Fundamentals of Trauma Recovery, Part 3
One of the hallmarks of PTSD are flashbacks. Flashbacks are triggered by a present-moment stimulus, sometimes minute. It is usually some sensory input — either internal or external — that was forged in implicit memory with the original trauma, which triggers the flashback. Flashbacks are experienced as a reliving of the trauma, including full-on physiological activation. Heart races, breath is shallow, mouth is dry, sweat breaks out — accompanied by vivid images, sounds, smells, or tastes from the past events. It feels so real that survivors speak of the flashback as though they are reliving their trauma again and again. In some ways, they are; the activation during a flashback is met with similar stress hormones and suppressed hippocampus as to when the original events occurred. Obviously, the distress flashbacks cause can be severely disruptive.
Stopping Flashbacks
There are 2 major components to address in stopping flashbacks. 1) registering with the hippocampus that the trauma can be remembered the same as other life events — in their proper context, in the past. 2) bringing your sensory experiences, both internal and external, to conscious awareness. This will further solidify what is in the present, versus what is a reaction to the memory.
While extremely distressing, flashbacks are, all in all, memories. They are vivid memories. Vivid enough to cause physiological arousal (heart, breathe, sweat/dryness). Yet they are only memories. Recognizing this fact, from your thoughts and language choice, all the way down to your bodily senses, is pivotal.
The Hippocampus Update
To stop flashbacks, your hippocampus has to register fully that the trauma has ended. You’ve got to neurologically set the traumatic events right where they belong: in the past. This is a complement to the exercises of living our epilogue (described in part 2). Updating your limbic system with the crucial information, “it is over!”, is going to have a strong effect in stopping flashbacks.
One way to jumpstart that update is in your language. In describing a flashback most trauma survivors use present-tense language. “It is happening again!” “He’s coming at me!” “I can’t move” “I hear the bangs!” are some examples. A simple-sounding intervention is to replace past-tense vocabulary to accurately describe the memory. This can have a surprising effect in cutting the intensity of a flashback, or stopping it entirely.
Adopting mantras that accurately describe the memory can be general or specific.
General mantras for flashbacks sound like “This is / that was a memory.” “I am remembering.” “It is not happening now.” Find language that fits for you, and practice the mantras. You might begin with using them after a flashback, or find that you can call on this tool already during a flashback.
Specific mantras will sound more like narrating the specific memory. “I am remembering what happened to me when I was a child. That was x number of years ago, and it is over. I am here now, and glad to be living in the year 2018.” This can also be applied during or after a flashback. With practice, applying this tool will get easier.
The sensory systems 
In a flashback, the internal sensory systems (perception of heart, lungs, digestive system, balance, muscle tension, etc) are firing intense signals that closely mirror what it was like at the time of the trauma. Often it can be the internal somatic marker of heart palpitations, for example, that trigger a flashback in the first place. The experience can very quickly override your awareness of what actually is happening around you, now, today.
Noticing what is happening internally along with what is happening externally is a monumental skill. You can fully register what parts of your experience are memory, and what is current.
The essential pieces are as follows:
– Notice and name at least one, or a few, internal sensations. These can include breathing, heart rate, muscle tone, tension, pressure, balance/dizziness, butterflies. If you can, name the emotion that accompanies the sensation (e.g. afraid)
-State aloud that this is a memory. These sensations are because you are remembering the event.
-Fortify what is current by shifting your attention to external senses. What you see, hear, touch, smell, or taste in the present. Use as many descriptors as you can. Include today’s date, time, etc, in order to become as fully aware as possible of what is right now.
-If you are, in actuality, safe – remind yourself again that the flashback symptoms were in fact because you were remembering. The event is long over.
-If you need to seek safety, do so.
Many will find that practicing the awareness of internal and external senses when you’re not having a flashback, will then make this tool easier to access during a flashback as well. Similar to rehearsing a drill for emergency situations.
If you suffer from flashbacks, take a few moments — or longer — to assess whether or not these practices are a good fit for you. Does the theory make sense to you? Can you imagine applying the exercises? Do you want to? You can try the pieces you’d like to, and leave the rest. Your mindful gauge (Part 1) is your ally.
