Flashbacks, the Brain, and Therapeutic Approaches

What are Flashbacks?

Flashbacks are re-experiencing events where aspects of a past traumatic experience are relived, as if they are happening again in the present. During a flashback, an individual may feel as if they are reliving the traumatic event vividly and realistically.

The Brain’s Role in Flashbacks

When a traumatic event occurs, it can become encoded in the amygdala, which is the part of the brain associated with processing emotions. Traumatic memories are stored as split-off images, sensations and feelings, separate from the story of the event. During a flashback the right hemisphere of the brain is activated, and the left hemisphere is deactivated. The original encoding of a traumatic event involves the release of glutamate, which reactivates receptors in the amygdala. This reactivation is why the memory feels like it is happening again.

• The thalamus and frontal lobe send signals to the hippocampus and the limbic system to bring the negative memory forward.
• The hippocampus stores the memory, and brings up associated pictures.
• The amygdala pushes emotions forward making the body believe it is experiencing the event again. The amygdala cannot differentiate between a fresh and an old memory.

How Flashbacks Are Formed

Flashbacks are often triggered by a stimulus that is similar to the original traumatic experience. These stimuli can be internal or external cues. The experience of a flashback can be triggered by:

• Sounds
• Smells
• Physical Sensations

Experiences that can lead to flashbacks include:

• Car accidents
• Hearing about a loss
• Being humiliated
• Rape
• Abandonment
• Abuse
• War

What Flashbacks Can Feel Like

During a flashback, individuals can experience a range of distressing symptoms including:

• Intrusive thoughts
• Nightmares
• Emotional distress
• Heightened somatic activity
• Behavioural manifestations of terror such as immobility
• Visual, auditory and other sensory aspects of the event
• A feeling that the traumatic event is happening again

Therapeutic Approaches to Flashbacks

Different therapies can help individuals manage flashbacks by working to change how the brain processes these traumatic memories. The goal of therapy is often to help people regain a sense of safety and control.

Acceptance and Commitment Therapy (ACT)

ACT aims to help people accept their thoughts and feelings rather than struggling against them. This can involve:

• Defusion, where clients learn to observe thoughts and images without necessarily treating them as facts.
• Mindfulness, which encourages present moment awareness. It involves noticing thoughts and feelings as they happen without judgment.
• Values-based action, where clients clarify their values and commit to behaviours that align with those values.
• Experiential exercises, which help clients make contact with thoughts, feelings and memories that they have avoided.
• Cognitive flexibility, learning to see alternative viewpoints and to reframe negative thoughts and beliefs.
• Willingness exercises, which increase a client’s acceptance of difficult experiences.

With ACT, people learn to relate to their automatic thoughts differently, so that they do not get stuck in trying to stop unwanted thoughts, but rather develop an attitude of “look there, my mind is at it again”.

Havening Techniques

Havening uses touch to reduce the emotional intensity of traumatic memories and eliminate unwanted feelings. It can be used to de-encode the emotional, cognitive and sensory components of a traumatizing event. The process involves:

• Recalling the traumatic event to reactivate the memory.
• Generating a subjective unit of distress (SUD) number to rate the level of distress from 0-10.
• Using Havening touch with the client visualising a calming experience such as walking up a staircase while counting or humming a familiar tune.
• This process helps to disrupt the neurobiological pathways that were produced during the traumatic event.

Havening can help with a variety of issues that are related to trauma including phobias, flashbacks and nightmares. Havening can be done content free where clients do not have to talk through what happened to them.

Neuro-Linguistic Programming (NLP)

NLP focuses on changing how a person represents the world by questioning limitations and exploring richer choices. When people are in distress it is often because their representation of the world is not good. NLP techniques for trauma include:

• Timeline Therapy, where the memories are not erased, but they no longer control the clients life, enabling them to open up to the world. In timeline therapy a client will recall a negative memory, however not go into much detail. The thalamus and frontal lobe send signals to the hippocampus and limbic system to pull that memory forward. The hippocampus will bring up the pictures associated with the memory and the amygdala pushes forward the emotions associated with the memory, making the body feel as if it is experiencing the event again.
• Meta Model is a collection of questions that help the therapist to obtain knowledge that is unique to the client’s context so that a more accurate picture of their experiences is created.
• Submodality work using techniques such as the swish pattern to change negative patterns.

Solution-Focused Brief Therapy (SFBT)

SFBT aims to help clients to develop a vision of a better future and identify steps to make that happen. It focuses on the future, rather than dwelling on the past. SFBT techniques include:

• Focusing on solutions rather than problems.
• Identifying strengths and resources that clients can use to turn their visions into reality.
• Looking for exceptions to the problem, times when the problem was not present or less severe.
• Asking future-oriented questions, such as ‘Suppose I made a full recovery. What would have helped me recover from what I’ve experienced?’.
• Scaling questions to measure progress and identify where clients are in relation to their goals.
• Validating each part of the clients experience.
• Challenging self-blaming stories.

SFBT is a time-limited approach, recognising that current disturbances are being generated in the present, rather than carried over from the past.

Summary

Flashbacks are a distressing re-experiencing of traumatic events. They are stored in the brain and triggered by cues associated with the original trauma. Different types of therapies such as Acceptance and Commitment Therapy, Havening, Neuro-Linguistic Programming, and Solution Focused Therapy offer approaches for helping people to manage the effects of flashbacks and move forward. These therapies can assist in calming and reducing the intensity of the flashbacks, restoring a sense of agency, as well as helping people to live more fully in the present.