Sufferers of both posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (Complex PTSD) experience terrifying flashbacks. Such flashbacks can be split into three categories as follows:
Below, I briefly describe the form each of these three types of flashback take:
As a result of a trigger (an event that reminds an individual, on a conscious or unconscious level, of their original traumatic experience) the PTSD / Complex PTSD sufferer feels as if the traumatic event (or aspects of the traumatic event) are happening in the ‘here and now’, forcing him/her to relive his/her trauma in the form of visual images.
As the result of a trigger (see above) the PTSD/Complex PTSD sufferer feels sensations, discomfort, or pain in body regions that were affected by the original trauma and that the sensations/discomfort/pain cannot be explained in terms of alternative causes (such as physical illness, disease or injury).
In other words, the sensation/discomfort/pain is a physical manifestation of inner psychological turmoil and causes the PTSD/Complex PTSD to relive the physical feelings endured during his/her past traumatic experiences. The well-known trauma expert, Peter Levine, puts forward the idea that one way to reduce such symptoms is through somatic therapy and ‘shaking them off.’
Amongst individuals who suffer from this type of flashback sufferers of complex PTSD are the most frequently affected. Unfortunately, however, the understanding of this kind of flashback is still in its relative infancy.
However, it is known that emotional flashbacks involve the PTSD/Complex PTSD sufferer, as the result of a trigger (see above), experiencing the emotions s/he experienced during the original trauma.
However, when these emotions are triggered (e.g. by an authority figure who, on an unconscious level, reminds him/her of his/her abusive father) s/he may not be aware of this link between his/her present emotional state (triggered by the authority figure) and the emotional state s/he experienced during his/her past traumatic experiences.
In short, then, emotional flashbacks involve the individual being forced to relive, often intensely and viscerally, emotions originating generated by the events of his/her traumatic past.
Examples of emotions the person may feel consumed by include intense fear, being under extreme threat, and being in danger of imminent abandonment. These powerful emotions may last for hours or longer (perhaps even for weeks).
THE ROLE OF THE BRAIN’S AMYGDALA:
Emotional flashbacks involve the part of the brain called the amygdala (which is involved with our fight/flight/freeze/fawn response and reactions to perceived or real danger) and, because of this, Walker (author of the tremendously helpful and highly influential book: Complex PTSD: From Surviving To Thriving) refers to the emotional flashbacks as an ‘amygdala hijack’ as, when they occur, the amygdala becomes hyperactivated and ‘takes over’, inhibiting the capacity to think rationally.
How to cope with traumatic, intrusive memories, and flashbacks:
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a) PLANNED AVOIDANCE: this technique involves avoiding TRIGGERS that, by experience, we know trigger our traumatic memories. This can provide valuable ‘breathing space’ until we feel ready to try to process and make sense of our memories, usually with the help of a psychotherapist. In order to use this technique, it is necessary, of course, to, first, spend some time thinking about what our personal triggers are.
b) ‘GROUNDING TECHNIQUES: this technique is based upon DISTRACTION; the rationale behind it is that it is impossible to focus on two different things at the same time. So, the idea of the technique is to strongly focus on something neutral, or, better still, something pleasant – the brain, when we do this, will be unable to focus on the memory which was giving rise to distress and emotional pain.
It does not really matter what we choose to focus on in order to distract us – it might even be, say, the chair in which we sit: what is its color, its shape, its texture and feel to the touch, the material from which it is made…etc…etc..? I know this sounds rather silly, but, if we concentrate on it like this for a while, almost as if we were carrying out a forensic examination, it can act as a powerful, temporary distractor when we feel, potentially, we could be overwhelmed by our thoughts and memories.
We can implement the grounding technique by using what are known as ‘GROUNDING OBJECTS’ – this term refers to physical objects (ideally, easily transportable). But, seriously, it could be something as simple as a shell from the sea-side – it can really be anything, just so long as it evokes a feeling of safety and comfort. When feeling distressed, the object can be held and looked at with the intense focus referred to above in the description of the grounding technique.
Also, as Proust helpfully pointed out, aromas can be very evocative – something relaxing such as lavender could be used. As well as using grounding objects, we can also use what are known as ‘GROUNDING IMAGES’. This involves thinking of a place in which we feel safe, secure, and comforted. It is a good idea to make the image as intense and detailed as possible (although people’s ability to visualize varies considerably – I’m hopeless at visualizing).
If you are able to visualize it in such a way as to allow you to mentally interact with it (e.g. imagine walking around in the location you are imagining) so much the better. To get to the safe imaginary place in your mind, it is also useful to have what is known as a ‘LINKING IMAGE’; again, as this is an imaginary way of linking (getting) to the ‘location’ it can be anything; for example, when feeling distressed, you could imagine yourself ‘floating away’ to your ‘safe place’.
Once mentally ‘located’ in the safe place, it is again helpful to imagine then ‘place’ as intensely as possible, using our old friend the GROUNDING TECHNIQUE, so that it almost feels you are really there, where NOTHING CAN HARM YOU. It is also possible to employ the assistance of what are referred to as “GROUNDING PHRASES‘.
These can be very simple, such as “I am strong enough to deal with this, I always get through it’, or, even more simply, ‘I’m OK’. We can try to bring these phrases to mind and repeat them to ourselves when we are feeling distressed.
There is even a technique known as ‘GROUNDING POSITIONS’. This, very simply, refers to altering our body’s position to produce a psychological benefit; for some, this might be standing up straight with shoulders back to produce a feeling of greater confidence; for others, it might be curling up in bed in embryo position to produce a feeling of greater safety and security. Such techniques, whilst, possibly, sounding vaguely silly, can be surprisingly effective.
c) IMAGE HABITUATION TRAINING
This is a type of exposure therapy that requires the individual suffering from flashbacks to give a detailed verbal description of the traumatic event with which the flashbacks are associated. This description is recorded and, after receiving training from the therapist, the individual undertakes individualized sessions in which he or she listens to the recording whilst visualizing the event being described. This is known as self-directed exposure. This can help to habituate the individual to the event and associated images to the point that his or her anxiety connected to these is significantly reduced.
FLASHBACKS, MEMORY, AND THE PREFRONTAL CORTEX: A STUDY
A study conducted in 2008 involving sufferers of disorders related to stress has helped to cast some light upon what is happening in the brains of individuals who are prone to experiencing flashbacks. First, it was found that these individuals’ ability to perform general memory tasks was inferior in comparison to the performance on the same tasks by healthy individuals. Second, when those suffering from a stress-related condition were asked by the researchers to carry out a ‘suppression task’ (a task in which they were required to attempt NOT to think about something) they demonstrated LESS ACTIVITY IN THE PREFRONTAL CORTEX than did the healthy individuals when instructed to undertake the same task. From this finding, it was inferred that these individuals (i.e. those suffering from a stress-related disorder) underactive prefrontal cortices interfered with their ability to prevent traumatic memories from breaking through into conscious awareness.