Flashbacks

Coping with the symptoms of PTSD

Most people are troubled by reliving the traumatic event over and over again in different ways. This is distressing and frightening. For reasons mentioned earlier, it is unlikely that this kind of reliving the traumatic event will stop completely until your trauma memories are more fully processed into ordinary memories. Until then, there are some things you can do which might make things a bit more controllable.

Managing Intrusions and Flashbacks:

Intrusions are most often in the form of pictures of particularly distressing parts of the traumatic event. They can be fleeting or last a few seconds, most intrusions are quitevivid some more than others, depending on factors such as PTSD severity, context, andhow they were triggered. People generally have a number of different intrusions, which repeat over and over again. These may replicate what happened at the time of the trauma,or can be about things you feared might happen but did not actually take place.

‘Flashbacks’ are especially vivid memories which usually include physical sensations,and are accompanied by a sense that the trauma is happening again. They usually last between a few seconds and a few minutes. Most people report that flashbacks are lessfrequent than intrusions.

Intrusions and flashbacks are readily triggered by factors in the environment which matcha feature of the traumatic event. A particular noise (for example, someone slamming adoor) might trigger them, or sometimes something as simple as a particular feel to the day is enough.

Most people who experience intrusions try to push them out of mind / or to suppress themusing distraction or other means’. In the short term this may appear to help, but research has shown that, ironically, we are generally more likely to think of something if weactively try not to do so.

To get more control over your traumatic memories it is helpful to learn new strategies tomanage them. These strategies might seem a bit counter-intuitive, but they do make apositive difference to the vast majority of trauma survivors.

Try not to suppress intrusions. Just let them happen without pushing the pictures, thoughts and feelings away. To show you how to do this, imagine you are standing on a train platform watching a train thunder through without stopping. You watch it come andgo, but do not get on it. You can think of your intrusions in the same way. Just let themgo through your mind, acknowledge that they are happening, but do not try to alter themin any way. Remember that trying not to think of something makes it more likely to come to mind. Suppression may also lead to a gradual build up of ‘pressure’, so that after a time an intrusion becomes so strong that it can no longer be pushed away. As a result the intrusion is particularly vivid and distressing. This process can also lead to full blown flashbacks.

Flashbacks should be treated in the same way, but because they tend to pull you back intothe past you will also need to ‘anchor’ yourself in the here and now. There are two mainways of doing this:

1. Focus on the differences between now and then:

Try to make yourself aware of the differences between the time of the trauma and the here and now. This may sound a bit daft because in many ways you already know that you are no longer in the middle of the traumatic event. But remember, the trauma memory is different from other memories, and does not know that the event is not still ongoing. To help yourself discriminate between the ‘then’ and the ‘here and now’, it is helpful to tell yourself in detail where you are now, and how this differs from then. You can say things like: “I know the trauma is no longer happening, because I’m sitting in my kitchen reading the paper”. “I’m in my car, not an ambulance”, “I now have a small child I did not have her then” etc.

2. Focus on using ‘anchors’ to help ground you in the hear and now:

If your flashbacks are particularly vivid it might be useful to make sure that you have something to anchor you in the here and now. Smells and sounds are good. To give you an example, a patient experienced strong smells of blood whenever he had a flashback to a particular traumatic event. The smell was powerful and made the memories particularly vivid. To help him get a bit more control over this, we tried out a number of different smells in one of our sessions, finally settling on ‘Fisherman’s Friend’ cough drops, which have a strong taste and vapour. This is obviously not a cure for the flashbacks but it did anchor him in reality a bit more. The strong taste and vapour of the Fisherman’s Friends were not part of the traumatic memory, and so provided a cue that the traumatic event was-not happening again. As a result the flashbacks became briefer, less vivid and less distressing.

3. Find the triggers to the memories so that you can make a bit more sense of what is happening to you.

Try to work out what might have triggered an intrusion or flashback. This may not stop it from happening again in the future, but it can help you make more sense of what is happening to you.

Most patients report that letting the intrusions happen without trying to stop them is initially frightening, but makes things a bit more controllable with practice.

Discriminating between now and then seems to be helpful to nearly everyone. It needspractice before it will make an appreciable difference to how frequent and controllable the intrusions and flashbacks seem to be. Try it and see whether it works for you.

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