Post Traumatic Stress (PTSD)
Coping with Flashbacks
By Matthew Tull, PhD, About.com Guide
Updated October 29, 2008
About.com Health's Disease and Condition content is reviewed by the Medical Review Board
Many people with PTSD struggle in coping with flashbacks. Flashbacks1 are considered one of the re-experiencing symptoms of PTSD.
2 In a flashback, a person may feel or act as though a traumatic event is happening again. A flashback may be temporary and some connection with the present moment may be maintained, or a person may lose all awareness of what is going on around him, being taken completely back to their traumatic event. For example, a rape survivor, when triggered, may begin to smell certain scents or feel pain in her body similar to that which was experienced during her assault.
People with PTSD may also experience dissociation3. Dissociation is an experience where a person may fee l disconnected from himself and/or his surroundings. Similar to flashbacks, dissociation may range from temporarily losing touch with things that are going on around you (kind of like what happens when you daydream) to having no memories for a prolonged period of time and/or feeling as though you are outside of your body.
Both flashbacks and dissociation may occur as a result of encountering triggers4, or a reminder of a traumatic event. To the extent that people are not aware of their triggers, flashbacks and dissociation can be incredibly disruptive and unpredictable events that are difficult to manage. However, you can take steps to better manage and prevent flashbacks and dissociation. These are described below.
Know Your Triggers
In coping with flashbacks and dissociation, prevention is key. Flashbacks and dissociation are often triggered or cued by some kind of reminder of a traumatic event (for example, encountering certain people, going to specific places), or some other stressful experience. Therefore, it is important to identify the specific things that trigger flashbacks or dissociation.
By knowing what your triggers are, you can either try to limit your exposure to those triggers, or if that is not possible (which is often the case), you can prepare for them by devising ways to cope5 with your reaction to those triggers.
In addition to reducing flashbacks and dissociation, knowing your triggers may also help with other symptoms of PTSD, such as intrusive thoughts and memories of a traumatic event.
Identify Early Warning Signs
Flashbacks and dissociation may feel as though they come "out-of-the-blue." That is, they may feel unpredictable and uncontrollable. However, there are often some early signs that a person may be slipping into a flashback or a dissociative state. For example, a person's surroundings may begin to look "fuzzy," or someone may feel as though he is separating from or losing touch with his surroundings, other people, or even himself.
Flashbacks and dissociation are easier to cope with and prevent if you can catch them early on. Therefore, it is important to try to increase your awareness of early symptoms of flashbacks and dissociation. Next time you experience a flashback or dissociation, revisit what you were feeling and thinking just before the flashback or dissociation occurred. Try to identify as many early symptoms as possible. The more early warning signs you can come up with, the better able you will be to prevent future flashbacks or episodes of dissociation.
Learn Grounding Techniques6
As the name implies, grounding is a particular way of coping that is designed to "ground" you in the present moment. In doing so, you can retain your connection with the present moment and reduce the likelihood that you slip into a flashback or dissociation. In this way, grounding may be considered to be very similar to mindfulness7.
To ground, you want to use the five senses (sound, touch, smell, taste, and sight). To connect with the here and now, you want to do something that will bring all your attention to the present moment. A couple of grounding techniques are described below.
Sound: Turn on loud music
Loud, jarring music will be hard to ignore. And as a result, your attention will be directed to that noise, bringing you into the present moment.
Touch: Grip a piece of ice
If you notice that you are slipping into a flashback or a dissociative state, hold onto a piece of ice. It will be difficult to direct your attention away from the extreme coldness of the ice, forcing you to stay in touch with the present moment.
Smell: Sniff some strong peppermint
When you smell something strong, it is very hard to focus on anything else. In this way, smelling peppermint can bring you into the present moment, slowing down or stopping altogether a flashback or an episode of dissociation.
Taste: Bite into a lemon
The sourness of a lemon and the strong sensation it produces in your mouth when you bite into it can force you to stay in the present moment.
Sight: Take an inventory of everything around you
Connect with the present moment by listing everything around you. Identify all the colors you see. Count all the pieces of furniture around you. List off all the noises you hear. Taking an inventory of your immediate environment can directly connect you with the present moment.
Enlist the Help of Others
If you know that you may be at risk for a flashback or dissociation by going into a certain situation, bring along some trusted support8. Make sure that the person you bring with you is also aware of your triggers and knows how to tell and what to do when you are entering a flashback or dissociative state.
In the end, the best way to prevent flashbacks and dissociation is to seek out treatment for your PTSD9. Flashbacks and dissociation may be a sign that you are struggling to confront or cope with the traumatic event you experienced. Treatment can help with this. You can find PTSD treatment providers in your area through the Anxiety Disorder Association of America website10, as well as UCompare HealthCare from About.com11. The International Society for the Study of Trauma and Dissociation (ISSTD)12 also provides a wealth of information on the connection between trauma and dissociation, how to cope with dissociation, and provides links to therapists who treat trauma and dissociation.
Linehan, M.M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
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