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OK, so now we have some idea as to why our past feels like our present, but what do we do about it?!

When experiencing some of the effects of trauma such as intense fear, anger, nightmares, and flashbacks, it can be difficult to stay focussed on the present, what is going on around us. Our thinking goes ‘off line’ while the brain goes into protection mode (the fight-flight-freeze stuff we talked about in the last blog.  These can sometimes lead us to cope in ways that might not be helpful for us in the long term, or might even be harmful for us. Here, I will go through a few of the strategies I use with people in my work, which are researched and found to be beneficial.  The first thing is to get you feeling safe again, in the present and reduce the level of emotion. 

A word of caution though, these are short-term, crisis strategies designed to help you cope when it feels overwhelming and confusing. They are not for long term use and are not a substitute for psychological interventions to treat the cause (i.e. the trauma) which will prevent these episodes from happening.  If you think you might be struggling with past traumas or have post-traumatic stress disorder (PTSD), then please do contact us for support and to know more about the treatments available. You can also visit our page about trauma and PTSD.

Grounding: (Najavits, 2002)

Grounding is great for helping you detach from emotional pain when it feels overwhelming (say a 6 or above out of 10), help you to focus on external stimuli rather than focusing inwards. It can also be useful to use these strategies when you feel unsafe, following a nightmare or flashback. Some people get warning signs that they might be about to have a flashback, if so, use grounding immediately.

Guidelines:

• Keep your eyes open! Turn the lights on.
• Focus on the present and stay factual, no judgements.
• It takes practice! Try it when you feel calm and see which ones work for you. 
• Leave prompts for yourself e.g. by the bed to help remind you to use it and what to do.

How to ground:

There are many ways to ground yourself, here are a few:

Mental grounding: describe the room in detail, what can you see, hear, smell; use mental games e.g. name all the animals beginning with B; go around the room (or where you are) and name things beginning with each letter of the alphabet; repeat safety statements to yourself: “I am in my room, I am X years old, I am safe.”

Physical grounding: get your feet on the floor and gently push (literally grounding yourself), grab something/an object and grip it (can be useful to carry these around with you), hold a fizzy drink in your mouth for a few seconds, hold ice cubes in your hands, have your favourite smell nearby.

Soothing grounding: say calming things to yourself, remind yourself you are safe, hug a teddy/blanket, look at pictures that bring up positive memories.

Peaceful or Calming Place:

Developing and practising imagining that you are in a calming, peaceful place can help your emotional distress reduce.  

• The place can be either real or imagined, but ensure that it has the effect of making you feel calm, so not somewhere that have any negative memories attached to it.  
• Once you have chosen somewhere, find somewhere to sit quietly to practice. 
• Close your eyes, imagine you are in your peaceful place, take note of what you can hear, see, smell, and feel all around you. 
• Know that you can change anything you want to make it more peaceful for you e.g. having more or less people around, the weather etc. 
• The more you are able to use your senses to imagine being there the better it will work for you. 
• Choose a name for this place and repeat it to yourself whilst imagining being there.
• Notice how you feel in your body when you are there, do you feel calm? If not, change the place to something else.

Breathing:

There are many different breathing techniques out there. If you know one that works for you, use it! I personally like using paired breathing (as described in Linehan’s manual, 2015) as research shows it is effective and my clients have found it very beneficial. Generally, the heart beats faster during in- breaths and slows down during out- breaths. When we are anxious or emotionally distressed our breathing gets faster. So, the idea here is to breathe out for longer than you breathe in. Counting can help you focus on the breathing (as opposed to what is causing the distress) but don’t worry about the numbers per say, as long as the breath out is longer it will work.  This might take 5-10 minutes but if you focus on the breathing, it will slow and you will start to feel less distressed.

Progressive Muscle Relaxation (PMR):

When the threat system is alert all of our muscles become tense. One way to calm the threat system is to relax all of our muscles – this signals to the threat system that everything is OK. PMR helps you recognise the difference between being tense and being relaxed, by changing the physiological response we also change the emotional response and therefore calm.  Work through each muscle group starting with your legs, bottom, stomach, shoulders, arms and finally the head. Tense each one as hard as you can, hold for about 10 seconds and then relax. Repeat each muscle group twice and then move on to the next.

Remembering it’s in the past & noticing differences:

This is a useful strategy to help you get back into the present, particularly if you are disorientated or stuck in the past. Remember, that trauma memories do not have a time or date stamp, so to you, they feel like the present even if they happened years ago. This technique helps train your brain that the trauma happened in the past by establishing a “time perspective” (Ehlers & Clark, 2000).
So, describe what happened in the past in past tense e.g. it was dark, and notice the difference between then and now: it was dark, now its light; I was 6 years old and now I’m 20, I was at school, now I’m in my own house etc etc.

An important note, all of these take practice! When in distress, it will be harder to remember and use the skills mentioned here. Practising them regularly when you feel calm will help them feel more familiar and therefore easier to use when you really need them. You can then also find the ones that work best for you.

References

Ehlers, A., Clark, D. M. (2000). A cognitive model of PTSD. Behaviour Research and Therapy, 38, 319-345.
Linehan, M. M. (2015). DBT Skills Training Manual, 2nd Ed. The Guilford Press.
Najavits, L., (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse.  Guildford Press.