Hi everyone, so I'm back in the fifth episode of this trauma series and today I'm mostly going to be talking about PTSD symptoms and how to manage them. Before I talk about that, I think it's very important to say that broadly speaking, not everybody has trauma memories that present themselves in that way.

Many people have traumatic experiences that don't manifest in PTSD, of course. Although PTSD is much more prevalent than what I think people generally realise. But a lot of people have traumatic memories which remain very shut down and locked away. And that, of course, is really the brain's way of kind of saying that you're not ready to necessarily engage with that.

We have a saying in trauma therapy, you've got to feel it to heal it, and that's very true. There are lots and lots of ways in which people can keep trauma suppressed and locked away. So I've seen people very focused on parenting, for example, or people who are workaholics. Or people who exercise in very extreme ways. Those are some very common ways.

Now please don't hear that it, especially if you are a long distance runner or a very engaged parent or a hard worker that you are necessarily a traumatised person and don’t realise it. That's not what I mean. What I mean is that these are ways in which one can sometimes keep trauma from the past at bay.

And as I said, it's a way of the brain saying, you're not ready. But, sometimes, PTSD symptoms can suddenly reveal themselves from the past. Sometimes many years later. Not always, of course, and often in that kind of situation, there's a more recent event or a difficult event or perhaps a traumatic event, typically which picks up themes from past traumas, and then I call those the barn door memories. That's where, the barn doors are blown open and one starts to get flooded with traumatic memories from the past.

Hopefully that won't happen to you because it can be quite disturbing and distressing for that person. And I spend a lot of time in the early sessions of therapy just trying to reassure people that actually, that's just your brain's way of saying, look, I think you're resilient enough now to cope with this and to deal with this. I think you're ready to engage with your story and come to terms with the ghosts of the past.

But of course it doesn't feel like that. Because when we have a flashback, we can get this real sense of nowness, this visceral, physiological experience, which takes us back there and almost retraumatizes us again.

We might feel frozen and stuck and powerless. We are very likely to dissociate. We've talked about dissociation in my CBT series, in more depth, but where there is trauma there is dissociation. It's not a taboo here, it's not something to fear talking about. It's very important to understand, though.

And if we then become dissociated, we become disconnected from others and from ourselves. And that can impact further on this sense of aloneness. And that is not a great combination together with this sense of nowness about the traumatic event we've just re-experienced or revisited in our mind. So what to do if they do arise?

Let's start with flashbacks, because that's the, probably the most common sign. Now, we've talked about what a flashback is, but essentially it's a reliving of a past event once reminded of it, which has this sense of nowness this visceral sense of this is terrifying now. The first thing to do is to just to notice it, to try to step back from it, and say to yourself, this is not happening now.

I am safe. This is from the past. This is my brain trying to remind me what needs healing. It's trying to lead me towards healing. It's trying to be helpful. I think that's a really important thing to, to say first of all, and next thing I would encourage you to do is to ground yourself.

We've talked about this again in the dissociation audio in the CBT series, but I would encourage the 5, 4, 3, 2, 1 exercise. Which is trying to stimulate the senses, so Five things you can see. Four things you can touch. Three things you can hear -outside is best because you have to strain to hear it, it can bring you further back into your body.

Two things you can smell. Go with safe smells. I often tell my clients to carry a cloth or a rag with a safe smell on it around with them in case they have a flashback. Just take deep lungfuls of that safe smell. Smell goes straight to the back of the brain and it's very effective at grounding us and bringing us back to the here and now.

And some people go with one positive thing about yourself personally I've never liked that. I go with one reason why you're doing what you're doing right now: ah, yes I was on my way to the kitchen to make a cup of tea and then I was reminded of something and I went into sort of a flashback and I froze. It just brings us back into what we were doing. I personally prefer that, but really you can add whatever you want there within reason.

There are other ways of grounding ourselves. Heavy exercise is excellent, but that might not always be practical - to go for a long run or a bike ride. So this, the mammalian dive reflex I talked about in that dissociation audio, where just a very quick way of bringing yourself back a bit, is to pour a sink full of really cold water, and just submerge your face intermittently into this cold water. And the receptors on the end of your nose will trick your brain into thinking that you've dived underwater and the oxygen will get shunted to your core and your blood pressure will drop and hopefully should should shock your body into a state of calm, calmness or certainly calmer than what you were whilst you were having the flashback.  Failing that, a cold shower can be effective too. Try those if you have a flashback.

Equally another common symptom of PTSD is to have nightmares. Really that's best addressed in trauma therapy. You can, if there's, particularly if there's a troublesome nightmare, there's such a thing as nightmare re-scripting. But that's best done with a therapist. And where you, we can literally learn to alter the course of that nightmare. And people often talk about that being very effective.

I'd say the best thing for nightmares is to ensure you do everything around sleep hygiene to make sure you're getting deep, good quality sleep. You're less likely to enter the stages of sleep where you're more likely to have a nightmare. So those are just some simple, basic things that you can do to try and bring yourself back into the here and now to feel less distressed by that reliving of that event from the past.

I hope that's helped.