An Introduction to Flashbacks, Nightmares, and Intrusive Memories
The next few weeks I’ll focus on another symptom group, Intrusive Symptoms, also called Re-experiencing. These are the prototype symptoms of PTSD and include nightmares, flashbacks, and intrusive memories.
The difference between a flashback and an intrusive memory is simple. In a flashback you’re actually reliving the memory, which means you’ve lost awareness of your current situation. This type of symptom is called DISSOCIATION and is more frequently seen in younger people.
With intrusive memories, you know where and when you are, but the memories keep intruding in your mind.
You may also experience severe emotional or physical distress without the actual memory attached. This often leads to misdiagnosis, as it looks more like an anxiety attack or episode of acute pain.
That said, all of these are examples of traumatic memories that have resurfaced and are seriously interfering with your life, both awake and asleep.
What are Traumatic Memories?
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. But in a truly terrifying situation, the brain regresses to more primitive functioning and grabs sequential snapshots, usually combined with very strong emotions, which it then isolates from your normal memory. I think of a traumatic memory as an emotional abscess, which your brain then walls off in order to protect you.
Traumatic memories are very potent. They contain a lot of negative emotions like terror, rage, shame, and despair, which makes flashbacks and nightmares emotionally overwhelming and disturbing.
Trauma memories don’t deteriorate with time. Our normal memories diminish or even get lost through the years, but if you activate a traumatic memory 50 years later, it recurs with all the same emotional intensity it held when it just happened.
Why do our brains do this? I can only assume this serves some life-preserving function. If you survive the first event, you can draw on this experience and repeat it whenever a similarly dangerous situation occurs. After all, you survived the first time.
Why do you revisit a Traumatic Memory?
Reminders of the trauma, or Triggers, can evoke the release of traumatic memories. Triggers are everywhere. They can be anything your mind sees as similar to the situation where you were traumatized. They cause your brain to retrieve the trauma 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. In fact, we all do this with good memories, hear a song or smell a food that reminds us of a pleasant occurrence in our past.
With traumatic memories, it’s good to learn and keep a list of your own triggers. That can help you to anticipate problems and understand what’s happening when re-experiencing occurs. If you live around someone with PTSD, it’s good to know his or her triggers. That way you won’t unintentionally hurt them. Two-way communication about triggers can be helpful to both parties.
Treating Intrusive Memories:
There are no medications that safely control the re-experiencing of traumatic memories. The treatment approaches that work best all have the same goal:
1) Detoxify the memory
2) Integrate it into the normal memory flow.
To accomplish this feat, you have to work in layers, kind of like peeling off an onion.
Detoxifying means reducing the intensity of affect and pain associated with the memory. It’s a little like letting the pus out of an abscess and significantly reduces the discomfort. There are many approaches to this “letting go” process, and I’ll give more detail in the next blog.
With less affect in the way, you’re better able to examine the memory in detail, including your feelings, physical sensations, and beliefs about its cause, intent, and long-term consequences of the trauma.
This process—detoxifying and reexamining the memory—has to be repeated over and over. (Remember the onion) Each time you work on it, you will make more progress until it can be safely integrated.
Next blog I’ll discuss specific treatment approaches for intrusive symptoms.