Thursday, August 10, 2006

Trauma, Triggers and Flashbacks

A trigger is something that sets off a memory transporting a person back to the event of the original trauma. A flashback can take the form of pictures, sounds, smells, body sensations, feelings, or numbness.

And, for those who may be teetering on the edge of these traumatic responses, The University at Alberta has some suggestions:

1. Tell yourself that you are having a trigger response or a flashback.

2. Remind yourself that the worst is over. The feelings and sensations you are experiencing are memories of the past. The actual event has already occurred and you survived. Now it is the time to let out the terror, rage, hurt, and/or panic. Now is the time to honor your experience.

3. Get grounded. This means stamping your feet on the ground to remind yourself that you have feet and can get away now if you need to. (There may have been times before when you could not get away, now you can.) Being aware of all five senses can also help you ground yourself.

4. Breathe. When we get scared we stop normal breathing. As a result our body begins to panic from the lack of oxygen. Lack of oxygen in itself causes a great deal of panic feelings; pounding in the head, tightness, sweating, feeling faint, shakiness, and dizziness. When we breathe deeply enough, a lot of the panic feeling can decrease. Breathing deeply means putting your hand on your diaphragm, pushing against your hand, and then exhaling so the diaphragm goes in.

5. Reorient to the present. Begin to use your five senses in the present. Look around and see the colors in the room, the shapes of things, the people near, etc. Listen to the sounds in the room: your breathing, traffic, birds, people, cars, etc. Feel your body and what is touching it: your clothes, your own arms and hands, the chair, or the floor supporting you.

6. Get in touch with your need for boundaries. Sometimes when we are having a flashback we lose the sense of where we leave off and the world begins; as if we do not have skin. Wrap yourself in a blanket, hold a pillow or stuffed animal, go to bed, sit in a closet, any way that you can feel yourself truly protected from the outside.

7. Get support. Depending on your situation you may need to be alone or may want someone near you. In either case it is important that your close ones know about flashbacks so they can help with the process, whether that means letting you be by yourself or being there.

8. Take the time to recover. Sometimes flashbacks are very powerful. Give yourself time to make the transition form this powerful experience. Don't expect yourself to jump into adult activities right away. Take a nap, a warm bath, or some quiet time. Be kind and gentle with yourself. Do not beat yourself up for having a flashback.

9. Honor your experience. Appreciate yourself for having survived that horrible time. Respect your body's need to experience a full range of feelings.

10. Be patient. It takes time to heal the past. It takes time to learn appropriate ways of taking care of yourself, of being an adult who has feelings, and developing effective ways of coping in the here and now.

University of Alberta:Triggers and Flashbacks


Ian Lidster said...

This is good, Deb, and the UofA suggestions are well considered. I have been in the news business one way or another for nearly 30 years, and even I, as jaded as reporters can get, become supersaturated with negative feelings about the state of the world, and of humankind. If we convince ourselves that we are lost and there is no hope, then we may as well give up. There have been many worse times in history, and we have to keep focused on the positives and not be triggered by doom and gloom. Meanwhile, I do not watch TV news, and with newspapers, I pick and choose what I am going to read. I can stay in a fool's paradise if I choose, and sometimes that 'is' what I choose.
As always, thank you, wise friend.


Sarebear said...

Wow. Good stuff. It's been a year since I had my "blackness" experience, and I'm afraid it's going to happen again.

It was set off by the sound of a very strangely sounding motorcycle going down the street, that woke me up into a horrific, hellish terrifying blackness that was and is beyond anything I can describe. The fathomless horror I felt, and how everything was so primitive and like I was yanked back to being 3-4 years old . . . I couldn't breathe, and there were images of a man's hands, very large.

Anyway, should this happen again, I have some idea of what to do, at least, if I'm conscious of being able to do anything.

I don't WANT there to have been some horrifying repressed memories of something that caused this blackness, but I'm so afraid that there is . . .

What I did the rest of the day was hold things close to me, as I felt very vulnerable and in imminent danger. I told my husband that I was wary, and that I needed coddling and space and for me to take extra care of me. So I did, even though I didn't understand what was going on.

Anyhoo, thanks for the post.

The GurL said...

Thank you for bringing this article to our attention.

As someone who suffers with PTSD myself, I'm always eager to arm myself with as many tools and coping strategies as possible.

Would you mind if I linked to both the original article and your own posting from my site?

Marj aka Thriver said...

Thanks Dr. Deb! Another great post with sound advice. I've used pretty much all of these techniques at one time or another and they are helpful. I think the one to remember that may be easy to forget is the one about taking time to transition back to adult activities. I find sitting in front of my soothing fountain with a cup of herbal tea works well for this. As more and more of us are exposed to trauma, this type of information become so vital. Thanks!

~Deb said...

Wow. I remember talking with my psychiatrist, and her telling me how she had an overwhelming number of people coming into her after 9/11. Even if people weren't in NYC, they were traumatized by this all.

What great tips on taking care of ourselves. I really really got a lot out of this post. Thank you!

drytears said...

Good post, nice tips.

Right before I overdosed I was pushed over the edge by something small and stupid, my sister playing her music too loud and not turning it down after I asked.

Now when ever she plays her music like that and won't listen to me it just sets me off, even if I was feeling really good at the time I just can't cope then.

I don't really exactly go back to my OD but, in a way this is still a trigger for me. It's a bit harder to cope with because I can't stop it. She won't listen to me and if I go in my room and try to clam myself with breathing I find myself holding pills, and while I know I can't take them nor do I think I would actually take them.

It's scarey that something so little and so dumb can push me so far over the edge.


BTW, I love your blog!

Dr. Deborah Serani said...

Dear Ian,
I bet you could talk alot about the secondary trauma you experienced in the news biz. You are the wise one, reminding us to pick and choose how we get the news of the day. That's the best advice of all.

Dear Sarebear,
I hear you. I can relate to your experience.

Dear Gurl,
Feel free to cite or use anything that is helpful. And I'll link you as well :)

Dear Marj,
Water is a great healer for me as well.

Dear Deb,
I'm so glad you found the post meaningul. I like to share and pass along things like this.


healthpsych said...

A very timely reminder and some excellent suggestions for coping with all this.

Can I also suggest that people are careful about what their children are getting exposed to in terms of news stories? I thought I was taking the right approach in talking through some of this stuff with my daughter (7) after she caught some of it on the news and it came up at school but I've noticed that it has made her a little anxious. It's a fine line I guess between not hiding things but assessing how much they can really cope with.

Dr. Deborah Serani said...

Dear Drytears,

Sometimes knowing can help make sense when you are in the middle of something really difficult. I am glad that you are okay now, but it sounds like it was quite a journey for you.

I am happy you like my blog. I'm coming over to visit you now.


Dr. Deborah Serani said...

Dear Healthpsych,
You make an excellent point. Secondary trauma or vicarious trauma occurs when kids see the broadcasts themselves or via contagion from our own anxiety.

I think you are right. There is a fine line.

Blogger is down right now, so I can't edit the post. But I will get it in there with a hat tip to you, my friend.


Fallen Angels said...

I think flashbacks and memory nightmares (which I have decided are really, really bad flashbacks), are the absolute worst things I deal with.


Moof said...

Excellent piece! That would make a great GR's submission!

Those who have these problems might consider printing out your advice, and taping it to the fridge. We're not out of "these times" yet, and having such good advice on hand may be very helpful in the days to come.

Thanks Dr. Serani!

sjobs said...

This summer I am trying to take a break from the news. Most of the time, it works, every once in while I turn it on to see what is going on in the world and it always seems like a nightmare.

The brain is an interesting thing, my greatest trigger responses usually deal with my mom. The smell of her Youth Day perfume always gets to me.

Thanks for the tips on dealing with it.


Anonymous said...

Oh Deb, thank you for posting this today of all days. I've got no words right now...just thank you.

Wanda's Wings said...

Thank you Dr Deb. This is the best advise I have been given on flash backs.
I never knew what to do. This is so helpul.

Sarebear said...

Thanks, Deb! (Er, it's ok that I call you that, right? Ever since a post about names on Shrink Rap, I don't know what convention I should use)

My daughter was very concerned about the Destiny Norton case (since it happened just 2 min down the freeway from me) . . . it was ALL OVER EVERYWHERE.

I blogged about it a little while back, about trying to figure out what to tell her, she had ALOT of questions. Course, this was all the day before the horrid details came out. Trying to keep THAT under wraps for the few days after was a nightmare; this story went national, but since it happened right here it was nonstop coverage all over.

We did, though, use it as an opportunity to go over with her what she should do in case of a harmful stranger. And my ologist gave me some good advice.

Her sensitivity was raised with the Elizabeth Smart thing awhile back, too.

Anyway. I don't want HER to be traumatized, I guess I just try to muddle my way through as best I can (although when she asks pointed questions about, what does her body look like, why did that man kill her, I don't want to be killed, etc., it kinda makes my heart stop!!)

Rose said...

Good steps to take. But the best is to step back and not listen to all the news reports. I heard about it this morning late. But I walked away and was able to not panic and go back to 911.

MeMe said...

well yeah, i am scared very badly. feeling very like not grounded, so i will try these techniques. thank you

Nancy said...

HI Dr Deb,
great advice, I am going to tune out the instant news of the internet, tv and radio for a while. 9/11 did a # on me. It paralized me with fear. I could not go to any public place, (never mind go on a plane) and this caused a problem around the Holidays, but thank God for on line shopping.
Again great advice, I'm glad I found your blog

mysti said...

Perfect timing once again! Just this week I was reeled back into the world of flashbacks due to being triggered. I had to pull up all I knew in dealing with them. This post I am going to print out because it is a good thing to read when one is having a flashback. It will help me instantly remember what I need to do. Thank you once again.
Wonderful post as always!

Miranda said...

good post (dont know where my last comment I remember last year my g/f and I were suppose to meet in Texas and then fly to New Orleans on Sept 17. When Katrina hit, we decided to just stay and hang out and about in Texas. Well we did alright, we were evacuating from Rita. It was one of the scariest things I've ever had to do. I'll never go back to Texas between June and November again.

And with all this terrorist alerts, I have to admit, Im even afraid to fly there in December.

Sometimes I think bite the bullet and go, but will that be the time that the plane goes down? or another hurricane hits? I never thought I'd be so afraid to travel.

ants said...

I think, the means for one's own encourage and overcome of the scare (terrorist actions at first),are certainly valuables, but even more like treatment of symptoms, not avoiding the ghost (demon) jump out one day again. To more effective cure against the scare of terrorism devil, we have to sacrifice some of our privacy to allove more free hands them, who are fighting against it.

Cathy said...

I imagine that this will be very useful and helpful to a number of people.

I feel badly for the families of the 911 victims; they must be really having a ahrd time watching this; thankfully it was thwarted...

east village idiot said...

Thank you Deborah - lots of people in NYC need to read this email right now. Thanks again.

Andrew said...

Those are all great steps, I agree, but did we really need to go past step zero? (beefing up the chocolate cache)

All the best,

Dr. Deborah Serani said...

Dear Fallen,
PTSD flashes are extremely difficult to tolerate. I know this personally and professionally. I hope you can get to the other side of this all soon.

Dear Moof,
I will send it on out as a GR submission. You are right about the times being different now.

Dear Mary @ Sjobs,
I think there is research about smell being the most intense sense for flashbacks. There are fragrances that remind me of loved ones too. It's hard, isn't it? Thanks for sharing your thoughts.

Dear Traci

Dear Wanda,
Flashbacks are very unsettling and can occur at any moment. They are so hard to move through! I am so glad that these tips from the University of Alberta can be helpful. I think sharing is one of the best things about blogging.

Dear Sarebear,
Of course you can call me Deb :)
It IS a tough balancing act to provide children with awareness without causing anxiety.

Dear Rose,
You are such a wonderful role model. I thought of you today as I was getting my car washed. There was a tv on in the place on CNN and people were talking about the terrorist news and all. I just paid my bill, walked out and let myself take in the sunshine. You are right, taking a step back is very important.

Dear Meme,
I hope that you can find some boundary and security. It is so hard to not feel grounded.

Dear Nancy,
I am very sensitive too, and I can relate to all that you wrote. BTW, I have been doing online shopping for years now...especially around holiday time :)

Dear Mysti,
I am glad that the timing of this post can be of some help. I hope that you can dilute the flashes and triggers.

Dear Miranda,
Since 9/11, I am on SUPER HYPER-ALERT when I travel. I am ready to kick serious butt if I need to or report something if it bothers me. I want you to realize that with knowledge comes power. Even though things like this scare us, we can turn the fear inward or outward. I hope you can transform your fear into kick-ass self-protection. Y'know what I mean? But I can understand how memories of the things you've been through can be so frightening and paralyzing.

Dear Ants,
Truth be told, I would not mind if less privacy meant more safety.

Dear Cathy,
We are at the five year mark with 9-11. And I am still working with ground zero survivors and emergency responders. The things that were seen on that day will take a great deal of time to dilute. So many tragedies, wars etc in our world. Sometimes human nature surprises me. I know there is more good in the world, but it escapes me how bad keeps on going and going and going....

Dear EVI,
I will be thinking of you and your family and so many of the city dwellers in the next few weeks --

Dear Andrew,

Heidi said...

I'm flying out to Boston on Weds..nervous, anxious , yes..But we can't let then win.

I just heard a plane flying low past my window ( I'm on the 6th floor) My radar goes up..ugh!

Thanx Deb xo

Meow said...

Great advice, Deb, and a very interesting post. Thank you.
Hope you have a wonderful weekend.
Take care, Meow

Sarah said...

What a great list! The recent events haven't 'triggered' me, per se, but this list is helpful for other traumatic experiences I'm recovering from. Definitely printing this out.

Alison said...

Very sound advice.

Precisiongirl said...

I think I've become de-sensitized. The recent foiled plot thing in the UK didn't really get me scared. If it had happened then I owuld have sat up and paid attention.

It just seems that this kind of thing happens every week now.

Clare said...

Great advice Deb and even better to just walk away as you (and Rose) suggested.

lightfeather said...

Thank you for this today.

Fallen Angels said...

I think I'm in for the long haul, Deb. :( Seems like more and more just gets added before anything can really be dealt least right now.

I have several pieces of paper with different things to do when a flash hits (breathing seems to be the hardest one for me, many times my T has told me to breath during a session)...but they are hard to remeber and of course not all in one place. You have all of them, plus a little more in this post. Do you mind if I print it out?


Cathy said...

Thank you for posting this. I needed it. I have the news channel on almost 24 hours a day.Its like I'm addicted to it.

I was also in NJ and scheduled to fly home from Newark on Fri. morning. But, with all the increased sucurity and 6 hrs. waiting time, my SIL drove me home to Ohio. I had my little granddaughter with me and I felt she would be very upset by all these men with rifles walking every where. I have been the biggest pessimist lately.

Deb S. said...

Timely, excellent advice. I was thinking about the anniversaries myself. Like Ian said, those of us who work in communications do that - just as those in your profession do.

I think your tips on dealing with trauma, triggers and flashbacks represent a great public service. Take it from someone who knows about all of them.

jumpinginpuddles said...

flashbacks that have all full blown human emotions smells sights etc involved are the ones that you cant simply do all those things and be ok at th end with. Wish there was a magic cure though

Dr. Deborah Serani said...

Dear Heidi,
You are right!

Dear Meow,
Hope you have a purrfect weekend too.

Dear Sarah,
It's so great that the recent events haven't triggered you in any way.

Dear ALison,

DEar Precision Girl,
Actually, many people report feeling desensitized as well. So you are not alone in this experience.

Dear Clare,
I need to take a break when things get too overwhelming in the news. I get very easily unnerved by such information.

Dear Lightfeather,

Dear Fallen,
Of course, please use anything that you find helpful in the blog. I hope that the flashes are not a long haul experience for you.

Dear Cathy,
I can understand how you feel about all of this. When I feel pessimistic, I try to remember that most people in the world are not evil and unkind. That helps me to find my balance again. And it is so hard for us to find a balance when we have our children and grandchildren to protect.

Dear Deb,
Yes, some professions are in the front lines of these things more than others. And we do have to make sure we don't get too overwhelmed by it all. A balance that is hard, but not impossible to achieve.

Dear JIP,
I often wish there was some elixir or technique that could dilute flashes as well. However, it takes a long time, and a lot of processing and hard work. That is why I like using the work "survivor" not victim. I wish you continued success in winning the flashback battle.


Nella said...

I like this post, gave me alot of info. I went and saw World Trade Center yesterday and that brought back alot of memories. Geart post.

Todd and in Charge said...

Thanks for a great post. Between the world headlines and the deteriorating economic picture, gas prices, etc., it's hard not be a little depressed about everything. Is that a rational response? In other words, is being optimistic and upbeat at present an irrational response?

Id it is said...

That was a much needed reassurance and reminder that one cannot live ones life on a series of flashbacks and triggers.

Anonymous said...

You know what this reminds me of....Days of sitting in front of the TV, not moving..after 9/11.

I think everyone, mental illness or not, has a certain "trigger point".

The awareness of what these triggers are though, THIS IS the ultimate prevention.


jane said...

Oddly enough, I learned about triggers via blogging. Thanks for providing us with tools we can use when we recognize that's going on.

Belizegial said...

Dr. Deb,

The info u provided here on trauma, triggers and flashbacks is very useful to have in hand, bearing in mind the traumatic times we are living in.

Here in Belize, the crime rate is at an all time high and we have all become somewhat desensitized to the various crimes that occur on a regular basis. However, when it comes too close to home, one can be reduced to tears when watching the news.

Just wanted to say hey and let u know that I recently added your blogsite under my favorite links.

Thanks for your valuable tips,

Sunnie Dee said...

Good timing with this post Deb. August is always a horrible month for me and I always struggle to remember those helpful things that I know keep things in reality. It was good to read the reminder

Hope said...

Great advice. My godson is flying out of Heathrow this week. I have had that heavy feeling of dread in the pit of my stomach since hearing the latest plot.
My husband and I agreeded over the weekend that the news/newspaper and talk radio needed to be shut off for a while. It may seem like putting your head in the sand, but a break from it sure is necesary.
I still pray for peace.

princessdominique said...

Great advice/suggestions. This is the perfect way to keep people in touch with what's going on without them going overboard. I admire when people offer solutions and don't just tell people to calm down.

CP said...

Honor your experience.

I like that one, Dr. Deborah.

I don't think people realize that they aren't just victims, but rather, survivors.

We are all worthy of a self-induced pat on the back from time to time.


wolfbaby said...

breathing is the hard thing to remember..

good luck

Anonymous said...

Thanks for this post. I don't think stomping my feet on the ground can ground me though. Pinching and rubber bands are better, although cutting still works the best.

CrackerLilo said...

My wife is working herself into exhaustion just so she can sleep without nightmares right now, poor baby. Oh, she says she can use the money, and of course that fall fashion season is coming up and new fabrics will be calling her name, but I know better.

I wouldn't see that damn movie if you paid me. It'll take a scalpel to get those memories out of my head.

ellesu said...

Thank you for this post. It is valuable information in times like these.

Dr. Deborah Serani said...

Dear Nella,
I hope seeing the movie offered good things for you.

Dear Todd,
I think holding onto a positive perspective is wonderful. Most of the world's population is filled with good and kind people. The things that are bad ARE BAD, but often we see them magnified to such a degree that we can become jaded and pessimistic.

Dear Id It Is,
You said it.

Dear Mom,
You wrote that so beautifully. Hugs back at'cha.

Dear Jane,
Blogging is wonderful for SO many things. I also learn a lot from the blogosphere.

Dear Enid,
I'll link you too. I did not know that the crime rate was so high by you. Be safe, my friend.

Dear Sunnie,
The summer months are triggers for me as well. {{{{{hugs to you}}}}

Dear Hope,
Limiting the news is a really important thing to do if you are overwhelmed by it all. There is a webiste I have on my links at the bottom - It's called the good news network. I like to go there to read wonderful things.

Dear Princess,
I love to share useful things. That's the teacher in me, lol!

Dear CP,
Here Here.

Dear Wolfbaby,
Breathing correctly IS hard to remember. But it can make a HUGE difference in moving through triggers or flashbacks.

Dear Anonymous,
I hope you can find other, more healthy ways to express and vent emotions and thoughts.

Dear Crackerlilo,
I can't go see the movie either.

Dear Ellesu,
Thank YOU.


CP said...

I'm having a bad time today, Dr. Deborah and I am taking your advice to heart. I am breathing through it. Remembering. Honoring.

I am also eating a lot of chocolate and chewing my nails to the quick, but hey, I'm coping.

August 17th is a hard day for me historically.

Thank you for allowing me to realize that and respect it.


dr peg said...

I've become what I call a "news monk."

No TV news, paper only on Sunday. The rest of my news I get from NPR, and not even on a daily basis.

With such a negative bias in the news, it's easy to become more discouraged than is realistic.

Wanda's Wings said...

This is the best advise I have ever seen on flash backs.