Coping with Flashbacks and Dissociation

Introduction

There are a variety of situations where a client or helpline caller may experience negative emotions and need to use coping strategies to help themselves cope. These can include flashbacks to abuse or trauma (such as in child sexual abuse or Post Traumatic Stress Disorder), dissociation, or simply intrusive thoughts or memories of a variety of painful experiences.

In these situations, there are a variety of techniques that can be taught to clients to help them stay grounded and cope. They are summarized below.

Physical Techniques for Coping with Flashbacks

Physical techniques focus on using your physical body or space to reduce your flashbacks or dissociation.

• Plant your feet on the ground or grasp the arms of a chair
• Repeat one’s name, age or location
• Go to a safe space (e.g. home), a place where you feel calm and safe

Behavioural Techniques for Coping with Flashbacks

Behavioural techniques are actions that you can take when you feel stressed or overwhelmed. Ways of expressing yourself can give you a sense of control that will make it easier to cope.

• Journal or writing
• Verbalizing emotions
• Calling a crisis line or mobile crisis team
• Going to the hospital
• Taking a walk

Cognitive Techniques for Coping with Flashbacks

Cognitive techniques are those things that involve your thoughts. These may be more challenging than the other techniques but with practice will become easier to use when you are feeling overwhelmed. Because these are hard to summarize they’ve been listed with more detail than the above techniques.

Identify Internal Cues

Internal cues are those things that prompt you to think that you are going to dissociate or experience flashbacks. Sometimes they come on randomly, but for other individuals there is a period of feeling flushed, having a racing heart, feeling anxious or restless, or other symptoms that precede the flashbacks or dissociation. When you recognize these occurring, using the other techniques on this list can help you cope.

Identify Associational Cues

Associational cues are those things that you associate with safety and security. These can be objects, sources of support like pets or other things that remind you that things will be okay. The association between the item and the positive thoughts it brings can help ground you.

Safe Space (Mind)

Going to a “safe space” mentally and remembering that what you are experiencing is temporary can be helpful. Guided imagery (described below) can help you find this safe space, which can also be a place in your own memory where you felt safe and protected.

Meditation and Guided Imagery

Meditation is a very common strategy for coping with flashbacks and dissociation. Meditation takes practice, but by using slow and steady breathing and trying to clear your thoughts when you are not in a state of dissociation or flashbacks, you will build this skill up to where you can implement it when you sense you are going to dissociate.

Guided imagery is similar, but rather than meditating or focusing on your own breathing, you focus on a guided story that will help keep you grounded.

Label Emotions

Labeling your emotions can be a very effective way of reducing immediate stress. This can be both to yourself (merely talking out loud), or to a support like a friend, a pet or a crisis line. Many people who experience trauma have difficulty labeling their emotions and this exercise (especially when practiced as part of comprehensive therapy) can help keep you grounded.

Cognitive Restructuring

Cognitive restructuring refers to techniques of identifying and challenging automatic or maladaptive thoughts. The simplest way to do this is with an ABC (Action, Behaviour, Cognition) worksheet. An ABC worksheet lists actions that made you feel bad, behaviours or results from that, and the cognitions that went along with that.

For instance,

• Action: A girl didn’t smile at me when I smiled at her
• Behaviour: I felt bad
• Cognition: I’m not attractive

This is an example of a common ABC scenario. The goal is to identify other possible cognitions so that you can “rewrite the script.” An example of a different script:

• Action: A girl didn’t smile at me when I smiled at her
• Behaviour: I realized she probably didn’t see me
• Cognition: Nobody has judged my attractiveness yet

This process is best accomplished with a therapist, but can be done in a self-help format. The book Mind Over Mood utilizes many of these techniques.

General Self Care for Coping with Flashbacks

• HALT – Hungry, Angry, Lonely, Tired. These are the 4 states that make it harder to regulate your emotions and increase your impulsiveness.
• Eating Healthy
• Exercising
• Medical Evaluation

5-4-3-2-1 Coping with Flashbacks

This technique is a very popular technique for coping that focuses on what you identify as real and also serves as a form of meditation.

1. In 5-4-3-2-1 coping, you begin by thinking about five things that you can see around you. Listing them off out loud can help you with this exercise. Study them and describe them to yourself. Performing deep breathing (a slow inhale over 5 seconds, holding for 5 seconds, and exhaling over 5 seconds) can help with this as well.
2. Next, describe 4 things that you can feel, such as your heart beating, your feet on the floor or your back in your chair.
3. Next, 3 things that you can hear, like a television in another room, traffic outside or birds singing.
4. After that, 2 things that you can smell – or two smells that make you happy, like fresh baked cookies.
5. Finally, end with one thing you can taste. Your saliva, gum, or food you ate recently? Some people also substitute “One thing you like about yourself” for this exercise as well.