Traumatic memories are not the same as normal memories. In normal life, your brain lays down a sequential memory track, kind of like a video but with all the senses. This is mediated by the hippocampus, the memory center of your brain. But in a truly terrifying situation, the stress chemicals turn off the hippocampus and turn on the amygdala to produce a traumatic memory. Trauma memories don’t deteriorate with time. Our normal memories diminish or get lost over the years, but if you activate a traumatic memory 50 years later, it recurs with the same emotional intensity you experienced at the time .
Reminders of the trauma, or Triggers, can evoke the release of traumatic memories. Triggers are everywhere. They can be anything your mind recognizes as similar to the traumatic situation. Triggers cause your brain to retrieve the traumatic memory in a “flash”.
Common triggers include:
Environment: heat, cold, rain, storm, etc.
Senses: smell, hearing, seeing, feeling, pain
Thoughts: about self, about the past, about a similar situation
Emotions: fear, anger, distress, disgust, guilt, shame
Media: news or movies about a similar situation
People associated with the trauma.
Your trigger may be as simple as a smell, a sound, a name, or the temperature outside. It may be a scene in a TV show, or a subject of conversation over dinner. It’s a good idea to keep a list of your triggers and share them with family and friends.
The purpose of Exposure therapy is to separate the trigger from the traumatic memory and integrate the memory back into your normal memory (hippocampus). There are many different ways to accomplish this goal, but they all contain the same steps:
1) LET GO of negative emotions and pain
2) Explore the memory in detail
3) Reexamine your feelings, emotional and physical, about the memory
4) Reexamine your beliefs about the memory
5) REPEAT the PROCESS until the memory is normalized
This is a highly repetitive process, like peeling skin off an onion one layer at a time. The first time you approach the memory, you probably won’t do much letting go of feelings or exploring the memory in detail. But as you repeat the process, it should get easier each time. If not, you may be repeating a flashback and need to choose a different approach. But you’ll undoubtedly repeat these five steps many times before you find yourself at peace.
The first step, letting go of emotions and pain, is the hardest for most folks. We all avoid terror, fear, grief, disgust, anger, shame, guilt, and other negative emotions. If the memory involves a physical injury, the pain is remembered by the body, and bodywork in the form of exercise or massage can help release it. Different approaches work at different times and for different personalities and traumas. Pick what works for you, but don’t be afraid to experiment with others.
Ways to Let Go:
1) Cry, scream, curse
2) Share with others and accept support.
3) Use art, music, poetry, theater, or dance to express yourself
4) Visualize draining the feelings and pain into an object, another person, or pet.
6) Mindfulness (keeping your focus in the present) and Meditation (emptying your mind of emotions and thought, while focusing on a higher concept)
7) Eye movements (like in REM sleep or EMDR)
9) Spirituality (giving your problems over to a higher power) and Forgiveness (of both yourself and others)
Medications that help with Exposure Therapy:
1) D-Cycloserene is an older medication used at high doses to treat tuberculosis and more recently at low doses to enhance the effects of NMDA in the brain. NMDA is a chemical in the brain used in both the formation and the extinction of traumatic memories. Research in mice found D-Cycloserene helped mice recover from fear of a sound that was previously paired with shock. It was also given to people with a fear of heights right before exposure to a terrifying virtual reality experience of riding in an open elevator. After only two therapy sessions with D-Cycloserene, patients showed marked improvement in their phobia, and that improvement persisted afterwards. Some desensitization programs have experimented with this approach, but D-Cycloserene stops working over time.
2) Cannabinoids also act on the amygdala, as many sufferers of PTSD have found. Our natural cannabinoid, anandamide, is decreased in PTSD and there is an increase in receptors in the amygdala, listening hard for a weakened signal. Cannabinoids in marijuana can activate these receptors and have been shown to desensitize people to triggers. With the increasing legalization of medical marijuana, there will hopefully be more research in this area.
3) Propranalol is a beta-blocker used to control blood pressure and arrhythmias by blocking beta-receptors to noradrenalin. Folks who took it right before exposure therapy showed significantly improved tolerance for trauma triggers. Perhaps the most available and best tested of the medications listed here, it also has the most side effects, but these can be minimized with the sporadic, low-dose treatment needed for exposure therapy.
Different Approaches to Exposure Therapy:
Telling your story is the oldest approach and still widely used. Back in ancient times warriors told stories around the campfire about their most dangerous adventures. This approach was formalized in Latin America for victims of governmental torture. It involves simply telling your story in detail to a receptive and supportive audience. You can tell it, write it, draw it, or even act it out, but you need at least one person to provide an audience. The more detail you include, and the more often you repeat your story, the better. Both detail and repetition are essential.
The first time you tell a memory, the affect may feel overwhelming. Don’t let that scare you off. The affect should decrease with each telling. Encouragement and supportive feedback help. Listeners need to listen and support, not judge, but their realistic feedback can positively change how you perceive your memory. Remember to include all the details. Even a song playing in the background may become a trigger if you don’t mention it in your reprocessing.
When talking fails. If talking triggers you into a flashback, then the talking therapies will fail. I found EMDR was helpful for those memories. Medications or massage may also help.
What is EMDR? It’s an abbreviation for “Eye movement desensitization and restructuring” and accomplishes the same goal of detoxifying memories and integrating them into your normal memory flow. But EMDR uses a natural mechanism that we use every night when we sleep—eye-movements.
You’ve heard of REM sleep? That stands for rapid eye movements. It’s a very important stage of sleep, and if you’re deprived of REM sleep, after a few days you will hallucinate. We’re taught that REM sleep helps us process the previous day’s memories. Aha! That’s what we want to do with traumatic memories—right?
EMDR is as simple as moving the eyes back and forth while remembering the trauma in detail. Initially it requires a trained therapist, but it doesn’t require you to talk, and once you learn it, you can use it anywhere, anytime. This treatment is specific for PTSD, is proven to work, and there are many licensed therapists who use it both in the VA and in private practice.
The VA offers virtual reality exposure programs for veterans with PTSD. These are designed to reproduce the combat situation in which the trauma originally occurred. Medications may be given first and the exposure can be done in time-limited bursts. Then a therapist helps the veteran to talk about and reprocess the traumatic memories. I’ve heard that this works but have no experience with it, and it’s only available in VA treatment centers.
Somatic Re-experiencing is a formal approach to massage and bodywork that helps your body remember and work through both the physical and emotional aspects of the trauma. Like EMDR, it does not require you to talk about the memory, but it can provide significant relief. I would recommend using a trained therapist as bodywork may trigger flashbacks.
Rewriting your Trauma is a creative approach. This was formalized for treating traumatic nightmares, but may work equally well for some flashbacks. You have to start at the beginning of the trauma at the same place the nightmare always starts. But then you change the story so it has a happy ending. The story you create doesn’t have to be real. You’re working with a dream, after all. But it must satisfy your needs emotionally. Then you practice visualizing it, over and over. I explain to folks that the old dream wore a rut into their brain, and they have to practice their revised dream until it makes an even deeper rut. What usually happens is they never dream either dream again. I see it as another approach to detoxify the traumatic memory.
CBT stands for Cognitive Behavioral Therapy and is widely taught to social workers and psychologists. It grew out of Behavioral approaches, like reinforcement of positive behaviors, and Cognitive approaches, like following your thinking back to your assumptions and questioning those. It works well for treating Obsessive Compulsive and Anxiety Disorders and is effective with medication for Depression.
In CBT the therapist helps the client examine the problem and the thoughts and behaviors related to that problem. Some therapists are trained to use behavioral desensitization, progressive exposure to the feared object, to reduce fear, avoidance, and obsessive thinking. In my personal experience, this doesn’t work as quickly as EMDR, especially if you’re dealing with bad flashbacks.
It’s important to have your sympathetic nervous system under control before you address your traumatic memories. (see Treatments for HyperArousal). Then if you’re still struggling with recurrent memories, flashbacks, or nightmares, you need to do some kind of Exposure Therapy. The addition of D-Cycloserene, propranolol, or a cannabinoid right before exposure seems to make this process easier.