Just started therapy, how can I deal with the constant flashbacks?
July 2, 2013 3:40 PM Subscribe
I have a lot of trauma in my past. My therapist is trying to teach me ways of being present, but I'm having a really hard time. Has anyone else with PTSD found something that helps calm the flood of memories?
I've spent most of my life trying to ignore my past, and even though we're going slow and haven't really delved into the more intense aspects of the traumatic things I've been through, I know I'm finally, after not telling anyone these things for my whole life, having to deal with my problems and it's like a floodgate is opening. I can't go a single minute without remembering something from my past. I've always had this sense of discontinuity in my life, which I know is a defence mechanism and doesn't necessarily serve me any more, but coming to terms with the fact that these things happened to me and it's part of who I am and I can't change it is so overwhelming. I know it takes time. But right now I just can't stop remembering things, even small things, even nothing particularly traumatic but right now every memory, even "good" ones, feels painful because it's a connection to my past. It's like my brain gets stuck in recall mode and I can't make it stop. So far the only thing that's helped is to remember something that happened a day ago or an hour ago. It satisfies my brain's apparent need to recall something but is at least closer to the present. Is this normal for people with PTSD who start therapy for the first time? It's all so overwhelming and I just want to be able to turn my brain off, stop remembering all these little things. My therapist suggested holding ice cubes in my hand but that didn't help. She suggested having a rubber band on my wrist to snap when I was feeling I was sinking into the state I get in when I start to remember things. Also trying to think of words that start with a letter (for example I'd choose "A" and then mentally list A-words like "ape apothecary analog apple asbestos etc etc.) Anyone else who has flashbacks like this, what are some mental exercises that help you snap out of it? What else can I do? I'm also the most depressed I've been in a really long time and it's brought back feelings of agoraphobia. When I go outside there's just too much stimulation, especially different smells walking through the neighborhood and the flashbacks are worse, like every other second vs. once every minute.
I've spent most of my life trying to ignore my past, and even though we're going slow and haven't really delved into the more intense aspects of the traumatic things I've been through, I know I'm finally, after not telling anyone these things for my whole life, having to deal with my problems and it's like a floodgate is opening. I can't go a single minute without remembering something from my past. I've always had this sense of discontinuity in my life, which I know is a defence mechanism and doesn't necessarily serve me any more, but coming to terms with the fact that these things happened to me and it's part of who I am and I can't change it is so overwhelming. I know it takes time. But right now I just can't stop remembering things, even small things, even nothing particularly traumatic but right now every memory, even "good" ones, feels painful because it's a connection to my past. It's like my brain gets stuck in recall mode and I can't make it stop. So far the only thing that's helped is to remember something that happened a day ago or an hour ago. It satisfies my brain's apparent need to recall something but is at least closer to the present. Is this normal for people with PTSD who start therapy for the first time? It's all so overwhelming and I just want to be able to turn my brain off, stop remembering all these little things. My therapist suggested holding ice cubes in my hand but that didn't help. She suggested having a rubber band on my wrist to snap when I was feeling I was sinking into the state I get in when I start to remember things. Also trying to think of words that start with a letter (for example I'd choose "A" and then mentally list A-words like "ape apothecary analog apple asbestos etc etc.) Anyone else who has flashbacks like this, what are some mental exercises that help you snap out of it? What else can I do? I'm also the most depressed I've been in a really long time and it's brought back feelings of agoraphobia. When I go outside there's just too much stimulation, especially different smells walking through the neighborhood and the flashbacks are worse, like every other second vs. once every minute.
Ask about EMDR and PTSD. I think it's intended exactly for this purpose. (Caveat: it didn't work for me, but I understand that it is very quickly effective for many people. Like, after just a few sessions.)
posted by instamatic at 4:29 PM on July 2, 2013 [1 favorite]
posted by instamatic at 4:29 PM on July 2, 2013 [1 favorite]
A lot of times, therapists encourage clients to work on their issues between sessions. In working with trauma, however, it's often actually much better for clients to give themselves permission to "turn off" their brains/memories between sessions, until new coping mechanisms are developed enough. Sometimes just giving yourself permission to not-think can help.
Could you ask your therapist for some sort of "closing up" ritual at the end of each session? It could be a visualization, like picturing yourself putting everything into a box, closing the box, and putting it somewhere safe; or a physical thing, like taking 30 seconds to "shake it out" and jump around the room all hokey-pokey like. It could even just be you, by yourself, going into the restroom and washing your hands and imagining the water taking away everything you talked about that session. Whatever you do, it might be most effective to do it in the office before re-entering "the real world."
Also make sure your therapist is wrapping sessions up in time for you to pull yourself back together, at least a little bit, before leaving the office. If she's letting you feel ripped apart until the very end of the session without downshifting for at least a few minutes, then you might ask her to stop you five minutes early and move toward more wrapping-up / summarizing / small talk until the actual end of the session (or that may be when you want to do the closing ritual).
A yoga teacher of mine (who was also trained in trauma work) always reminded us at the end of class that what we had just done had opened our hearts and left us very open, which was great, but which was a too-vulnerable way to go back out into the world. So she would just gently remind us to take a few moments to mentally and emotionally protect ourselves (without "closing ourselves up" again) before leaving the studio. I think some sort of simple way of doing that might be helpful for you.
The VA has an excellent website on PTSD. You might check out their Self-Help and Coping section for other ideas.
posted by jaguar at 4:30 PM on July 2, 2013 [8 favorites]
Could you ask your therapist for some sort of "closing up" ritual at the end of each session? It could be a visualization, like picturing yourself putting everything into a box, closing the box, and putting it somewhere safe; or a physical thing, like taking 30 seconds to "shake it out" and jump around the room all hokey-pokey like. It could even just be you, by yourself, going into the restroom and washing your hands and imagining the water taking away everything you talked about that session. Whatever you do, it might be most effective to do it in the office before re-entering "the real world."
Also make sure your therapist is wrapping sessions up in time for you to pull yourself back together, at least a little bit, before leaving the office. If she's letting you feel ripped apart until the very end of the session without downshifting for at least a few minutes, then you might ask her to stop you five minutes early and move toward more wrapping-up / summarizing / small talk until the actual end of the session (or that may be when you want to do the closing ritual).
A yoga teacher of mine (who was also trained in trauma work) always reminded us at the end of class that what we had just done had opened our hearts and left us very open, which was great, but which was a too-vulnerable way to go back out into the world. So she would just gently remind us to take a few moments to mentally and emotionally protect ourselves (without "closing ourselves up" again) before leaving the studio. I think some sort of simple way of doing that might be helpful for you.
The VA has an excellent website on PTSD. You might check out their Self-Help and Coping section for other ideas.
posted by jaguar at 4:30 PM on July 2, 2013 [8 favorites]
And in looking at the VA site, I can 100% recommend their PTSD Coach app. If you have an iPhone or Android, you can download it to your phone. It allows you to upload photos and music, and then you can choose a symptom you're currently suffering (anxiety, insomnia, etc.) and then it'll give you a bunch of suggestions for coping, including showing you your happy photos or calming music. For each suggestion you can say whether it worked or not, and if it didn't, it'll give you another suggestion. It's really, really well done.
posted by jaguar at 4:34 PM on July 2, 2013 [3 favorites]
posted by jaguar at 4:34 PM on July 2, 2013 [3 favorites]
Mod note: This is a followup from the asker.
I'm actually trying medication for the first time in my life, (citalopam, vitamin D+B complex in the morning and trazodone+melatonin+magnesium for sleeping) and I know the first couple of weeks starting medication can be difficult and I'm just trying to wait it out and see, but I think the flashbacks have gotten worse since I started taking all those things. It's like my mind is racing with all these memories but the psychomotor retardation part of depression is worse. Or maybe it's more like a "playing dead" response to remembering these things, not just plain ol' depression. I hid in my crawlspace for 3 hours the other day feeling completely paralyzed but my mind was racing, just remembering things. Like one memory triggers another and then another and it feels so endless. I know the symptoms of depression don't necessarily go away symmetrically when starting antidepressants. I just can't stop thinking about my past and want to turn my brain off and it's so exhausting re-living all these things even though from the outside it just looks like I'm sitting here.posted by cortex (staff) at 4:36 PM on July 2, 2013
I had low-grade PTSD from a sexual assault and EMDR has been key in helping me overcome the overwhelming sensations I used to feel in relationship to the residual damage that was sitting with me since the attack. Right now I haven't been able to do EMDR consistently and there's been a definite breakdown in my ability to keep intrusive thoughts at bay, and like you I occasionally have these bizarre paralyzing moments where I find myself somewhere in my apt fixating on some aspect of myself, my mind racing uncontrollably. EMDR helps me sort through that series of thoughts in a rational, cohesive way and after a while you can actually start to sense it when your mind starts sifting through memories and restacking them in ways your brain can understand. Rather than just seeing a movie going 50mph along with a tidal wave of horrible emotions, you start to watch a slideshow sort of click into place and it's as though you're further and further away each time. Definitely ask your therapist about it. I wish you peace; I know this is a super horrible time, but you can get through it.
posted by These Birds of a Feather at 5:07 PM on July 2, 2013
posted by These Birds of a Feather at 5:07 PM on July 2, 2013
I'm seeing a therapist for PTSD and she is treating me using EMDR. It has been very effective for me, particularly in coping with intrusive and racing thoughts.
She also gave me a big long list of exercises to use when my anxiety is building. I can't find it right now, and tearing my house apart trying to find it is freaking me out (ha!) so I'll scan and post it later if it turns up.
Some of them are similar to what you are doing, one is picking a colour and looking around the environment and noticing everything that is blue (e.g.). Then you can pick a second and look around and list all the things that are orange and blue, alternating. (This one doesn't actually work for me, because I find it just makes my mind race around looking for as many blue things as fast as I can, but maybe it will work for you.)
Another is to stand in a doorway and push hard against it with your arms, your hands or your forearms, depending on how narrow the doorway is, I guess. I use this one a lot. If I feel like I need to be more subtle than that, I will lean up hard against the doorway, digging the corner into my back or find some other thing to press up against. It's the sensation of of pressure and contact that pulls me back into my body.
She also taught me the butterfly hug, which I've recommended here before. And as I said then, I totally hate that it's called the butterfly protocol, but if you can get past that, I find it helpful. It's kind of do it yourself EMDR, so bear that in mind. I do just a few taps (5-6) to calm myself down and doing it for longer kind of starts me processing stuff, which isn't always what I want/need to be doing in the moment.
I also have a 4-7-8 breathing exercise (inhale for to the count of 4, hold for 7, exhale for 8) that is helpful. The principle behind the deep breathing is that when we begin to freak out, the amygdala takes over and starts up the fight of flight cycle, and the frontal cortex where all the executive function happens (thinking, reasoning, deciding) gets shut down. The deep breathing gets some oxygen to your thinking brain which gets it back in the driver's seat. I think 4-7-8 originates with Dr. Andrew Weil, and so may in fact have no scientific basis, but it works, so I use it. Mainly, the rhythm keeps me from hyperventilating.
Also, this: "that these things happened to me and it's part of who I am and I can't change it" is not true. Things happened to you, but they are not YOU. And you can absolutely change how you feel about them and what effects those events have on your life. While it's true you can't re-do the past, you can make such an enormous change in how you approach the memories of trauma that you have every reason to be hopeful. And I don't say this in a flip "you just have to change how you think about it" way, but instead I'm commenting on the fact that trauma actually changes how your brain works, but with therapy and through the wonder of plasticity, you can heal your brain. This is a really science-y way to say this; and this is a readable pop-psych way of saying it.
I wish you luck. It will get better. I'm very VERY good at shoving all my feelings down and putting a lid over them, but in the early days (months) of therapy things were pretty awful. It definitely got worse before it got better and I used to get really angry when people would suggest exercises like these because I was always way too caught up in whatever was tormenting me at the moment to pull out any kind of coping tools. But eventually it does get better and then they can really help.
posted by looli at 7:12 PM on July 2, 2013 [3 favorites]
She also gave me a big long list of exercises to use when my anxiety is building. I can't find it right now, and tearing my house apart trying to find it is freaking me out (ha!) so I'll scan and post it later if it turns up.
Some of them are similar to what you are doing, one is picking a colour and looking around the environment and noticing everything that is blue (e.g.). Then you can pick a second and look around and list all the things that are orange and blue, alternating. (This one doesn't actually work for me, because I find it just makes my mind race around looking for as many blue things as fast as I can, but maybe it will work for you.)
Another is to stand in a doorway and push hard against it with your arms, your hands or your forearms, depending on how narrow the doorway is, I guess. I use this one a lot. If I feel like I need to be more subtle than that, I will lean up hard against the doorway, digging the corner into my back or find some other thing to press up against. It's the sensation of of pressure and contact that pulls me back into my body.
She also taught me the butterfly hug, which I've recommended here before. And as I said then, I totally hate that it's called the butterfly protocol, but if you can get past that, I find it helpful. It's kind of do it yourself EMDR, so bear that in mind. I do just a few taps (5-6) to calm myself down and doing it for longer kind of starts me processing stuff, which isn't always what I want/need to be doing in the moment.
I also have a 4-7-8 breathing exercise (inhale for to the count of 4, hold for 7, exhale for 8) that is helpful. The principle behind the deep breathing is that when we begin to freak out, the amygdala takes over and starts up the fight of flight cycle, and the frontal cortex where all the executive function happens (thinking, reasoning, deciding) gets shut down. The deep breathing gets some oxygen to your thinking brain which gets it back in the driver's seat. I think 4-7-8 originates with Dr. Andrew Weil, and so may in fact have no scientific basis, but it works, so I use it. Mainly, the rhythm keeps me from hyperventilating.
Also, this: "that these things happened to me and it's part of who I am and I can't change it" is not true. Things happened to you, but they are not YOU. And you can absolutely change how you feel about them and what effects those events have on your life. While it's true you can't re-do the past, you can make such an enormous change in how you approach the memories of trauma that you have every reason to be hopeful. And I don't say this in a flip "you just have to change how you think about it" way, but instead I'm commenting on the fact that trauma actually changes how your brain works, but with therapy and through the wonder of plasticity, you can heal your brain. This is a really science-y way to say this; and this is a readable pop-psych way of saying it.
I wish you luck. It will get better. I'm very VERY good at shoving all my feelings down and putting a lid over them, but in the early days (months) of therapy things were pretty awful. It definitely got worse before it got better and I used to get really angry when people would suggest exercises like these because I was always way too caught up in whatever was tormenting me at the moment to pull out any kind of coping tools. But eventually it does get better and then they can really help.
posted by looli at 7:12 PM on July 2, 2013 [3 favorites]
I haven't tried EMDR, but from what I understand of trauma, right-left brain integration seems to be crucial, and that's what EMDR involves.
I found the book Invisible Heroes both encouraging and helpful. It uses a lot of visualizations and body awareness to help you process and integrate trauma symptoms. This, again, has a lot to do with right-left hemispheric integration.
I can't prove this, but I'm convinced creative doing or making, preferably in some way that connects you to other people, is important in healing trauma. My accidental miracle cure for flashbacks and panic attacks was discovering Sacred Harp singing. I can't say this would work for everyone, but for me it was a magic combination of factors. I could basically scream at the top of my lungs, feel myself intimately connected to a group of loving people and relate to the world and express myself in an emotional, non-logical way. A woman in Surviving Survival overcame disabling grief and depression at the sudden death of her young daughter by taking up knitting. It sounds flip but there seem to have been some very deep processes at work there.
You mention feeling paralyzed. If you believe Peter Levine, feeling frozen and mute is part of what exacerbates trauma. Maybe taking up something physical, like tai chi or dance, or even boxing? Yoga and tai chi also did a lot for me.
posted by stuck on an island at 2:43 AM on July 3, 2013
I found the book Invisible Heroes both encouraging and helpful. It uses a lot of visualizations and body awareness to help you process and integrate trauma symptoms. This, again, has a lot to do with right-left hemispheric integration.
I can't prove this, but I'm convinced creative doing or making, preferably in some way that connects you to other people, is important in healing trauma. My accidental miracle cure for flashbacks and panic attacks was discovering Sacred Harp singing. I can't say this would work for everyone, but for me it was a magic combination of factors. I could basically scream at the top of my lungs, feel myself intimately connected to a group of loving people and relate to the world and express myself in an emotional, non-logical way. A woman in Surviving Survival overcame disabling grief and depression at the sudden death of her young daughter by taking up knitting. It sounds flip but there seem to have been some very deep processes at work there.
You mention feeling paralyzed. If you believe Peter Levine, feeling frozen and mute is part of what exacerbates trauma. Maybe taking up something physical, like tai chi or dance, or even boxing? Yoga and tai chi also did a lot for me.
posted by stuck on an island at 2:43 AM on July 3, 2013
This may be pretty weaksauce compared with some of the other techniques described above, but a system that has worked for me for the last few years is:
At the moment the unpleasant memory intrudes, don't force it away. Freeze it, like pressing [pause] on a DVD, and hold it for a second. Then in your mind's eye, take a Polaroid picture or a screenshot of it. Look at the picture, not the memory itself. Now, again in your imagination, set fire to the picture and watch it burn to ashes.
Sometimes I mentally blow the ashes away, and sometimes I let a wind blow them away. Either way it's gone, and I can get back to today. Takes about 5-10 seconds depending on the memory.
It's not a permanent fix but it's helped me a lot.
posted by Hogshead at 4:30 AM on July 3, 2013 [1 favorite]
At the moment the unpleasant memory intrudes, don't force it away. Freeze it, like pressing [pause] on a DVD, and hold it for a second. Then in your mind's eye, take a Polaroid picture or a screenshot of it. Look at the picture, not the memory itself. Now, again in your imagination, set fire to the picture and watch it burn to ashes.
Sometimes I mentally blow the ashes away, and sometimes I let a wind blow them away. Either way it's gone, and I can get back to today. Takes about 5-10 seconds depending on the memory.
It's not a permanent fix but it's helped me a lot.
posted by Hogshead at 4:30 AM on July 3, 2013 [1 favorite]
The ice cube and the rubber band aren't meant to be punitive. They are meant to bring the OP back to objective, current, what is happening right now reality. There are other tactile things that can do that. A scent you love on a hankie, or a bottle of spray that you can use. A small smooth stone that you can rub. A piece of fabric (have several that you can switch out and wash if this works for you). A sound you make or a phrase you say.
I'm disappointed that this may not have been explained well.
One of the things that worked very well for my PTSD was repeating "that is over." I have gotten better at treating the memories more like a movie.
If worry thoughts are getting to you, try setting aside a specific period of time during the day to worry. Write a list of things as they come up throughout the day, and just remind yourself that you will worry about them at 7pm (or whatever time you've picked), and only for the allotted time.
My therapy suggestion for PTSD is always Dialectic Behavior Therapy with a trained practitioner. It's designed for people with Borderline, but don't let that scare you. It starts with mindfulness training, which is what I mentioned up top. Focusing on what is actually happening right now.
posted by bilabial at 8:50 AM on July 3, 2013 [1 favorite]
I'm disappointed that this may not have been explained well.
One of the things that worked very well for my PTSD was repeating "that is over." I have gotten better at treating the memories more like a movie.
If worry thoughts are getting to you, try setting aside a specific period of time during the day to worry. Write a list of things as they come up throughout the day, and just remind yourself that you will worry about them at 7pm (or whatever time you've picked), and only for the allotted time.
My therapy suggestion for PTSD is always Dialectic Behavior Therapy with a trained practitioner. It's designed for people with Borderline, but don't let that scare you. It starts with mindfulness training, which is what I mentioned up top. Focusing on what is actually happening right now.
posted by bilabial at 8:50 AM on July 3, 2013 [1 favorite]
It sounds like you need a new therapist who specializes in trauma.
posted by yarly at 5:42 PM on July 3, 2013
posted by yarly at 5:42 PM on July 3, 2013
first, if you haven't already let your doctor know about all those supplements you're taking in addition to the meds. there might be a conflict there making things worse. you can look up drug interactions, also for supplements, at wholehealthmd.
here is some good info on both grounding skills & managing intrusive symptoms. i don't have ptsd but when my mind is spinning i find journaling helpful and also just distracting myself with a movie or web surfing. something to break the non-stop mental loop.
posted by wildflower at 5:57 AM on July 4, 2013
here is some good info on both grounding skills & managing intrusive symptoms. i don't have ptsd but when my mind is spinning i find journaling helpful and also just distracting myself with a movie or web surfing. something to break the non-stop mental loop.
posted by wildflower at 5:57 AM on July 4, 2013
Mod note: This is another followup from the asker.
Thanks everyone for the ideas. I know doing something creative can be cathartic. Luckily I'm a creative person and I've found that playing piano also helps me calm down-- It pushes everything else aside at least for a little bit. I've been writing a bunch of music lately and I imagine each song is a house that I'm the architect and I built it and every time I hear it/play it I can step inside of it and since it's totally mine, because I created it, I can feel safe there. I know that may sound really strange but I thought I'd mention it in case anyone else ever searches askMefi for this same issue and maybe that would be helpful for them too. I should have put that in my initial post but I was feeling pretty out-of-sorts at that moment.posted by cortex (staff) at 10:19 AM on July 4, 2013 [1 favorite]
Also, In my case, the blanket fort thing is itself a trigger-- which I never even realized before, so thanks for bringing that to my attention.
I'm definitely going to give EMDR a shot. I was aware of it before but after doing more reading it sounds very promising.
I know finding the right therapist takes some time but I saw a few others and they just were not people I could ever see myself opening up to. And what's the point of going to therapy with someone you don't feel you can talk to? I also knew I just needed to pick up the phone and make an appointment because I knew I could easily have justified not starting therapy by blaming my frustration with finding someone right. So she may not be the perfect therapist for me and trauma isn't her main area of expertise but at least I got that initial step out of the way of trying therapy which I had this enormous mental block about my whole life. Her main approach is Cognitive Behavioral Therapy which seems like a good fit for some other issues I'm having but I'm starting to realize that a lot of those other issues are much more rooted in the traumatic stuff than I realized (or wanted to realize for that matter).
Also my mental health nurse practitioner (the one doing the prescribing) knows about everything I'm taking and everything else besides the B vitamins I started under her advice.
One last thing-- the "that these things happened to me and it's part of who I am and I can't change it" thing is my words, not my therapist's. And you're absolutely right, I shouldn't let it define me.
Thanks again, everyone.
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posted by jeff-o-matic at 3:43 PM on July 2, 2013