The one factor which is invarably present for trauma survivors is that of intrusive thoughts and imagery. These are the hallmark of PTS, and one of the recognised symptoms of PTSD. The extent to which intrusive thoughts or images dominate a persons life varies considerably, both from person to person and from time to time.

In the immediate aftermath of a trauma intrusive thoughts and images are likely to be present most of the time, often perventing sleep, and then when sleep finally does come intruding in the form of disturbing dreams and nightmares. This is naturally extremely upsetting, but it needs to be emphasised that it is part of the normal ajustment process which aids an individual in "working through" a trauma. After a while, usually some weeks, imagery and thoughts of the event will fade, perhaps only reasserting themselves just before sleep when the person is more relaxed. During the daytime the memories and images are frequently at the back of the mind, but although a suffferer is aware that they are there, he/she is able to distract him/herself by normal activity.

For some people however, the intrusion of these images does not fade. They continue to be present both as nightmares and during the day, often occurring without warning and at the most inappropriate moments. Sometimes the images are so strong that every graphic detail reappears, as if before the persons eyes, and they are transported back to the heart of the trauma, as if it were happening again. It is this occurrence which is called a Flashback. When a Flashback occurs sufferers often feel that they are losing control, and that the unwanted thoughts, and images seem to a great extent to have a life of there own. They cammonly feel that they are not the some person as before.

In extreme cases, the individual experiencing the flashback becomes cut off or dissociated from normal functioning. Later perhaps even hours later, when the flashback subsides, they cannot remember what happened, what they did or where they went. When this happens the sufferer often speaks of having "lost time". In clinical terms the occurrence is known as a dissociative flashback. In very rare cases the dissocation continues, and a person may even move to a new area and take on a whole new identity. This is described clinically as Psychogenic amnesia.

Dealing with flashbacks

Anyone who experiences the unpleasant intrusion of a flashback is likely to make every attempt to resist it happening again. Flashbacks are unfortunately immune to such resistance, as evidenced by the fact that the more the individual tries to stop him/herself thinking about any particular thing the more he/she thinks about it. In fact in the long term it is more helpful to eccept the intrusive imagery that fight it.

Strategies which have been found useful in dealing with flashbacks are:

Containment. The individual accepts the experience of flashbacks as temporarily part of life and allows time for example 20 minutes at a convenient time of the day, to "watch a video of the trauma." The "video" is then "shut down", the rest of the day is "free", and the person has a sense of controlling the thoughts and images rather than being controlled by them. When this strategy is employed there is also a need to control time spent in rumination following or between "viewing" the trauma. "Containment" can be very helpful for some individuals, allowing them to gradually process their trauma. For others, however, it is not successful and other strategies are neccessary.

Desensitisation to the Trauma. This involves re-experiencing the traumatic memories in a controlled and safe environment, so that the pain and fear associated with them gradually decrease. Desensitisation usually has positive results in dealing with the effects of single incident trauma, but is best achieved in conjuction with a trained and trusted therapist.

Cognitive Restructuring. This involves identifying the specific, thoughts or self-verbalisations related to the trauma that are generating distress. A sufferer is then helped to balance negative memories of the trauma with positive memories of his/her life experience and perhaps also behaviour during the trauma. In this way a person gradually learns to evaluate the trauma differently and hand in hand with this re-evaluation comes a reduction in intrusive thoughts and imagery. Cognitive Reconstructing forms one part of a trauma recovery programme, and is usually achieved in partnership with a Cognitive Behavioural Therapist.

There is no quick and easy cure for flashbacks. However they can be reduced over time with help. Eventually the trauma survivor can remember the trauma without overwhelming, intrusive experiences. If your experiencing flashbacks and would like the support then phone ASSIST there helpline can be found on the ASSIST main page.

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Post Traumatic Stress Sufferers and System abuse Victims Steering Group,

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