What to Do During a PTSD Flashback Episode

Flashbacks occur when someone experiences an intrusive memory of a past traumatic event. These experiences can feel like the trauma is happening all over again in the present moment.

People often experience visual memories as well as other sensory aspects of the traumatic event. It is vital to learn coping strategies to prepare for and manage if and when a flashback occurs.

Flashbacks can be overwhelming and scary, so having a plan is essential. In this article, we will cover several techniques that can help many people, including grounding, breathing, and self-talk techniques, as well as guidance on what to do if you need additional support.

Understanding PTSD Flashbacks

During times of heightened stress, such as a traumatic event, memories tend to be improperly coded during the process of turning short-term memories into long-term memories, meaning that all the visual and other sensory inputs aren’t put together neatly. This can make memories of traumatic events disjointed, incomplete, and difficult to control. 

Flashbacks often seem to feel real and like they are happening in the present because, during a flashback, that’s exactly what the brain seems to think is happening. Various parts of the brain, such as the amygdala, insula, and sensory and motor areas, are activated, while other parts of the brain show less activity, resulting in a sense of “nowness” that people who experience flashbacks often describe. This isn’t the case for regular memories, which are stored, accessed, and experienced in different ways. 

Types of Flashback Experiences 

There are several types of experiences associated with experiencing a flashback. 

• Visual flashbacks involve “seeing” images in one’s mind that were involved with the traumatic event. Not everyone experiences this, as not everyone is a visual thinker.
• Emotional flashbacks are the re-experiencing of emotions associated with an event. Many people experience overwhelming emotions, such as anxiety, fear, panic, anger, and sadness. 
• Somatic flashbacks involve experiencing body memories and physical sensations related to the trauma, which can sometimes involve physical sensations of pain and discomfort. 
• Dreams or nightmares about the trauma can occur for some, while other people may have dreams not related to the specific event itself that are upsetting.
• Dissociation occurs when someone feels disconnected from their body or is unable to recall stretches of time.

Recognizing You're Having a Flashback 

Not everyone experiences them in the same way, but there are several ways to know if you’re starting to have a flashback. Some people start experiencing anxiety, while others feel fatigued. Many people have a sense of disorientation, confusion, or trouble thinking clearly.  If you’ve experienced one before, think back to how it started and make a note of the initial experiences you had. Recognizing your personal patterns can be a helpful aspect of coping and managing flashbacks. 

Immediate Grounding Strategies

The 5-4-3-2-1 Sensory Technique

The 5-4-3-2-1 technique engages the five senses and helps utilize the present moment to override the brain’s sense of being pulled back into the past due to a flashback. To try this technique:

• Name 5 things you can see
• Name 4 things you can touch (and touch them)
• Name 3 things you can hear
• Name 2 things you can smell
• Name 1 thing you can taste

Orient Yourself to the Present 

Orienting yourself in the present moment is another way to overcome the sense of “nowness” associated with the past traumatic event, which can be overwhelming and upsetting. Try saying the current date, time, your location, and your age out loud. You can try looking around and describing your surroundings in detail. Additionally, reality-check statements, such as “This is [year], not [year of trauma], and I’m safe now.”

Physical Grounding Techniques

Physical, also known as somatic, grounding strategies can help by using your body as a means to regain a sense of safety and security.

Try feeling your feet on the floor, walking on a textured surface, or stomping your feet on the ground. Press your hands against the wall, squeeze a pillow or blanket, or clap your hands. Try holding onto an ice cube or splashing cold water on your face. Touch different varieties of textures around you. 

Progressive muscle relaxation is another strategy many find helpful. This includes tensing and relaxing muscles while taking slow, deep breaths. Try starting with your head, working your way down through your torso, all the way to your feet.

Movement-Based Grounding

There are many movement-based grounding strategies, such as standing and walking, gentle stretching or yoga poses, jumping jacks, or engaging in other physical activities. Movement helps connect us to the present by using not just the five senses named above, but also proprioception.

This sense is our body’s awareness of itself in its environment. By using your whole body and all your senses, you are presented with a wealth of new, fresh information for your brain to process, helping it prioritize the present moment rather than stored memories.

Breathing Techniques for PTSD

Box Breathing Method

The box-breathing method is a tried-and-true practice for calming one’s nervous system. It works by using the lungs to essentially tell your brain that everything is okay. When we are under a real and present threat, our bodies can’t take slow, deep breaths.

By doing so, your brain receives signals from the body that you are safe, which can help your nervous system slow down. Try:

• Breathe in for 4 counts
• Hold for 4 counts
• Breathe out for 4 counts
• Hold for 4 counts
• Repeat 

Extended Exhale Breathing 

Another strategy is breathing with an extended exhale. This also starts to activate the parasympathetic nervous system, which is also known as “rest and digest” mode, that helps to slow the heart rate and reduce panic. 

• Breathe in for 4 counts
• Breathe out for 6-8 counts
• Repeat

Paced Breathing with Counting 

Paced breathing is another option, which involves counting breaths to help focus the mind. Try putting one hand on your chest and the other on your belly, and try to only breathe in such a way that the hand on your belly rises. This technique is also known as diaphragmatic breathing.

Using Your Senses to Ground

Using your senses can be a highly effective way to ground yourself in the present moment. Here are several types of sensory activities to try out. It’s best to have a few to choose from in your coping toolbox.

Strong Scents

Scent can be a powerful tool for emotional regulation. Due to our brain’s structure, just smelling something activates the hippocampus and amygdala. Try creating a scent kit using: 

• Essential oils (peppermint, lavender, eucalyptus)
• Coffee grounds or beans
• Citrus peels
• Scented lotion or hand sanitizer

Tactile Objects 

Engaging in a physical activity with your hands can help release nervous energy, and it also utilizes the highly sensitive parts of your hands to send soothing messages to your nervous system. Here are some objects that can be used for this purpose:

• Stress balls or fidget toys
• Smooth stones or crystals
• Soft fabric or textured materials
• Worry beads or mala beads
• Personal comfort objects
• Playing with flour or dough

Temperature Changes

Temperature changes are a well-known “hack” for regulating the nervous system. In particular, cold can help to slow one’s heart rate. When our bodies experience a temperature shift, it can help distract the nervous system from an emotional stressor, allowing it to focus on the crucial task of regulating the body’s temperature. Try using:

• Ice packs or frozen objects
• Cold water on wrists and face
• Warm tea or coffee
• Hot shower or bath (when safe)

Taste Techniques

Taste is another sense that can be used to help ground oneself. Try using something that’s a favorite of yours, including but not limited to:

• Strong mints or sour candy
• Gum chewing
• Lemon or lime
• Cinnamon or ginger

Mental and Cognitive Strategies

When experiencing a flashback, there are also some things you can do to coach yourself through the moment, as well as help ground yourself. 

Self-Talk and Affirmations 

Create some personalized statements that you know you need to hear. Say these things to yourself silently or aloud, whichever is most comfortable for you. Some examples include:

• "That was then, this is now"
• "I am safe in this moment, the danger has passed"
• "This feeling will pass, it always does"
• "I survived it then, and I'm surviving now"

Reality Testing

Reality testing is a method of comparing how something feels (your internal world) with how things actually are (the external world). When someone is experiencing a flashback, it can feel true that you are back in a dangerous or hurtful situation, but it isn’t really accurate.

Focusing on the contrast between how you feel and where you are in the moment can help to evaluate your thoughts and feelings in a more helpful way. Try comparing past trauma circumstances to your present reality. What are the concrete differences? Another thing to try is to check the facts (your age, year, location, and surroundings).

Safe Place Visualization 

The safe place visualization is essentially creating a mental safe space using your imagination. It can be a real place that represents a sense of safety and calm, or you can make something up that feels good to you.

Try imagining what it would be like to be in that safe space using all five of your senses. Practice being in this safe space during calm moments, and get familiar with it. Once it’s become a familiar place, you can use it as an anchor during flashbacks.

Container Technique 

The container technique can be a way to temporarily provide some relief. You can imagine putting the memory in a box, and tell yourself that you can open it later with your therapist or when you feel safe. This can help to create some distance from the trauma memory that is too overwhelming at the moment. 

When to Seek Immediate Help

It’s essential to recognize when you or a loved one needs to seek professional support. This may be the case if someone is unable to emerge from a flashback or extended periods of dissociation, or if they’re unable to care for themselves.

Crisis Situations

The 988 National Crisis Hotline can be a valuable resource if you’re unsure about what to do and no one is in immediate danger to themselves or others. They can provide support for people experiencing thoughts of suicide or self-harm, and link you up with local mental health crisis resources to assess for treatment options. 

Emergency Situations

The 911 emergency number should be utilized when someone is exhibiting violent behavior toward self or others, if someone is an active self-harm or suicide risk, is unable to return to reality, or in case of medical emergencies (injury, heart problems, breathing). Be prepared to inform them of your location, signs and behaviors you observe, any safety concerns, and whether the person has any underlying medical conditions. 

Takeaway

There are a number of helpful strategies for managing and coping with flashbacks. Grounding through your senses and body can help bring you back into the present. Breathing techniques can help slow your heart rate and the body’s threat response system, while mental and cognitive strategies can remind you of what’s true and real in the present moment. 

Recovery from flashbacks and post-traumatic stress disorder is possible. If you or your loved one is looking for mental healthcare for PTSD recovery or crisis support and prevention, reach out to us at Willow Health today. We offer same-day or next-day appointments with both a psychotherapist and a psychiatric medication clinician, who can assess your needs and identify a plan for individualized care. 

Frequently Asked Questions

Here are some answers to some commonly asked questions about flashbacks.

Will flashbacks ever stop completely? 

This depends on the person, but for most people, they do experience fewer and less severe flashbacks over time.

How long does it take for therapy to reduce flashbacks?

Everyone is different, and there’s no quick fix to healing from trauma. Recovery can take time, but many people experience relief from the worst of their symptoms in 15-20 therapy sessions. People with more complex needs, including underlying mental health conditions, may need therapy for more extended periods of time.

Are flashbacks a sign I'm getting worse?

For many people, their symptoms often worsen before they improve. Experiencing flashbacks can actually be a sign that, now that you’re in a safe environment, your brain and body are finally processing the traumatic event. Flashbacks are simply a sign that you need support.

Can I drive or work with PTSD flashbacks?

If you’re concerned about your ability to drive or work while experiencing flashbacks, it’s recommended to consult with a healthcare clinician who can assess your individual situation and come up with the best plan to ensure your safety.

Sources 

Full article: Re-experiencing traumatic events in PTSD: new avenues in research on intrusive memories and flashbacks 

How Long Will It Take for Treatment to Work? 

The Role of Odor-Evoked Memory in Psychological and Physiological Health - PMC 

TIPP: DBT Skills, Worksheets, Videos, Exercises 

PTSD Basics 

Post-Traumatic Stress Disorder - National Institute of Mental Health (NIMH)