What is a ‘flashback’?
We often use the word ‘flashback’ to describe a memory that pops into our heads, perhaps when we’re talking about everyday experiences. We may say. ‘I had a flashback to that holiday in Crete when you fell in the pool’, or ‘That shirt gave me a horrible flashback to the party’. What we’re describing is a short, vivid memory of an incident in the past. It may be an unpleasant incident, but such a memory is not in any way a flashback as experienced by a trauma survivor.
When trauma survivors experience a flashback, it’s a reliving of the event as if it is happening in the here and now. Flashbacks involve very vivid imagery and extreme emotions and are often evoked by a sensory experience (more about this later). The sensory experiences that can trigger flashbacks may be a smell, a sound, a taste or a feeling or touch and experiences of flashbacks can occur in the immediate aftermath of the traumatic event or years afterwards.
Flashbacks are involuntary. Survivors don’t have control over them, and this is often what makes them frightening. They can be short, disjointed, flashes of memory that sometimes leave the trauma survivor shocked afterwards, or they can be longer experiences of different aspects of the trauma the survivor has experienced. The flashbacks can also involve the senses, and survivors speak of vivid sensations of smell, sounds and colours.
What are triggers?
A trigger is something that can set off, or spark, an involuntary, intense body memory of a previous traumatic event. Triggers set off unprocessed traumatic memories that remain in the body as sensory memories: these memories differ from normal processed memories which are logged into short-term memory as they happen, then transferred into long-term memory where they can be recalled at will. As traumatic events change the way the brain processes memory, the survivor holds the sensory imprint of the event. A trigger can result in a body memory that has an emotional intensity with feelings similar to those experienced during the original trauma. The survivor may behave in the same way she did during the attack, for example, freezing or lashing out, because the brain cannot differentiate between the intensity of the memory in the moment and the terror experienced by the survivor when the attack happened.
Why are flashbacks triggered by sensory experiences?
When someone experiences a trauma, their memory processing is affected. There is an excellent short, animated film made by the Lanarkshire NHS and Gender-Based Violence services which explains how the brain is affected by a traumatic experience. It can be accessed on YouTube at Trauma and the Brain – YouTube – it’s only around 8 minutes long.
This film explains how memory is processed and how the brain changes during a traumatic event so that memory is no longer processed as a narrative, or story, but in fragments of senses so that survivors remember a sound, a smell, a feeling, or touch. A good example of this is when a survivor of a car accident says, ‘It was all a blur. I can just remember the screeching of the tyres.”
Because the sensory memories are so vivid, when a trigger is experienced, such as the smell of a certain aftershave, or strong alcohol, the memory of the attack can be brought to the surface and a flashback can occur. The survivor feels separated from the present and can also feel completely dissociated from her surroundings. The fear of flashbacks may mean that a survivor begins to isolate herself, avoid certain situations, or be reluctant to leave home.
Triggers
Triggers can be anything and are often the most common things in the lives of survivors, and to complicate matters, the survivor may or may not realise that she has encountered a trigger and may be afraid and confused by her feelings or her behaviour. Survivors describe triggers as:
- The smell of alcohol on the breath
- The smell of cigarette smoke on the breath
- The smell of cigarette smoke on someone’s clothes
- The touch of certain clothing, a fabric, or upholstery
- A colour, or an object of a certain colour
- The sight of a group of men
- The sight of a particular piece of clothing, or uniform
- The taste of a certain drink, food or sweet, or the taste of alcohol in the survivor’s mouth
- The unexpected sound of a male voice
- The sound of a piece of music or song
- The sound of a door banging a certain way
- The sound of keys rattling
Other survivors talk about everyday objects that were used in their abuse, which makes it difficult to avoid some triggers as they are in the homes of family members or friends. For those survivors who can identify their triggers, it can be a little easier to manage and avoid panic attacks or flashbacks in public.
Triggers are very personal. Different things affect different people with the triggers most commonly activated by one of more of the senses. The reaction people have to triggers can cause immediate, unexplained changes in behaviour and reactions that bypass the rational part of the brain.
In Peter Walker’s book, “Complex PTSD: From Surviving to Thriving”, he writes about “the look” being a trigger for many survivors of childhood sexual abuse. He writes, “Typically, the look is empowered via a psychological process called conditioning. Here is a classic example of aversive conditioning. Technicians deliver an electric shock to an animal in a cage at the same time they ring a bell. The animal of course has a fearful and distressed response to the shock. It does not, however, take many repetitions of pairing the sound with the shock before the sound alone elicits the same upset response in the animal.” This, Walker states, is exactly the same as the terror the child experiences when they see ‘the look’ and know that the physical, or sexual abuse will follow.
“Traumatic memories are fundamentally different from the stories we tell about the past. They are dissociated: The different sensations that entered the brain at the time of the trauma are not properly assembled into a story, a piece of autobiography.”
Bessel van der Kolk: The Body Keeps the Score (2014), p194.
Intimacy
At times of sexual intimacy, there can be powerful triggers and may stop the survivor from having any intimate relationships. In their book ‘The Courage to Heal’, Ellen Bass and Laura Davis describe a situation of a woman going into a flashback while having sex with her partner, and how they managed the situation.
“One woman had a lover who helped her stay in the present just by saying, “Open your eyes, Edith. Open your eyes.” When she opened her eyes, she saw him, saw her own room, and was able to slip back into the present, away from the flashback.”
Having a long-term partner or lover who understands what a flashback is can be very helpful to the survivor. There is a huge amount of written material online [1] [2] [3] that can help improve understanding about flashbacks and how to help someone close who is having a flashback so the partner of a survivor can access these to help her/him understand some of the potential triggers.
But having a basic understanding that a flashback can trigger the fight/flight response where fear becomes the dominant emotion and feelings of terror, panic, helplessness, and sometimes freezing can occur, can be helpful for the survivor and her partner. Some books/articles suggest having a ‘code word’ that the survivor can use if she feels threatened or afraid. The couple alone must find the best way to manage the triggers, a way that feels most comfortable, and least threatening to the survivor.
Coping with flashbacks
Grounding
Flashbacks are a symptom of the trauma the survivor has experienced in the past, and one way of helping draw back from the flashback to the present moment can be to use a range of techniques that help the survivor remain in control when the flashback threatens to take her back to a place of powerlessness and fear.
Grounding techniques are often recommended for helping cope with flashbacks, to help bring the survivor back from feeling ‘in the moment’ when the abuse or attack happened, back to the present. Some commonly used grounding techniques that may help are based on feeling or recognising things that are around the survivor in the present.
A survivor may find it useful if they use their senses to help the grounding. For example:
- Stamp the feet, wiggle toes, any movement that allows contact with the floor or ground
- Flex and relax hands or fingers, grab the arm of a chair, touch something smooth or rough to get some feeling in the fingertips
- Listen to what’s around, traffic, people talking, birds, music on the radio
- Look around, colours, trees, people out walking, the colour of chairs or carpet if inside, the texture of what is around in their immediate environment
- Feel the texture of clothing, the arms of a chair, a wall or something that’s being held in the hands. A common grounding object used by survivors is a small stone or crystal that can be carried in the pocket. The stone may be rough or smooth.
- Speak, sing, shout, if possible, repeat positive phrases like, “I am ok” “I am safe”
- Breathe slowly and deeply. When a flashback happens, the fear can make the survivor hold her breath or freeze. This can result in feeling faint or dizzy so consciously breathing slowly and deeply can ensure that oxygen gets into the body and the threat of dizziness or fainting can be reduced.
- If another person is there, hold their hand, squeeze it, or ask them to speak.
The sense of smell can be very powerful and is often a trigger for a flashback. If a smell has triggered the flashback, it may be useful to avoid this when grounding and instead focus on other senses.
A combination of these techniques can be used or can be adapted depending on where the survivor is, and who she is with.
[2] Understanding PTSD Flashbacks and Triggers – PTSD UK
[3] Flashbacks and Dissociation in PTSD: How to Cope (verywellmind.com)
