101 Distraction Techniques: Tools for Intrusive Trauma Symptoms

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101 Distraction Techniques


     When it comes to complex trauma, survivors can face any number of debilitating symptoms — from flashbacks, nightmares, and intrusive/overwhelming emotions, to unsafe impulses, unmanaged dissociation, and all the challenges of daily living that are magnified when you're wrestling your mental health. Many skills and therapeutic tools can be vital to getting through, but sometimes they just don't feel like enough. You may've been successful at putting memories away, but are still left in a funky headspace that you can't seem to shake off. Or, maybe you've gotten grounded, but are too flooded with emotions to look at what got you so off-kilter. Sometimes you just need a middle step before you can continue with your other skills. Distraction can be a surprisingly helpful tool, and is often under-appreciated.

     One thing to keep in mind when using distraction is that it's not a long-term solution. Relying on it too heavily, or in place of other therapeutic tools, can actually lead to "stuffing", avoidance, and increasing the dissociation of what's causing you distress. This only makes it more likely to revisit intrusively and when you're least prepared for it. But, when you're really struggling in the short-term, switching gears and doing something completely unrelated can give you the footing you need. Even neurologically speaking, it's very common for those with PTSD to recycle through thoughts, memories and feelings circularly. Betting off that feedback loop can sometimes offer greater reprieve than if you'd stayed on it relentlessly trying to put things away. Activating different parts of the brain that aren't overtired can bolster your resources and give you access to the circuitry vital to thinking with clarity and reason again. Then, when you return, you're much more equipped to tackle things head-on instead of just going along for the ride.

     We've divided our list of 101 Distraction Techniques into three categories based on how much mental and physical effort they require. We know that sometimes all you can manage is what's doable from where you're sitting and/or involving very little mental energy. Other times you need to get moving a bit or start an activity. Then are the occasions where a really complex, elaborate and intricate task is needed to bring you out of the place you've been trapped for so long.

      As with all our of our lists, there will be tools here that aren't helpful for everyone. There may even be some that are triggering, upsetting, or would antagonize some of your specific symptoms. You know yourself and your symptoms best, so use your best judgment, trust yourself, and just pass on the tools that aren't for you. There are a hundred others to choose from!

 

Low-Effort

  1. Watch a TV show. If you don't have cable or a subscription service, many television networks offer free access, without a log-in, until you get closer to the most recent episodes.
  2. Watch a movie. Light-hearted comedy, drama to suck you in, or an old favorite - there are countless films to whisk you away for a bit.
  3. Sing. It doesn't matter if you're a professional vocalist or can't to carry a tune, singing engages a completely different part of your brain. Plus, the vibrations in your chest give great sensory feedback, and the vocalization reminds you of your voice.
  4. Watch cute videos on YouTube. About as low-effort as it gets: puppy/kitty videos, laugh challenges, or Vine compilations, take your pick.
  5. Mindless doodles/finger painting/playing with clay. This may be especially helpful to those with child parts who need an activity of their own.
  6. Grab a snack.
  7. Drum on a surface. Like singing, the vibrations and bilateral stimulation of your hands tapping will engage different parts of your mind and bring your attention you away from what's intruding on you.
  8. Play a game or use a fun app on your phone. Even if you aren't a gamer, search the app store. You might find one that speaks to you. It can be a great escape to get lost in for a bit.
  9. Video games.  Any console, any game!
  10. Tear out words/photos/etc. for a collage. Ask a local doctor's office or hairdresser for their spare magazines. Mindlessly rip out photos and words that speak to you. (Bonus: you may get to put tabloids to good use for once -- they often have the scathing, overdramatic words that happen to be great for a therapeutic collages. Shocking! Betrayal! You Won't Believe It!).
  11. Discover new music. YouTube, Spotify, Pandora, so many ways to find new gems!
  12. Wash your face/hands or brush your teeth. A quick refresher can help you restart your day on a brand new page. 
  13. Re-watch highlights from your favorite sport. It's easy to forget just how many epic, captivating moments there were once some time has passed. Relive your excitement. Plus, you already know how it ends, so you don't have to pay super close attention!
  14. Gratitude list. When your mind only wants to remind you of distressing things, focusing on 10+ things you're grateful for can really take you to a whole new atmosphere in your mind and heart.
  15. Imagery exercises. Containment exercises, healing pool/healing light, guided meditation, so many options!
  16. Play a board game with a friend. Something simple like Sorry!, challenging like chess, or silly like Cards Against Humanity, there are lots of options to distract you in the company of friends.
  17. Card games. Solo works, too, if there's no one around.
  18. Play with a pet. Pets (when they aren't being rotten) are the best distraction!
  19. Listen to a podcast/audiobook. 
  20. Try to laugh without smiling. Trust me, this is something you need in your life.
  21. Color-breathing / breathing techniques. An example of color-breathing here.
  22. Untangle cords/necklaces/strings in a drawer. If this is something that won't aggravate potential OCD behaviors or anxieties, this can be a perfect chore when you need a distraction.
  23. Clean out social media friends lists. Aaaah, just imagine the relief!
  24. Read a children’s book to parts inside. If you're struggling to stay focused, maybe young parts are who need the attention and care most.
  25. Play with a tangle, fidget cube, pin art, sand tray, etc. You can do this right where you're sitting, without needing to think -- a perfect option when you're still heavily in symptoms but trying to come out.
  26. Count by 7’s, list all the prime numbers, divide. Okay, this may be more medium-effort if math isn't your jam, but at least you don't have to go anywhere! ;)
  27. Browse art sites for images you love. Whether it's DeviantArt, flickr, Pinterest or somewhere else, sometimes soothing, fun or beautiful images can bring your mind to a brand new place.
  28. Sit outside and pay attention to all the things in nature. A change of scenery and a chance to connect with the earth can sometimes be all we need.
  29. Apply lotion. If this isn't a personal or sensory trigger, this can be grounding, an act of self-care and a distraction all in one!
  30. Allow yourself a nap. Sometimes that's just the only functional distraction we can muster.



Medium Effort

   31. Puzzle books. Sudoku, crosswords, word finds, variety puzzles, logic problems, take your pick!
   32. Read a book. Any book!
   33. Play music. On your phone, computer, radio, iPod, anywhere! You just might start singing along ;)
   34. Dance party. Let's be honest, this could solve most things in life ;) And, if you think you're too cool for that, turn this on and tell me you don't wanna move. If those don't get you groovin' and you're more modern, give. these. a. go. And, if all else fails: BAM.
   35. Watch videos on a topic you’re unfamiliar with. It's much easier to have your attention captured when you're learning something brand new.
   36. Draw/use an adult coloring book.
   37. Make an Amazon wishlist/Pinterest board of things you want. If you can't escape your current circumstances, envisioning a future time can be a nice way out.
   38. Send texts/messages to friends to check in with them. Concentrating on someone else can be a great way to step out of our own mind and its symptoms. Caring for others also helps reconnect you to the world at large.
   39. Organize all the files on your computer. Most of our workspaces could use a good cleaning up anyway!
   40. Wash your makeup brushes. (Or paint brushes/other work tools.) Yeah, this one probably needed done awhile ago, too! 
   41. Bullet journaling. You can start any time of year, and the structure-combined-with-creativity format can provide a great detailed distraction.
   42. Create a new playlist. One for sleep/relaxation, one to pump you up, a good one for when you're driving or doing chores, or just one for ambient background noise -- put together something you'll love and thank yourself for later.
   43. Take a shower/bath. Concentrate on all the scents and textures for extra grounding, too.
   44. Clean all your electronics. Your phone, your keyboard, laptop screen, earbuds -- they could all use your attention too, if cleaning won't engage OCD loops.
   45. Schedule appointments you’ve been putting off. Call the dentist, women/men's health doctors, insurance company, landlord, whoever you need to see. Make those appointments!
   46. Stretch/do yoga. It's not the answer to all of a body's ails like many often suggest, but it is a phenomenal resource for trauma survivors to get into their bodies, recalibrate their autonomic nervous system through steady breathing, and get out tensions or trapped anxieties that have been buzzing inside.
   47. Write an email or letter to someone. Send some heartfelt kindness to someone who made a huge impact on you, someone you've been thinking about, or those you've been worried about.
   48. Call up a friend/family member. Just to talk about anything and nothing at all.
   49. Write reviews for things you’ve purchased online. Do others a great service while offering yourself a distraction by letting them know what you thought of an item.
   50. Take photos and edit them in really unique ways. Use filters you never use, effects you'd normally never choose, and heck, even take photos of things you'd never bother to capture! Have fun with it! Discover something new and creative. 
   51. Try new ways to style your hair. You never know what new aesthetic you'll fall in love with.
   52. Test out a totally new makeup look or facial hair style. You just might love it!
   53. Follow a DIY tutorial (even if just to laugh at yourself). Hey, we aren't all cut out to be on HGTV!
   54. Research new homes/cars/phones/assistance you may need. These important, highly detail-oriented tasks can really grab your focus and reign you in because it matters.
   55. Paint your nails. Any gender, any age and with any color!
   56. Fold laundry. A slightly mindless task, but one that still requires your attention and coordination.
   57. List your recent accomplishments.  You'll be amazed at just how many things you've done recently that you so easily forget without writing them down. It can be easy to recall the challenges, but the impressive and/or proud memories sometimes fall to the wayside. These can also be incredible to review at the end of a year!
   58. Write a poem/alpha-poem/etc. It doesn't have to be a good poem. ...but, it just might turn out to be anyway!
   59. Watch a documentary. There are some phenomenal ones on YouTube for free if you don't have Netflix/cable -- and they span the range of just about any subject matter!
   60. Creative/expressive writing. There are excellent creative writing prompts online if you're stuck.
   61. Do something childlike. Sidewalk chalk, hopscotch, color with crayons, skip rope. Or, just enjoy this video if you're nervous about letting little you step up.
   62. Buy yourself a small gift. You deserve it.
   63. Do a jigsaw puzzle. There are so many unique kinds out there, too, not just a traditional 500-piece.
   64. Make a handmade gift for someone.
   65. Take a walk. Down the driveway, out in your neighborhood, through a park, on a nature trail, just go anywhere.
   66. Make your own containment box/journal.
   67. Go to the grocery store and buy new foods. Look for things you always wanted to try!
   68. Send positive comments to friends/strangers. Fill up friend's and stranger's social media with kind, helpful, supportive, encouraging and/or complimentary things. We could all use it, but it also makes you feel good, too. You don't have to be fake or forced about it, just say the things you often think but maybe don't always say.
   69. Organize a drawer/closet. This can even leave you feeling as though you've decluttered your mind a bit, too.
   70. Self-care. Look up ASMR videos (if that's okay for you), oddly-satisfying compilations, or other visually/sensorily appealing content that will calm your senses.



HIGHER EFFORT

   71. Go to a movie. Watching at home is great, too, but sometimes getting out of the house, being in the company of others and experiencing a film larger than life can capture your attention in a way that watching at home can't manage.
   72. Make an elaborate meal. Something that requires prep, organization, many steps, and that you follow the recipe correctly -- a good kind of complicated.
   73. Begin learning a new language. We're definitely into the higher-effort category now, but sometimes high levels of concentration and detail are needed to get someone out of the places they've been trapped in for days. A new language is a great way to shift gears entirely.
   74. Begin learning sign language, Braille or another communication skill. Help make life more accessible for others and earn a skill of your own to feel proud about accomplishing.
   75. Learn an instrument. Piano, guitar, ukulele, violin, flute, drums -- what speaks to you?
   76. Build/do construction. Whether you're a beginner or this is your forte, working with your hands and with a variety of pieces/elements can be an excellent distraction.
   77. Go for a drive. Definitely make sure you're grounded enough for a task like this, but if that's in-check and you just need to carve out some fresh space in your mind, hit the road!
   78. Volunteer. Pick a charity, shelter, trash pick-up, soup kitchen, or even just a friend in need. Lend a hand, your heart and your time. Focusing on others is a great way to escape your own trials.
   79. Play a sport. Soccer, basketball, baseball, tennis, volleyball, bowling, so many options!
   80. Work out. Whether you hit the gym, or get moving in your home, a workout (especially with great tunes) can be a great distraction.
   81. Build a house of cards, stack dominoes, etc. Pick your favorite tedious, high-concentration task that demands your full attention!
   82. Garage/shed tasks. Work on your car, clean up a tool or tackle box, stain a shelf, complete other tasks that are waiting for you outside the house.
   83. Repair things around the house. Fix a sink, a broken chair, squeaky door, bent light post.
   84. Organize an event/party/vacation. Fewer things more detailed and task oriented than that!
   85. Go through your clothes/closets and donate what you don't need. Focusing on keep, trash, and donate piles can keep your mind focused in many places at once, leaving room for little else.
   86. Rearrange/redecorate a bedroom or other room in the house. Change of scenery can keep you from falling back into the same spaces of your mind.
   87. Do gardening/landscaping/outdoor work. If you don't have a yard of your own, pot plants for inside your home or offer to help someone else with theirs.
   88. Update your internal world. Many with DID or OSDD have an internal world, and some can add new elements with enough concentration and effort. New rooms, parks, pets, gardens, landscapes, and so much more. Give it an update!
   89. Go out to eat. Peruse the menu and pick something you don't normally get.
   90. Go out for a treat. Grab some fro-yo, dessert, or something enjoyable -- bonus if you do so with others!
   91. Try a Rubix cube/impossible puzzles. Learn how to solve 'em!
   92. Information deep dives. Learn about a social, political, historical topic you always wish you knew more about.
   93. Head out to a coffee shoppe/bookstore. Do the same work, projects, reading, self-care, etc., you’d be doing at home, but in the company of other people.
   94. Go to/look for new public places. Check out local libraries, parks, bookstores, or other small shops you never ever knew existed around you.
   95. Clean out your car/gym bag/purse/wheelchair/wallet/etc.
   96. Finish work you've been putting off. Whether it's school work, take-home tasks for your job, or volunteer projects, get 'em done and cross 'em off your list!
   97. Meet up with a friend/family member.
   98. Visit a barn or farm. Ride horses, learn more about agriculture or animals, experience a different way of living.
   99. Go to an art, space, or historical museum. Learn all there is to know; transport yourself into another time and place.
   100. Money stuffs. Start filing your taxes, collect receipts, balance your accounts, apply for assistance, pay bills, do all those yucky things no one wants to do but has to. It'll demand all of your focus, but then feel like a relief to be done and off your mind. 
   101. Learn a new physical skill. Kickboxing, martial arts, jujitsu, self-defense -- get out all the anxiety, fear, and anger out of your body and begin to feel strong and empowered in your body and what it can do!


~    ~    ~
 

     We sincerely hope this is helpful to you! Feel free to bookmark it for the future, particularly for those times when it feels too hard to even think or remember what you may need. Also, share your go-to distraction techniques below and help us keep this list going! You may have the perfect solution for someone else's distress!

 

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MORE POSTS YOU MAY FIND HELPFUL:

    Grounding 101: 101 Grounding Techniques
    Flashbacks 101: 4 Tools to Cope with Flashbacks
    Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
    Imagery 101Healing Pool and Healing Light
    DID MythsDispelling Common Misconceptions about Dissociative Identity Disorder
    Did You Know?: 8 Things We Should All Know about C-PTSD and DID
    Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
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Index: Library of Articles

Index: Library of Articles

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Dissociation and Survival vs. Living: A Survivor's Story

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A CSA Survivor's Relationship with Dissociation, Survival and Living:

     
    "There are many things I wish I could help people understand about childhood trauma; this just happens to be one I hear very little about. Like many survivors, I struggle to hear sentiments like, "Oh my! I'm so so glad that's over now and you got through it!", "I can't believe you got out of that alive. I couldn't even do that now! I'd give up," or "At least you know your worst days are behind you. You know you can conquer anything!". Even resources and groups for trauma survivors, as well as therapists and clinicians, can share quips like "You survived the abuse, you're going to survive the recovery!". While these things intend to uplift or highlight our strength, they all categorically deny the fundamental mechanism that allowed us to survive in the first place, and why adulthood is the real hard part: dissociation.

    Make no mistake, those of us who endured trauma as children are courageously strong. We were forced to be tougher than most; and, by nature or necessity, we became resilient, creative and sharp. But Little Me didn't even experience the bulk of the trauma back then. I wasn't connected to the physical pain or sheer terror; I wasn't incapacitated by shame, disgust or uncleanliness; I wasn't aware of the immorality, nor was I having a crisis of conscience. I also didn't even know who was hurting me for much of my childhood - parts of my mind did, but not me. Little Me wasn't facing the anger or the blistering sting of betrayal from those I loved most hurting me in such inhumane ways. I wasn't yet aware this was abnormal or something that could make me feel alien or 'different' from my peers. I was numb, I was hyperfocused on the things I could control, and I was even made to feel special or self-confident in certain areas very early on. While some of that confidence dwindled over time and I became more aware of my unhappiness and "irrational" fears, none of that compares to what you imagine a tortured child feels — let alone what I was about to feel later in life.

    That suffering is here now. Adulthood is when all of it breaks through and confronts you with a vengeance. No, the abuse is not "over", it is not "behind me", it is not "something I got through". As far as my mind and body are concerned, it is NOW. It is very alive and in full-effect. Each excruciating detail of physical pain, disgust, and revulsion; every tidal wave of anger at those who knew and did nothing; each immobilizing shockwave of new material that re-writes my entire life story from how I once knew it. THIS is when my survival is tested. I am hypervigiliant, terrified, exhausted, unsure if I'm even real. I exist in hollowing spaces of grief for Little Me and the life I should have had. ...lost in an endless state of confusion, horror, disbelief and dismay. It is all day. THIS is live trauma in my brain and body. THIS is my battleground, and I am fighting for my life NOW. As an adult, not as a child.

     Furthermore, the dissociative process not only contorts the timeline of when we experience our trauma, but dissociation as an independent symptom challenges life as an adult, too. (..even beyond the forgetfulness, memory gaps, driving troubles, safety, maintaining a job, etc.) One of the most critical elements in trauma recovery is establishing healthy relationships and improving our overall worldview. It's very hard to want to carry on when all you've known is the absolute worst of mankind. Being able to look around, connect, and believe the world is still good is vital to our sanity, safety and healing. But, dissociation challenges this. It can dull your senses, leave you numb to positive feelings, keep you at an emotional distance from love or affections shown to you. It can keep you trapped in a surreal in-between state of both the past and the present -- where you respond to what's happening today with the same emotional maturity you had as a child. Emotional flashbacks, unexpected triggers, and other sudden symptoms that crop up - particularly in intimate relationships or the more meaningful aspects of life - can complicate joy and frustrate those in your life. But most of all, no one wants to just "be alive", we want to LIVE. Fully and authentically, with all the vibrance and richness available to us. But, dissociation has a way of diluting and blurring the world - stripping it of its color and beauty. How do you hold onto a light that you can barely see, feel or trust is even there?

    Like most all means of sheer survival, dissociation has its pros and cons. Just like chemotherapy and emergency surgery, they can keep you alive, but there are risks. They're also unpleasant in the moment and, separate from the conditions that necessitate these interventions, they alone carry longterm consequences. But, without them, you wouldn't be here -- so it's a constant tug of war with perspective and gratitude. Dissociation is no different. It got me through. It saved my life. It gave Little Me a fighting chance. But it also made life after abuse so darn difficult. Because, I should feel free. The abuse has ended, I am safe. I should be dancing and singing and holding everything I love dear to my chest. But instead, now is when I fight. Now is when I stare down my trauma, my innocence, my perpetrators - all with adult intellect and understanding - and try to decide if this life is worth living and if I'm up for the task.

    It is worth it. And, I am up for the fight. I'm going to do this and will do it with grace and strength. But then, and only then, can you say I survived the impossible or that 'it's over now'. This is the battle. ..and not for just survival, but for life. To make this existence meaningful now. I am going to conquer this. ..the trauma, the feelings, the defeat, the difficult relationships, the dissociation. I will also remain appreciative of what dissociation made possible for me, despite its thorns. I want Young Me to get credit for surviving the horror. But I want Adult Me to be credited for not only surviving more anguish, but for learning to LIVE, too."

 

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MORE POSTS YOU MAY FIND HELPFUL:

    Grounding 101: 101 Grounding Techniques
    Flashbacks 101: 4 Tools to Cope with Flashbacks
    Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
    Imagery 101Healing Pool and Healing Light
    DID MythsDispelling Common Misconceptions about Dissociative Identity Disorder
    Did You Know?: 8 Things We Should All Know about C-PTSD and DID
    Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller

 

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An In-Depth Conversation with Elizabeth Vermilyea

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   If you've worked in the field of trauma and dissociation for any amount of time, the name Elizabeth Vermilyea will likely be very familiar to you. For survivors new to their healing, you may not know her by name, but you've most certainly been using her tools and symptom management skills! In part due to her own humility and unassuming disposition, it's quite possible to be unaware of the impact of Elizabeth's work, despite having benefitted from it for years and years. If learning the detailed process of containment, modulation, healing pool/healing light imagery, or the more welcoming takes on internal communication, sounds familiar to you -- you have her to thank for that!

   Elizabeth's workbook, "Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress" truly revolutionized the way that trauma survivors could not only learn about their conditions, but explore a variety of tools to alleviate their suffering at the same time. An unintimidating and easy to understand look at complex trauma, it allowed survivors to really work at their own pace. Clinicians were also given a new language with which to explain coping skills to their clients, and most importantly, a chance to work on them together.  Elizabeth's message of educating with compassion and warmth, and always including survivors in the process, has remained steadfast throughout the years and is a lasting legacy on the community. Through her continued work in the field, she keeps the momentum of trauma education and care headed in the right direction -- always focused but empathic.

    It is our absolute honor and privilege to bring to you an in-depth interview with someone we admire and value so deeply. You'll get a chance to learn more about Elizabeth's personal journey, her experience weeding through the at-times tepid and contentious world of trauma, and also explore the past, present and future of trauma care! We sincerely hope you enjoy!


❧     ❧     ❧

 

Let’s start with some background for those who are being introduced to you for the first time.

・Where are you from/currently residing? Where did you attend school and what did you earn your degree in?
How long have you been practicing and in what capacity do you currently work with trauma survivors?

     I was born in Raleigh, NC, and I currently live in Napa, CA. I don’t like to focus on schools and degrees because I don’t think they tell us anything about who someone is. Suffice it to say, I’ve spent a great deal of time on my education, but I really learned the most from the people I’ve worked with over the years both as clients and colleagues. Currently I do not treat survivors, but I do train and consult with professionals and survivors alike. My consultation with survivors focuses on managing traumatic stress symptoms.

 

・What made you interested in pursuing trauma disorders? Did you always know you wanted to focus here, or was it something that found you?

     I like to say that I tripped and fell into this work, and then fell in love with it. I had intended to become an experimental psychologist. My first job out of college was at the Masters & Johnson Sexual Trauma program at River Oaks in Louisiana, and I got that job after sending out resumes everywhere I could. They were the ones who called back! It didn’t take long for me to realize that I wanted to make a career in the trauma field.

 

・When did you come to understand the full impact of complex childhood trauma vs. trauma as an adult? What was your introduction to dissociative disorders like?

     My work at River Oaks was my introduction to all of this. I remember going home one night in tears after having heard some horrific stories of abuse at the hands of a man’s parents. I found my mom and said, “Thank you for not abusing your power over me.” I realized how much that relationship means, how it can be twisted, how it can torment a child. Most of the clients in that program were diagnosed with a dissociative disorder, so I learned a great deal there. The program took a relational approach to the work, and I appreciated that. It wasn’t so hierarchical or tied to the strict medical model.

 

You began your work in this field over 25 years ago — a time where dissociative disorders were even more heavily stigmatized, disbelieved and could even be used to question the integrity of the very clinicians who supported their existence.

・What would you say the climate was like when you were first starting out? Did you face any particular challenges — clinically, interpersonally or even within yourself? 

     I started this work at the beginnings of what would become known as the recovered memory debate era, but I didn’t encounter much of that controversy until I moved to Baltimore and began working at Sheppard Pratt in their Trauma Disorders Program. Across town was Johns Hopkins and Paul McHugh who staunchly denied that recovered memories could be valid and that dissociation was real. The climate among those of us at Sheppard Pratt was one of dedication to the cause and to believing people. When I was starting out, the challenges I faced were related to understanding that horrible things are done to people, but that doesn’t mean the world is horrible. Holding those truths together is an important part of the work for all of us. More challenges came later when I began to chafe against the medical model and hierarchy in the treatment arena, and especially the “once a patient always a patient” mentality.

 

・When did you decide you wanted to write a book? And not just an informational or educational book but specifically a workbook for survivors?

     For several years I ran a PTSD Symptom Management group at Sheppard Pratt. I used to create worksheets because there weren’t any around that met the needs of the clients and my needs as a helper. Over time, I had a rather large portfolio of these worksheets. My colleagues and the clients started telling me I should write a book. So I began.

 

・Were there any unique obstacles to getting it published? Did you ever have any reluctance or hesitation, particularly given the atmosphere back then?

     Getting the book published was an incredibly serendipitous series of events. I was meeting with Esther Giller, the President and CEO of Sidran Institute, a publication company specializing in traumatic stress education and advocacy. Let me see if I can remember it the right way. She was looking for someone to come on board as a trainer for a Federal Grant project she was involved in. At the same time, she was looking for someone to produce a self-help symptom management book for a project being underwritten by the States of Maine and New York who were embarking on a massive training effort in their public mental health systems. This is a long story, but a good one.
     Survivors in the State of Maine had sued the state saying not only was the mental health treatment they received not helpful, but worse, it was hurtful. So the State handed down a consent decree that all state mental health personnel be trained in what is now called Trauma-Informed Care. This was the beginning! Esther had located professionals to create the material for training personnel (the good folks at TSI CAAP – Karen Saakvitne, Laurie Ann Pearlman, Beth Tabor-Lev, and Sarah Gamble – who wrote the Risking Connection Curriculum), and they also wanted material for the clients. That’s where I came in. I left Sheppard Pratt to take the training job at Sidran, and Sidran published the book, which was then distributed to survivors in the Maine and New York public health systems for free. I’m really proud of that.

 

Your workbook, whether you know it or not, truly revolutionized trauma care on the patient level. Worksheets were printed out on trauma units, weekly inpatient groups were held to teach your skills, your techniques and scripts became the go-to standard for coping with specific symptoms, and survivors in countries across the globe use your tools by name (sometimes not even knowing where they came from or having read your book)!

・Did you ever anticipate that your work would have such a profound impact or global reach, let alone become the foundational launchpad for which survivors worldwide would begin their trauma healing? 

     I am humbled beyond words by what you’re saying. I can tell you when I did the second edition I felt really good that there was still an interest in the book and that it was still useful thirteen years after the original publication. It’s mind boggling to think it has the impact you describe. I guess I have to take your word for it! I really felt I had arrived on the day a friend told me her book had been stolen! I replaced it for her, but for someone to steal it… it must be valuable!

 

・What has it meant to you seeing your work, and not just your book but your advocacy and education in all forms, fill such a massive void in the trauma community?

How does it feel knowing most has stood the test of time?

     Like most people dedicated to this work, I feel good about being able to educate, support, help, advocate, and hopefully change for the better the process of healing for trauma survivors. I know that every professional I am able to help will spread that exponentially outward, and that’s why I do it. I think it has stood the test of time because the material I focus on is universal and not subject to treatment trends. I want to offer something that can help everyone every time.

 

・What would you say is the biggest change you’ve noticed in the field of trauma since beginning your studies (ex. education, the approach to care, general attitudes toward trauma/dissociative disorders, etc)?

     The biggest change I’ve seen is the mainstreaming of trauma-informed care. There used to be a handful of treatment centers providing good treatment, and now, thanks to the Adverse Childhood Experiences (A.C.E.) study, there’s a deeper understanding of trauma as a public health issue. Even Oprah has got on board recently! I’ll be working with the Oregon Commission for the Blind next month because they want to better serve traumatized persons in their vocational rehabilitation programs. That’s huge! If you Google “Trauma Certificate Programs” you can find them all over the country. That’s amazing!

 

・What areas do you feel still need significant improvement? Is there anything you feel is almost missing entirely? What changes would you like to see be made in those areas?

     We need to improve the awareness, understanding, and addressing of the intersections of trauma with addiction and the criminal justice system. These intersections are at the heart of recidivism in both arenas. We have to keep showing agencies and organizations what’s in it for them and how trauma-informed practice can support and enhance their existing work. Essentially, we have to sell it.

 

・Do you have any colleagues or mentors that you really look up to or admire?

     Oh gosh, too many to name. I can tell you one person who had tremendous influence on me professionally. Her name was Andrea Karfgin, and she was a psychologist. She died several years ago, but she lives on in me. She taught me how to think about this work, how to understand really important dynamics in the work, and she guided me through tough lessons as a professional. I hesitate to mention other names for fear I’d forget someone. I worked with a number of survivors who were brave and trusting enough to let me into their inner worlds and allow me to walk with them into the wider world with more confidence, faith in themselves, and stronger boundaries toward life beyond survival. I’ve had many colleagues who were instrumental in shaping my professional development. I’ve had the privilege to work with some of the most respected people in the field and to have worked with the amazingly skillful lesser-known warriors for survivors. What I love is that I keep meeting people in the field who continue to inspire me and who keep me on track. I am so grateful that I get to do this work.

 

・What keeps you going after sitting face-to-face with some of the darkest, heaviest tragedies this world has had to know? What keeps you focused, rejuvenated or inspired?

     In the beginning I wrote a lot of songs to process what I was seeing, feeling, and understanding. I would play music for the clients in the evenings, sometimes songs about them and their struggles and strengths. That helped a lot. I keep a guitar in my office in case any of my staff need to sing the blues. Laughter is important and has always been a way for me to rejuvenate. We have to be able to laugh in the midst of awareness of such pain. I’m fortunate that people put up with my goofy humor. What helps most though is that with every workshop I do, I encounter people who believe, who want to help, and who are eager to learn how to be more effective in the work. It gives me such hope!

 

・·Do you have any advice to new, or even veteran, clinicians who are seeking to work with trauma patients?

     Do your own work. Get a good clinical supervisor. Make friends with countertransference. It will help you through so many confusing moments, and being able to notice it, understand it and use it to strengthen the relationship will be helpful and a huge protection when facing ethical dilemmas. Cultivate a good support system. Pay attention to and address signs of vicarious trauma, compassion fatigue and secondary traumatic stress. TAKE VACATIONS!

 

・What is the biggest thing you’ve learned from your patients, or other survivors, over the years? What have they taught you that books could not?

     I’ve learned that I can never give up on a person, never write them off, because people are more resilient that we imagine, and we never know when the moment of hope will come - the moment of immersive transformation that gives someone a reason and the will to continue. I’ve learned to trust people’s judgment about themselves. I’ve learned to be kinder. 

 

・If there was one thing you wish the world could understand about trauma survivors, or the clinicians that help them, what would it be?

   There is no “them.” There is only us.


 

❧     ❧     ❧

 

     Thank you, Elizabeth for your sincerity, your thoughtfulness, and your humble dedication to survivors everywhere.

    You can find more information about Elizabeth here on her website. You can also order the "Growing Beyond Survival" workbook here (or here). [Note: While the blue cover edition is still available on Amazon, the Second Edition (green cover) is the most up-to-date and has the most current perspective on trauma, so we of course recommend that one. The first is also no longer in print, but Amazon has held onto some copies.]  We cannot recommend this workbook highly enough. It has been the first recommendation on our Resource page, since the day it was made, for a reason!
 

 

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MORE POSTS YOU MAY FIND HELPFUL:

    Grounding 101: 101 Grounding Techniques
    Flashbacks 101: 4 Tools to Cope with Flashbacks
    Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
    Imagery 101Healing Pool and Healing Light
    DID MythsDispelling Common Misconceptions about Dissociative Identity Disorder
    Did You Know?: 8 Things We Should All Know about C-PTSD and DID
    Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller

 

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4 Tools to Cope with Flashbacks

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    There is no delicate way to put it: flashbacks are just awful. Whether you've just started having these upsetting and intrusive symptoms, or you've been fighting with them for years, we know how challenging and exhaustive they can be! Thankfully, a wide variety of tools and skills exist that can help you break free -- each one highly customizable to your specific needs. That said, some of the very best resources out there can take some time, and a lot of practice, before you've shaped them into the go-to symptom management tools you need. Skills like imagery, containment, split-screen, etc. are incredibly valuable, but they can be quite advanced, and even turn some away from using them altogether if introduced too soon. For those new to their healing, you may need options that are very straightforward and uncomplicated. For those with an entire workshop of tools already, we know it's still possible for giant waves of new or stubborn material to put your best skills out of reach. Items that are extremely easy to recall in a time of panic or crisis may be the only things at your disposal. We hope to be able to offer you exactly that.

    Before we get too far, let's first define what a flashback is! Whether you're a trauma survivor yourself or a loved one/supporter of one and are trying to learn more, you may be surprised to learn there are different types of flashbacks:

 

 

 

    So, what can you do?

     We recognize that half the battle when you're struggling is just being able to remember that these tools even exist and are available to you. When you're terrified, feeling very young, or you aren't oriented to the present, it can be really hard to even recognize that you're symptomatic. Try to be compassionate with yourself (or your loved one or patient) about this. Years upon years, sometimes decades, have been spent responding to distress and fear in the same exact way; it is very hard to retrain the brain to a different response when you're only presented a chance every so often. Also, flashbacks stem from a completely different section of our daily-functioning brain. It's hard work to override that circuitry, and none of us think very rationally or critically when we're flooded with fear and adrenaline. But, with practice, and by trying to utilize these skills as early as you can in your symptoms, you'll find that they become more habitual and automatic, taking less conscious effort and becoming more like muscle memory.

     Let's get to it!

 

 

Grounding

     Your absolute number one, first line of defense for any posttraumatic symptom is to be grounded -- or at least substantially more grounded than you are. None of your other skills will be effective if you aren't grounded first. (You can learn more about what it means to be grounded, as well as have an entire list of 101 Grounding Techniques to use, right here on our website!) We know it can sometimes feel really impossible to practice grounding before you've put a memory away, because that memory is what's fueling your dissociation and making you ungrounded. But, if you're heavily dissociated, and stuck in the past, you're only putting the memory away in the past - not in the here and now. It will continue to find you. As you start the grounding process, you'll find that some of the intensity of the past material backs down, which frees you up to use any other skills (like containment or modulation) that you may have fully, which takes things down another notch, allowing you to get even more grounded, and so forth.

   What are some of you best, most-easily accessible grounding tools?:

  • Open your eyes. Uncover your ears. Make as many senses available as you can!
  • Look around. Try to label 5 things you can see, 5 things of a single color, 5 things of one shape.
  • Listen. What do you hear? Is it close or far? Loud or soft? Pleasant or grating?
  • Open up, feet on the floor. If you're curled into a ball, or have your feet tucked up on the chair, try to put them on the floor and press your feet into the ground.
  • De-trance. If you are rocking, tapping, or engaging in other rhythmic or trancing motions, try to start slowing them down to a stop or make sure they're no longer a pattern.
  • Sit upright. If you are slouching deep in your seat or laying down, try to sit up. Lying prone can be very disorienting and triggering for many.
  • Orient. Remind yourself of the date, your age, where you are, and that you're safe now.
  • Movement. If you feel frozen and unable to move, start by just trying to wiggle your toes or finger tips. Slowly work up the body, little by little, until you have movement.
  • Smell. Inhale strong fragrances (they don't have to be pleasant!). Coffee, candles, lemon, etc.
  • Taste. Chew gum, eat mints, or suck on sours. Eat a meal or snack. Drink a very cold or warm beverage.
  • Touch. Run your fingers over unique textures within reach. Your clothes, the furniture, a zipper, a pet, a grounding stone or fidget item.

   There are many many other grounding tools you can find in our article, but we'll move on to our next step.

 

 

Self-Talk

     Our inner monologues are far more important and powerful than we tend to give them credit. Self-talk during a flashback can be part of your grounding, or it can be used to keep you calmer and steadier as you employ other techniques.  It can be hard to access your grounding skills or other tools if you are in a panic, or can't remember what's happening to you or who you even are. Self-talk can be a vital skill that helps everything else fall into line.

   You can say things to yourself like:

  • "This is a flashback. It is just a flashback; it is not real. This is not happening right now."
  • "I am safe now. No one is presently harming me. There is no external threat to my safety right now."
  • "I am an adult now. My name is ______. I am ____ years old. It is 2018."
  • "This will not last forever. I have the power to make this symptom go away."
  • "I am competent. I am able. I have done this before."
  • "It's important that I get grounded. Dissociating can feel safer, but I've learned it puts me and others at risk. I can do this."
  • "I can ask for help. I am worthy, even if that's hard to believe right now."
  • "I will be okay. This is temporary. I can feel it getting easier already."

   Find a mantra or phrase that feels right to you, something you know you'll remember when it's time. Talk yourself through the process. It is healthy and helps keep you planted in reality.

 

 

Separating Past from Present

     Separating past from present works on many levels as a combination of self-talk, grounding and reality-testing. It's also a tool that outsiders or loved ones can help you with, too! It's not just all up to you! During a flashback, it's very easy to be disoriented from the current time or place. You could feel like you're all the way back in the 80's, believe you're a small child, or just in a completely different environment than you truly are. Taking the time to label - either in your mind, out loud or in writing - all the things that are different now, from the past that you're currently lost in, can help your mind tease apart what was once very unsafe from the security you're currently in.

   Some examples:

  • "It is 2018, not [fill in the date/timeframe of the flashback]"
  • "I am a strong, competent adult now; I am no longer a helpless child."
  • *look at body* "These are adult hands and feet. I am taller now." Observe other physical changes like tattoos, body modifications, health changes, even wrinkles or grey hairs.
  • "There were no smartphones back then. TVs didn't look like this. I didn't have a laptop or desktop computer like this."
  • "I live on my own now. This is MY house/apartment. I can drive now. I have children/a spouse/a partner now. These are my car keys."
  • "I have a voice. Before I would have been too scared to even make a sound right now." [Then use your voice in any form to prove to yourself it's safe to do so.]
  • Label any changes about your abuser(s): their age, location, relationship to you, living status, etc.
  • Label any other major life changes: geographic locations, jobs/professions, people you know now that you didn't back then, other appearance changes
  • List (or listen to) popular music, movies, entertainment you enjoy now. Remind yourself these things did not exist back then.
  • Acknowledge the positive supports you have in your life now: new pets, friends, a therapist, a partner, family members, etc.

 

 

Internal Communication

     Internal communication is a bit more specific to those with DID/OSDD systems, but it can still be applicable in different ways to those with C-PTSD or PTSD. It is also not exactly an "easy, basic skill" in dissociative disorders, as was the case with the other tools we've offered. This is definitely a bit more of an advanced skill, however, it is very important to include because failing to check inside can often render alllllll your other attempts at grounding/symptom management ineffective. It may come as a surprise to some, but alters in a DID/OSDD system, or even just parts of a less compartmentalized C-PTSD individual, are capable of sending flashbacks your way on purpose. It is not always with nefarious or hurtful intent. It's often with the aim to protect or is used as a means of communication - handing you things they feel are important for you to know/feel/be reminded of/etc.  When this is the case, using symptom management to make the flashback go away may just exhaust you.

     If you already have some well-established communication inside your mind with parts inside, you can certainly ask them these questions more directly. But, if you aren't there yet, or if you don't have as differentiated alters, you can still send these thoughts back into your mind and see what bubbles up. For those who are just attempting to establish more communication with their systems, sometimes opening that line during a flashback can be the first successful connection that comes through.

   Some questions you can ask alters/your mind (then, open yourself up to allow the answers):

  • "Is there a reason I'm being shown this flashback right now? Is someone sending this to me?"
  • "What are you trying to communicate by making me relive these images/feelings/physical pain?"
  • "Is someone else in a flashback but came/got too close to the front of the mind? Can we do a role call and see that everyone is grounded and present?"
  • "Are you trying to make me feel as unsafe as YOU feel right now about something happening in our life?"
  • "Do you want to scare me back into silence?" "Is this your way of reminding me we aren't supposed to talk or tell anyone?"
  • "Are you trying to shut me down? ...make it so that I can't talk/go to work/go out with a friend/accomplish x task/leave the house/etc?" "Why are you afraid of me doing that?"
  • "Did something trigger you that I don't know about? Did you see/hear/feel something really familiar that I didn't notice?"
  • "Are you feeling ignored? ..like I don't care? ..like I'm not listening to you or taking your feelings into consideration? Are there other ways you could get my attention that don't include re-traumatizing me?"
  • "Are you oriented to the present? I know that it's 2018, but do you? How can we work on getting grounded together? Do you need to look through my eyes or feel in the body that we are safe and not in danger right now?"
  • "Did someone else inside order you to share this memory with me? If so, you can say so without revealing yourself to me. I want to talk to them, not you; you're not in trouble."
  • "Am I being punished for something? Can it be shared with me what I did wrong or which rules I broke without this flashback? I can't have a conversation with you about it or make amends if I can't think straight."

   There are many ways to appeal to parts inside to get to the root of why a flashback may have been sent your way. It is also possible to send these thoughts throughout the mind even if you do not have parts or a system. Many aspects of the mind may still be operating under a similar pretenses and using these symptoms as a protective defensive mechanism -- maladaptive as that may be. Appealing internally may strike a chord and enlighten you to what the real issue is. The answer may just "click" the moment you ask, even if you can't hear a direct/"audible" reply. Once that has been discovered, you will be better able to tackle things appropriately, to meet that need or fear, instead of just exhausting yourself on symptoms management skills that won't work until that is resolved.

 

❧        ❧        ❧

 

     We sincerely hope these four basic, foundational tools will be able to help you find relief and distance during a flashback -- no matter what stage you're at in your recovery. Once armed with more stability and a framework from which to work, you can then explore more detailed and elaborate skills with confidence!  We will absolutely be covering more imagery, containment, modulation, and journaling skills that are helpful in the fight against flashbacks. (We've already introduced a couple!) So, stay tuned. 

     Please don't hesitate to share some of your go-to strategies for flashbacks below and consider bookmarking this page for quicker, more direct access should you need it while you're struggling!

 

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MORE POSTS YOU MAY FIND HELPFUL:

    Grounding 101: 101 Grounding Techniques
    Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
    Imagery 101Healing Pool and Healing Light
    Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
    DID MythsDispelling Common Misconceptions about Dissociative Identity Disorder
    Did You Know?: 8 Things We Should All Know about C-PTSD and DID

 

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