coping with the symptoms of post-traumatic stress disorder · this 6-week group aims to teach you...
TRANSCRIPT
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Coping with the symptoms of
Post-Traumatic Stress Disorder
An 8-week coping skills course
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Welcome to the Group
This 6-week group aims to teach you some practical skills to help you cope better with the symptoms of Post-Traumatic Stress Disorder. These skills can help you to feel better over the next few weeks, but will also prepare you for further therapy, if this is appropriate for you. One to one therapy aimed at helping you to process and make sense of your past experiences can be difficult and upsetting at times. The techniques covered in these group sessions should make this process a little easier for you, by giving you some skills to manage anxiety, distress, and re-experiencing symptoms. Think about when you learnt to ride a bike- you probably had stabilisers to help you balance until you became confident. The coping skills covered in these sessions can act like your own personal stabilisers.
Session Outline
Week Topic
1 Introduction to PTSD, how it affects me and how this group can help 2 Managing anxiety and calming down
3 Grounding techniques, coping with dissociation and nightmares
4 Coping with Flashbacks 5 Reclaiming Your Life
6 Self-compassion
7 Practicing self-compassion
8 Recovery plan
Each week there will be a task for you to complete between sessions, to help you try
out the coping skills and find the ones that work best for you. At the end of the 6
weeks, you will leave with a Coping Skills Plan, which you can take with you and use
in the future, setting out the skills that you have found helpful.
After the group finishes, you will each be offered a one to one review with the group
facilitator, to discuss your experience of the group, and options for further therapy.
Your facilitator(s) is/are:
*If you have any questions or concerns, need more support, or would like to talk
about personal issues or experiences, please do speak to your group facilitators,
either before or after the group session, or by telephone on 023 8027 2000 or 0800
612 7000.
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One of the most valuable things about these groups is the support that you can give to each other. To help
everyone feel safe and comfortable, it is helpful for the group to agree some guidelines for the sessions.
We will discuss and agree these as a group, but here are some suggestions below:
Put mobile phones on silent so they do not interrupt the group
Respect others people’s points of view
Listen when others are talking
Please try to be on time, but if you are late do come in and join us
If you are unable to make it to the session, please telephone the office on 023 8027 2000 or 0800 612 7000 to let us know.
Please do not come to the group under the influence of alcohol or drugs
Please keep information shared within the group sessions confidential.
Other rules that the group has agreed:
Sometimes talking in the group can bring up difficult feelings or memories for
people. How shall we manage this together? What do people need from the
facilitator, or each other?
Keeping Safe: Working Together
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If you are feeling very low and need some support between sessions, there are a number of places that you
can turn to:
Contact Steps to Wellbeing- 023 8027 200 (within office hours)
Your GP- you can request an urgent appointment
Telephone 111 for medical or mental health advice if your surgery is closed
Go to A&E if you feel so low and are worried about hurting yourself or someone else
The Samaritans- 08457 90 90 90 for someone to talk to
Think of a friend, partner or family member that you can seek support from
Useful Telephone Numbers:
e.g. my GP surgery
My Personal Safety Plan
Signs that my mood is deteriorating
What steps can I take to manage this? Where can I get support?
Keeping Safe: Support Between Sessions
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Introduction to the group
Coming along to a new group can be daunting, and many people feel anxious. To help everyone start to
settle in, we are going to start with an exercise to help everyone get to know one another.
Divide into groups of two and interview each other using the following questions as a guide. You will have
to present this information back to the group so it will help to write it down.
I would like to introduce ___________________
________________ is the kind of person who likes
1. ____________________________________
2. ____________________________________
3. ____________________________________
_____________ gets annoyed by
1. ________________________________
2. _______________________________
3. ________________________________
Someday ______________________ would like to
1. ____________________________________
2. ___________________________________
3. ____________________________________
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What is Post-Traumatic Stress Disorder?
Other experiences that you may have noticed:
Mood swings Disturbances in sleep and/or appetite Depression Chronic pain Poor attention Headaches Depersonalisation Relationship problems Derealisation Self-medicating with alcohol/drugs Dissociation Changes in beliefs about self, others and the world
Re-experiencing-
flashbacks, nightmares, as if
it's happening again
Hyperarousal- feeling on
edge, wound up, anxious
Avoidance- of places, people,
situations, memories, emotions
PTSD can develop
following a single
traumatic event, or
repeated, prolonged
exposure to
traumatic, dangerous
or distressing
experiences
About 20% of people who
experience trauma go on to
develop PTSD
PTSD is sometimes
thought of as a normal
reaction to an abnormal
event
The symptoms of PTSD such as flashbacks are
linked to the way human memory works.
The symptoms of PTSD can seem strange,
confusing or frightening, but they can be explained
and treated
PTSD used to be
called “shell shock”
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The Role of Avoidance
When faced with something unpleasant or frightening, we naturally want to avoid it.
In the short term, this can help you to side-step painful emotions, such as anxiety.
In the longer term however, avoiding situations, thoughts or emotions can actually
maintain your symptoms.
Avoidance
Prevents you from reality-testing your fears
Maintains inaccurate beliefs or predictions
Means that you do not learn to tolerate or cope with emotions
Lowers your confidence and self-belief
Prevents you from updating or processing your memories
Therefore-
PTSD symptoms such as flashbacks continue
Anxiety remains
When faced with similar situations in the future, you are more likely to use avoidance again, creating a vicious circle
A key part of therapy is reducing avoidance, in a structured, step-by-step way, to
help you to process your trauma memories more completely, to test out your fears
and start to face them, and to develop your coping strategies and belief in your
ability to manage these situations. There is no expectation that you will start to do
this during these group sessions, but it is helpful to be aware of the role that
avoidance plays in maintaining the symptoms of PTSD. Reducing avoidance is an
important part of therapy, and of reclaiming your life from PTSD.
My Experience of Post-Traumatic Stress Disorder
Think about your own experiences, and note down how PTSD affects you day to day.
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Other changes I have noticed
Physical changes- appetite, sleep, health, pain
Activity- what I do, or avoid doing
Emotions- e.g. anxious, sad, angry, ashamed,
Thoughts- how has my thinking changed
Re-experiencing
Hyperarousal
Avoidance
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Coping with PTSD: Week 2
The Fight or Flight Response
When we were evolving and adapting as early humans the threats we faced were very immediate and very
real. We needed to be able to respond quickly and effectively. Those who could survived and reproduced,
so we have inherited the brain mechanism that they had: the fight or flight response.
Imagine you face such a threat: What do you want to do?
Our emotions have a purpose. Our most basic emotions like fear, anger or disgust are vital signals to help
us meet our basic needs for self-preservation and safety. It would be dangerous to be indecisive about a
threat to our survival, so the brain runs information from our senses through the most primitive, reactive
parts of our brain first. These areas of the brain control instinctive responses and they don’t do too much
thinking. This part of our brain communicates with the rest of our brain and our body to create signals we
can’t ignore easily: powerful emotions and symptoms.
The Fight or Flight response is a physiological response triggered when we feel a strong emotion like fear.
Fear is the normal emotion to feel in response to a danger or threat. Fear also has a close relative we call
anxiety. The Fight or Flight response evolved to enable us to react with appropriate actions: to run away, to
fight, (or sometimes freeze to be a less visible target).
But for most of us life isn’t about fighting or escaping predators or enemies anymore. The Fight or Flight
response was designed to deal with life-threatening dangers, but it is much more likely to be triggered by
more complex and subtle concerns:
So it is important to think of this as a normal response, but one which can be triggered too often, by things
which we perceive to be a threat to us. A good analogy is the smoke alarm. A smoke alarm is designed to
alert us to the danger of fire but it cannot distinguish between steam from the shower, burnt toast or a
house fire. While the first two examples are not real threats the third is but the response of the alarm is the
same- and in each case the alarm is difficult to ignore!
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PTSD and the Fight or Flight Response
Just like a smoke alarm being set off by burnt toast, your alarm system can be set off when something in a
situation reminds your brain of a trauma that you’ve experienced. Sometimes you might recognise what set
the alarm off, but sometimes these cues can be so subtle that you cannot identify them. You experience
heightened arousal, alertness, or anxiety, but it can seem like these feelings came out of nowhere.
When the alarm system is triggered, adrenaline is released. Adrenaline is a hormone that acts on the body
to get it ready for action- Fight or Flight.
Adrenaline: getting the body ready for action
Rate of breathing increases, so oxygen levels in the blood increase.
Heart rate increases, the heart beats harder, and blood pressure increases.
Blood flow is diverted from the core (digestive organs) to the periphery (limbs, skin)
Blood vessels near the skin relax, increasing blood flow moving
to the surface, leads to feeling flushed or hot, this in turn leads
to sweating, resulting in dampness and rapid cooling, so there
may be alternating hot and cold.
Digestive system is slowed or switched off.
Rapid ‘Mexican wave’ contractions in digestive system-
churning stomach or butterflies
Increased desire to pee or poo as the body tried to ‘lighten the
load’
Reduced bloodflow to salivary glands leads to dry mouth
Muscles tense up, which can lead to tremors or shaking; neck,
shoulder or chest pain.
Pupils dilate (to increase peripheral vision) but leading to a loss
of focus, ie blurred vision.
Brain function changes, we become more instinctive and less
rational or cognitive
Immune responses decreases.
Sexual response inhibited.
Remember the Amygdala and your brain’s alarm system:
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Strategies for Managing Emotional Arousal
1. Breathing techniques 2. Progressive Muscle Relaxation 3. Visualisation and imagery 4. Listening to music 5. Walking
1. Safe Place Imagery 2. Making a cup of tea 3. Having a bath or shower 4. Massage 5. Pampering 6. Exercise 7. Meditation 8. Reading 9. Music, films, TV
1. Getting enough sleep 2. Regular meals 3. Limit caffeine and alcohol 4. Regular physical activity
My Ideas to Try:
Calming Techniques Self-Soothing Self-Care
Calming Techniques
Self-Soothing
Self-Care
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Breathing
When the Fight or Flight response is triggered, our breathing becomes faster, to help us take in more
oxygen to power our muscles when we run away, or fight off danger. If we are not actually running or
fighting, this can lead to hyperventilation where we take in too much oxygen and feel light-headed.
Controlling and calming your breathing can help to dampen down the physical sensations of anxiety,
prevent hyperventilation, relieve feelings of faintness and light-headedness, release tension in the chest
and stomach areas, relax your body and divert your attention away from the situation that triggered the
anxiety.
Diaphragmatic Breathing
Diaphragmatic breathing is a technique that can be easily learnt and practiced to help reduce these
symptoms and help to rebalance the O2 and CO2 levels in our body. The diaphragm is a large muscle that
sits across the base of the ribcage. It is best to start practising this breathing technique daily so that it
becomes like second nature. Initially when learning this skill, it can be easier to practice lying down, as it
becomes more practised you can try it in a sitting or standing position.
- Place one hand on your chest and one on your stomach. - While you breathe in through your nose, notice your stomach area starting to rise and fall with
the breaths. This means that you are fully inflating your lungs. Try to keep any movement in your chest to a minimum.
- Slowly and steadily breathe out through your nose. - Repeat this cycle and try to fall into a rhythm. We should aim for eight to twelve breaths every
minute. - Breathing in and out equals one breath. - Some people find it helpful to count as they breathe. Try breathing in to a slow count of three,
and breathing out to a count of four, so that the out-breath is slightly longer than the in-breath. - You do not have to “breathe deeply”, just aim for a steady, comfortable rhythm.
As with any new skill, it may be difficult at first. If you find it tricky, just practice breathing in and out for five
seconds. Or you could try imagining that you are gently blowing on a candle flame, so that it flickers but
does not go out.
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Progressive Muscular Relaxation Script
Find yourself a quiet place to relax. Turn off your phone and dim the lights. This is your time...a time for
complete and utter relaxation. For this relaxation, you can either sit or lie down. Just make sure that you
are warm enough, and that you are comfortable. Let your hands rest loosely in your lap, or by your side.
Now close your eyes.
Become aware of your breathing, and notice how your abdomen rises and falls with each breath...
Now take a long slow deep breath in through your nose, all the way down into your stomach. Hold the
breath for just a moment, and then exhale through your mouth. Allow your breath to carry away all stress
and tension as the air floods out of your lungs.
Take another slow breath in through your nose. Fill your lungs completely. Hold it for a moment...and
release the breath through your mouth. Empty your lungs completely.
Take a third deep breath in. Hold it for a moment, and then let it go.
Feel that your body has already undergone a change. The tension in your body has begun to loosen and
subside. Now let your breathing rhythm return to normal...and relax....
During this relaxation I will ask you to tense various muscles throughout your body. Please do this without
straining. You do not need to exert yourself, just contract each muscle firmly but gently as you breathe in. If
you feel uncomfortable at any time, you can simply relax and breathe normally.
Bring your awareness to your feet and toes. Breathe in deeply through your nose, and as you do, gradually
curl your toes down and tense the muscles in the soles of your feet. Hold your breath for just a few seconds
and then release the muscles in your feet as you breathe out. Feel the tension in your feet wash away as
you exhale. Notice how different your feet feel when tensed and when they are relaxed.
Take another deep breath in again, tense the muscles in the soles of your feet and hold this position for a
few seconds. Now release. Feel yourself relaxing more and more deeply with each breath. Your whole body
is becoming heavier, softer and more relaxed as each moment passes.
Now bring your awareness to your lower legs...to your calf muscles. As you draw in a nice deep breath,
point your toes up towards your knees and tighten these muscles. Hold for just a moment, and then let
those muscles go limp as you exhale.
Once again, draw in a deep breath...and tighten your calf muscles. Hold for a few seconds, and then let it all
go. Feel your muscles relax, and feel the tension washing away with your out-breath.
In a moment you will tense the muscles in the front of your thighs. If you are lying down, you can do this by
trying to straighten your legs. You’ll feel the muscles pulling your kneecap upwards. If you are seated, you
can tense these muscles by pushing your heels down onto the floor.
Take a deep breath in, and tense the muscles in your thighs. Hold for just a moment, and then release
everything. As you do this, the blood flow to your muscles increases, and you may notice a warm tingling
sensation. Enjoy this feeling of soothing relaxation in your thighs.
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Again, breathe in deeply and tighten your thigh muscles. Hold for a moment. Now release. Focus on letting
your muscles go limp and loose.
Draw in a nice deep breath and gradually tighten the muscles in your buttocks. Hold this contraction for a
few seconds, and then release your breath. Feel the tension leaving your muscles. Feel them relaxing
completely.
Once more, breathe in deeply and tighten the muscles in your buttocks. Hold for a moment. Now release
them. You are becoming more and more deeply relaxed.
Take another breath, and this time, gradually tighten all the muscles in your legs, from your feet to your
buttocks. Do this in whatever way feels natural and comfortable to you. Hold it...and now release all these
large strong muscles. Enjoy the sensation of release as you become even more deeply relaxed.
Now bring your awareness to your stomach. Draw in a nice deep breath and then tighten these muscles.
Imagine you are trying to touch your belly button to your spine. Now release your breath and let your
muscles relax. Notice the sensation of relief that comes from letting go.
Once again, draw in a deep breath and then tighten your stomach muscles. Hold for a few seconds... and
then let them relax as you exhale and release all tension.
Bring your awareness to the muscles in your back. As you slowly breathe in, arch your back slightly and
tighten these muscles....Now release your breath and let your muscles relax.
Again, draw in a deep breath and then tighten your back muscles. Hold for a few seconds...and then let
them relax and release.
Now give your attention to your shoulder muscles and the muscles in your neck. As you slowly draw in a
nice deep breath, pull your shoulders up towards your ears and squeeze these muscles firmly. Now breathe
out completely, and allow your contracted muscles to go loose and limp.
Again, pull your shoulders up towards your ears and squeeze these muscles firmly. Now feel the tension
subside as you relax and breathe out. Feel the heaviness in your body now. Enjoy the feeling. Feel yourself
becoming heavier and heavier. Feel yourself becoming more and more deeply relaxed. You are calm,
secure, at peace.
Now it’s time to let go of all the tension in your arms and hands. Let’s start with your upper arms.
As you breathe in, raise your wrists towards your shoulders and tighten the muscles in your upper arms.
Hold that breath and that contraction for just a moment...and then gently lower your arms and breathe all
the way out.
You may feel a warm, burning sensation in your muscles when you tighten them. Feel how relaxing it is to
release that tightness and to breathe away all tension.
As you curl your upper arms again, tighten the muscles as you breathe in. Breathe in deeply. Now relax
your arms and breathe out.
Now bring your awareness to your forearms. As you breathe in, curl your hands inwards as though you are
trying to touch the inside of your elbows with your fingertips. Now feel the tension subside as you relax and
breathe out.
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Again, take a deep breath in, and tighten the muscles in your forearms. Hold it for a moment, and then
release them. Feel the tension washing away.
Now, take another breath in and tightly clench your fists. When you have finished breathing in, hold for just
a few seconds, and then release. Notice any feelings of buzzing or throbbing. Your hands are becoming very
soft and relaxed.
Take another deep breath in and clench your fists again. Hold for just a few seconds, and then release. Let
your fingers go limp.
Your arms and hands are feeling heavy and relaxed.
Take a couple of nice long slow breaths now, and just relax. Feel yourself slipping even deeper into a state
of complete rest.
Now tighten the muscles in your face by squeezing your eyes shut and clenching your lips together. As you
do, breathe in fully. Hold it...now breathe out and relax all your facial muscles. Feel your face softening.
Once more, breathe in deeply while you scrunch the muscles in your eyes and lips....and release.
Now bring your awareness to the muscles in your jaw. Take a deep breath in, and then open your mouth as
wide as you can. Feel your jaw muscles stretching and tightening. Now exhale and allow your mouth to
gently close.
Again, fill your lungs with air and then open your mouth wide. Now let your mouth relax and let your
breath flood all the way out.
You are now completely relaxed from the tips of your toes to the top of your head.
Please take a few more minutes to rest. Relax. Listen to the sound of your breathing and enjoy the lovely,
warm sensation of physical relaxation
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Week 3: Grounding Techniques
Grounding techniques are another way of bringing yourself back to the present if you are experiencing a
flashback, if things start to feel unreal or if you wake up from a nightmare.
You can ground yourself in the present in many ways, such as by using an object, a picture or phrase. It is a
good idea to have a grounding tool for each of the 5 senses, because trauma memories are often sensory
memories, such as a smell that you remember from the past.
Examples of Grounding Tools:
Grounding Objects to Touch
Pebble Stress ball Crystal Ribbon or fabric Piece of jewellery Marbles Small toy or keepsake Stroke a pet
Grounding Smells
Scented oils e.g. lavender Perfume Coffee beans or tea bags Fresh oranges Sweets or chocolate Olbas oil or tiger balm
Grounding Tastes
Fisherman’s Friends Chocolates Extra Strong Mints Strong tea
Grounding Words and Phrases
My name is ____ I am here in Southampton It is the year ____ Facts such as where you work Describe the room you are in Lists – alphabet of animals, things that are green
Listen to the radio
Grounding Sights
Important photos Describe what you can see around you
Look at grounding objects
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Coping with Dissociation
What is dissociation?
Dissociation is being disconnected from the present, from the here and now. It happens to everyone at times- think about driving on autopilot and not remembering part of the journey. But sometimes dissociation can develop following traumatic experiences, as a way of the mind detaching from what is happening, to avoid painful emotions and memories.
Signs of Dissociation
Staring blankly into space, perhaps losing time
Feeling detached from reality, or the world feeling unreal
Feeling spaced out
Out of body experiences
Feeling as though you are not real, loss of sense of self
Coping with Dissociation
Label it- “This is dissociation”. Remind yourself- “I can handle it”
Try to recognise any signs that you may be starting to dissociate
Develop and use grounding techniques
Explain to friends and family, and ask them to help to ground you by prompting you to describe your surroundings, or saying your grounding phrases to you
Grounding Yourself in the Present: Focussing Your Attention on Your Surroundings
Look round you and describe the following:
4 things I can see (table, chair, carpet, window)
4 things I can hear (traffic, air conditioning, radio, talking)
4 things I can feel (carpet, trousers, chair, warmth)
3 things I can see….
3 things I can hear…..
3 things I can feel….
2 things I can see…..hear…..feel
1 things I can see….hear….feel
Develop your own Grounding Techniques-
Collect together a set of grounding objects, including scents and tastes. Write grounding phrases, and
complete the Flashback Halting Protocol. Keep these with you to use whenever you experience flashbacks,
keep some by your bed if you have nightmares. Write a list of your techniques here:
Tip-experiment with different
grounding techniques to see
which ones work best for you.
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My Grounding Techniques
Coping with Nightmares
During one to one therapy, your therapist can help you to process your trauma memories, leading to fewer
disturbed nights. They may also use techniques to help you to change the images in your nightmares,
making them less frightening, and giving you some control over them. In the meantime, these strategies
could help you to cope with them.
Before bed-
- Developing a calming bedtime routine to help you relax - Remind yourself that you are in a safe place, and use calming breathing if you are anxious - Cut down on caffeine, and avoid TV, computer, tablets and phones for 1 hour before bed - Make sure you have your grounding objects to hand
Your Bedroom-
- If your bedroom reminds you of your traumatic experiences in some way to alter it, to help your brain to tell the difference between then and now
- Ideas- move the furniture around, buy a nightlight, play relaxation music whilst getting ready for bed, wear certain pyjamas, choose a distinctive bed cover
If you wake up from a nightmare-
- Switch on a bedside light - Use your grounding techniques- say grounding phrases, hold objects - Drink cold water - Use relaxation - Use Safe Place Imagery - Some people find it helpful to read for a while, or get up and splash cold water on their face
- Try to avoid stimulants such as TV, nicotine and caffeine
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Imagery Techniques for Coping with Nightmares
Images are very powerful, and can be associated with strong emotional reactions. You can
learn to use imagery to help you to cope with distressing images that form part of nightmares
or dreams. Read through the list of imagery manipulation techniques below and choose one
to try out. It can be helpful to practice with a neutral image to begin with.
Imagine your chosen image on a TV screen. Change the TV from colour to black and
white. Turn down the volume, or imagine using the remote control to change the channel away from
the image. Alternatively, imagine the image moving away from you, getting smaller and smaller until it
disappears.
Picture the image on a wall in front of you. Imagine getting a big brush and pot of paint,
and painting over it. You can paint it any colour you like.
Some people find it helpful to change the image to make it funny or absurd in some
way, for example by picturing something silly or impossible, to make the image less scary or unpleasant
for you.
You can change the ending of your dream to something that feels better for you. For
example, if you always wake up at a particular point in the dream or nightmare, rehearse the story
while you are awake, and continue the story on in a way that feels ok for you. For example, you could
imagine someone coming in to help you, or imagine you doing something different and resolving the
situation. In this new story, you want to make it less frightening or upsetting for you. It can be as
fanciful as you like, it’s your story. Practice this while you are awake and calm, and run through it
before you go to sleep at night. This can help to change the story within your dreams.
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Week 4: Coping with Flashbacks
A Flashback occurs when a person re-experiences a trauma memory- feeling or acting as though it is
happening again. For example, a soldier who has returned from a war zone may hear the bang of a
firework, and react as if it is a gunshot, dropping to the ground or reaching for a weapon. Physical
sensations that were felt at the time of the trauma may be felt again, and emotions connected with the
original event may be experienced again in the present.
Flashbacks are triggered by some kind of reminder of the traumatic event. This could be a place, sound, or
smell, or something more subtle like a colour or lighting level. Information from your senses (sight, smell,
touch, sound) has a quick link to your brain’s alarm system, so the “fight or flight” response may kick in.
Memories of what happened at the time of the traumatic event (s) are triggered. These memories are
different from other memories because they were not fully processed at the time that the event (s) took
place, and have a “here and now” quality about them.
There are two sets of skills that can help you to manage flashbacks: Grounding Techniques and Spot the
Difference
Knowing your flashback triggers and practicing “Spot the Difference” can help you to remain anchored in
the present, and help your brain to recognise the difference between past memories and the present
situation.
Step 1: Keep a diary to record your flashbacks, and identify what triggers them
Step 2: Complete a Then and Now card and read it thoroughly
Step 3: If you know you are going to be faced with one of your triggers, read your Then and Now card
beforehand, and make sure you keep it with you to re-read if necessary.
“Spot the Difference”
Discriminating between Then and Now
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Spot the Difference: Then and Now card
Then: describe the past situation- time, day, season, people present. List what can you see, hear, feel, smell, and your emotions
Now- next to each item in the previous column, write down what is different about the present situation
Spot the Difference: Then and Now card
Then: describe the past situation- time, day, season, people present. List what can you see, hear, feel, smell, and your emotions
Now- next to each item in the previous column, write down what is different about the present situation
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Spot the Difference: Then and Now card
Then: describe the past situation- time, day, season, people present. List what can you see, hear, feel, smell, and your emotions
Now- next to each item in the previous column, write down what is different about the present situation
Spot the Difference: Then and Now card
Then: describe the past situation- time, day, season, people present. List what can you see, hear, feel, smell, and your emotions
Now- next to each item in the previous column, write down what is different about the present situation
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Flashback Halting Protocol (adapted from Rothschild 2000)
Right now I am feeling…….(describe your emotions e.g. scared)
In my body I am sensing….(describe sensations e.g. pounding heart, shaky)
I feel this because I am remembering….(name traumatic event(s) without detail)
At the same time, I am looking around where I am now in (YEAR) and (PLACE)
And I can see….(describe what you can see)
And so I know (NAME of traumatic event(s)) is not happening again now.
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Trigger Diary- the aim of this diary is to better understand your trigger situations, so that you can create Then and Now cards to help you manage these triggers
Date and Time
Trigger Situation- describe in detail What, where, when, who
Intrusive memory, flashback, nightmare
Rate sense of “nowness”0-10
Rate distress 0-10
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Date and Time
Trigger Situation- describe in detail What, where, when, who
Intrusive memory, flashback, nightmare
Rate sense of “nowness”0-10
Rate distress 0-10
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People who experience PTSD often report feeling locked in the past and have a sense that the
trauma has stopped their life moving forward. They can feel stuck and seem unable to resume
their former life or start a new one. This can leave to further feelings of feeling disconnected from
your former self, not knowing who you are anymore. You can also feel your previous life goals no
longer matter or are unattainable to you.
A key part of therapy for PTSD is referred to as “Reclaiming your Life”. This involves thinking
about the way in which your life has changed since you experienced the traumatic event (s)- which
activities or situations are you avoiding? What would have to change for you to feel as though you
are moving on? Starting to make these changes can help you start to move on from what
happened, to feel less “stuck”, or as though your life is “on Hold”. This process also helps to break
the vicious cycle described below, where loss of beneficial activates leads to lower mood, and also
helps to tackle avoidance, which maintains your anxiety by preventing you from testing out your
fears and learning to overcome them.
Week 5: Reclaiming your life from trauma
This week, we will help you:
Step 1: Identify areas of your life you have withdrawn from significant activities or
relationships in response to the trauma.
Step 2: identify the beliefs which have support your withdrawal
Step 3: Action Plan: Develop a step by step realistic action plan to help you re-engage with
activities and people who matter to you.
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An Example of how to reclaim your life:
Step 1: The vicious cycle:
Because the trauma has had such a big influence on your life, it can become the only lens through which
you look at life. Though you might recall pleasures and achievements from before the incident, you
probably only do so briefly and just long enough to dwell on what you have lost as a consequence of the
trauma.
The first step forward is to recognise that you are using a trauma lens, then to stand back and instead see
the bigger picture.
On the next page is a worksheet which will prompt you to think about this. You can also spend some time
looking at old photographs, memorabilia or writing a journal about your pleasures and achievements
before the trauma. All of this will help you in your action plan to reclaim your life back.
Belief due to trauma:
“Nobody cares about me anymore”
Emotions:
Sad, Angry
Behaviours/response to thought
Cry
Stay in bedroom
Ignore text messages/calls
Cancel/avoid friends
less self care
sleep more
sk
Physical Symptoms
Tearful
Low motivation
Tired
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To start Reclaiming Your Life, think about the following:
What things have I stopped doing that I used to enjoy or find beneficial?
Are there any new things that I would like to try or start doing?
If my PTSD symptoms disappeared tomorrow, what would I like my life to look like?
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Step 2: Identify the beliefs which have supported your withdrawal.
PTSD can bring with it negativity in terms of how you view yourself, others and the world around
you.
For example you might think
“I should be over
this by now”
“I don’t know who I
am anymore” “People don’t
understand me”
“Everyone will let
me down/hurt me” “The world is unsafe”
“I may lose control”
These beliefs can keep you feeling stuck and prevent you from moving forward and reclaiming
your life back. Plus whenever your mood dips you will have greater access to the memory of
the incident and it will seem more vivid and real.
It is therefore important to take the sting out of your negativity as quickly as possible; the
longer you pick at or ruminate about these thoughts, the more difficult it will be to see a
different perspective.
By re-engaging in activities you enjoy, are important or valuable to you, will not only help
change your perspective and stop you looking through the trauma lens. It will also help
improve your mood and help you re-engage in life again. It will also help you challenge these
thoughts and help you believe less and less.
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Weekly Activity Planner
Activities are much more likely to happen if you plan them in advance. Getting into
a routine can really help too!
Rate each activity 0-10 for M = Mood, P = Pleasure, A = Achievement
Days of the Week
Time of Day Saturday Sunday Monday Tuesday Wednesday Thursday Friday
Morning
Afternoon
Evening
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Week 6- Developing Self-Compassion
So far the course has covered the effects trauma can have and some useful
management techniques. We know that when we are traumatized we have a threat-
focused mind. One reason we develop PTSD is because we struggle to regulate or
calm our threat focused minds, so we live in a state of ‘current threat’
Over the next two weeks we will look at how to develop and use self-compassion to
help us regulate and move forward in our day to day lives.
Compassion can be defined as:
“a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent
it." (https://compassionatemind.co.uk)
“a sensitivity to suffering in self and others with a commitment to try to alleviate
and prevent it." (https://compassionatemind.co.uk)
Question 1: If you were do show compassion to someone in distress,
how would you show it? What would you do? How would you act and
behave towards them? What words would you use? What would you
say?
Question 2: What impact would your words and the actions that you
have identified above have on the person and their level of distress?
Question 3: Does showing others compassion, when they are
distressed, help reduce distress? Is compassion effective?
Question 4: How do you respond to yourself when you are distressed?
Do you treat yourself the same way you would treat someone you care
about?
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Our mind-set is important!
We all know what it is like to be in different states of mind; calm, angry, scared,
happy, frustrated. Our mind-set determines how we think, feel and act.
In order develop self-compassion we need to understand our mind-sets, in
particular the threat-focused mind-set.
Understanding the threat focused mind: Work through each area of the above circle
and apply to yourself when you are in a situation or your facilitators may want to
work through a specific example with you.
Ask yourself:
1: Attention: What do we tend to focus on when anxious?
2: Thinking Reasoning: If we are anxious in a situation are we imagining how well
we will perform? How well the situation will go? Or are we imagining the worst case
scenarios?
3: Behaviour: how to we behave? Do we tend to avoid anything we see as a threat?
Do we convince ourselves that the worst case scenario will happen and so act
accordingly?
4: Emotions: what mix of emotions do we experience in a threatened mind-set?
5: Motivation: what are the basic desires, wants and wishes of an anxious mind?
When anxious we are motivated to reduce the anxiety or threat as quickly as
possible. This is the way our brains were built and is no fault of our own.
Threat
Attention
Imagery/
fantasy
Emotions
Behaviour
Thinking
Reasoning
Motivation Taken from D Lee, the
compassionate mind approach
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6 : Imagery/fantasy: when anxious our imagination is threat based. We can have
fleeting images or memories of previous anxiety or premonitions about future
threats.
The compassionate mind
The compassionate mind is not a critical mind like the threat focused mind. The
compassionate mind is based on understanding and caring, which is more likely to
activate the soothing system, which was talked about in previous weeks.
So how can we bring ourselves in to this mindset? Let’s look at those circles once
more.
1: Attention: our compassionate mind will turn its attention to helpful, supportive
memories with a positive focus.
2: Thinking Reasoning: Our brain acknowledges the suffering and trauma we have
experienced and understand why we may feel this way.
3: Behaviour: Our brain helps us to work out and take actions that are in our best
interest and also the best interest of others. We might call for courage to deal with
the things that frighten us or find difficult right now. We might look at how we are
currently responding to the trauma and the symptoms, understand why we feel this
way and support ourselves in practical ways to help us feel calm and supported.
Compassion
Thinking
Reasoning
Attention
Imagery/
fantasy
Behaviour
Motivation Emotions
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4: Emotions: The emotions linked to this mindset are linked to feelings of warmth,
support, kindness and connection. Over the next 2 weeks we will share with you
some guided exercises to support this.
NB: developing self-compassion will not rid you of your fears but it will help you to
cope with negative emotions better.
Skills we have already covered that will help you build your
compassionate mindset:
1: safe place imagery
2: soothing Rhythm Breathing
3: grounding techniques’
4: Self soothing Behaviours
Out of all of our 5 senses smell has the fastest
route to our brains. For example: we often
smell danger before we can see it. Smells are
also good triggers for emotional memories
(good and bad). So a smell can quickly
trigger our threat system if we smell
something linked to our trauma. We can use
smell to help us build our compassionate
mind set and train your mind to associate
feeling soothed and calm with a particular
smell.
Try using your chosen smell next time you
carry out safe place imagery or a breathing
exercise
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Week 7: Developing the compassionate mind:
As humans, we tend to be hard on ourselves
We are often compassionate to other people, but critical of ourselves
People who have experienced trauma often have negative thoughts about themselves, believing that they have been damaged, contaminated, that they have changed as a person or that others will judge or criticise them. These thought bring about feelings of guilt, shame and low mood.
When you are having a difficult time, you need support and encouragement to get through it
However, people who have experienced trauma often judge themselves harshly, reporting self –critical thoughts such as “I am not the person I used to be”, “I should be over it by now”, “I am weak”.
These thoughts affect your emotions and behaviour
Learning to be more compassionate towards yourself can help you in your recovery
Compare the Critical Voice and the Compassionate Voice
Critical Voice Compassionate Voice Examples- What would it be like to experience this?
Examples- What would it be like to experience this?
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Practicing Self-Compassion
Notice your inner self-critical voice over the week. Note down the things that it says to you. Notice the
tone of this voice- is it judging, cold, angry? Practice writing down compassionate responses to these
criticisms- this is difficult to begin with so keep practicing. Imagine a trusted and kind friend, family
member or colleague. It could be someone you know now, or knew in the past, or someone from this
group. If you have trouble thinking of someone, you could use a famous person, character or religious
figure, who you believe to be kind, compassionate, fair and gentle.
Critical Voice Compassionate Response e.g. “I should have been more assertive”
“I was scared, I was caught unawares and didn’t have time to think it through. My fight/flight response kicked in to try and protect me. It is easy to look back now and wish things had been different, but this will just make me feel worse. Most people in my position would have done the same, it is not my fault”.
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Critical Voice Compassionate Response
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Week 8: My Coping Skills Plan
You have now completed the Coping with PTSD group. Please take some time to think about what
you have learnt from the sessions, and which skills you need to take with you.
What have I learnt about PTSD, and about my own symptoms?
What changes have I made since I started coming to this group?
My Relaxation Strategies My Grounding Techniques
My Self-care Activities My Self-Compassionate Statements
Other Techniques that I have found Helpful How I can start to Reclaim My Life