FLASHBACKS
A flashback may be temporary and you may maintain a connection to the present moment or you may lose all awareness of what's going on around you and transported completely back to your traumatic event. For example,a rape survivor, when triggered, may begin to feel pain in her body similar to the pain felt during her assault.
Flashbacks from early childhood are different because they do not include facts. There are two types of memory - explicit and implicit.
What can a person do about implicit flashbacks?
DISASSOCIATION
People with PTSD may also experience dissociation which is an experience where you may feel disconnected from yourself and/or your surroundings. Similar to flashbacks, dissociation may be temporarily losing touch with your present environment (like a daydream), or having no memories for a prolonged period of time (temporary amnesia) or feeling as though you are outside of your body.
FLASHBACK OR INTRUSIVE THOUGHT?
REDUCE THE INTENSITY IF FLASHBACKS
NIGHTMARES
Nighttime memories often manifest as distressing dreams or nightmares in which the traumatic event is relived. Additionally, the opposite is an intrusive daytime memory which is called a flashback.
Nightmares cause increased arousal so you are more reactive to your environment. This may be associated with significant anxiety. These symptoms may lead to difficulties falling or staying asleep (which is insomnia)
Some people have nightmares known as replicative nightmares and these are that are exact replays of the trauma that they experienced. Others have nightmares that are related to the trauma indirectly or symbolically.
Nightmares following trauma are different than ordinary nightmares because they can happen earlier in the night and during different stages of sleep than typical dreams. They may also be related to sleep-disordered breathing: Sometimes treating an underlying breathing problem can help to reduce or even eliminate violent nightmares.
The trauma and stress from it can disrupt your sleep by triggering your body’s fight-or-flight response which will ramp up production of neurotransmitters that will keep you awake and ready to fight when it’s time to sleep.
THERAPEUTIC HELP
Dealing with nightmares can be assisted by cognitive behavioral therapy (CBT). See TREATMENT. CBT has been shown to be most effective for treating nightmares associated with PTSD by helping you to understand and change the thoughts about the trauma and your programmed response to them. CPT helps to train you to replace negative thoughts with more accurate and less distressing thoughts. It may help you cope with feelings of anger, guilt, and fear associated with the trauma. A therapist can help you process the event, learn not to blame yourself, and help you understand how the incident was not your fault.
With exposure therapy, you will learn to have less fear about your memories. Any associated thoughts, feelings, or situations that remind you of the trauma will be less distressing. By thinking about the trauma in a controlled, safe environment, you will gradually be less stressed or anxious about the event. This is accomplished by desensitization which helps you to address distressing thoughts by defusing bad memories incrementally.
STRATEGIES TO HELP NIGHTMARES
A flashback may be temporary and you may maintain a connection to the present moment or you may lose all awareness of what's going on around you and transported completely back to your traumatic event. For example,a rape survivor, when triggered, may begin to feel pain in her body similar to the pain felt during her assault.
Flashbacks from early childhood are different because they do not include facts. There are two types of memory - explicit and implicit.
- An explicit memory before age 5 is immature. Implicit memories are a memory of an emotional state and may go back to birth.
- When the memory of a strong emotional state is activated the person is exposed to an involuntarily replay. Since facts are not replayed, the emotions seem to belong to what is going on in the present.
- Implicit flashbacks from early childhood can be powerful because they can overtake a person and dominate their emotional state. But the person may not realize what they are feeling is memory. If they cannot remember a past event that caused these feelings, the feelings naturally seem to belong to the present.
- In an implicit flashback the person mistakenly believes that someone or something is presently causing these feelings.
- Something triggered the feelings but the feelings do not fit the situation. They are more intense and far more persistent. Intensity and persistence are the keys to know if we are experiencing a flashback.
What can a person do about implicit flashbacks?
- Recognize that when an emotion is too intense and too persistent to fit the current situation then you may be experiencing the flashback of an experience from the event.
- Put the emotions into words with a therapist or explain to them what triggered the feelings. By linking the presence of a therapist to the emotions felt will neutralize them.
DISASSOCIATION
People with PTSD may also experience dissociation which is an experience where you may feel disconnected from yourself and/or your surroundings. Similar to flashbacks, dissociation may be temporarily losing touch with your present environment (like a daydream), or having no memories for a prolonged period of time (temporary amnesia) or feeling as though you are outside of your body.
FLASHBACK OR INTRUSIVE THOUGHT?
- There is a slight difference between a distressing memory, image or thought, versus a flashback.
- A flashback is certainly intrusive but it is also dissociative (there is a brief or extended period where time and reality are suspended).
- During intrusive thoughts, memories, and images there is a a dual awareness of time (both past and present is maintained). This awareness is lost during dissociative flashbacks because past and present have become confused.
- Flashbacks are dissociative because when a person has a flashback, they generally believe that they are actually "back there" in both time and place.
REDUCE THE INTENSITY IF FLASHBACKS
- Find a safe place where you can calm and soothe yourself. Remove yourself from the situation.
- Separate from a person or a conversation that is triggering you.
- Tell yourself you are experiencing a flashback
- Assure yourself it is not real.
- Tell yourself that it will pass.
- Identify the feelings underneath. Are you scared, sad, lonely, overwhelmed, or stuck?
- Counter the inner criticism. Tell yourself you did nothing wrong. Use soothing and positive inner dialog not negative self talk.
- Ask God or your higher power for help. Pray.
- Focus on your body and how it feels. Focus on your breathing and feel each inhale and exhale of air. Count your breaths.
- Identify the trigger. What did you do, see, hear, smell or feel?
- Use positive affirmations. Look at yourself in the mirror and tell yourself things that make you feel good.
NIGHTMARES
Nighttime memories often manifest as distressing dreams or nightmares in which the traumatic event is relived. Additionally, the opposite is an intrusive daytime memory which is called a flashback.
Nightmares cause increased arousal so you are more reactive to your environment. This may be associated with significant anxiety. These symptoms may lead to difficulties falling or staying asleep (which is insomnia)
Some people have nightmares known as replicative nightmares and these are that are exact replays of the trauma that they experienced. Others have nightmares that are related to the trauma indirectly or symbolically.
Nightmares following trauma are different than ordinary nightmares because they can happen earlier in the night and during different stages of sleep than typical dreams. They may also be related to sleep-disordered breathing: Sometimes treating an underlying breathing problem can help to reduce or even eliminate violent nightmares.
The trauma and stress from it can disrupt your sleep by triggering your body’s fight-or-flight response which will ramp up production of neurotransmitters that will keep you awake and ready to fight when it’s time to sleep.
THERAPEUTIC HELP
Dealing with nightmares can be assisted by cognitive behavioral therapy (CBT). See TREATMENT. CBT has been shown to be most effective for treating nightmares associated with PTSD by helping you to understand and change the thoughts about the trauma and your programmed response to them. CPT helps to train you to replace negative thoughts with more accurate and less distressing thoughts. It may help you cope with feelings of anger, guilt, and fear associated with the trauma. A therapist can help you process the event, learn not to blame yourself, and help you understand how the incident was not your fault.
With exposure therapy, you will learn to have less fear about your memories. Any associated thoughts, feelings, or situations that remind you of the trauma will be less distressing. By thinking about the trauma in a controlled, safe environment, you will gradually be less stressed or anxious about the event. This is accomplished by desensitization which helps you to address distressing thoughts by defusing bad memories incrementally.
STRATEGIES TO HELP NIGHTMARES
- Adjust your bedroom. Create a space to sleep in that makes you feel safe and allows you to sleep well. Typically a dark room is best for sleeping but if it scares you use a nightlight or leave a closet or bathroom light on.
- Having a spouse or trusted family member in the room with you or nearby may also help you to relax, if possible.
- Find healthy ways to blow off steam. Avoid avoidance behaviors like using drugs or alcohol to escape in sleep. These habits can cause even more sleep disturbances.
- Yoga is a particularly relaxing exercise. Pair it with your mindfulness exercises and you may find yourself calm before bed. Another before bed routine that is calming is a warm bath.
- Avoid chemical stimulants like caffeine and external stimulants like using the computer (especially if you look at distressing and triggering news or websites). Additionally if you are triggered by violent television programs avoid them before bed.
- Sleep when you need to but don’t force it. You may find that you need more sleep following a traumatic experience or you may feel sleepy at different times. Brief naps or rest periods during the day may help. Avoid letting sleeplessness become another stressful trigger. Get out of bed and do a quiet activity until you feel ready to try to sleep again.