COPING WITH TRAUMA SYMPTOMS

What to do if you are experiencing flashbacks and nightmares

FLASHBACKS

Flashbacks are vivid memories in which a person re-experiences the traumatic event as if it is happening again, often with the same thoughts, emotions, bodily sensations, sounds or smells that were present at the time. Naturally, this is very distressing and tends to leave people feeling frightened and panicky.

What can you do if you are experiencing flashbacks? The first step is to notice that you are having a flashback, take a steady breath in through the nose and out through the mouth, and remind yourself that you are having a flashback and that the event is over and you are safe now. Then look around and notice things about your environment that will help to ground you in the present. It can help to use all your senses, e.g. notice five things you can see, four things you can hear, three things you can feel in contact with your body, two things you can smell (you may need to move around for this) and one thing you can taste. The aim is to bring your attention to the present moment, so that you are no longer caught up in your distressing memories. If this is a new strategy for you, you will probably need to practice it a number of times to get some benefit from it; learning any new skill (e.g. driving, playing an instrument) is hard a first and becomes easier with practice.

It is thought that flashbacks are your brain's way of trying to process the traumatic event that you experienced. However, because of the nature of the event, most people, understandably, try and stop the flashback before the worst moment. This means that the brain never gets to the point where the traumatic element was over. It can be helpful to remember the point after the trauma where you felt safer, then when you are having a flashback you can try mentally fast-forwarding to this safe point, which will help you remember that the experience ended.

NIGHTMARES

Nightmares or disturbing dreams are very distressing and can have a huge impact on someone's life; they disrupt sleep and can mean that a person becomes afraid of going to sleep and may even avoid sleeping. This can then create further difficulties, as getting enough sleep is helpful for regulating our moods and enabling us to function at our full potential. The strategies for flashbacks are also helpful to use when you wake up from a nightmare. The key point is to remind yourself that you are no longer in the traumatic situation and you are safe now and to ground yourself in the present. It may help to have something in your bedroom that will help you focus on the present, e.g. something like an LED clock that you can see in the dark, or a handkerchief with your favourite smell on it.

There is a scientifically proven technique for nightmares called imagery rehearsal. Imagery rehearsal involves thinking about the nightmare during the daytime and then creating and imagining a different ending for the nightmare or dream, which leaves the person feeling calmer or some other, more desirable emotion. This new ending is then rehearsed several times in imagery during the day and before bedtime, to strengthen this alternative, less distressing version of the dream so this is will be more likely to be recalled during sleep than the original version. Some people can use this technique on their own (see below for a link to the step-by-step self-help nightmare protocol from Dialectical Behaviour Therapy), but most people benefit from doing this with a therapist experienced in this method. This is a technique that tends to work very quickly when assisted by a therapist, often after one session.