I was asked “How can you jog your memory to remember something traumatic?”. The first key point is to understand your symptoms. I explain more in the article below…
My PTSD symptoms
The first step in coping with PTSD is to understand how it affects you. Look at the symptoms below, and tick any that have affected you at least twice in the last week.
- Upsetting thoughts or memories about the event that have come into your mind against your will [ ]
- Upsetting dreams about the event [ ]
- Acting or feeling as though the event were happening again [ ]
- Feeling upset by reminders of the event [ ]
- Bodily reactions (such as fast heartbeat, stomach churning, sweatiness, dizziness) when reminded of the event [ ]
- Difficulty falling or staying asleep [ ]
- Irritability or outbursts of anger [ ]
- Difficulty concentrating [ ]
- Heightened awareness of potential dangers to yourself and others [ ]
- Being jumpy or being startled at something unexpected [ ]
My thoughts and beliefs
Trauma affects how we think about ourselves, other people, and the world around us. These thoughts and beliefs can powerfully affect how we live our lives. It is helpful to reflect on how trauma has affected us.
Write down your answers to the following questions.
- Things I thought as I was experiencing trauma
- How my trauma has affected the way I think about myself
- How my trauma affected the way I think about other people
- How my trauma affected the way I think about the world
- Calming the threat system: Relaxed Breathing
Controlling your breathing sends a signal to your threat system that everything is ok. Calm breathing is slow, relaxed, and from the diaphragm (‘belly breathing’), whereas anxious breathing is quick, tense, and high up in the chest.
- Begin by sitting somewhere comfortable but supported
- If you feel comfortable to do so close your eyes, otherwise stare off into the middle distance
- Breathe in slowly and steadily for a count of 3
- Breathe out slowly and steadily for a count of 5. Our bodies relax most on the out-breath
- Repeat for a few minutes. It’s normal for your attention to wander off. If it does, just gently bring it back to focus on your breathing.
Calming the threat system:
Another technique for slowing your breathing and calming your mind is to use imagery while you breathe. Some people find it helpful to imagine breathing colored air. You can memorize these instructions, you could ask someone to read then slowly for you, or you could record yourself speaking them and then listen to the recording.
- Imagine a color representing tension, or tense feelings
- As you breathe, calmly and steadily, imagine breathing out air tinged with that tense color
- See the colored air in your mind’s eye, and watch as you breathe it out and it floats away
- Allow the tense colored air to become paler and paler, as you breathe out all of the tension
- Now bring to mind a color representing calming, soothing feelings
- Imagine breathing in this relaxed colored air
- Just notice what happens in your body as you imagine breathing in the relaxed air
- Continue breathing this way for a few minutes
Swing breathing is another imagery technique for slowing your breathing and calming your mind. You can memorize these instructions, you could ask someone to read then slowly for you, or you could record yourself speaking them and then listen to the recording.
Allow your breathing to become slower … and more regular. Just focusing your attention on your breath … on the air flowing in … and out … of your mouth and nose.
Your breathing finding a steady rhythm. Breathing gently from low down in the belly. Taking slow steady breaths. Breathing in gently … and slowly and smoothly exhaling … Breathing in gently … and slowly and smoothly exhaling.
And as you continue to breathe slowly and gently … in a rhythm that’s comfortable to you … I’d like you to imagine … and then begin to feel … that you’re on a swing. Gently swinging backwards … and forwards … backwards … and forwards … finding that you’re swinging in rhythm with your breathing … just gently swinging … relaxed and peaceful. Pay attention to how it feels to swing gently forwards … and backwards … peaceful … relaxed … at ease. Just swinging gently … and smoothly … smoothly .. and gently.
And you can carry on breathing calmly and gently for as long as you like. Relaxing into this gentle rhythm more and more as time goes by.
When we feel under threat our muscles tense up – ready to fight or take flight. Keeping the muscles tense is one of the body’s ways of trying to keep you safe. One way of letting your body know that you are safe is to deliberately relax all of your muscles.
Progressive muscle relaxation involves tensing, then relaxing, all of the muscle groups in turn. Find a comfortable spot, sitting or lying down. Then, for each of the muscle groups in turn, follow this pattern:
- Tense the muscles
- Notice the tension for a few moments
- Notice the sensation of relaxation as the tension drains away
Relax each of the muscle groups in turn:
- Upper arms
- Shoulders (lift up slightly)
- Upper back (shoulders back slightly)
- Lower legs / calves
- Neck (gently move neck back)
- Muscles around eyes (scrunch face up)
Creating a safe place
A safe place is somewhere that you create using your mind and imagination. It is a place that you can go anytime, wherever you are.
For some people, it is a place that they remember from their past as being particularly safe and calm. For others, they cannot easily remember a time like this from their past and so they work on creating one for themselves now. Either way, the same process applies. You can have more than one safe place and it can change over time as you wish. It is your creation and your own personal ideal.
It is useful for your safe place to have certain qualities though: it needs to be a place you feel calm, not judged, warm, free and above all safe.
How to create a safe place:
- If you feel comfortable enough, close your eyes and take a deep breath in and count to three. Then breathe out slowly to the count of five. Do this several times. As before, spend some time slowing down and controlling your breathing until you reach a calm and soothing rhythm. As you breathe in, imagine you are breathing in a sense of safeness and relaxation. As you breathe out, imagine you are breathing out all of the tension in your body.
- Begin to imagine a place where you feel calm – where are you?
- Focus on what you can see, take a minute to look all around you in your mind. You may perhaps even turn around to see what’s behind. Concentrate on any objects that you can see, the colors around you and areas of lightness and darkness.
- Focus on what you can hear, take your time to notice the noises, even the subtle ones. What noises can you hear close by? What noises can you hear in the distance?
- Focus on what you can smell. Again, take a minute to really notice the smells around you.
- What can you feel? Is it hot or cold? Are there textures under your feet?
- Focus on any taste in the image and notice this for a minute or two.
- Now focus on how you feel in your body, feelings of calm and safety in this image. Focus on the release of tension. Where do you feel this feeling in your body?
- Keep imagining your safe place in as much detail as possible and revisit that feeling of calm and safeness over and over, noticing where you feel it in your body.
- Is there a word that might remind you of your safe place? If so, what is it? If you have a word, repeat it in your mind over and over as you keep your safe place in your mind.
- When you are ready, take some deep breaths in again and slowly open your eyes, trying to hold onto that calm feeling.
Remember, you can come back to it whenever you want to. The easiest way to do this is to start by slowing down and controlling your body and to repeat the word that you picked that reminded you of your safe place. In doing so, it will be easier to return to your safe place whenever you would like.
Write a description of your safe place in as much detail as you can. Remember to include information from all your senses. What word have you chosen to remind you of your safe place?
Coping with memories:
Use all of your senses
When we are having a flashback, or as we wake up from a nightmare, our awareness of the things around us in the here-and-now can be diminished. Just as we can re-experience traumatic memories in all of our five senses, we can use those five senses to try and ‘ground’ us back in the present.
Look around you and use those sights to remind yourself that you’re in the present and that you are safe.
It can be helpful to carry an object with us that remind us that we are safe, such as a stress ball, a pebble, or a flower.
Focus on all of the noises around you in the present moment. Use them to remind you of where you are.
Smell can be one of the most powerful ways of learning to soothe and comfort yourself Try using essential oils, your favorite plants, or any comforting aroma.
Strong tastes such as chewing gum can be helpful. For people who re-experience ‘taste memories’ it can be helpful to focus on the absence of taste in the present moment.
Coping with memories: 5-4-3-2-1
When our minds and bodies feel as if they are fully immersed in the past, using all of our senses at once can be a very effective way of bringing ourselves back into the present. Focus on:
5 things you can see
4 things you can feel / touch
3 things you can hear
2 things you can smell
1 thing you can taste
Reminding yourself it was in the past
When a memory is triggered it can feel as if the traumatic event is happening all over again. Our minds and bodies can feel like we are back in the moment the trauma took place, rather than recognizing that we are revisiting a memory.
During a flashback, we often describe what we can see or sense in the present tense. For example, Alex said “he’s standing right in front of me and I can see him” whilst he was having a flashback.
To help put the memory in the past, it is useful to practice rephrasing your common thoughts about the event in the past tense, particularly whenever you have a flashback memory or after having a nightmare. This technique is most helpful while we are in the midst of a flashback. It may seem simple but it can be a powerful technique to help your brain, in the heat of the moment, remember that it is not happening all over again. Here are some examples
|Current thinking||Remembering it is in the past|
|He’s here in the room||He was in the room when I was attacked|
|I hear the gun fire||I heard the gun go off when I witnessed the robbery|
|I can see the headlights||When I was in the car accident I could see the headlights coming toward me|
|I can feel him behind me breathing down my neck||When I was assaulted I could feel the man behind me and I could feel his breath on my neck|
Write your most common thoughts when you’re having a flashback and then rephrase them so they are in the past. Practice saying them to yourself often.
Remembering the past:
It’s just a memory
Remember, our brains (particularly our amygdala) don’t care whether something is happening in real life or whether it is a memory – our minds and bodies react in the same way by activating the threat system.
A simple yet effective technique is reminding yourself that you are responding to a memory rather than the actual event. This can be helpful in reminding your brain that you are not, in fact, back in danger. Try writing a statement down on a card to carry round with you.
For example, Alex would write down and look at the phrase:
When I was attacked the man stood right in front of me, he is not in front of me now. I am just remembering the memory of when I was attacked. THIS IS MY MIND AND BODY REACHING TO A MEMORY. IT IS NOT HAPPENING AGAIN.
If you feel comfortable with it, you may also consider asking your partner or a friend to gently remind you that you are responding to a memory, that the trauma is not happening again, and that you are safe.
Fast forward to safety
When we are bothered by flashbacks we often forget that we can have control over the memories and that we can control our own minds. It is very important to remind ourselves that we are safe, and that the events are over. One way to do this is to think of our memories as being like a video tape, and to remember that we can fast forward it.
Here are some steps in helping you train your mind to ‘fast forward to safety’
1) Think of your traumatic event
2) Think about the first time you felt safe afterwards – really picture this scene as clearly as you can in your mind. Where were you? What were you doing? Who were you with? How did you know that you were safe? Don’t forget to think of all five of your senses.
3) Write down a description of this moment of safety.
4) When you have a flashback, practice ‘fast forwarding’ to this safe time. Quickly see everything that happened after the moment in the flashback, and then focus on the feeling of safety telling yourself that it is in the past. Try and focus on how this safety feels in your body. Try and stay with that feeling of safety for as long as possible.
The more you practice this, the better your brain will get at putting these memories in the past.
The differences between then and now
Remind yourself of things that have changed since the time of the trauma. For example, if you have had your birthday you can remind yourself “I am 45 now and was 44 when I was in a car accident”. You may have changed your physical appearance and remind yourself “I have long hair now but it was short when I witnessed the robbery”
What has changed for you since you experienced the traumatic event?
Grounding the date
Remind yourself the current date, where you are, the time of day etc. For example, “today is Thursday 5th May 2017. I am at work. It is 10:55am. It is spring and it is sunny outside. I am safe. I survived”. You may take this further by writing down and reminding yourself that the traumatic event took place at another time. For example, it took place on a winter afternoon in December.
When did the traumatic event take place? What is the current date? Can you describe the here-and-now?
Noticing triggers for flash backs
Flashbacks and intrusive memories can be triggered by reminders that are linked to the traumatic event: someone who has been in a car accident might be triggered by the sight of certain cars, the sound or traffic, or sirens.
Like trauma memories, the mind and body doesn’t seem to be able to recognize that these things (i.e. sights, sounds, smells etc.) are no longer signs of danger. Instead, the mind and body react as if they are under threat.
It is important, therefore, to try to train the brain to break the link between then and now and to help the brain recognize that these things are no longer signs of danger.
The first part is to first identify what might trigger your flashbacks and intrusive memories.
Some of Alex’s triggers were:
- People standing behind me
- Dark streets
Some of my triggers are:
Flashback triggers – breaking the link
Next, systematically think about the differences between what you experienced during the trauma and how different things are now.
|Similarities||Feeling scared||Feeling scared|
I was 25 then
I was 32 now
Helping with self-harm
People self-harm for a variety of reasons. Sometimes it is to cope with powerful emotions, to distract from something overwhelming, or to feel something instead of feeling numb.
Unfortunately, it can come with severe unintended consequences, such as causing lasting physical damage to our bodies. This can be a dangerous way of trying to cope.
Self-harm often serves a purpose, so just trying “nor to do it” can feel impossible. It can be helpful to find out more about the reasons why you self-harm and then try a different behavior instead of harming yourself.
Working out why I self-harm
- To express pain and strong emotion [ ]
- To deal with anger [ ]
- To feel something when I feel numb and disconnected [ ]
- To calm down [ ]
- To see blood [ ]
Any other reasons:
What are my triggers?
What could I substitute instead of self-harm?
If you self-harm to… express pain and intense emotion, try writing down your feelings, drawing or painting how you feel, writing down difficult feelings then ripping them up, or listening to music which expresses how you’re feeling.
If you self-injure to… deal with anger that you cannot express openly, try working through those feelings by doing something different – running, dancing fast, screaming, punching a pillow, throwing something, ripping something apart.
If you hurt yourself in order to… feel something when you feel numb inside, hold ice cubes in one hand and try to crush them, hold a package of frozen food, take a very cold shower, chew something with a very strong taste (like chili peppers, raw ginger, or a grapefruit peel), wear an elastic rubber band around your wrist and snap it (in moderation to avoid bruising).
If you inflict physical pain to… calm yourself, try taking a bubble bath, doing deep breathing, writing in a journal, drawing, or doing some yoga.
If you self-harm to… see blood, try drawing a red ink line where you would usually cut yourself, in combination with any of the other suggestions above.
Remember, understanding and knowledge are key. Try to make a note of every time you feel the urge to harm yourself. Write down what was happening at that time and what was going through your mind. Also, make a note of what you did to cope, taking care to write down which behaviors you found helpful and which ones were less helpful to channel and soothe your feelings of distress.
PTSD often affects our ability to sleep. We may have difficulty getting to sleep if we lie in bed thinking about how our life has changed and wondering if things will get better. We may avoid going to sleep for fear that we might have more nightmares. If we do manage to get to sleep we may then wake up after experiencing nightmares. It is normal to have difficulty getting back to sleep.
The tips and ideas below have been selected to try and help you increase the chance of getting better sleep.
1. Bed is for sleeping and sleeping happens at night-time
- Try and keep your bedroom and bed for sleeping only
- Avoid sleeping in the day
- Develop a routine before bed time such as having a relaxing bath or listening to some relaxing music and go to bed at around the same time each night. Try and wake up around the same time each morning. Small children find habits and routines comforting, and the same things work for adults too. As adults, we forget that these things apply to us as well
- If you cannot sleep after 30 minutes, get up and try an activity such as listening to some music. Do this for about 15 minutes then return to bed and try and sleep. Repeat this as often as is necessary until you go to sleep
- Make your bedroom a nice place to sleep – try smells or flowers (or some new bed sheets!)
2. Be kind to your body
- Do not go to bed hungry
- Try and avoid spicy food late in the day as this can act as a stimulant in our bodies
- Reduce caffeine but definitely avoid caffeine after 4pm- remember caffeine is also found in tea and fizzy drinks like pop. You can buy de-caffeinated versions of these drinks if needed
- Although alcohol can initially make us feel sleepy, it stops us from experiencing restful sleep and is not great for PTSD or Adrenal Fatigue. It can also make it harder to fall asleep again, if you wake up in the middle of the night
Coping with nightmares
Practice calming yourself down after a nightmare by using any of the previous techniques.
Having a card with the information from the tips previously tried may help ground you back in the moment. For example, you may have a card with the phrase ‘I am safe, it is May 2011 and I am in my bedroom’ by your bedside to read after you wake from a nightmare.
Having a picture that reminds you of the present can also be useful to have by your bedside if waking from a nightmare as it will help your brain focus on the present and calm your threat system quicker.
Taking a smell to bed and having it ready can, again, be a useful way to help your brain remember where you are following a nightmare. A calm and soothing smell can also help you get off back off to sleep after a nightmare.
Try: Any of the other grounding strategies that you have developed can be helpful if you wake from a nightmare
If you experience frequent nightmares, especially the same or similar dream over and over, then research has shown that you can ‘rescript’ the nightmare to make it much less powerful. For example, someone who had nightmares about being in a road traffic accident imagined that the road was made of marshmallows and was soft and bouncy.
Spend time in the day thinking of the nightmare but practicing a different ending: an ending you would prefer and that makes you feel safe. Practice the repeat ending over and over in your imagination. The more you can rehearse new ending the better chance your brain has of remembering it. It might also be helpful to talk through your nightmares with someone else. It doesn’t matter how odd the new ending might be, or that it didn’t really happen.
Think about your nightmare from the perspective of a Hollywood script writer:
- Write down your nightmare as though it were a story
- Think about how you would want to feel different if you could change the nightmare
- Change some of the events in the nightmare that would lead to the new feeling
- Write the new ‘script’ for the nightmare. Rehearse it to yourself.