Abstract
Dreams have traditionally occupied a marginal position within cognitive–behavioral therapy (CBT), largely due to the field’s historical emphasis on conscious cognitive appraisal. However, contemporary metacognitive and schema-oriented models increasingly acknowledge the role of implicit beliefs and affective processes in maintaining psychopathology. The present study reports a qualitative clinical case series examining the integration of structured dream exploration within CBT for three adult patients diagnosed with personality disorders characterized by deficits in metacognitive monitoring and self-reflective capacity. Dream material that emerged spontaneously during ongoing therapy was explored using the Description, Memory Sources, and Reformulation protocol, a structured cognitive method designed to facilitate systematic analysis of dream narratives. Across cases, dream exploration was associated with greater access to core emotional themes, clearer maladaptive schemas, and enhanced differentiation of internal states. In particular, dream narratives appeared to facilitate bottom-up activation of schema-relevant content that was not readily accessible through standard verbal-cognitive techniques. Collaborative examination of dream material also appeared to support therapeutic engagement. Given the descriptive nature of the design, the small sample size, and the absence of standardized outcome measures, the conclusions remain preliminary. Nonetheless, these findings suggest that structured dream work may represent a theoretically coherent adjunct to CBT in patients with compromised introspective functioning. Further controlled research is warranted. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
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@article{Albanese2026,
title = {Clinical applications of dream work in cognitive therapy: Evidence from the literature and case discussions},
author = {Marzia Albanese and Debora Meneo and Orlando Ricciardi and Emanuela Ricchezza and Francesco Mancini and Fabrizia Tudisco},
editor = {American Psychological Association (APA)},
doi = {10.1037/drm0000356},
issn = {1573-3351},
year = {2026},
date = {2026-09-10},
urldate = {2026-09-10},
journal = {Dreaming},
abstract = {Dreams have traditionally occupied a marginal position within cognitive–behavioral therapy (CBT), largely due to the field’s historical emphasis on conscious cognitive appraisal. However, contemporary metacognitive and schema-oriented models increasingly acknowledge the role of implicit beliefs and affective processes in maintaining psychopathology. The present study reports a qualitative clinical case series examining the integration of structured dream exploration within CBT for three adult patients diagnosed with personality disorders characterized by deficits in metacognitive monitoring and self-reflective capacity. Dream material that emerged spontaneously during ongoing therapy was explored using the Description, Memory Sources, and Reformulation protocol, a structured cognitive method designed to facilitate systematic analysis of dream narratives. Across cases, dream exploration was associated with greater access to core emotional themes, clearer maladaptive schemas, and enhanced differentiation of internal states. In particular, dream narratives appeared to facilitate bottom-up activation of schema-relevant content that was not readily accessible through standard verbal-cognitive techniques. Collaborative examination of dream material also appeared to support therapeutic engagement. Given the descriptive nature of the design, the small sample size, and the absence of standardized outcome measures, the conclusions remain preliminary. Nonetheless, these findings suggest that structured dream work may represent a theoretically coherent adjunct to CBT in patients with compromised introspective functioning. Further controlled research is warranted. (PsycInfo Database Record (c) 2026 APA, all rights reserved)},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
