I previously wrote about understanding the symptoms of PTSD here and learning about how it develops and factors that maintain it here. Today’s focus is how to cope with the cluster of PTSD symptoms called re-experiencing or “intrusive” symptoms.
What are Re-experiencing Symptoms?
Re-experiencing or Intrusive symptoms of PTSD are symptoms where you feel as if you are re-living the trauma or being haunted by the trauma. The memory of the trauma plays out so vividly for you that you feel as if it just happened again. The most intense version of this is when you have a flashback and for awhile you forget that you are safe and you believe you are back in the trauma again. These memories are “intrusive” meaning they pop up and intrude on your day at the worst times. These memories also cause intense emotional and physical reactions, leaving you feeling very upset and very worn out.
Why do we Re-experience the Trauma?
A common complaint with trauma memories is “Why can’t I just forget it” or “Why can’t it be just like any other memory?” Trauma is a horrific, dangerous, abnormal event that is not supposed to fit into our schema of how things in life are supposed to be. The trauma does not “fit,” it is a senseless situation that our minds are trying to make sense of. However, at the time of the trauma you do not have the time, safety, or energy to sit down and think through what is happening, explore your feelings, evaluate what this means to you, and make sense of the whole situation. Because of this, your trauma memory is very disorganized and stays jumbled in your mind. The trauma memory pops into your mind whenever it has a chance in an effort to get you to organize and make sense of it. However, it is very painful, both emotionally and physically, to re-experience the trauma memory and we try to push it away (avoidance), so the memory does not get organized and just keeps intruding.
Many people at this say at this point “But I think about it all the time! Shouldn’t the memory be organized by now?” The key difference here is that often trauma memories playback like a broken record. They keep skipping back to the worst parts, you cringe, and automatically try to shut it down. You don’t actually process it all the way through, beginning, middle, and end.
These re-experiencing symptoms tend to happen more when there is stillness, which is why many trauma survivors try to cope by being busy at all times. Quiet time often feels like the enemy to a trauma survivor.
How to Cope with Re-experiencing Symptoms
Re-experiencing symptoms are very upsetting because your mind goes away from the safety of the present moment to the pain, danger, and fear of the trauma memory. To cope with this, you need skills to bring your mind out of the scary trauma memory and back to the safety of the present moment. (If you are ACTUALLY in a dangerous place, do not try to cope with the memory, and instead, just try to get to safety!)
However, most of the time, we are actually safe, and it is just the memory of the trauma that is unsafe. For example, someone who was sexually assaulted at a party is reminded of her trauma when she sees the party decorations aisle in the store and feels afraid, panicked, and sick. The store she is in is actually safe – nobody is threatening her. But she feels unsafe and afraid because of the trauma memory.
The primary tool used to cope with re-experiencing symptoms is called grounding, which is actually a set of many skills to help pull you away from the danger of the trauma memory and back to the safety of the present moment. Grounding is also very helpful for coping with panic attacks. I will review two types of grounding here: mental grounding and physical grounding.
Many people with PTSD struggle with feeling either too much (overwhelming emotions and memories) or too little (numbing and dissociation) when they are reminded of their trauma. When you are overwhelmed by your symptoms, you need a way to cope so that you can gain control over your feelings and feel safe. Grounding helps you step away from whatever intense emotions and/or memories you are experiencing and brings you back to the safety of the present moment.
What is grounding?
Grounding is a set of simple strategies to help you cope with intense symptoms of PTSD (e.g., flashbacks, nightmares, panic, and rage). You can also think of it as “distraction,” “centering,” or “a safe place.” Distraction works by focusing outward on the external world, rather than focusing inward on upsetting memories, thoughts, or feelings.
Grounding should only be used to get you through the moment when you cannot tolerate the discomfort you are currently in; this tool should not be used on a long-term basis because this can lead to avoidance.
Guidelines for grounding
- Grounding can be done any time, any place, anywhere, and no one has to know.
- Use grounding when you are faced with really intense thoughts, feelings, or memories.
- Keep your eyes open, scan the room, and turn the light on to stay in touch with the present.
- Focus on the present moment, not the past or future.
- Relaxation is NOT the goal of grounding. The point of grounding is to get through a very difficult time safely, not to relax.
2 Ways to Ground Yourself
Two major ways of grounding are described below – mental and physical. “Mental” means focusing your mind; “physical” means focusing on your senses (e.g., touch, hearing, smell). You may find that one type of grounding skill works better for you, or both types may be helpful.
- Describe your surroundings in detail – for example, “The walls are white; there are five pink chairs; there is a wooden bookshelf against the wall…” Describe objects, textures, colors, shapes, and numbers, etc.. You can do this anywhere. For example, on the bus: “I’m on the bus. I’ll see the river soon. Those are the windows. This is the bench. The metal bar is silver. The bus map has four colors.”
- Play a “categories” game with yourself. Try to think of “types of dogs,” “jazz musicians,” “states that begin with ‘A’,” “cars,” “TV shows,” “writers,” “sports,” “songs,” or “cities.”
- Describe an everyday activity in great detail. For example, describe a meal that you cook (e.g., “First I peel the potatoes and cut them into quarters; then I boil the water; then I make an herb marinade of oregano, basil, garlic, and olive oil…”).
- Use an image: Glide along on skates away from your pain; change the TV channel to get to a better show; think of a wall as a buffer between you and your pain.
- Read something, saying each word to yourself. Or read each letter backward so that you focus on the letters and not on the meaning of words.
- Use humor. Think of something funny to jolt yourself out of your mood.
- Count back from 100 by 7 or say the alphabet, very s…l…o…w…l…y.
- Run cool or warm water over your hands.
- Grab tightly onto your chair as hard as you can.
- Notice your body: the weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. You are connected to the world.
- Dig your heels into the floor – literally “grounding” them! Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground.
- Touch various objects around you: a pen, keys, your clothing, the table, the walls. Notice textures, colors, materials, weight, temperature, sounds. Compare objects you touch: Is one colder? Lighter?
- Carry a grounding object in your pocket – a small object (a small rock, clay, a ring, a piece of cloth or yarn) that you can touch whenever you feel triggered.
- Jump up and down.
- Extend your fingers, arms, or legs as far as you can; roll your head around.
- Clench and release your fists.
- Walk slowly, noticing each footstep, saying “left” or “right” with each step.
- Eat something, describing the flavors in detail to yourself.
- Focus on your breathing, noticing each inhale and exhale. Repeat a pleasant word to yourself on each inhale (e.g., a favorite color, or a soothing word such as “safe” or “easy”).
What if grounding does not work?
Grounding can work! But, like any other skill, you need to practice to make it as powerful and effective as possible. Below are suggestions to help make it work for you.
- Practice as often as possible, even when you don’t need it, so that you’ll know it by heart.
- Do not wait until you are distressed to start practicing. The best way to learn a new skill is to start practicing it when we are feeling calm and in a non-stressful state.
- Practice faster. Speeding up the pace gets you focused on the outside world quickly.
- Try grounding for a looooooonnnnngggg time (20-30 minutes). And, repeat, repeat, repeat.
- Try to notice which methods you like best – physical or mental grounding methods, or some combination.
- Create your own methods of grounding. Any method you make up may be worth much more than those you read here, because it’s yours.
- Think about why grounding works. Why might it be that by focusing on the external world, you become more aware of an inner peacefulness? Notice the methods that work for you – why might those be more powerful for you than other methods?
- Make up an index card on which you list your best grounding methods and how long to use them.
- Have others assist you in grounding. Teach friends or family about grounding, so that they can help guide you with it if you become overwhelmed.
- Prepare in advance. Locate places at home, in your car, and at work where you have materials and reminders for grounding.
- Create a recording of a grounding message that you can play when needed. Consider asking your therapist or someone close to you to record it if you prefer.
- Don’t give up! You can practice grounding by listening to recordings. There are many that can be found online or even in apps (I recommend PTSD Coach, which is a free app created by the VA).