Post-Traumatic Stress Disorder
How triggers and flashbacks manifest in PTSD.
Posted Oct 01, 2019
A common symptom of PTSD are flashbacks or the re-experiencing of the past trauma in the present. Flashbacks are often “triggered” by a present-day event that reminds the person of the traumatic incident. Internal bodily sensations, such as a fast heartbeat and rapid breathing, can act as a trigger and cause a flashback. The external environment, such as a smell of body odor or the smell of alcohol, can act as a trigger and lead to a flashback.
Triggers prime the body for a physiological response of fight/flight or freeze, a response similar to the circumstances of the original distressing event. Some flashbacks are visual, as well as auditory and physical, so the person will see, hear, and feel the past abuse experience as if it was happening in the present. Sometimes the memories last a few seconds, sometimes minutes, and for one of my clients who had severe PTSD, flashbacks lasted more than an hour.
Trauma can have a long-term debilitating impact on our functioning. However, it is impossible to live a full and engaged life while simultaneously avoiding experiences that may potentially trigger flashbacks. Professionals can help promote coping strategies to help manage and diminish triggers and the strong feelings and bodily sensations that are often associated with the triggers.
To interrupt the impact of triggers on our daily life, the past must be explored, articulated, and regulated. This starts with learning how to recognize what the triggers are because each person will have different triggers based on their individual experiences. A number of my clients are triggered and feel more vulnerable around the holidays.
One of my clients, Angela, came into the session and said she felt “out of control." Angela felt overwhelmed because she was having strong feelings and no context or reason to explain her experience. Rather than avoiding her feelings, we explored her feelings in more depth. Angela’s “rollercoaster ride” of distressing feelings was triggered by the thoughts of going home, with her daughter, to visit the family for Thanksgiving. Angela comes from a large extended family and as many as 30 family members come to visit. As a child, holidays were a time of drinking that led to inappropriate and aggressive interactions, angry outbursts, and on some occasions physical violence. Angela revealed to me that it was during a Thanksgiving gathering that her older cousin molested her. Once we were able to name the event and the trigger, Angela and I were able to understand her anxiety, depression, and periods of anger she was experiencing about going home to visit her family. Angela revealed that the anxiety and fear were increased with the thought of exposing her daughter to the same people who "hurt her as a child."
Once Angela was able to make the connection that going home for the holiday was the trigger for the emotions she was feeling, she was able to take charge and create a plan to support her feeling safe during the visit. Angela decided that she would stay for three hours, because after three hours the dysfunctional interactions and drinking would increase. During the three hours, Angela would focus her attention on her two nieces and her sister. She would also help her grandmother and mother with the preparations for the meal—an activity she always enjoyed, even as a child. After dinner, Angela would leave and join friends for the remainder of the day. Angela’s willingness to explore her feelings led to her increased awareness of what was triggering her anxiety and depression. As a result, she created a safety plan for her and her daughter that would allow her to protect herself in a situation that in the past made her feel vulnerable. In essence, Angela created a plan to protect her wellbeing which enabled her to feel comfortable while spending time with the people she loved during the holidays. By facing her triggers, Angela was able to manage and to some extent overcome the barriers and triggers that were undermining her sense of well being.
Clients come into therapy because they know that their past or a particular traumatic incident is limiting them and interfering with being able to feel fully alive and engaged in the world and with others. They have an understanding that by not facing the past they are being held hostage to the traumatic experience.
Research has enhanced our understanding of the long-term effects of abuse, neglect, and trauma on a person’s functioning. There are a number of techniques that can be used to limit the impact and buffer a person’s susceptibility to being triggered and to enhance resiliency—the ability to bounce back despite the obstacles one has endured. One important tool is to improve natural support systems and sustain healthy significant relationships. Warm and caring connections can act as a protective factor to ward against feeling vulnerable to unexpected triggers.
When someone experiences a trigger, it involves both emotions and the body. The body reacts to triggers in the same way that mirrors the original traumatic event i.e. fight/flight or freeze. The body needs to be regulated so the individual can feel safe again and put the experience in the past. Yoga, Mindfulness Practice, Emotional Freedom Techniques (EFT), and neuro-feedback are a few of the interventions that help to regulate the nervous system and improve increased states of calm as well as increase one’s ability to manage the challenging experiences that life presents.