(Faure - "Pavane")
One of the most distressing aspects of a flashback is its unpredictability and its potentially overwhelming strength. Your flashbacks may feel to you as uncontrollable as a nightmare and indeed, flashbacks have been described as 'waking nightmares' (Meichenbaum, 1994).
Getting to Know Your Flashbacks/Listening to Your Body's Responses
The first step is for you to notice and understand what happens to you while you experience a flashback ' Think back to the last time you had a flashback or alternatively, wait until you experience the next one, and address these things:-
A. Recognize the triggers:
* When did it happen?
* What were you doing at the time?
* What else was going on when it started?
* Was anybody else with you?
* Can you recognize any similarities between your current
situation and the situation that you were transported to in
your flashback?
* Can you remember when you have felt this way before?
* What is similar and what is different to the previous
situations?
* What do you think triggered it? (For example, thoughts,
smells, sounds, pictures, feelings, taste or reminders such as
conversations, media or special events, such as
anniversaries.)
B. Identity the traumatic memory:
1. What do you remember about your flashback?
2. Even if it feels a little distressing, describe in as much
detail as you can what went through your mind.
3. Can you describe or draw the images that you saw during your flashback?
4. Do you know how long it lasted?
5. Were you noticing what was going on around you or did the
flashback block everything else out?
C. Get to know your body's responses:
1. What sensations did you notice in your body during the flashback?
2. Try and describe them in as much detail as you can.
3. How strong were these sensations? Can you try and give them a rating between 0 - 8
4. What were your thoughts about these sensations?
5. How did you react and respond to those sensations in your body?
6. What actions did you take to make yourself feel better?
7. Can you think of other ways you may have used to control flashbacks in the past?
Every flashback has three stages (Meichenbaum, 1994). The first is the 'trigger stage'. This tells you what started it in the first place. Triggers are different for each person and therefore it is important that you try and work out what the special triggers might be for you. (This could also be useful for controlling your intrusive memories.) Triggers can be thoughts, images, sounds, smells, something someone does or says, tastes, special events, currently stressful situations, financial or medical problems, and many more.
The second stage consists of the 'surfacing of memories' during the flashback. These are the upsetting memories that make you feel as if you are reliving aspects of the trauma. They can seem so real and their images can be so sharp and acute, that you may feel that you are right back in the actual trauma. You may literally feel as if you are 'taken over' by these memories and that you stop all other activities while you are experiencing the flashback. Traumatic memories take the form o-f visual images but can be accompanied by sounds, smells, tastes and other physical sensations. The flashbacks usually last between a few seconds and a few minutes, but when they are really severe they can last more than one hour.
The third stage is the 'aftermath' of the flashback. At this stage the person will often still feel very strong physical sensations. Some people find that their breathing increases, others notice that they are feeling cold and shivery-or very hot or that their heartbeat is rapid ' Often people can have very strong emotional responses to the flashback itself, getting Very angry, for example, or feeling very sad and distressed. The feelings can be disorientating: if you have stopped all other activities during the flashback it can then be hail to remember what was said or went on during the current episode of your flashback. This is more likely to happen if a flashback lasts longer than a few minutes.
It is important to remember that flashbacks are your mind's way of trying to make sense of what has happened to you. They are a common reaction and therefore you do not need to feel frightened by them. Like other PTSD symptoms, they are an indication of 'unfinished' business, suggesting that further healing needs to occur before the impact of the trauma can be resolved.
The more you are able to monitor when your flashbacks happen, and what they are like, the more familiar you will become with them. Once you can recognise a flashback and notice your reaction you are ready to try to gain more control over them. This is not an easy process and most people find that it takes time to learn to do so. It is important that you give yourself a chance and preserve even if things don't work immediately.
One way of controlling flashbacks is to avoid certain situations or thoughts that are known triggers for your flashbacks. This can be very helpful, especially if some triggers cause such strong responses in you that you, or others around you, do not always feel safe when they occur.
Remember:- The use of avoidance strategies can be helpful under certain circumstances because you have to protect yourself from the strong reactions that a flashback can trigger (including behaviours that could be unpleasant or dangerous to others). However, it is probably not helpful to use only avoidance strategies, especially if, in order to avoid a potential trigger, you have to forego situations that under other circumstances would be pleasurable for you.
Different management strategies
1. Rescript your memory
a. Write down in as much detail as possible the flashback memory that normally occurs in response to this trigger.
b. Ask yourself what the most distressing aspect of this flashback memory is. Write down why this affects you so much.
c. Describe the sensations that this flashback memory sets off in you.
d. Now think of a way in which you could rescript the flashback to make it less distressing to you. Is there is anything in this imagery that you could change so that you would feel more in control?
e. Rewrite the flashback memory including this changed image.
f. Practise imagining yourself experiencing the flashback in this changed form.
g. Then practise rescripting this flashback each time it is set off by your identified target trigger.
2. Resize your memory and watch it like a film
a. Follow steps a to c as above.
b. Now try and imagine watching your flashback memory like a film. See if you can reduce its image in size so that it would fit onto a small television screen.
c. Practise watching this as often as possible. Slow down the speed of the film, or 'freeze' frames if you wish. 'Grey’ down the colour.
d. Then practise watching your flashback in this way, when your identified trigger sets it off.
Once you have mastered more control over this identified target trigger and feel fairly comfortable about tolerating it, you can then select a different target trigger to work on.
Grounding techniques can help bring you back into the present if you have become disconnected from reality during a flashback. They shift your focus away from the flashback and reduce its intensity.
1. As soon as you notice the first signs of a flashback, focus on any object in your environment around you. Look at the chosen object and describe to yourself:
* its color
* its shape and size
* its texture (go over to it if you can and feel it)
* its age and what it might be used for
* what you like or dislike about it.
2. Grounding smell.
a. Identify a scent you really like that is not connected to your trauma.
b. Obtain a small item that carries this scent, for example, a small lavender sachet or a tissue impregnated with an aromatherapy oil that you like, a small bottle of your favourite perfume or the smell of cedar or cooking vanilla.
c. Each time you notice the first signs of a flashback breathe in some of this scent and allow yourself to be calmed by it.
3. Grounding object.
a. Instead of using scent, find a small object, like a stone, a piece of smooth wood, a conker or an acorn or other nut, or a worry stone or worry beads.
b. Carry this on you and feel, touch and look at it each time you notice the first signs of a flashback.
4. Grounding Position.
a. Identify a bodily position that is especially comforting to you. This could be curling up, leaning against a wall, squatting down, etc.
b. Use this at times when you notice the first signs of a flashback. As these positions can be very personal, you may find they work best when you are on your own.
5. Other techniques that might help ground you during a flashback are simply walking about, telling yourself (silently) your name, the date and time of the day, or reciting a poem or singing a song, or simply squeezing thumb and third finger together.
6. Breathing and relaxation techniques are also very helpful in combination with the exercises suggested here.
(Faure - "Pavane")