**1. Introduction**

Since the birth of psychotherapy, work with dreams has been mainly developed in the realms of psychoanalysis, psychodynamic therapy, and less commonly within humanistic or existential therapy. Within the framework of cognitive-behavioral therapy (CBT), very few dream analysis concepts have been elaborated on. However, in recent years, cognitive therapists have found a new interest in work with dreams [1].

Referring to dreams in CBT is fully justified if the cognitive processes that are involved in the dreaming process are considered. Dreaming includes such cognitive processes as: accumulating content in both semantic and autobiographical memory; representing these elements in a visual and auditory manner and in other modalities; combining the above representations into a dream scene; creating a narrative sequence for the dream scene; and focusing on dream

content [2]. Dreaming is also related to assimilation of personal experiences into one's existing memory system. During this process, waking life events are contextualized through the formation of connections between previous cognitive and emotional experiences and present circumstances [3]. Dreams are one way of assimilating waking experiences into the schemata because they help to classify emotional experiences from the waking state, compare them with memories, and plan future actions [4]. These processes are possible in the case of dreams that do not reflect powerful emotional traumatic events. Such dreams (usually nightmares) are very likely to be recurrent, as they are an attempt to complete the assimilation of negative waking experiences [3, 4].

group led by Saul [12]. The main goal of their project was to examine the psychoanalytical theory of "inverted hostility" in depressed patients [13]. This concept assumes that a selfpunitive need to suffer occurs in depression [14]. It was suggested that "masochistic" dreams are related to depression and that subjects with masochistic tendencies might be more prone to this disorder, so the study confirmed the psychoanalytical concept of "inverted hostility" [13]. In fact, this is the only article by Beck in which he referred to psychoanalytical interpreta-

Dreams in Cognitive-Behavioral Therapy http://dx.doi.org/10.5772/intechopen.70893 99

In his next project, Beck, in collaboration with Ward, extended the research and confirmed his previous findings [15]. In discussion, he assumed that: (a) it is not necessary to analyze dreams, or assume any unconscious meaning, to assess their thematic significance; (b) the manifest dream content correlates well with important themes in a person's waking life; (c) the themes of a person's pathology and of his or her will correlate, suggesting the existence of a certain mechanism that regulates how we construct meaning; and (d) systematic and experimental study of dreams would be useful in isolating other thematic correlates of spe-

The aforementioned conclusions were fundamental for a cognitive shift of Beck's thinking about the mechanisms of mental disorders. Along with Beck's personal disappointment with the results of his own psychoanalytical therapy and his dissatisfaction with how psychoanalytical therapists treated their patients, his conclusions on dreams led him to abandon psychoanalysis and motivated him to work on his own therapeutic method [12]. In 1971, Beck published his last paper on dreams; this was the only one that concerned dreams and a cognitive approach [9]. In this article, he defined dreams as "(…) a visual phenomenon occurring during sleep" [9]. According to Beck [9], dreams reflect the patient's concept of the self, the world, and the future. Consequently, dreams are seen as reflecting a patient's cognitive patterns, which are specific to the individual and "exert a maximum influence on the content of dreams" [9]. Therefore, some dreams can be a useful tool in cognitive restructuring as they

Moreover, according to Beck [9], a single dream may provide a clarification of the patient's problem. After formulating a series of alternative hypotheses, a dream can support one of them, modify them, or offer completely different possibilities. Dreams might also be considered as a kind of biopsy of the patient's psychological processes. Pathognomonic dreams show, in turn, the way the individual sees himself, the world, and the future. Dream content

Beck, at the beginning of his academic and therapeutic carrier, was deeply interested in dreams. After he established the basis of cognitive therapy, he wanted to spread his ideas. He was frustrated with the psychoanalytic politics of personal loyalty and in turn, psychoanalytic therapists were not interested in contributing to the "broad psychotherapy" postulated by Beck. Therefore, he turned toward behavioral therapists, who offered him a supportive community and opportunities for bringing cognitive therapy to a wider audience [17]. This alliance with behavioral therapists forced him to abandon his research on dreams. Subsequently, due to ideological, financial, and pragmatic reasons, Beck, decided not to continue his interest in dreams. CBT still bears the consequences of this decision: until now, working with dreams has been neither well implemented nor well researched. Freeman and White [8] pointed out

help reveal cognitive distortions, schemas, and maladaptive thought patterns.

may reflect changes in waking cognition due to progress in therapy [16].

cific psychopathologies and pinpointing their mechanisms [14].

tion of dreams.

Treatment of recurrent frightening dreams within the framework of CBT is well elaborated [5]. This topic has been addressed in other reviews and meta-analyses [5–7]. Working with nightmares in CBT is developed and often applied, but working with dreams, in general, in CBT is barely elaborated and rarely used. A vicious circle occurs due to a lack of research on the use of dreams in CBT, and there is a very little knowledge about dream analysis in this therapeutic approach; therefore, therapists do not want to elaborate on this topic during therapy sessions [2, 8].

The main aim of the chapter is to present perspectives on working with dreams within the framework of CBT. The first perspective concerns the historical view on the usage of dreams in CBT. The second functional perspective includes an analysis of the conceptual functions of working with dreams in CBT. Finally, yet importantly, the processual perspective is focused on practical issues related to working with dreams in CBT.
