When American soldiers came home from the Vietnam War, many found it hard to return to normal life. They were haunted by nightmares; unable to shake the images of explosions and death from their minds, even while awake. They struggled with feelings of anxiety, depression, and anger; confused about how to to make sense of what they had witnessed. In 1980, the afflictions of these soldiers — along with research on the psychological impact of trauma on Holocaust survivors, rape victims, and others — led the American Psychiatric Association to define a new condition called Post Traumatic Stress Disorder (PTSD) in the DSM.
Although people often associate PTSD with veterans affected by the horrors of war, the condition can develop in anyone who has experienced a dangerous, shocking, or life-threatening event such as rape, childhood abuse, or a serious accident. According to the National Institute of Mental Health, PTSD will affect 6.8% of U.S. adults in their lifetime. The condition is defined by symptoms like panic attacks, depression, and insomnia, but one of the most characteristic and debilitating symptoms of PTSD is something called “flashbacks.”
Flashbacks are like waking nightmares. They are intense, repeated episodes of re-living the traumatic experience while you’re fully awake. Flashbacks can come on suddenly and feel uncontrollable. They are more like a nightmare than a memory because sufferers often cannot distinguish between the flashback and reality, feeling like the traumatic experience is happening again, in the moment. Flashbacks are vivid, sensory experiences. During one, a sufferer might see, hear, and smell things they saw, heard and smelled during the traumatic moment.
How can flashbacks be such an all consuming, visceral experience? How can they transport you back to the traumatic experience almost instantly? To understand that, we’ll explain what’s happening in your brain when a flashback occurs.
The Impact of Traumatic Events on Memory
To understand what happens in your brain during a flashback, you first need to understand how memories are formed and how trauma disrupts the way this process normally works.
Memory is a complex process that involves many parts of your brain, but to keep it simple, we’ll focus on two of the key players: the amygdala and the hippocampus. The amygdala is associated with emotional memory — especially the formation of fear-related memories. It evolved to ensure your survival by strongly encoding memories of past dangers you’ve experienced so that you recognize and respond to those threats if you see them again.
The hippocampus, the other region of your brain heavily involved in memory, acts like the brain’s historian. It catalogs all the different details of an experience like who was there, where it happened, and what time of day it was into one cohesive event you can consciously recollect as a memory. In your typical, day-to-day life, your amygdala and hippocampus work together to turn your experiences into distinct long-term memories.
However, during a traumatic event this system works a bit differently. Because you are in danger, your body’s built in fight-or-flight mechanism takes over and your amygdala is overactivated while the hippocampus is suppressed. From an evolutionary perspective, this makes sense: the processes involved in building a cohesive memory are de-prioritized in favor of paying attention to the immediate danger. As a result, your memory becomes jumbled.
When the threat has passed, you are left with a strong, negative emotional memory of the experience, but you lack clear recollection of the context of the event. In other words, you may learn to associate individual sights, smells, and sounds from the event with danger, but be unable to recall the sequence of events clearly.
Later on, if you encounter things that remind you of the traumatic event, like a smell that was present when it happened, your amygdala will retrieve that memory and respond strongly — signaling that you are in danger and automatically activating your fight-or-flight system. This is why during a flashback, you start sweating, your heart races, and you breath heavily — your amygdala has set off a chain reaction to prepare your body to respond against a threat.
Normally when your amygdala senses a possible threat, your hippocampus will then kick in to bring in context from past memories to determine whether or not you are really in danger. But because the hippocampus wasn’t functioning properly during the traumatic experience, the context of the memory wasn’t stored, and there’s no feedback system to tell your amygdala this situation is different and you’re not in danger. Also, since the memory is retrieved without context like where or when the experience happened, you might even feel like the traumatic experience is happening again.
Therapy Can Help You Overcome Flashbacks
Understanding what’s happening in your brain during a PTSD flashback can help you learn strategies to cope. You can work with a therapist to identify triggers for your flashbacks, such as certain objects, people, or places. Then, you can work with them to identify ways to respond calmly to these triggers through relaxation techniques as well as cognitive and exposure therapies.
While PTSD can be a debilitating condition — in some cases taking years for the survivor to be stable and healthy enough to process the trauma — with appropriate treatment it can be successfully overcome.
I have undergone four years of EMDR Therapy (Eye Movement Densensitation Therapy) for Complex PTSD due to childhood abuse from a paedophile ring for fourteen years organised by my parents in Ireland in the 1970s in Ireland. I have processed many painful and traumatic memories using this form of psychotherapy. Today we processed a very difficult period involving a time of abuse invoving a priest which is currently particularly acute as flashbacks due to the trial of Cardinal Pell here in Melbourne, Australia. Flashbacks are difficult due to the danger of triggers. When I have triggers it upsets my alters (Ihave Dissociative Identity Disorder) and therefore I self-harm so have been going through a period of exteme self-harm. Today we worked on strategies to lessen the self-harm and settle down the alters by coping with the triggers. Theses are the strategies we developed that you might want to use if you are suffering from flashbacks:
1. Tell yourself that you are having a flashback
2. Remind yourself that the worst is over. The feelings and sensations you are experiencing are memories of the past. The actual event has already occurred and you survived. Now it is the time to let out the terror, rage, hurt, and/or panic. Now is the time to honor your experience.
3. Get grounded. This means stamping your feet on the ground to remind yourself that you have feet and can get away now if you need to. (There may have been times before when you could not get away, now you can.) Being aware of all five senses can also help you ground yourself.
4. Breathe. When we get scared we stop normal breathing. As a result our body begins to panic from the lack of oxygen. Lack of oxygen in itself causes a great deal of panic feelings; pounding in the head, tightness, sweating, feeling faint, shakiness, and dizziness. When we breathe deeply enough, a lot of the panic feeling can decrease. Breathing deeply means putting your hand on your diaphragm, pushing against your hand, and then exhaling so the diaphragm goes in.
5. Reorient to the present. Begin to use your five senses in the present. Look around and see the colors in the room, the shapes of things, the people near, etc. Listen to the sounds in the room: your breathing, traffic, birds, people, cars, etc. Feel your body and what is touching it: your clothes, your own arms and hands, the chair, or the floor supporting you.
6. Get in touch with your need for boundaries. Sometimes when we are having a flashback we lose the sense of where we leave off and the world begins; as if we do not have skin. Wrap yourself in a blanket, hold a pillow or stuffed animal, go to bed, sit in a closet, any way that you can feel yourself truly protected from the outside.
7. Get support. Depending on your situation you may need to be alone or may want someone near you. In either case it is important that your close ones know about flashbacks so they can help with the process, whether that means letting you be by yourself or being there.
8. Take the time to recover. Sometimes flashbacks are very powerful. Give yourself time to make the transition form this powerful experience. Don’t expect yourself to jump into adult activities right away. Take a nap, a warm bath, or some quiet time. Be kind and gentle with yourself. Do not beat yourself up for having a flashback.
9. Honor your experience. Appreciate yourself for having survived that horrible time. Respect your body’s need to experience a full range of feelings.
10. Be patient. It takes time to heal the past. It takes time to learn appropriate ways of taking care of yourself, of being an adult who has feelings, and developing effective ways of coping in the here and now.