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Management of Traumatic Flashbacks

Introduction

Flashbacks are vividly experienced memories. We usually think of them as being memories of traumatic events, now experienced as if the event were being relived, with all of the same intensity of feelings. It is important to recognize that when we suffer from flashbacks, we are not suffering from the original traumatic event, but rather we are suffering from the way that our mind is now processing the memory of what happened. Although flashbacks are often upsetting and intrusive, they can be thought of as a way that our mind has of telling us that something terrible has happened and that there is still a need to master and to learn from what happened.

Step 1: Thinking About the Traumatic Event

It is useful as a first step to review the meaning in your life of the event being remembered, even before reviewing the details of what actually happened. This step is often done with the help of one of the therapists. With respect to the traumatic scenes, it is useful to review the issues of who was responsible for which actions in the scene, what the impact of the event was on your life and on the lives of others, and the meaning that you would like the event to have in the future. One of the key points in this step is that it is important to limit the assessment of your responsibility to only what was under your control.

Step 2: Talking About the Traumatic Event

Many people unfortunately keep their traumatic events a secret from everyone in their lives. This is unfortunate because the secrecy maintains the idea that participation in the traumatic event was shameful and even unforgivable. The person bearing the secret memory can think that he or she could never be accepted or loved if anyone ever found out about the traumatic event. Although it is wise to consider who can handle knowledge of the event and who cannot, to keep the event an absolute secret from everyone reinforces the idea that any participant should feel shame, even if that participant was a victim. It is useful to bear in mind that professional therapists maintain confidentiality, and are ideal for the purpose of unburdening yourself of painful secrets. The very act of talking about traumatic events, so that you do not feel alone with them, is helpful to you.

Step 3: Using the Dissociated Perspective

In order to avoid feeling overwhelmed by the emotions that were originally experienced in the scene represented in the flashback, one technique that is often very helpful is that of visualizing the scene as if you were watching it on a movie screen. The usual flashback involves experiencing the remembered scene from the first person perspective, also called the associated perspective, which involves visualizing the scene from the perspective that you had when you were actually involved in the traumatic situation. The movie screen technique, however, involves visualizing the scene from an external, third-person, or dissociated perspective, so that the visualized scene now contains yourself (as you were then, not as you are now) as one of the characters being viewed. Your perspective now is that of an observer rather than that of the participant you originally were. The effect of this shift in perspective is a change in the emotional experience, because the feelings of an observer will be different from, and usually less intense than, the feelings of the original participant.

Step 4: Exercising Control Over the Image of the Traumatic Event

Once you have learned to visualize the flashback scene on an imagined movie screen, it is useful to learn to develop a sense of control over the scene by imagining that you are in the audience watching this movie scene, and that you have a remote control which allows you, at will, to change the movie picture’s brightness, size, direction, speed, sound volume, and distance of the screen from the viewer. Practice doing this in your imagination until you have a good sense of control over the scene which is visualized from this external perspective.

Step 5: Modifying the Image of the Traumatic Event

Visualize on an imagined movie screen the original scene, with you as one of the characters in the traumatic scene, usually in the role of the victim. Pay attention from your position of observer to the thoughts and feelings about what you are observing. Recognize the unfairness of unnecessary suffering, and pay special attention to your feelings of compassion towards the victim that you were in the original scene. If there was a perpetrator, pay attention to your experience of anger.

Then think about what you would like to express to the victim that you were then, if you could. Think about what you would like to do in that scene if you could be present as the adult you are now, in addition to being there as the younger victim that you were then. As you think about the options available, keep in mind that you want to think about doing something that will result in you as the adult feeling good about yourself, and that will result in you as the victim feeling better. I therefore recommend that you not think about revenge as a suitable option, because that would put you in the role of perpetrator.

When you have found an intervention that you would feel good about carrying out, imagine floating from your seat in the movie theatre and entering the screen image as a new character in the scene. You can be visible to some or all or none of the other characters in the scene, as you wish. Carry out in this fantasy the intervention that you feel happiest with. Pay attention to how you as the intervenor feel as you carry out the intervention. Then switch roles and from the position of the former victim that you were, pay attention to how you feel now in this new version of the scene.

If all had gone according to plan, you should have positive feelings from the perspective of the intervenor, and you should have much better feelings than you did from the perspective of the victim. You can try different versions of interventions so that you can find one, or several, that result in the generation of better and better feelings.

Step 6: Living Without Traumatic Flashbacks

As you learn to apply this technique, you can appreciate that, just as with any other skill, it requires instruction and practice, and it is never mastered perfectly. Using your self and/or your therapist as a coach is helpful.

As you think about this exercise and about the original event, you may find that the original meaning of the event that you experienced changes. This is quite normal, and even desirable. After all, you do not want your entire life to be determined only by painful memories of specific events in the past.

If the flashbacks were a significant problem for you in the past, then living your life without them will feel quite different and unfamiliar. You might find that it feels strange at first not to be distressed by them any longer. Some people feel guilty about no longer suffering from painful flashbacks. If this is the case, you will probably need to talk about this problem with your therapist. Be assures that you can learn to feel comfortable without painful flashbacks.