Flashbacks and Dissociation in PTSD: How to Cope

Flashbacks can be common in PTSD (post-traumatic stress disorder). Many people with PTSD struggle to cope with flashbacks and dissociation, which may occur as a result of encountering triggers that remind them of the traumatic event they experienced.

Flashbacks and dissociation can be incredibly disruptive and unpredictable. This is particularly true when people are not aware of their triggers. However, you can take steps to better manage and prevent flashbacks and dissociation and stay in the present.

Understanding Flashbacks

Flashbacks are one of the re-experiencing symptoms of PTSD. In a flashback, you may feel or act as though a traumatic event is happening again.

A flashback may be temporary and you may maintain some connection with the present moment. Or you may lose all awareness of what's going on around you and be taken completely back to your traumatic event.

Understanding Dissociation

People with PTSD may also experience dissociation. Dissociation is an experience where you may feel disconnected from yourself and/or your surroundings.

Similar to flashbacks, dissociation may range from temporarily losing touch with things that are going on around you, kind of like what happens when you daydream, to having no memories for a prolonged period of time and/or feeling as though you are outside of your body.

Coping Strategies for Flashbacks and Dissociation

Know Your Triggers

Flashbacks and dissociation are often triggered or cued by some kind of reminder of a traumatic event. For example, encountering certain people, going to specific places, or some other stressful experience may trigger a flashback.

By knowing what your triggers are, you can try to limit your exposure to those triggers. If that isn't possible (which is often the case), you can prepare by finding ways to cope with your reactions to triggers.

Identify Early Warning Signs

Flashbacks and dissociation may feel unpredictable and uncontrollable. However, there are often some early signs that you may be slipping into a flashback or a dissociative state. For example, your surroundings may begin to look fuzzy or you may feel as though you're losing touch with your surroundings, other people, or even yourself.

Flashbacks and dissociation are easier to cope with and prevent if you can catch them early on. Therefore, it's important to try to increase your awareness of their early symptoms.

Next time you experience an episode, revisit what you were feeling and thinking just before the flashback or dissociation occurred. Try to identify as many early symptoms as possible. The more ​early warning signs you can come up with, the better able you will be to prevent future episodes.

Learn Grounding Techniques

As the name implies, grounding is a particular way of coping that is designed to "ground" you in the present moment. In doing so, you can retain your connection with the present moment and reduce the likelihood that you slip into a flashback or dissociation. Grounding can be similar to mindfulness.

Grounding techniques use the five senses (sound, touch, smell, taste, and sight). To connect with the here and now, do something that will bring all your attention to the present moment.

Sight: Take an inventory of everything around you. Connect with the present moment by listing everything around you. Identify all the colors you see. Count all the pieces of furniture around you. Taking an inventory of your immediate environment can directly connect you with the present moment.

• Sight: Take an inventory of everything around you. Connect with the present moment by listing everything around you. Identify all the colors you see. Count all the pieces of furniture around you. Taking an inventory of your immediate environment can directly connect you with the present moment.
• Smell: Sniff some strong peppermint. When you smell something strong, it's very hard to focus on anything else. In this way, smelling peppermint can bring you into the present moment, slowing down or stopping a flashback or an episode of dissociation.
• Sound: Turn on loud music. Loud, jarring music will be hard to ignore. As a result, your attention will be directed to that noise, bringing you into the present moment.
• Taste: Bite into a lemon. The sourness of a lemon and the strong sensation it produces in your mouth when you bite into it can force you to stay in the present moment.
• Touch: If you notice that you're slipping into a flashback or a dissociative state, hold onto a piece of ice. It will be difficult to direct your attention away from the extreme coldness of the ice, forcing you to stay in touch with the present moment.

Turn on loud music. Loud, jarring music will be hard to ignore. As a result, your attention will be directed to that noise, bringing you into the present moment.

Bite into a lemon. The sourness of a lemon and the strong sensation it produces in your mouth when you bite into it can force you to stay in the present moment.

If you notice that you're slipping into a flashback or a dissociative state, hold onto a piece of ice. It will be difficult to direct your attention away from the extreme coldness of the ice, forcing you to stay in touch with the present moment.

Enlist the Help of Others

If you know that you may be at risk for a flashback or dissociation by going into a certain situation, bring along some trusted support.

Make sure that the person you bring with you is also aware of your triggers. They should know how to tell when you are entering a flashback or dissociative state, and how to respond to help you.

Research suggests that PTSD reduces social support resources, but that having strong social support helps lessen the impact of the condition. Reaching out for help and building your support network are essential when dealing with trauma-related symptoms.

Seek Treatment

In the end, the best way to prevent flashbacks and dissociation is to seek out treatment for your PTSD. Experiencing flashbacks and dissociation may be a sign that you are struggling to confront or cope with the traumatic event you experienced. Treatment can help with this.

Psychotherapy

There are several different types of psychotherapy that can be helpful for treating PTSD and reducing symptoms of flashbacks and dissociation. Some of these include:

• Cognitive behavioral therapy (CBT) is an approach to talk therapy that helps people identify and change thoughts and feelings that contribute to symptoms.
• Cognitive processing therapy (CPT) is a form of CBT that focuses on changing perceptions of traumatic events.  
• Eye movement desensitization and reprocessing therapy (EMDR) helps people process trauma using bilateral eye movements.
  

You can find PTSD treatment providers in your area through the Anxiety Disorder Association of America and UCompare HealthCare. The International Society for the Study of Trauma and Dissociation (ISSTD) also provides a list of therapists who treat trauma and dissociation, along with other resources.

Medications

There are no FDA-approved medications specifically for the treatment of flashbacks or dissociation. However, some prescription medications may help people manage symptoms of PTSD. These include:

• Selective serotonin reuptake inhibitors (SSRIs) such as Zoloft (sertraline), Prozac (fluoxetine), and Paxil (paroxetine)
• Selective norepinephrine reuptake inhibitors (SNRIs) such as Effexor (venlafaxine)