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.