5 Interventions for Traumatic Flashbacks

When a flashback to trauma occurs, neuroimaging reveals that parts of the brain responsible for reason, logic, language, and timekeeping can become unresponsive. That leaves the traumatic memory and the brain’s fear sensors to run unchecked! Blood pressure and heart rate spike, and the brain and body can respond as though the trauma is actually occurring again.

This is very scary for us to experience, and probably for you, too, if you or a loved one has PTSD (post-traumatic stress disorder). It’s hard to know what to do when in this state because the brain’s executive functioning may be temporarily compromised.

After visiting two trauma centers as a patient (one residential, one in-patient), reading PTSD, DID (dissociative identity disorder), and DBT (dialectical behavior therapy) books and patient manuals, and attending four day per week individual trauma therapy for the past fifteen months, we wanted to share with you our “Greatest Hits” of techniques to cope with traumatic flashbacks, feeling unsafe, or experiencing ideation of self-harm.

The first step to take is to write a list of steps you are already taking that are working for you and leave space to add some of the techniques you might learn about in this post.

Create an index card, computer file, phone picture, email, or some other format that will be widely available to you whenever and whenever you need it–whether you are at work, on a bus, at dinner, in bed, out with friends, shopping, etc. Remember, the brain’s decision-making may be compromised, so keeping this list where it is easily accessible is as important as what is on the list.

As regards medications you might take in these situations, it is still recommended that you have a list of additional interventions because medication takes time to affect your body. All of the interventions below are intended to be easy and fast-acting because time matters when you feel unsafe! And please know that we care about you as we write this, even though we may not know each other yet.

1. Forward Fold: while you are either standing or sitting, slowly bend your upper body until your head is level with or below your heart. Be sure to keep breathing (you may wish to add intervention 2 while in forward fold). In forward fold, you are saturating your brain with blood that may be otherwise deprived due to hyperventilation, decreased circulation, etc., as a result of your flashback. We stay in forward fold typically for 30-60 seconds (you can experiment with how much forward fold is long enough to be effective for you) and then slowly unfold. Often, the rush of blood to the brain helps reset our nervous system. If we’re not yet convinced, we proceed to the next step.

2. 3x3x3 Breathing: we breathe in for a count of 3 (1 Mississippi, 2 Mississippi, 3 Mississippi is how we count), hold our breath for a count of 3, and then exhale for a count of 3. Pay special attention to the exhale so that you are fully present and can consciously begin the count again for breathing in. If your mind wanders, gently bring your mind back to your breathing (Mind, are you curious about other things? Can we breathe together first?) and expand to 4x4x4 breathing, 5x5x5 breathing, and see if you can comfortably get all the way to 7x7x7 breathing. This is often sufficient for us to be calmer. We often start this mindful breathing while in forward fold. They work well in tandem.

Note: timed breathing may not be ideal if you have OCD (obsessive compulsive disorder). When our OCD is highly active, we try a visualization of breathing in energetic air at a rate more slowly than before, holding onto our breath as it cleans out our worries, and then slowly releasing the worries to the universe to recycle.

3. Ice Cubes: ice is highly effective for us as a substitute for self-harm. Many who self-harm are looking for a release. Squeezing an ice cube in either or both hands produces a very intense sensation very quickly. If you are somewhere without access to ice and with access to water, running the coldest water available on your wrists is a potentially effective alternative.


4. Ice Dive: the ice dive is the most complicated of these options–and still it can be prepared in approximately two minutes–and is a great option if the prior three steps have helped give you some relief and you still want more relief or if the prior three steps have not dented your fear. Fill your largest mixing bowl or similar container two-thirds or three-fourths full with the coldest water possible, and add 10-12 ice cubes if available. Let ice sit for a minute to chill the water. Place the bowl on a counter or dining table. Act like you are about to dive into the Arctic Ocean (put your arms out like you are diving from a diving board), take a deep breath, and plunge your face into the bowl of ice water. See if you can hold your breath for more than 5 Mississippi! It’s hard to do because the water is so cold. It’s fine to come up for air, catch your breath a quick moment, and then simulate another dive into your Arctic Ocean! The ice dive is like doing all three of the first steps together, and it really helps reset our nervous system. Don’t try to hold your breath any longer than you feel comfortable; you don’t want to start choking on water. The goal is to slow your world down–safely. Feel the sensation of the cold as the world chills out like your face. Feel tiny air bubbles as they escape your nose.

5. Emergency Help: If the first four steps do not help and you either don’t take medication or it hasn’t helped you yet, it is safe to ask for help. You can call your local crisis hotline (put the number on your emergency plan), your therapist’s after-hour number, or 911. Tell whoever answers that you feel unsafe and slowly explain your situation.

We hope you will not feel shame for any of these steps because this is what self-care looks like. You are deserving of every tender word and deed that the world can offer.

If any of these interventions help you, will you let us know? If you have a quick and effective favorite flashback intervention, will you share it with all of us by writing a comment? If we work together, we can know that we are not alone in our hard times, and we can share gratitude, empathy, and joy, too.

Now is Now

The present–now–can be a challenge to focus on for everyone.

Think of how much time we spend on past events: dissecting our behavior, others’ behavior, an event. We’re like history detectives except we often presume our own guilt without a preponderance of evidence. In other words, our rear-view looking is often biased against us.

Future looking is often loaded with worry. It’s as if we’re striking constantly at a piñata filled with spiders. We should stop before we let them loose.

The only real time is Now. If we are not in an abusive situation, our Now is probably safe. Look around your Now: hear safe sounds (we hear cardinals calling), see safe things in your room and outside your window, taste your favorite hot or cold beverage and savor it, touch your favorite keepsake or trinket while knowing you do so Now.

We read a lot about how to be in the Now. For dissociators, being Now is perhaps life’s greatest challenge. Here are some facts on time:

Everything happens in a Now. The past is how we remember a prior Now. It is no longer happening. We are remembering in the Now.

The future is a fantasy that will never occur. That isn’t to say we can’t set and achieve a goal. It’s to say that no matter how detailed our future fantasy, it will never fully match the Now as it unfolds.

Choose to occupy the safe Now.

When our brains don’t want to lead, feed them data from our senses and know that is occurring in the infinite unfolding of Now.

If we are not safe in a Now, make safety the priority.

As with every skill, being Now takes practice. Let’s be gentle with ourselves as we practice. Practice Now.

Are You Intensifying Unpleasant Feelings with “The Layer”?

We keep reading in self-help books that “feelings are natural” and “judgments are dangerous.” Wait, what’s the difference between a feeling and a judgment? Can you have one without the other? We had to have it explained to us repeatedly, and we think we understand!

If our boss says in front of coworkers, “I received your application for a hardship withdrawal from your 401(k). I’ll let you know once HR gets back to me,” we could understand if we felt violated. We would have preferred if our boss discussed this with us privately.

We stray from feelings to judgment when we think She is singling us out again or She sucks at managing people. Judgments ascribe intention to an action. (Without asking her, can we really know why she disclosed our private information in front of others?) Feelings are about the emotion stirred in us as a result of circumstances.

Here’s the thing about judgments: they intensify unpleasant emotions–making them even more unpleasant–because they allow us to personalize something that may have nothing to do with us (she may have disclosed private information because she is an open person who shares about herself willingly or because she kept forgetting to tell us she received our application and, in haste, told us in front of others).

Avoiding the judgment (blame, accusation, etc.) allows us to avoid adding an additional “Layer” of secondary emotions: anger, shame, more fear.

“The Layer” can be especially toxic when applied against ourselves. How many times have we been the one to accidentally disclose private information in front of others and then think I’m such an idiot! Why do I do such stupid things? 

Adding this layer of self-judgment intensifies our regret and The Layer itself becomes the point of fixation. We might even forget what our supposed transgression was (social gaffe, traffic ticket, raising our voice at a loved one) and the self-judgment layer takes on a life of its own. We can get into spirals: shame spiral, anger spiral, fear spiral. We can become physically ill from our emotions and the physical manifestation becomes the result and focus of The Layer.

We have found that if we intervene at the point of judgment–and back away from judgment–our feelings instantly become…survivable. Without The Layer, we suddenly have options. We can take action to remedy the situation, we can get in touch with (and meet) our needs underlying the feeling, or we can ride it out like a brief rainstorm. Even hurricanes end.

In life, how many times will we succeed simply by doing nothing? Avoiding adding The Layer is a stop sign for spirals. By not making the situation worse, we automatically make the situation better. We get in touch with our feelings and learn that feelings are natural and survivable. Avoiding judgment helps us forgive others and ourselves more readily.

In short, avoiding The Layer is like avoiding pouring lemon juice on our wounds. The wounds heal much faster and with much less pain.

When we catch ourselves judging, stopping is the same as peeling back The Layer. It can be undone.

Like any other skill, avoiding The Layer will take practice. If you’re like us, you’re practicing a lot of new skills. Maybe do yourself a favor and Bookmark this page. Come back to it. Practice.pexels-photo-129743.jpeg


Engaging Our NOW Senses

Expectations are the enemy of presence.

When we have expectations, we see only what we’re looking for. In science, that’s called confirmationbias. If a researcher is looking to see if kale helps zebras grow longer eyelashes, she might notice something that’s not actually there.

If we think the lady who lives in the apartment across the hall doesn’t like us, we may look for evidence to support that expectation.

Expectations are the enemy of being present. Instead of being present, with expectations, we are in a limited version of reality.

To try to set aside expectations, practice a quick grounding exercise that engages all your senses:

(1) Look around the room you’re in or go outside. (2) Name three objects. (3) Touch two objects and describe how they feel to you. (4) Listen for two sounds. What do you think they are? Be as specific as possible. (5) Notice and name one smell.

Now we’re using our Now Senses!

Now we’re primed to see the neighbor as she is today. Maybe her eyelashes look exceptionally long. Perhaps it’s from all the kale!

Start Now!

The only way to get somewhere is to start

Do you ever wish you could learn to bake treats, identify the birds and trees in your neighborhood, replace a harmful habit with a beneficial one?

There is a shortcut you can take toward all of these goals–and to every goal!


Yes, it’s that simple. We might think we need to learn every tree and every bird call before we venture out and try. Perfectionistthinking. We feel embarrassed or ashamed to fail.

Failure? If we started with one bird–the one whose pretty song inspired us to learn more–and learn what it’s called, then we’ve started! At our own pace, we can learn another and another.

If we want to drink fewer sugary sodas, can we stop? Can we drink carbonated, calorie-free water instead? What if we go four days without a sugary soda and then drink one? Are we a failure? Let’s say we are not. Let’s say that four days without a sugary drink were a new and valuable achievement.

And if we value the goal and get off-track, the best time to resume it is as soon as we realize we’re off-track.


If we go three more days without a sugared soda, then we achieved our goal seven out of eight days. That kind of success percentage would get you into the weather forecaster hall of fame, baseball hitter hall of fame, and is more successful than if you’d never started!

Write down a few goals. Maybe we’ve been putting off talking to the doctor about exercises to help our posture. Let’s call the doctor and ask about it, or send a written message. Start. Once she gives us information, we’ll use it to schedule physical therapy or start those exercises. What we won’t do is make another excuse involving perfectionism and failure.

We must start in order to succeed. One day of doing leads to two, and before we know it, we’re on a roll.

Ready? Set. Start.