How To Cope With Flashbacks In Post-Traumatic Stress Disorder (PTSD)?

Flasbacks are probably among the most discussed symptoms of post-traumatic stress disorder, but that doesn't mean they're well-understood. What can flashbacks be like? How can you cope with them if they happen to you? And how can you help someone with PTSD deal with them? 

First things first: What actually counts as trauma-related flashbacks?

Nearly everyone reading this will have seen flashbacks in movies or TV series. You know how it works — the creators want to show their audience what a person or group of people previously experienced, or what a place used to be like, so they cut footage that's as real as what's shown to be happening in the present right in. 

PTSD flashbacks, too, are often shown in that very same way. A soldier is triggered by something — a sudden touch, a loud bang, or the face of someone they served with — and is suddenly transported back to the moment of their worst trauma. Because this can be used as a plot device to portray what a character went through in the past, these TV flashbacks can go on for a long time. 

Not all flashbacks are like that, though. There's been much debate in the scientific community about what qualifies as flashbacks and what doesn't, but the current version of the diagnostic and statistical manual of mental disorders (the DSM-5) is more inclusive. Any intrusive memory that causes someone with PTSD to relive a traumatic event or an aspect of it with a profound sense of "now-ness" can be considered a flashback. These memories are different from those you can consciously "spin up", and often pop up with no warning in response to a reminding trigger. 

While experiencing a flashback, someone may completely lose touch with the here and now, or only partially. Research has shown that flashbacks tend to induce markedly different physical reactions and after a flashback is over, a person may be confused, disoriented, and unable to perform well on tasks that require problem-solving. 

So, if you're wondering whether you or someone you care about is experiencing PTSD-related flashbacks or not, know that:

• Flashbacks cause you to experience the past, or some element thereof, as if it were happening right now. 
• You may completely feel as if you were in the past and reliving a traumatic experience, or you may retain a sense of being where you actually are while experiencing the flashback. 
• Flashbacks don't have to "play like a movie". You may "only" experience a smell related to your trauma very strongly, or reexperience the same physical pain you were exposed to during a trauma. You may also be emotionally overcome by the same feelings you had then, like acute fear. While flashbacks always involve a profound sense of "it" happening again, they may only focus on one element of a traumatic experience. 
• Flashbacks don't have to go on for very long. They may last a second, or even less. 

Examples of what people with PTSD may actually experience, as shared with researchers, include hearing footsteps behind them or seeing their attacker flash before them with a knife in their hands. This is quite interesting, as studies have shown that PTSD sufferers often experience flashbacks that cause them to relive not the peak of a traumatic experience, but the moments immediately preceding it. That'd be the moment when you realize something really bad is about to go down, and there's nothing you can do to stop it. It may also be the moment before your brain dissociates to be able to get through what follows — things that you may not be able to recall completely, as PTSD often causes memory gaps. 

How can you cope with PTSD-related flashbacks if they're happening to you?

Intrusion symptoms — which include intrusive memories and thoughts, nightmares, and physical and emotional reactions on being reminded of the trauma, as well as flashbacks — aren't nice. Many people with PTSD will have become emotionally hardened and tough over the course of their lives, and don't exactly relish the thought of analyzing everything that's happening to them in a shrink's office or over cake and lattes with a friend. 

Those things don't keep the flashbacks away and don't help you feel better in the long-term, either. Not everyone will want to hear this, but seeking therapy (and sometimes medications) is one of the most effective ways to decrease your PTSD symptoms long-term, including flashbacks. 

As for how to deal with flashbacks, both as they're happening if you can, and after they're over, you could try:

• Concious, focused breathing — a very basic grounding technique that is always at your disposal. (Though this is always suggested because it actually helps many people, of course, it may be triggering for some people with PTSD for whom aspects of breathing were somehow restricted during their traumas.)
• Focusing on the physical aspects of the world around you — maybe something small, like a coffee cup, or maybe something big, like the sky line. 
• Making an effort to think of a person who induces feelings of love, caring, and safety — this could be a partner, child, sibling, friend, or pet. Focus on the image of that person and the good feelings they invoke. This is a form of "loving-kindness meditation".
• Try repeating a mantra that works for you, such as "I am safe now", or "it is over", or "I am going to be OK".  

How to help someone you care about who is dealing with flashbacks

PTSD flashbacks and the reactions trauma survivors have as they're happening and in the aftermath can be scary and difficult for loved ones, too. One of the hardest things may be wanting to help the person with PTSD in your life but not really knowing how. Every person with PTSD is different, and the ways you can help may depend on your relationship with them — so ask. In a matter-of-fact, not overly emotional or fussy way, just ask. "What kinds of things do you appreciate when you're particularly triggered or have just had a flashback, and what makes it worse? How can I help, and what should I definitely not do?"

The answer will vary. Some may appreciate your calming presence and a hug. Others would very much thank you for giving them the physical and emotional space to deal with it on their own. Some may want to talk about their traumatic experiences, while others definitely won't. Some would like a cup of tea. You won't know until you ask, but in the meantime — don't start touching a person in the middle of any kind of PTSD-related reactive episode withou their permission. It may trigger them, and they may lash out. That won't make either of you feel any better.