Flashbacks, triggers, and grounding techniques
What is Grounding?[edit]
Grounding techniques can be used to help deal with (dissociation, addiction, self-harm and other mental health issues, including temporary dissociative experiences such as the flashbacks[1] and nightmares[2] experienced by people with posttraumatic stress disorder. Grounding is used to help you remain in the the present, being aware of your surroundings, [3]:4 and now, so you do not feel like you are reliving the trauma. [2] Grounding is particularly effective at helping people to manage flashbacks. [2]
Grounding is one of the most important aspects of treatment. This is the reason it should be learned as the first coping strategy, as it is used throughout the whole treatment. People with dissociative disorders have problems with staying in the present. It is easy to avoid the present to avoid things like stress, bad memories or worries about the future, but this avoiding will backfire in the long term.
Not being present may involve spacey or foggy, getting lost in daydreams, or getting preoccupied with thoughts. This can happen even when not being aware of it. In dissociative disorders specifically, not being present may also involve losing control over actions (watching yourself do things) or losing time.[3]:4
Triggers[edit]
A trigger is anything that sets you off emotionally and activates memories of your trauma. It’s particular to you and what your experience has been. Triggered, we revert to the feelings and behaviors we had in the traumatizing situation. [4]
Triggers can be environmental (smells, sights, sounds, textures, touch), or they can be inner conditions—like feelings (for example, feeling overwhelmed, fearful, trapped or out of control), but they might also be subtler. We may be very aware of some of our triggers while being totally unconscious of others.
When you have self-awareness, you'll often notice a sense of reactivity, anxiety, and a desire to escape the situation that caused the trigger. [4] The desire to avoid or escape a trigger happens even if you are unaware of the trauma memory the trigger has activated.
Intrusive thoughts[edit]
Trying to stop yourself thinking about something tends to make it worse:
A scientist called Wegner (1989) found that thoughts that have been deliberately pushed away occur about twice as often as thoughts that haven't been suppressed."[5]:88
Hertbert (2008) states that "when something is on our mind so much that we can't stop thinking about it, feel taken over by it or find ourselves ruminating about it at inappropriate moments, it is usually ineffective just to tell ourselves to forget about it. Trying to suppress a worry or an obsessive idea often causes it to rebound even more strongly."[5]:87
Flashbacks[edit]
Flashbacks often occur as a result of a trigger. Flashbacks may also be referred to as abreactions,[6] and are a form of temporary dissociation. [1] Flashbacks are a very common feature of PTSD and Dissociative Identity Disorder.
A flashback is "the sense of being back in the original situation, experiencing it as you did at that time. You may experience it through all of your senses, or through only some of your senses, as the memory itself has often been fragmented. It will not necessarily be cinematic, as it is in the movies."[4]
“You cannot make yourself have a flashback, nor will you have one unless you are emotionally ready to remember something. Once remembered, the memory can help you to face more of the truth. You can then express your pent-up feelings about the memory and continue on your path to recovery. Think of the flashback as a clue to the next piece of work. No matter how painful, try to view it as a positive indication that you are now ready and willing to remember.”[7]
Beverly Engel states that "amnesia, flashbacks, and fragmented memories aren’t the normal state of affairs. They are indications of something gone wrong and like footprints in the snow, they had to come from somewhere."[7] Flashbacks are an example of an intrusive symptom of PTSD. [6]
Body memories is a term used to describe flashbacks can take a physical form, including pain which has no organic cause, shortness of breath, and feeling your chest being crushed. [8] Body memories are an example of implicit memory. Somatization disorder and pain disorder have both been been linked to childhood trauma. [8]
Flashbacks can be dealt with by learning relaxation exercises, becoming desensitized to trigger through exposure exercises, and grounding. [1] Processing the trauma behind the flashback is fundamental in preventing future flashbacks.
Grounding Exercise[edit]
Grounding means staying connected to the body, the earth, and the here and now. [4] Grounding can reduce the intensity of a flashback. This grounding exercise can help stay in the present.
This exercise is not something fixed in stone. You can modify it to suit your needs, so it feels good to use. Especially when it doesn't seem to work, it may be helpful to look whether it can be done differently.
- Notice three objects in the room. Of each object, describe a few properties (color, texture, shape, etc.).
- Notice three sounds you hear. Describe a few properties of them. For example, what is it? Does it sound pleasant? How loud is it?
- Touch three objects near. Describe a few properties of how they feel. For example, cold or warm, rough, smooth, pleasant to touch etc.
- Go again over all those objects you have noticed. See how you are in the same place as the objects you just saw. Near the sounds you just heard (or still hear). Being in reach of the objects you just touched (or still touch).
- Repeat this as needed, possibly varying the amount of things you notice. Be creative. Go ahead and make this practice your own. Your way of being present. [3]:5
Grounding Ideas[edit]
Some people carry an item that they can grab hold of if they are feeling like they may be triggered, such as a piece of jewellery or a rock. Others remind themselves where they are by looking around and saying what they see.
- It is important that you remind yourself that you are safe and that you are not reliving the trauma, no matter how bad it feels.
- After the flashback is over, try to understand it. Perhaps write it down or talk about it with a trusted friend or a counselor
- Sometimes it is helpful to rate the flashback, with, for example 10 being the worst, 0 being the best. It can help you get an idea of how things are going for you over time. [2]
References[edit]
- ^ a b c Taylor, Steven. Clinician's guide to PTSD: A cognitive-behavioral approach. Guilford Publication, 2009.
- ^ a b c d King Edward Memorial Hospital Sexual Assault Resource Centre, Government of Western Australia Department of Health. Dealing with Nightmares and Flashbacks. Retrieved May 13, 2013, from http://kemh.health.wa.gov.au/services/sarc/documents/flashback.pdf
- ^ a b c Boon, Suzette (2011) (coauthors: Kathy Steele, Onno van der Hart). Coping with trauma-related dissociation : skills training for patients and their therapists. 468. New York: W. W. Norton
- ^ a b c d Cori, Jasmin Lee, and Robert Scaer. Healing from trauma: A survivor's guide to understanding your symptoms and reclaiming your life. Da Capo Press, 2008.
- ^ a b Herbert, Claudia (2008) (coauthors: Wetmore, Ann). Overcoming Traumatic Stress. A self-help guide using Cognitive Behavioral Techniques. .
- ^ a b Whitfield, Charles L. "Memory and abuse: Remembering and healing the effects of trauma." Hci, 1995.
- ^ a b Engel, Beverly (1990) (coauthors: Eleanor Hamilton). The Right to Innocence: Healing the Trauma of Childhood Sexual Abuse: A Therapeutic 7-Step Self-Help Program for Men and Women, Including How to Choose a Therapist and Find a Support Group. 859.
- ^ a b Chu, James A. (2011). Rebuilding shattered lives treating complex PTSD and dissociative disorders. 146
