Background: Studies on the organization and structure of dreams before and after acute myocardial infarction (AMI) are lacking. Methods: We retrospectively studied dream pat-terns before and after AMI in the STEP-IN AMI trial (Short TErm Psychotherapy IN Acute Myo-cardial Infarction). We also describe how this pattern may change during ontopsychological short term psychotherapy (STP) performed after AMI. Forty seven patients (pts), age 31-70, were studied. Results: At baseline 21/47 (45%) pts remembered dreams, which increased to 43/47 (91%) with psychotherapy (P< 0.0001). Recurring dreams, described as a state of anguish, despair, the perception of an inability to complete an action, or the grief of one’s mother’s early death, oc-curred before AMI in 16/47 pts (24%). After the third psychotherapy session no pts reported re-curring dreams (P< 0.001). In dreams that occurred during the year before AMI, 12 of 25 symbols referred to people known to pts and who had died of a cardiac disease; 9 of 25 symbols referred to an accident, danger, or distressing events. Globally, 21 of 25 symbols were associated with danger to an individual’s life (84%). The incidence of “negative” symbols was sharply reduced during psychotherapy, from 84% to 32% during the first 3 psychotherapy sessions, and 9% in the last phase of psychotherapy (P< 0.0001). Conclusions: Our study shows that pts with AMI fre-quently do not remember dreams that occurred before AMI or report distressing dreams. Short Term Psychotherapy after AMI significantly increased the ability to remember dreams and sharply reduced the incidence of negative/distressing dreams. Results suggests that STP may act as a stimulus for inner personal change for AMI pts.