Some more Technical info on Flashbacks as well as Practical
ideas on how to Support Someone Suffering from Flashbacks
1. The impact of trauma on memories:
There is a long psychosocial history of research dating back to the end of the
nineteenth century, which suggests that there is something inherently different
about traumatic memories in general, and child sexual abuse memories in
particular, which makes them susceptible to becoming unavailable to a
person’s conscious awareness for long periods of time.
It is thought that separate ‘somatic’ (body) memory systems operate to
process memories of trauma.
(see van der Kolk and Fisler 1995; van der
Kolk and van der Hart 1991)
Traumatic memories, comprised of fragmented visual images and physical
sensations are stored out of conscious awareness in relatively ‘pure’ form as
sensorimotor memories.
Retrieval of such memories is often spontaneously and unexpectedly cued,
taking the form of physical sensations, visual images (often described as
‘flashbacks’) and a sense of re-experiencing the traumatic event. This is a
common phenomenon for people who have experienced childhood sexual
abuse.
2. Brain functioning Necessary for Clear Memory Processing:
mature and adequate function of the amygdala and hippocampus regions of
the brain are necessary for clear memory processing of life’s events. During a
traumatic event, this may not function properly.
The limbic system regions of the hippocampus and the amygdala are
especially pertinent to understanding traumatic memory. They consist of two
lobes one on each side of the brain.
The hippocampus
 The hippocampus is integral to processing information transmitted from
the body on the way to the cerebral cortex. The cerebral cortex is
responsible for all higher mental functions including speech, thought
and semantic and procedural memory.
 processes the data necessary to make sense of those experiences
within the time line of personal history and the sequence of the
experience itself.
The Amygdala
 processes and then facilitates the storage of emotions and reactions to
emotionally charged events.
 The amygdala does not succumb to the stress hormones that suppress
the activity of the hippocampus.
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
No matter how high the arousal, it appears that the amygdala
continues to function.
As the stress level increases, hormones may be released that suppress
hippocampal activity. Gunnar & Barr 1998 suggest that prolonged cortisol
secretion, as may be found with trauma, can affect the functioning of the
hippocampus.
Some individuals with PTSD recall their traumatic experiences as highly
disturbing emotional and sensory states, but without the time and space
memory context that is facilitated by hippocampal function.
3. Dissociation
The concept of Dissociation provides a psychological understanding that
traumatic events which threaten to overwhelm the personality cause the mind
to divide, resulting in one ‘part’ holding the memory which is not conscious to
the other ‘part’.
During a traumatic incident, the victim may separate elements of the
experience, effectively reducing the psychological impact of the incident.
Loewenstein, 1993 describes it as “the minds attempt to flee when flight is not
possible."
Theories of dissociation hold that when traumatic events are intensely
threatening to the integrity of the personality, they are not processed in the
same way as other memories (Bowman and Mertz 1996; Terr 1994; van der
Kolk 1994).
Instead, the biological impact of extreme stress results in a failure of encoding
of the experience – a memory is not formed in a normal way and remains
fragmented.
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Dissociation will fragment a memory often for long periods of time, until the
mind is able to reintegrate traumatic memories into a more useful form of
encoding, enabling it to be understood in a cognitive, rationale form.
4. Flashbacks
Many survivors of sexual abuse experience flashbacks, during which they reexperience the abuse or aspects of it. It is a common, though not always
present symptom of PTSD.
“In rare instances, the person experiences dissociative states that last from a
few seconds to several hours, or even days, during which components of the
event are relived and the person behaves as though experiencing the event at
that moment.” (American Psychiatric Association 1994:424)
During a flashback the autonomic nervous system prepares the body for
fight/flight/freeze as if the event were occurring now.
Flashbacks can be visual, auditory, behavioural and/or tactile.
Flashbacks can be a way in which the memory resurfaces. They are also a
symptom of not yet having had the chance to process the trauma adequately.
As a result, the traumatic event (or a part of it) overwhelms the mind so that it
feels like part of the trauma is being experienced again. It can be an
extremely frightening and distressing experience.
It is a different state of consciousness to simply recalling it from a person’s
memory. During flashbacks, survivors classically lose touch with the here and
now, and with their current selves. They may shake, look distant and out of
touch with you/the room. They may say things that are in response to the
flashback or people in it.
For flashbacks not to overwhelm and re-abuse a person, support is needed to
keep the person grounded and with some levels of control.
They will need help to keep in touch with the here and now, and with their
“adult selves”. It is important to keep grounded. It can be achieved through
things like:

Get the person suffering from the flashbacks to describe something
physical and tangible close by e.g. the chair they are sitting in, the room
they are in. If you use this at the early onset, as you see their conscious
state altering, you may be able to help them divert and avoid the
flashback.

Ask them to describe to you a place that is one of their favourite places.
Get them to describe what they can see, hear, smell, what they feel like
when they are there. Teach them mentally to 'go to' that place, in order
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to put a break on the flashback. It can help to have a photo of this
favourite place to keep at hand and use when needed.

flashbacks come hand in hand with severe disassociation and therefore
often people will lose the ability to feel parts/all of their body or be able
to connect with sending brain signals to move parts of their body. Use
simple body work touch to re-engage their brains to connect with their
physical bodies
eg. People can stamp their feet and wiggle their toes, tuning into being
aware of what it feels like.

Focusing on breathing. Often this becomes disturbed or a person can
be vulnerable to hyperventilating. Help can be given by talking through
a relaxed breathing rhythm, or breathing with them so that they can
follow you.

Inviting the client to speak as their adult selves to the scared part of
them that is experiencing the flashback. This is if they can get in touch
with their adult/nurturing side; if the flashback is severe they may well
be beyond this.
Remember - the flashback will eventually stop and subside.
After a flashback:

Once it is over, help the person to get back in touch with the here and
now at a very simple level. It is probably best to focus on practical and
comforting things like making a drink, rather than attempting to talk
about anything challenging again.

encourage the person to write down all they can remember about the
flashback and how they got through it. Ask them to write down anything
they can think of that triggered the flashback starting.
Flashbacks are fragments of memories that have not been able to be
properly encoded in the memory system: they tend to be free-floating
without a sense of time/order/context as well as surrounding details.
Writing down what is remembered and talking it through in counselling,
can enable the memory processing systems to re-encode and reintegrate this piece of traumatic memory.
The other aim of inviting them to write in the way described above, is to
help them become more aware of triggers to the memory thus being
able to use this information, as well as providing a reminder that they
did get through and therefore can again.
Flashbacks if used in this way are an important part of the process of healing.
If they are only experienced as a re-traumatisation with no re-gained and re-
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integrated memory, then the flashback is likely to be more detrimental to the
person’s healing than constructive.
Recommended Book: ‘The Body Remembers: the Psychophysiology of
Trauma and Trauma Treatment’ by Babette Rothschild. ISBN 0-393-70327-4.
Norton
Words in this document copyright 2011 © Life Centre, Chichester, UK
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