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Since June is Post-Traumatic Stress Disorder Awareness Month it seems relevant to focus on the common but debilitating symptom of flashbacks that so often accompanies a PTSD diagnosis. Flashbacks can be terrifying for clients because they often occur without conscious warning, despite the fact that they are always the result of “triggering” that occurs by either an internal or external experience. These can be sensory-based experiences that manifest through smells, sounds, tastes, textures, or images that are subjectively perceived to be threatening because they are reminders of similar past events that were trauma-based. Common examples include the smell of cologne, alcohol, or cigarettes that are associated with one’s perpetrator, or a car backfiring in a way that is reminiscent of gunfire on the battlefield. Triggers can also occur in response to an inter-personal dynamic such as verbalizations or non-verbal cues that communicate disdain, disapproval, aggression, or threat. Additionally, trauma survivors can be triggered by environmental cues that are reminiscent of places where they were disempowered or abused.
It’s important to normalize that when clients get triggered and either objectively or subjectively believe they are unsafe, the reasoning part of their brains that handle cause and effect thinking, analysis, and insight goes off-line. Instead, triggers put clients in the more primitive parts of their brains where survival through fight, flight or freeze become the top priority. The re-experiencing of a prior threat through a flashback is also happening in the more primitive parts of their brains, so it is impossible for them to have the insight that can discern the past from the present. For clients in flashback, the past tense terror and helplessness feel present-moment real. Helping these clients regain a sense of empowerment and control by re-grounding them and showing them how to work with flashback experiences is a critical part of the healing process. Consider incorporating some of these simple strategies as first steps towards managing flashbacks:
- Encourage the client to identify the experience as either a visual, somatic, cognitive, or emotional flashback depending upon how it manifests for them (a past memory they see, a body sensation, a thought, or a frozen in time feeling.) Noticing and naming an experience is a way to bring the reasoning and insight-oriented part of the brain (pre-frontal cortex) back on-line.
- Have the client stand up and move to counteract the freeze response and help them re-claim a sense of control over their body.
- Have the client hold something ice cold or very warm then describe the sensations to help bring them back into their bodies and assist in the re-grounding process.
- Incorporate aromatherapy by using oils, votive candles, hand lotion and tea bags that offer calming scents and have a pleasant, present day association.
- Have the client breath into images that represent present day safety or a safe place and have them store the resource on their cellphones for easy access.
- Have the client listen to music that is soothing and connects to a positive, present tense memory.
- Have the client say, out loud, things they see, hear, and feel in their current surrounding to re-activate the pre-frontal cortex and provide a reality check for their actual present tense experiences.
It makes sense to practice these strategies with clients when they are not in the throes of a flashback, so they can fully take in the instructions, have some success with them, and provide feedback about the ones they like and find helpful.
Please check back next week for Part Two of this series. In it, we will explore how therapists can help clients work with a flashback image and “re-story it” so true healing can begin.
