The Wellness Toolbox and Flashbacks

I am providing support for a person who is recovering from Post Traumatic Stress Disorder (PTSD), and who experiences lots of intrusive and horrific flashbacks of the trauma he has experienced. It seems like the flashbacks are trying to keep him from being who he wants to be and doing the things he wants to do. Sometimes, for him, it feels like the trauma is going on and on and on. A key topic of conversation is “What helps?” “What Helps” and the Wellness Toolbox are to me, the same.

He says being heard and having a conversation with a supportive person helps him a lot. So that would be two Wellness Tools, being heard and conversation. That sounds easy. We can all do that. We can put that at the top of our Wellness Toolbox. However, there are some issues in assuring that these Wellness Tools are really helpful.

The supporter needs to know the difference between conversation and being heard. If the person just wants to be heard, the supporter should just “be there”, letting the person know that they are paying attention, but not interrupting with ideas, corrections, advice, or stories of their own.

If the person wants to have a conversation, the supporter can share ideas, possible strategies, and even share briefly their own experience. However, the supporter needs to always keep their role in mind and not become the central focus of the conversation.

When listening and having a conversation, validation is very, very helpful. It helps to say things like, “that sounds really hard”, “I am so sorry that happened to you”, “that is terrible”, or “it is hard to understand that anyone could treat you like that.”

In my recent conversation with the person I am supporting, I have taken a risk and suggested reframing negative thoughts. For instance, in one of our conversations, he said, “My problem is, I am really lazy.” I challenged him on that. I reminded him of what he has been through. I reminded him of the hard, hard work that he is doing to recover from severe trauma, and the incredible work he has done becoming a musician and sharing his talent so readily with others. I keep reminding him of his resiliency, his generosity, and of his warm and gentle spirit.

Not everyone is going to be acceptable as a supporter; a person who will listen or who can be a partner in a conversation. For me, and I know it is the same for him, there are only certain people I can converse with, that I can share my life with, and others that I would not trust to hear me in a supportive way or to respect my confidentiality. One of the things I have done to make it easy for him to reach out to get this kind of support quickly when he needs it, is to make a list of the phone numbers of the people he trusts and who might be available to talk. He has copies of the list in key places. He also has the list on his I-pod and on his cell phone. When he is having a hard time and can’t think of any one to call, he can reach for the list and easily find someone. He uses the phone a lot for this. A phone with unlimited minutes helps. When he is troubled by flashbacks or a nightmare at night, he has a supporter on his list who is in a time zone on the opposite side of the country who he can call at much later hours.

Diversionary activities should also be on the list of Wellness Tools to deal with flashbacks. You can have a very long list of these. For him, playing music is key. His experience mirrors my own. Sometimes doing the things I love to do helps, and sometime the flashbacks intrude and intrude and intrude. That is why it helps a lot to have a long list of diversionary activities, activities you can easily access, so that if one thing doesn’t work, you can try others until something does work.   My list includes:

Playing the piano   Sketching   Working in my garden   Quilting   Sewing   Knitting  

Watching a video   Riding my exercise bicycle   Writing a poem   Reading a good book

With a long list like this, I can be sure I find something that will divert my attention and decrease the frequency and severity of the flashbacks.

I am interested in collecting ideas on this important topic. If you have strategies that you have used to reduce the frequency and severity of your flashbacks, please let me know. You can send an e-mail to info@mentalhealthrecovery.com or go to my Facebook page at Mary Ellen Copeland. Your ideas are important and may very well be helpful to others.

Here are some of the responses we received to this article:

One of the statements I use to assist people face their traumas is to suggest to them that they are survivors.  In the here and now, they have used coping mechanisms, which are miraculous. Sometimes, though, these coping mechanisms don’t work anymore. It’s time to learn new ways in their efforts to face and conquer their situations.   K.W.

Hello!
First, thank you for bringing this important topic to the forefront.
I would like to share a few tools that I use to lessen the effects of my flashbacks.
I respond best to sensory-based grounding, such as firmly planting my feet on the floor and placing my hands on my knees (often rubbing my knees) and focusing on those sensations during the flashback.
Another sensory tool that I use is to notice aloud and/or on paper as many things as I can from my surroundings for each of my five senses.  I also use grounding self-talk, reminding myself of the day and time.  These tools often help to ground myself in the present.
Finally, to minimize the anxiety that often comes with a flashback, it often helps me to simply acknowledge that I am having a flashback and to use self-talk, such as, “I am having a flashback.  This has happened before and I know that I will get through it.  I am going to use (insert tool) to help me to cope until it passes, as I know that it will.”
I truly hope that this information is helpful.
Most sincerely and with gratitude for all that you do,  MJ F

Mary Ellen,
I’m so glad you’re working on helping people with PTSD through WRAP.  My own WRAP has been very helpful with my PTSD.  I do have some suggestions of things that have helped me:
A good therapist.  With PTSD, especially PTSD that stems from chronic trauma at the hands of someone you ought to be able to trust, the issue of trust can be huge.  So if you’ve given the therapist a real go and are still uncomfortable, find someone you can trust, someone who works with trauma survivors and understands the unique challenges that presents. My T is doing EMDR with me, and it’s been amazing.
Mindless AND mindful activities.  When I’m really triggered, I can start to slip into a numb sort of state where I can’t even feel the pain of what’s happening.  And that can be a good thing in the short term, a coping skill my brain developed to help me get through the hard stuff.  I try not to delve into it until I’ve seen my therapist or have a close and safe friend to process it with, so I do things like read or watch TV or play games–mindless sorts of things.
But I also need to listen to myself and know when it’s time to journal about it or talk about it or do some positive affirmations–mindful sorts of things.
Chasing away black-and-white thinking.  I have to remind myself 1) that I’m not a failure just because the dishes didn’t get done tonight, and 2) my friend isn’t a bad person just because she was too busy to talk tonight.  People aren’t simple enough to just be either good or bad. I know there are so, so, so many others, but those are definitely my top three tips.  Have a great day!  TK

Sometimes it is important to focus on the present. 

“That was then; this is now.” [ Usually to be used near the end of a conversation or interview].
“I cannot imagine what that feels like.”
“Is there anything, today, that might have set this off?” (i.e. establish his triggers–some can be avoided)  MB

There are many. A few are weighted blankets (we started a whole program for this here), massage on back with weighted ball, some specific scents, sound machines, some specific movement strategies, rocking on rocker or glider rocker, joint compressions, crawl through fabric tunnel.  These vary by age appropriateness, and we assess for each person’s preferences.  We also do sensory processing evaluations, more in depth, with some people. JD

Many thanks to all of you who have shared your experiences so that others can learn from them.  MEC

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