In the last reading we thought about how trauma memories create ‘triggers’, which activate automatic defence mechanisms in our bodies. There are two types of defences: action-based (fight-or-flight), and immobilization-based (freezing, shutdown). Post-Traumatic Stress (PTS) is an over-activation of these defences.
The reading also discussed the Window of Tolerance, the zone where we are able to deal with being triggered without being sucked into either of these extremes.
This reading will talk about managing some specific side-effects of PTS: flashbacks, panic attacks, and nightmares.
Flashbacks
A flashback is a sudden experience of intense feeling linked to the trauma. The most common flashbacks contain an image from memory, but flashbacks can also include sounds, feelings, or body actions. They might happen after you notice something that reminds you of the trauma, or they might come completely without warning. Flashbacks can put us into fight/flight mode and outside the Window of Tolerance.
If you are having a flashback, try the following process:
- Name it in your mind as a flashback. It is something happening inside you, not something happening to you.
- Remember this is part of a memory. You are not in the past any more, and you can take care of yourself in the present.
- Slow your breathing, as much as you can, to a comfortable level. If you can concentrate, use a breathing exercise (there are several breathing exercises described on the SAMSN website).
- Ground yourself. Pay attention to the details of where you are. Feel the ground under your feet.
- Take some sort of deliberate action with your body, like walking or swinging your arms. Movement reminds your body that you are not actually trapped.
- If the trigger is linked to your location, get somewhere else if possible.
- Remind yourself a flashback is just a feeling, and you can cope with feelings.
After a flashback
Flashbacks are intense experiences and can knock us about a bit. After a flashback expect to feel tired. Take it a bit easy if you can and don’t expect too much of yourself.
Later, you might want to think about what triggered the flashback. Even if it took you by surprise, if you go back and think about it, you might be able to identify the trigger.
- Think back and figure out when you felt calm before the flashback happened. Then, figure out when you started to feel the flashback.
- Go back and forth in your memory between these two times. Where were you? What was happening around you? What could you see and hear? Was there anything around you that was associated with your past?
- Look inside as well as outside. Flashbacks can be triggered by internal events like feelings or thoughts. What were you feeling just before the flashback? What were you thinking? What was happening in your body?
Having an idea what triggers a flashback can help in seeing it coming and having a bit of time to calm and ground yourself.
A piece in the jigsaw
Although flashbacks are hard going, sometimes they give us information that fills in memory gaps. Some men have described how a flashback provided the ‘piece in the jigsaw’ that helped them make better sense of what happened. If a memory is known and accepted as part of our past, it is less likely to bother us in the present.
Panic attacks
Panic attacks are very similar to flashbacks, but they don’t come with images or memories. Just like with flashbacks, panic attacks can include rapid breathing, a racing heart, dizziness, disorientation, muscle tension, shaking, and so on. They are an intense fight/flight response.
The same things that help us get past a flashback will also help with a panic attack. You might also try:
- Looking around, seeing and naming where you are and the things you can see and hear.
- Naming the feelings you are having (‘panic,’ ‘keyed up,’ ‘terror’ etc.). Naming a feeling gives us a bit of distance from it.
- Noticing and naming where the feelings are in your body, and what they make your body want to do.
- Noticing both what you are feeling, and that there is no actual threat in the external environment. These things are not contradictory. One is noticing what is happening inside, and one is noticing what is happening outside. Comparing the two gives perspective.
- Reminding yourself, if necessary, that the old trauma is not happening now.
Later, you might ask yourself, were there any feelings or signs that you now think meant that you were going to have the panic attack?
Other tips
Think about a person you trust and admire (now or in the past). When you think you might have a panic attack, try to think hard about this person, how they make you feel, and what it would be like if they were with you now. Alternatively, you can do this with the memory of a place or time that is special to you.
Panic attacks generate a lot of fight/flight energy. You can get some of this energy ‘out’ by moving around rapidly, swinging your arms etc., or tensing your muscles.
Nightmares
Nightmares have been described as flashbacks that happen when we are asleep. They might include detailed memories, or just fragments, symbols or feelings.
After a nightmare, you might try:
- Remind yourself it was just a nightmare. It isn’t happening in real life.
- Ground yourself by concentrating on and naming your surroundings.
- Slow your breathing and relax your muscles.
- If the fight/flight energy feels strong, don’t try going back to sleep. Interrupt the experience by getting up and doing something else for a while.
If you have the nightmare more than once, you might try:
- Remember – even better, write down – what happens in the nightmare.
- Go over the nightmare again in your mind, but this time ‘re-script’ the ending. You can make it change and end in any way you would like. Think how you would feel if the dream had ended this new way, and try to feel the feelings.
- Don’t forget feelings other than fear. If the nightmare brought emotions like anger or sadness, include these feelings in the rescript, but in a way where you are supported and safe.
- Rehearse the rescript in your mind for about 5 minutes before going to sleep, and follow it with a relaxing activity or relaxation exercise that works for you.
There are lots of other tips and suggestions for managing PTS symptoms on the SAMSN website.