about "mood congruency", it could be called "carry-over effect". Apparently I was too excited by the mood congruency literature, and would like to study it in the dream context. Let's discuss it later. To Michael's comment on the Method Section: MICHAEL SCHREDL WRITES: >Personally, I think the participants knew very well the aims of >the study. I would protest your argument that the participants knew very well the aims of the study(Mental health function of dreaming, role of dream recall in traumatic environment). My text was apparently confusing in the previous draft of the manuscript, which you must refer to: the purpose of the study was NOT intensively explained to the participants. I wrote that the instructions were written in a tightly-scripted statement in order to guarantee consistency from home to home. (It went: "Nocturnal dreams are familiar to all of us. We would like to better understand childrens' dreams and to know what they 'see' in their dreams. Therefore we kindly ask you to report every morning what kind of dreams you had in the night...". The instructions also included a clause about us maintaining the anonymity of each child and technical advice as to how to report. I have the dream diary forms in English (in addition to Arabic, Kurdish, Somalian, Spanish and Finnish). We were conscious that we should absolutely avoid exerting ANY pressure on substance, quality or quantity of dreams. We never even hinted to the children that they should report numerous or little dreams, and the variation in dream recall was substantial and indeed proves that. MICHAEL SCHREDL WRITES: >Second, the results may be influenced by experimenter effects >since the groups were interviewed by two different persons. >The researcher himself (highly motivated) obtained the sample >with higher dream recall frequency. I think a comment on this >should be given. It would have been ideal to use the same field workers in both places, but sadly, for "security reasons", even a Gaza resident who may travel to work in Israel must return daily to Gaza. I would argue that fielworkers in both Gaza and the Galilee, were highly motivated. MICHAEL SCHREDL WRITES: >Personally, I like the funny sampling method ... There is, >however, one weakness in this approach shortly addressed by >Punamäki. She did not give a response rate or a sample size of >all potential participants. This could lead to severe biases in >the data. We took every child (in the chosen age range) in every third house in a given area. Therefore it is impossible to report the sample size of all potential participants, because we have no idea about how many potential participants live in houses that we did not visit. On results: Please, see my response to Peretz Lavie concerning the confusing values in the figures. I would like to hear all of my colleagues solutions about how to take into account the variation of dream recall in constructing dream content scores. I have chosen two ways: (1) using the recall score as a covariant when possible, and (2) dividing the content scores by the number of dreams + subsequent standardization. The latter alternative allows us to use the scores in a correlation analysis. I would like to return in our next exchange to discuss the dynamics between memory, saliency, bad dreams and nightmares. Michael Schredl and Tore Nielsen provide intriguing views of the problem. PEREZ LAVIE WRITES: >I read the paper several times and each time I read it I was >more confused. There are too many questions related to the >data presentation and data collection procedure that cast some >doubt regarding the meaning of the findings. (Here I also respond to Deirdre Barrett comment) Figures 3, 4a and 4b illustrate the interaction between two predicting variables on one dependent variables. Therefore raw scores cannot be shown here. Plotting the interaction reveals simple regression lines predicting the level of dream recall (fig. 3) and symptoms (figs. 4a, 4b) in degree of traumatic events and repressive tendencies (fig. 3), and in degree of death and wounding and dream recall (figs. 4a, 4b). (Observe that "predicting" is not a causal but rather a technical term here). Significant interaction means that the association between, for instance trauma and symptom, is different among those with low and high recall, i.e. regression of Y on X depends upon the value of Z. But because the independent and "moderating variable" are continuous predictors in regression analysis, the "low" and "high" are not in their original scores. They were chosen to be one standard deviation below the mean, at mean, and one SD above the mean (Cohen & Cohen, 1983). Researchers often choose to illustrate the interaction effect by using the schematic or conceptual definitions (Low, Medium and High) of the X-axis. This choice might have been less confusing. There are some disagreements, as I understand, about how to construct the interaction term in regression analyses. I followed Aiken and West (1991), who often refer to the highly influential Cohen & Cohen (1983) in converting the interaction variables into centred scores. The X-axis scores range accordingly. [Another conversion possibility could be the use of mean deviation scores or, as we did in the old days, just to use any standardized variables in interaction (cross product term)]. PERETZ LAVIE WRITES: >There is no information on the number of subjects in each >category of traumatic events (Figures 1a 1b and 2)... The Traumatic Event Checklist was normally distributed, and therefore I ranked in three percentiles that conceptually depict low, medium and high levels of exposure. Indeed the number of cases in each group in Figures 1a, 1b, and 2 would have helped to make any sense of the findings. However, it is not customary, according to APA guidelines. PERETZ LAVIE WRITES: >What are the definitions of frequent and infrequent dream >recalls (every night ? 6/7 nights? vs 0?, 1 2/7 nights???). The dream recall variable was used as a continiuous variable in all the analysis (as dependendent and independent variables in regressions). If I used it as grouping variable in ANOVA, for instance, I conceptualized it high dream recall (7-6 nights), medium (5-4) and low recall (1-3) and no recall at all. Dream recall variable was normally distributed, so the categorization is not a great problem. You may be right that we use in liteture to careless the term infrequent and frequent recallers. But if you have a continous variable, it has become customary to name the phenomenon accoring to the opposites. PERETZ LAVIE WRITES: >The differences between the traumatized and non traumatized >groups are far from being clear. There is, indeed, a problem to objectively agree on the differences between the so called traumatized (Gaza) and the so called non traumatized subjects (Galilee). The research setting was planned to increase understanding on trauma (or stress)-dream association. International, Israeli and Palestinian human right documentation all indicate that childhood in Gaza involved a substantial level of environmental violence, dangers and painful experiences, greater than in Galilee. However, I also measured the personal exposure to traumatic events, so there are two different indicators about the level of trauma. I agree that these groups should not be call traumatized or non-traumatized. Perhaps "violence-group" and "comparison group" would have been better. PERETZ LAVIE WRITES: >I also found it particularly distressing that in the discussion >section, Dagan Lavie and Bliech (1991) study is cited as >supporting the observation that "the sleep of traumatized >people is lighter.." while this study reported precisely the >opposite. This was absolutely my mistake and misunderstanding to which I do not have any rational explanation. Naturally, our results indicated a deeper sleep, heightened thresholds and lower level of dream recall among PTSD patients. I feel very embarrassed. But I think that we have not yet exhausted the question about active blocking versus vigilant processes among trauma victims. A theory of PTSD, as originally understood by Mardi Horowitz provides evidence that intrusive and avoiding symptoms tend to oscillate across the recovery process. The dream researchers Wright and Koulack (1987) suggest in the similar lines that mastery dreams incorporate disruptive events and affects (intrusive), and compensatory dreams avoiding painful events. So the field is interesting, and our results on trauma-recall differ. I would like to heard your further comments, but the scientific level of my paper seemed to frustrate you. RICHARD J. ROSS WRITES: >... it is almost certainly premature to argue from >correlational data that infrequent dream recall protects >children from developing depressive symptoms but makes them >more susceptible to somatic and anxiety symptoms. It is for sure a mistake to say that recall 'protects from developing symptoms', as developing apparently refers into future. An interaction effect refers, however, to a moderation, which means that the negative (vulnerability) effect of trauma (on well-being) is attenuated or cancelled. You are right, one should be more clear, and we (psychologists) always dispute about the moderating and mediating effects with statisticians. RICHARD J. ROSS WRITES: >Also, I would be interested in the authors' response to my view >that a necessary distinction between TRAUMATIC events and major >life changes/stressors has been obscured in the Introduction. The conceptualization of life stress, traumatic stress, trauma and traumatic events surely requires more work. I do not think that I equated bereavement or divorce with traumatic events of this sample (detections, night raids, deaths). I used the results of the few empirical research on stress-dream associaiton to learn about the possible link. The content of the stressful events do not have to be exactly the same, the other research still gives you some ideas when constructing hypotheses. The more interesting question might be the subjective appraisal of trauma or stress as Kathy Belicki noted. TORE NIELSEN WRITES: >I want to know how much these effects derive from the fact that >her traumatized subjects simply experienced more nightmares >(possibly PTSD nightmares) and that, by definition I think, >nightmares are both salient (awaken the person) and mood >congruent (cause post awakening distress)? The question about nightmares, PTSD-nightmares 'traumatic dreaming' and bad dreams is a crucial issue in populations exposed to painful experiences. I agree that they should have conceptualized more clearly in the present article. The issue also relates to the controversial issue whether dreams play any adaptive role, have some psychological function or any meaning in information processing. In trauma research, there is a tendency to equate trauma related, repetitious and bad dreams with symptoms. Conceptually they are confused with nightmares, because they, indeed, constantly wake up the dreamer and increase distress. When starting the research I was (and still am) very impressed by the work by Hartmann and Belicki about nightmares. Basing on clinical knowledge I strongly believe that nightmares also deserve contextual analysis, they cannot be considered just as one category (without content) in dream research. In diagnosis it might be appropriate. The empirical question should be about variety, dream features (actors, scenes, controllability, narrative fragmentation) and function of vicious vs. benevolent dream. The occurrence of nightmares can be calculated in the data, using one of the Hartmann criteria, according to which the dream is interrupted. There were two indicators of that: A person spontaneously reports him/herself waking up by the dream: "I screamed loudly (in the dream) and thereafter I woke up screaming". We also explicitly asked the child to report whether he/she woke up in the night, and why. I agree that it is a very good idea to analyze more carefully the nightmare dynamics separately in the comparison and 'trauma' groups. TORE NIELSEN WRITES: >... on page 254, the author states 'infrequent dream recall >protected children from developing depressive symptoms when >they were exposed to experiences of death and wounding, but >made them more susceptible to somatic and anxiety symptoms'. >This sounds like causal reasoning does it not? I am aware of the danger of understanding some psychological responses as 'protective' or vulnerable in a cross sectional study setting. The moderating role of a variable refers, however, to the fact that the association between explaining and criterion variables (e.g. trauma and symptoms) is different in different conditions (e.g. remembering/not remembering dreams). So, even if it sounds like playing with words, I would argue that the recall protects (or makes more vulnerable) a child from negative impact of trauma. Finally, I agree with Tore, who would like to see descriptive results about nightmares and bad dream prevalence in these diaries. Unfortunately, for objective considerations of space, editors usually omit those few samples. As you all know, writing for scientific journals often means reducing your reporting to a limited number of pages, a phenomena which sometimes gives your paper a 'choppy' feeling. KATHY BELICKI You wrote so kindly that I hardly can react. Being in science is to be on constant guard, so for me it easier to defend and argue. I have to say I never suspected some colleaques' "jealousy", because from our point of view psychological field work in current political situation in Gaza is troublesam, using Palestinians as sample is like academic suicide, and this was my first dream research. It was based very much on clinical stories and the fact that Middle Eastern people seemed to express their pain naturally through dreams. I lived a part of my life in Jerusalem, and this explains the professional contants with Palestinians and Israelis. I would like to continue discussion. And thank for you patiency. Yours, Raija-Leena Punamaki, Psychologist, Ph. D. Senior Research at the Finnish Academy of Sciences Department of Psychology Division of Applied Psychology Meritullinkatu 1 B 00014 University of Helsinki Finland Tel: +358-9-1912 3253 Fax: +358-9-1912 3379 email: raija.punamaki-gitai@helsinki.fi home email: punamaki@cc.helsinki.fi