A flashback is a memory of the past that intrudes into the present and makes the past seem as if it is actually occuring in the here and now: “A sudden, vivid recollection of the traumatic event accompanied by a strong emotion” as stated by Matsakis in 1994.
Flashbacks are a common symptom for PTSD sufferers. They are part of Intrusive reactions, which are together with avoidance and physical symptoms among the three major types of reactions in PTSD.
Intrusive memories are:
*Memories or thoughts of the trauma suddenly popping into your mind
*Dreaming about the trauma over and over
*New aspects of the trauma coming to you through nightmares or thoughts
*Feeling as if the traumatic event is happening again
*Reacting to triggers, such as smell, sound, date, or any stimulus associated with your original traumatic experience (including new associations) that push you back into the trauma through a flashback or an abreaction (A full-blown reliving of the trauma in real time).
*Getting really, really nervous or uncomfortable in a situation that reminds you of or is similar to the trauma
A good way to deal with intrusive memories is to build dual awareness. In short this means that you accept and reassure yourself that your trauma is NOT occurring in the present time and that you are safe. Having dual awareness helps you look at the trauma while you are secure in the knowledge that you are really in the present environment. When having built dual awareness one is capable to switch between past and present and take control over the intrusive character of these memories.
I’ll write down an exercise to develop dual awareness as written in The body Remembers by Babette Rothschild.
Remember a recent mildly distressing event (something where you were slightly anxious or embarrassed)
- What do you notice in your body?
- What happens in your muscles?
- What happens in your gut?
- How does your breathing change?
- Does your heart rate increase or decrease?
- Do you become warmer or colder?
- If there is any change in temperature, is it uniform or variable in sectors of your body?
Bring your awareness back into the room you are in now. Look with awareness
- Notice the color of the walls and the texture of the rug
- What is the temperature of this room?
- What do you smell here?
- What do you see?
- What do you hear?
- Does your breathing change as your focus of awareness changes?
Now try to keep awareness of your present surroundings while you remember that slightly distressing event.
- Is it possible for you to maintain awareness of where you are physically as you remember that event?
End this exercise with your awareness focused on your current surroundings
It takes some time to build dual awareness. When being in therapy it can be very helpful to do this with your therapist, because he or she can guide you through this process. You’ll notice that switching between past and present becomes more easy when dual awareness is growing.
Back to the flashbacks. Lots of trauma survivors are suffering from flashbacks. There are two kind of flashbacks: the slight ‘blip’ in time or the memory of an entire experience, occurring in real time just as it did in the past. This last one is called abreaction.
A flashback can be visual and/or auditory parts of the trauma, but also body memories (such as pain), emotions (intense anger that comes out of nowhere, or extreme feelings of fear), and behaviors (acting in certain ways when a trigger comes up), or intrusive thoughts. Whenever a flashback happens, it feels as if the trauma is happening all over again.
You do not blackout, but you do leave the present time temporarily. Flashbacks reinforce terror and feelings of helplessness.
During a flashback, your trauma gets replayed with great intensity; in many cases, unless you know how, you may not even be able to separate your flashback from present reality, reinforcing the impact of that trauma on you.
Sometimes it’s very difficult to make sense of flashbacks, particularly when there are not entire scenes of traumatic events or just parts of the events. Usually a flashback also includes some emotional and sensory aspect of the traumatic event. Your entire nervous system is involved when you have a flashback; it becomes hyperaroused when you are exposed to trauma triggers. This is why flashbacks feel as if they are real.
Important things to ask yourself when having a flashback are:
*What is the flashback trying to tell me?
*Do I have more to see?
*Do I have more to feel?
*Do I have more to hear?
*Do I have more to learn or accept about what happened to me?
*Am I able to grab onto only this piece of the memory without getting lost?
One important way to deal with flashbacks is to get outside of your head and into the world around you. You can do that by writing about it, talking about it, drawing it, making a collage about it, or otherwise representing it someplace other then in your mind. Also grounding exercises and exercises for your senses can be usefull.
I, myself always use this one (because you can do it anywhere):
Name 5 things…
-you are looking at
-listening at
-physically experiencing or feeling (no emotions)
with all you attention and concentration
Then 4
Then 3
Then 2
Then 1
End this exercise with all your attention at both feet grounded.
I also use this exercise on a daily basis to build and maintain my dual awareness and to keep present and stop dissociating.
Another exercise I do to deal with flashbacks has to do with positive psychology. Being positive is very important. It means you are building resilience. You need resilience to cope.
In general flashbacks make people feel helpless. Sometimes there are other returning feelings as well, such as feeling worthless or rejected or something else.
It is important to counter those beliefs through affirmations and positive thinking. It will make the flashback less intense when you don’t buy its message.
The exercise I am doing is simple. I take some time every day to write down situations that counter the feelings the flashbacks give me; for example helplessness.
I write down at least 5 situations in which I didn’t feel helpless. I try to write it down with awareness and try to relive how it felt to not feel helpless. It’s ok to repeat situations you wrote down before; Flashbacks are repeating itself as well, but try to think of at least 5 different situations per day. You can also write down things you have accomplished because they make you feel competent, which counters feelings of helplessness.
There are lots of exercises to deal with flashbacks, most of them are powerful and you can better do them in the safe surroundings of therapy. I will write one down. It is from the PTSD workbook (Williams and Poijula). It’s about beginning to deal with a flashback.
Think of a flashback you have had in the past two weeks
-Describe the flashback and what you experienced (sensatory information also)
-Have you had a similar flashback in the past?
-If so, then under what conditions?
-What’s the connection between these flashback-experiences?
-How did the flashback smell, feel, or sound?
-Who was involved?
-How did the actual traumatic experience smell, feel or sound?
-Who was involved?
-How are the flashback and the past traumatic situation different or the same?
-What actions can you take to feel better as the flashback occurs?
-How can you ground yourself to stay present when flashbacks occur?
-How did you feel as you did this exercise (also give it a grade from 1-10, where 10 represents worst possible feelings)
Other ways to deal with flashbacks:
*Repeatedly blink your eyes hard
*Change the position of your body
*Use deep breathing
*Use imaginairy to go to your safe place in your mind, or surround yourself in your mind with safe persons
*Go to your actual safe place
*Surround yourself with safe objects (physical elements that make you feel safe (such as a stone, a picture of someone you love, a teddybear, anything), hold them
*Move vigorously around your environment
*Name objects in your environment out loud
*Tell yourself the date, year and your age and tell yourself loud and clear it is over.
*Listen to a soothing audio recording, for example one a therapist made for you if you are in counseling. Also relaxation exercises or calming music
*Clap your hands
*Stamp your feet on the floor
*Wash your face with cold water
*Hold something cold or hot
*Say positive statements (affirmations) about yourself
*In your imagination, spray the memory with a bottle of cleanser until it goes away
*Try to project a superhero in your memory to save you or grant yourself superpowers to save yourself
*Project the flashback onto a dry erase board and then erase it; do the back and forth movements of the eraser with your hand (countering body memories and taking back control)
*Draw the flashback on paper, or write it down. Then destroy it or get rid of it (shred it, burn it, bury it, anything)
*Put the flashback into some type of vault or container (real, on paper, or symbolically, in your mind). You can tell yourself: “I acknowledge I am feeling like this, but I don’t want to drown in it. I put it away for now and I will come back and look at it later if I can handle it.”
*Touch your ear, follow it’s every line with all your attention, try to recreate it in your mind
*Change environment. Go outside for example.
*Put a rubber band around your wrist. Snap it and focus on how it feels like, instead of what’s going on in your head.
*Count. For example every day, hour or minute of your age. Or use your watch or pulse as a way to count
and to conclude this post:
The Flashback- Halting Protocol.
I wrote about Dual Awareness earlier this post. The following protocol (also from The Body Remembers Rothschild) is based on it. It is designed to reconcile the experiencing self with the observing self and generally will stop a traumatic flashback quickly, according to Rothschild.
You should practice this technique on ‘old’ flashbacks (those you have had, processed, and perhaps put to rest) so that you can learn it well, without being overpowered by it.
When you’ve learned enough you can use it later when having a flashback that includes new memories or previously unknown traumatic events or material.
The Exercise
The flashback I am using is ………
Say to yourself (preferable aloud) the following sentences, filling the blanks:
Right now I am feeling ……… (insert name of the current emotion, usually fear) and I am sensing in my body ……… (describe your current bodily sensations, name at least 3), because I am remembering ……… (identify the trauma by title only, no details!)
At the same time, I am looking around where I am now in ……… (the actual current year),
here ……… (name the place where you are), and I can see ……… (describe some of the things that you see right now, in this place), and so I know ……… (name the trauma, again by title only) is not happening now/anymore. [J. lets me add: I already survived!]
How did this technique work for you? What was it like to do it?
Evaluate ………
To me, this looks like the perfect way to conclude this post. I hope anybody found it helpful =)
