Managing PTSD Flashbacks

This Is Your Brain:

The brain is incredibly complex and really smart people are still learning vast amounts of information about the incredible minute details of how the brain, functions, processes information, and heals. If we look at the brain in a very oversimplified way, we could say that the brain is comprised of three main parts that have three main functions - Survival, Emotions, and Rational Thought. For the purposes of this post, we will focus on only 2 facets of the brain which I will explain very simply.

The first is a small cluster of cells near the base of the brain called the Amygdala. This is a primary segment of the survival part of the brain. It is responsible for your fear and your reaction to a dangerous or life-threatening situation. Important to know is that when the amygdala is activated, the emotional and rational parts of your brain are shut down and you may have trouble focusing, making decisions, or control your reactions to what is happening to you. Some part of you goes on auto-pilot to get through the situation at hand. Sometimes this is referred to an amygdala or lymbic hijack.

The second part of the brain is neural pathways. These pathways are like roads that link all the different areas of your brain. For example if you see the color blue and start to feel calm, there is a neural pathway linking the identification of a specific color (rational thought) to a feeling (emotion) in your brain. Interestingly, the more you use a specific neural pathway, the more ingrained the pathway becomes. This is how we form habits. We can change a habit by creating a new pathway that arrives at the same place by a different route.

This Is Your Brain on Trauma:

Your brain naturally reacts to certain life-threatening situations by having the amygdala take over control of the brain. This creates what is known as a fight, flight, freeze or fawn response. This trauma response is intended to literally save your life. Everyone’s trauma response is unique, but generally falls under these four categories. Some people get angry and fight back against the attack. Others run away and avoid the attack. Some folks stay still and try to become invisible to the attacker. And, less well known, are those who try to placate or win over the attacker. Each of these are valid responses when experiencing a traumatic situation.

Trauma can also weaken neural pathways that lead to rational thoughts or emotional responses and instead create pathways that bypass these two parts of the brain entirely and directly trigger the survival part of your brain. Trauma literally rewires the brain to go straight to a trauma response. The more a trauma is experienced (like child abuse/domestic violence/cults) the more ingrained that pathway becomes. In these devastating cases when you are enmeshed with your abuser and unable to escape, you may find yourself perpetually in a trauma response.

This Is Your Brain After Trauma:

Post-Traumatic Stress Disorder is when a traumatic event (or similar trauma repeated over a longer period of time called Complex PTSD) creates a semi-permanent short circuit from a sensory cue to that trauma response. Because the brain reacts to the body’s signals, the exact same event doesn’t even have to be happening in real life to trigger you. This is called a flashback. During a flashback, or amygdala hijack, you are unable to access the emotional or rational parts of your brain and are trapped in survival mode.

One example of how a flashback can take over is that someone who survived a deadly hurricane only has to watch images of a hurricane on TV to be retriggered. The images on the screen trigger the body to remember the feeling of the event and the body tells the brain it is happening again and the amygdala takes its cue and takes over. Now someone who is physically safe in sunny weather is stuck in the trauma response of fight, flight, freeze or fawn.

So How Do I Get Out of the Trauma Response?

Below I've outlined an action plan that can be used when in a flashback. (I've used it myself!) The biggest piece is to really have patience with yourself. While going into a flashback may feel like turning on a switch, you have to navigate a neural maze to come back out which takes time - often several days or even weeks if the flashback is super intense. Give yourself lots of time and be gentle with yourself. The original situation that created the trauma was not gentle, so be sure to offer that to yourself now.

1. Recognize you are in a flashback

Sometimes we are just having a bad day, but if that bad day lasts several days or stretches into weeks, we may want to check in to see if we are actually in a flashback. Red flags are internal cues that something is off. These feelings tend to be extrememly intense and you aren't able to let them go in a reasonable amount of time. They tend to linger and fester...

Red flags to watch for:

- Panic attacks

- Anxiety flare-ups

- Nightmares

- Severe irritability, flashes of anger or rage

- Irrational fears & violent fantasies

- Extra spacey

- Extra sensitive - taking all things very personal

- Depression & feeling worthless

- Feeling completely alone or abandoned

- Feeling vulnerable or out of control

- Feeling helpless like a little kid

- Intuition is off or shut down

- Noticing you are in fight, flight, freeze, fawn

- Difficulty doing daily tasks

Basically, its like someone turned up your uncomfortable emotions (anger, fear, worry) to 11 and your ability to calm down, self-soothe, or be rational has been hijacked. Nothing is making you feel better...

Identifying triggers:

Triggers are generally one time events that launch us into a flashback. Triggers can be internal, like feelings, or external, like events. Sometimes it is possible to identify ahead of time that a particular event will be triggering, like going back to a family reunion, but sometimes we don’t know what exactly set us off. That’s okay. Some external triggers can be very subtle – like your boss using the same tone of voice your mother used when she was disappointed – and we may not always catch them when they happen. Some internal triggers can also be ways to recognize we are in flashback and are both red flags and triggers. It is important to note that you may be experiencing multiple triggers around the same time, like if the news repeatedly plays triggering footage of an event and you wind up having nightmares and panic attacks. Examples of some potential triggers are:

- Visiting the location of event/abuse

- Seeing your abuser again in person or on video

- Lawsuit with abuser

- Watching the news

- Watching a violent or traumatic video/movie

- Hearing a story similar to yours

- Nightmares

- Panic attacks

- Feeling vulnerable or out of control

- Feeling shamed or made fun of

- Major life transition (a death, a birth, big move, new job, marriage, breakup)

- Remembering the original trauma event

- Feeling criticized or shamed

Once you realize you are in a flashback, then you can start to work through it to come out on the other side. This is the point where you begin to reprogram your brain to strengthen your neural pathways out of the trauma response.

2. Triage

Triage is basically making sure you are physically safe and removing the situations that are causing you to be triggered. Make sure any of the following triggers are managed.

- Physically remove yourself from the situation/people that are triggering you.

- Assert your boundaries – screen your calls, cancel future plans, etc. to keep yourself safe

- Turn off the TV/Shut off the computer (or just watch super light movies & shows i.e. rom-coms or kids movies)

- Be gentle with yourself. If your go-to pattern to feel better when you are upset is self-abusive (drinking, binge eating, etc) try something different. These behaviors often lead to shame which can retrigger you or trigger a whole other PTSD flashback. Often, when I’m feeling an overwhelming urge to indulge in unhealthy patterns, I’ll just go to bed.

Please note that if you are currently being abused, getting yourself to a safe place is the most important thing to do. To leave an abuser you must be mentally, physically, and emotionally prepared to do so. For help and support, you can call the National Domestic Violence Hotline at 1(800) 799-7233 or go to https://www.thehotline.org/. While they focus mostly on adult domestic violence, they have resources for any abuse situation. Another resource is Helping Survivors at https://helpingsurvivors.org/. They work with a wide variety of assault support, recovery, and justice.

3. Create Space. When you are in a flashback, it can feel like the walls are closing in and everything feels tight. Give yourself some space to process and nurture yourself. Learning self-care is especially important (and can be difficult) if you didn’t feel cared for as a child. Try different things to find out what works for you to feel comforted.

- Get active – go for a walk, exercise, move your body to get in your body.

- Meditate – this can help calm your overactive mind

- Be in nature – this can help calm your mind and body

- Write/journal – can be about your feelings or not - anything you want

- Create art - draw, paint, play music

- Take some time off of work if you can to relax

- Talk with a therapist or trusted advisor

- Check-in with safe friends - tell them what's going on

- Clean your space - your physical environment is often a reflection of your inner world

- Change your scenery – get out of the house, visit a friend, rent an air bnb for a night

- Do something nice for others – helping others can remind us of our own positive impact

- Do something nice for yourself – can remind us that we deserve nice things

- Read a book/articles on PTSD (my fave is “Complex PTSD: From Surviving to Thriving” by Paul Walker)

4. Come back to yourself

Once you are feeling better, don’t dwell on the event or situation. This could retrigger you. You deserve accolades for your strength, resilience and bravery for doing the hard work to move through the flashback. Relax and appreciate how strong and capable you are.

Sometimes, you can put a safety plan in place for yourself for the next time this happens. Have a list of your personal red flags and triggers, how to triage for your situation, and what you can do to offer yourself space. Creating a disaster preparedness kit can be especially helpful if the trauma was from a weather event/natural disaster.

Remember that PTSD rewires your brain and those patterns created by the trauma are shortcuts to the fight, flight, freeze, fawn response. If you were a child when the trauma happened, then your brain was still developing and the trauma response has become a foundational part of not only your brain’s landscape but your identity as a person. The good news is, our brain can rewire itself, but it just takes time. Be patient with yourself. The flashbacks may never completely go away, but with enough awareness and bravery, they can become less frequent and less intense.

You’ve got this!