Stabilisation: Managing Flashbacks

This blog post is the second of a series relating to safety and stabilisation within trauma therapy. My previous blog post on building a sense of safety can be found here.

What is a flashback?
A flashback is a memory of a traumatic event that the brain has not processed properly. As the memory has not been processed properly, when experiencing a flashback, it can feel as though the traumatic event is actually happening in the present and can involve experiencing the thoughts, emotions and bodily sensations that you originally experienced during the actual trauma.
In short, speaking from experience, flashbacks are pretty terrifying.
Flashbacks are a symptom of post traumatic stress disorder.
I have previously written a blog post explaining what post traumatic stress disorder is in more depth.

Why should we manage flashbacks?
You might ask why you should have to manage flashbacks?
Wouldn't it be better not to have them at all?
Life would certainly be easier if you didn't have flashbacks however often the processing phase of trauma therapy involves becoming worse before you become better.  This may mean that you are likely to have more or stronger flashbacks during the process and it is important that you are able and prepared for managing this in your daily life.  Also, the better you are able to manage flashbacks, the less impact they will have on your life and they will become progressively less intense.  To give an example, fireworks used to trigger bad flashbacks for me but since building and practicing skills to help me manage those flashbacks, fireworks now have very little affect on me compared to before.

I think that what it comes down to is that as a survivor of trauma you owe it to yourself not to allow the trauma to negatively affect the rest of your life and managing flashbacks is a way of achieving this.

Managing Flashbacks

Recognise what you are thinking and feeling
Often it is uncertainty that breeds fear, sometimes just recognising and putting a name to how you are thinking and feeling can offer a little reassurance and help you to identify how you could manage these thoughts and feelings.
What emotions are your experiencing? Fear, anger, anxiety, sadness, panic, terror?
What thoughts are you experiencing? Often negative thoughts are attached to memories of traumatic events. You may experience some of the thoughts you had at the time of the trauma. These could include: I'm going to die, I'm not good enough, I'm trapped (these are some of mine).
What bodily sensations are you experiencing? Change in body temperature, heart racing, sweating,  shaking,  pain or numbness in a part of your body?
By asking yourself these questions you will be better able to put words to what you are experiencing. You can think to yourself - I'm feeling very afraid, I'm having thoughts that I'm under threat and am going to die, I'm feeling hot and shaky and that's because I'm having a flashback.

It will pass
Once you have established that you are having a flashback, you can reassure yourself that these feelings will pass.  For me, this is the most helpful thing I can do. When in the midst of the flashback, the overwhelming feeling is that you are trapped in the trauma and it will never end.  However, simply telling yourself - I'm having a flashback, some thing's triggered me but these feelings will pass, can offer so much reassurance that the flashback will not last forever and will stop soon.

Focus on things in the present - the traumatic event is not happening now
As I've said, the whole nature of a flashback is that it makes you feel as though the trauma is happening to you right now in the present when, in fact, it happened in the past.  It is therefore important to focus on the things around you in the present that tell you that you are in the present and the trauma is not happening now, you are just remembering things from the past.
The first thing you could do is affirm the date and time - I will often reach for my phone as it is the first thing I see on there.
Focus on the things around you in the present that are different to when the trauma occurred. You can use your senses for this. For example, a person might be with you who wasn't there during the actual trauma, you might be in a different place with different material things around you to where the trauma took place, there are going to be a number of differences to be spotted.  Spotting these differences can help to remind and convince yourself that the trauma is not happening now.

Assess whether the present situation is safe
Based upon the last step assess whether the present situation you are in is safe.
Are you in any real danger?
If you assess that you are not then that can be reassuring and help the flashback to pass.
 If you identify that you are in fact in an unsafe situation then it is about thinking how you could make your situation more safe.
Is there a person around who you could go to for help and could make you feel safer?
You may decide that the situation is completely unsafe, there is nothing you can do to make it safe and in that case, it would be wise to leave the situation and find a safer one to be in.

The shrinking image technique
Sometimes flashbacks can be accompanied by intrusive images.  You may see something linked to your trauma that is not really there in the present yet it won't go away and it is making it difficult to convince yourself that the traumatic event is not happening now.  I would often experience this during a flashback but my psychologist taught me this really good technique that helped me to overcome it.
You have to try and remind yourself that it is an image you are seeing and not the actual thing,
you can do this by:
Imagining putting the image on a screen and manipulating it - change the colours, blur it out, reduce the size, rotate it, erase the scary bits, delete it.
I usually pretend I'm on Photoshop and imagine myself editing the image - clicking the delete button feels amazing!
What I find is that manipulating and changing the image in your head shows you that you have power over it, it doesn't have power over you.

Address your physical sensations
A lot of the time your physical sensations will be linked to anxiety and so techniques to slow your breathing will help to bring this bodily response down. I am probably going to write a whole post on breathing and relaxation techniques but some of the tips I gave on my past blog post about
panic attacks may be useful too.
If you have bodily sensations that involve numbness or make you feel as though you can't move a part of your body, then it is about doing things to prove to yourself that in your present situation you are able to move those body parts. I have experienced this in connection to my legs - I've felt as though I was trapped and prevented from using my legs.
To combat this, I find it is best to start small and build up. Try to move a small bit of that body part then build up. I might start with moving just my toes then build up to standing up and then moving around. You can say to yourself, the trauma is not happening now because I wouldn't be able to do this right now if it was.

Challenge your thoughts
Some of the things I've mentioned already involve challenging your thoughts but going back to what I was saying about negative thoughts being attached to traumatic memories,  these too can be challenged more directly.
It can be helpful to have prepared challenging thoughts beforehand. For example, if the negative thought triggered was 'I'm not good enough' you could challenge it with the thoughts -
 I am good enough, it wasn't my fault, I'm only feeling this way because I am having a flashback.
It can be really difficult to challenge your thoughts when those negative cognitions become so strong during a flashback but I find that the more you say something to yourself, the more convinced you feel that it is true. Make sure it's the positive challenging thoughts you are reinforcing rather than the negative ones.

Know your triggers
Triggers are reminders in the present that activate a past traumatic memory and trigger a trauma response such as a flashback. Triggers can be sights, smells, tastes, bodily sensations, significant dates or seasons, similar events and places, or strong emotions that are in someway linked to the original trauma. You may not be aware of what triggered your flashback at the time. Sometimes I only identify the trigger after I've calmed down from the flashback and have had a chance to reflect.  Knowing the kind of things that trigger you can help you prepare in advance and can also help you to identify your trauma response symptoms in their early stages.  You can plan in advance, what techniques might help you manage each trigger before you confront them.  It can help to keep a trigger diary so that you can list the kind of things that trigger you and reflect on the techniques you used to calm yourself down and stay grounded in the present. You can learn from each experience of being triggered and use it to prepare for when you may face those triggers again.This is one of the pages from one of my old trigger diaries...

You don't have to feel as though you have to record everything that triggers you - that could get a bit time consuming and exhausting. I tend to record the experiences that stand out as being the most significant. This might be a trigger that I felt I managed particularly well so that I can remember how I managed it for next time.  Or I might record a type of trigger I hadn't encountered before or one that I felt I could have dealt with better so that I can work to improve for next time.

I hope these pointers have given you some ideas about how you can better manage flashbacks.  I think there's always a danger that when you create a guide type of thing like this, you end up making everything sound so straightforward and easy when it is anything but. I know from experience that flashbacks are by no means an easy thing to have to face in your life.  Implementing some of the ideas I've mentioned above is not going to automatically have a hugely positive impact on your life. Recovery is not straightforward and doesn't travel in a straight line. There are going to be flashbacks you will feel you managed well and they may be followed by flashbacks which you may feel you didn't manage well at all.  That is just how it goes.  It is also about finding the techniques that work best for you.  I can honestly say though that simply trying to manage your flashbacks time after time, setback after setback, will show itself to be worthwhile in the end.
By seeing each flashback as an opportunity to learn how better to manage, you will work your way closer to the life you want to lead, one that isn't dominated by past trauma.

Hope this is helpful in some way.

Love and Strength,
The One Day Seeker