{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T18:22:27Z","timestamp":1794075747180,"version":"4.8.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,25]],"date-time":"2020-11-25T00:00:00Z","timestamp":1606262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students\u2019 nightmares demonstrated frightening themes of being under attack and loss of self-efficacy\/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students\u2019 nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students\u2019 nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.<\/jats:p>","DOI":"10.1371\/journal.pone.0242414","type":"journal-article","created":{"date-parts":[[2020,11,25]],"date-time":"2020-11-25T13:25:44Z","timestamp":1606310744000},"page":"e0242414","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["The nature of posttraumatic nightmares and school functioning in war-affected youth"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4311-1988","authenticated-orcid":true,"given":"Gerlinde C.","family":"Harb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon-H\u00e5kon","family":"Schultz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,25]]},"reference":[{"issue":"2","key":"pone.0242414.ref001","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/j.1365-2214.2011.01246.x","article-title":"A systematic review on the mental health of children and adolescents in areas of armed conflict in the Middle East","volume":"38","author":"L Dimitry","year":"2011","journal-title":"Child: Care, Hlth Dev"},{"issue":"1","key":"pone.0242414.ref002","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s12310-016-9175-2","article-title":"School-related outcomes of traumatic event exposure and traumatic stress symptoms in students: A systematic review of research from 1990 to 2015","volume":"8","author":"MM Perfect","year":"2016","journal-title":"Sch Ment Health"},{"key":"pone.0242414.ref003","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5\u00ae)","author":"American Psychiatric Association","year":"2013"},{"key":"pone.0242414.ref004","volume-title":"Humanitarian needs overview. 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