Stanford Medicine researchers have shown they can reliably induce dreaming during anesthesia. The team believes the technique could become a new treatment for PTSD.
A study published in July in the journal Anesthesiology found that 69% of 452 patients dreamed under a five-step protocol using propofol, a common surgical sedative. Of those who dreamed, 86% described the experience as positive or somewhat positive, according to a Stanford Medicine report published Tuesday, Sept. 8.
The protocol does not change the standard anesthesia process during surgery and does not increase the risk of patients becoming aware during an operation, said Boris Heifets, associate professor of anesthesiology, perioperative and pain medicine at Stanford Medicine and the study's senior author.
The five steps are straightforward: tell the patient they might dream, use propofol during emergence, monitor brain activity via EEG, allow at least 10 minutes of quiet emergence and ask about dream recall immediately upon waking.
That 10-minute quiet window proved the hardest part. Most of the 452 patients did not get a full 10 minutes of undisturbed emergence in the busy operating room. Among a subgroup of 57 who did, the dreaming rate jumped to 93%.
Patients who recalled dreaming also reported better sleep quality under anesthesia than those who did not.
Pilleriin Sikka, a research scientist in anesthesiology, perioperative and pain medicine at Stanford Medicine, is the study's lead author. Harrison Chow, clinical associate professor of anesthesiology, developed the project with Heifets after first observing potentially therapeutic dreaming in surgical patients.
From operating room to PTSD clinic
The team has moved the protocol out of the operating room and is testing it on people who are not undergoing surgery. An open-label trial with 15 patients with moderate to severe PTSD is nearing completion, with results Heifets described as promising. A randomized, blinded trial with a control group is planned next.
Before anesthesia in the PTSD trial, a licensed therapist guides the patient through image rehearsal therapy. The patient reimagines an aspect of their trauma with a better ending, bringing the association to mind before going under.
Heifets sees parallels to psychedelic therapy. The team measured the "psychedelicness" of anesthesia dreams using the Mystical Experience Questionnaire and found it rated at what Heifets called "a pretty decent dose of psilocybin."
Heifets said the work shows researchers can reproduce psychedelic-like experiences with propofol, which is not itself a psychedelic. "To me, it screams that the experience itself … is critical and has very little to do with the underlying drug," he said. "This needs further work, obviously, but it's a strong suggestion that it is the subjective experience itself that is so crucial."
He noted that some PTSD patients are wary of psychedelics. The anesthesia approach takes about an hour, compared with the six or more hours a psychedelic session can require.
A Palo Alto resident shaped the research
The study builds on earlier case studies Stanford Medicine published in April 2024. Among the patients featured was Mare Lucas, a Palo Alto resident who experienced a significant reduction in PTSD symptoms after having vivid, positive dreams during surgery at Stanford Health Care in August 2022. Lucas had suffered from PTSD following the death of her son in 2017.
Lucas said in the April 2024 report that solutions like the dreaming protocol need to reach mainstream medicine now.
No completion date has been announced for the ongoing PTSD trial.
