Updated: Oct 9, 2022
A couple of years ago, I was lucky enough to play on a new Oculus Rift virtual reality system. As I put the headset on, I found myself transported to a different time and place, all the time while remaining in my living room. The experience of virtual reality was mind blowing the first time I tried it. Although I knew where I was, my brain and my body were reacting directly to the input of the VR system. The experience was 3D and all around me. I could walk through the environment and, using the hand controllers, reach out and interact with the objects in the world I was in. In many ways, it really did feel like I was inside the game.
One experience stood out for me. It was a game (more of an experience) in which I found myself in the position of a base jumper leaping off tall buildings. The graphics were basic but, as I found myself (unexpectedly, at the time) suddenly running to the edge of the building and leaping off, my body responded immediately and, much to my embarrassment and the amusement of those around me, I instinctively pulled back and pulled the VR headset off. I had genuinely panicked, just for a moment, and my heart rate had shot up, even though I KNEW it wasn't real. To my body's threat response system, the experience was indistinguishable from the real thing.
In some ways the experience of VR is analogous to the experience of extreme cognitive fusion. Cognitive fusion is when we become so hooked by our thoughts and feelings that we lose contact with where we are in the present moment. Cognitive fusion is a very normal and is a regular feature of our daily lives. If you have ever fantasised, daydreamed, or found yourself going over an argument you have had, or wished you'd had, then you've experienced cognitive fusion. In those moments we can almost feel like we are in a different time and place, living the experiences in our minds.
A flashback is perhaps one of the most extreme experiences of cognitive fusion. A common experience for people suffering with psychological trauma, such as PTSD, they are more than an intrusive painful memory of a traumatic event. With painful memories, as most people experience them, they are still aware that they are experiencing a memory in the here and now, while the experience of flashback is like being right back there at the moment of the trauma, reliving it.
Flashbacks are fully immersive experiences, including any and all the senses (sight, sound, touch, smell, and taste) and an intense emotional reaction to the threat they faced. Not everyone has a visual memory (with pictures in our minds, as we tend think about memories) but the experience of reliving the moment is key. When a flashback is triggered, we are hooked so tightly by our memory that it becomes all that we are aware of. Like wearing a VR headset, when you are in the midst of flashback the mind and body are responding directly to memory it is experiencing and treating it as though it is really happening here and now. In the same way that I lost contact with the room I was actually standing in, we can lose contact with where we are in the present moment, when experiencing a flashback. We could be in a park, a supermarket, our home, or anywhere, but for the moments when we experience the flashback we experience being back there, fully immersed in our memory. Like the VR experience, but far more so, we could almost reach out and touch the contents of memory. Indeed, it may feel as though we are. And, of course, like my reaction to leaping off a virtual building, while objectively the contents of the memory are not happening in the present, any more than I was really falling off the side of a skyscraper, the distress, and physical reactions to it very much are.
Of course, a flashback is a far more intense experience than any VR experience could be. With the current technology, VR's primary input is visual, while a flashback will often include all our senses making it a visceral experience. But what they have in common is both involve being disconnected with the present moment, losing the awareness of where we are now, and becoming caught up in the content of our experiences. I lost contact with the reality of my living room and the floor beneath my feet and experienced the world in front of my eyes, objectively no more than computer graphics, as real and my body responded accordingly.
Similarly, in a flashback we lose contact with the reality that our painful memories are memories we are having, and instead respond to them as though the content of those memories is really happening here and now. And, because they related to painful, distressing, traumatic experiences that we really have experienced in the past, these intense experiences our minds are generating are often a terrifying (virtual) reality in the present.
So, what can we do? Clearly, it was much easier for me to escape the VR world and come back to the present moment than it is for someone in the middle of a flashback. Nonetheless, some of the principles are the same. When I took off the headset, I was able to instantly widen my attention to reconnect with the world around me. I became aware that I was in my living room, aware of the sights, smells and sensations that come with that, and aware that thankfully I was not falling to my death. I became aware of the ground beneath me, the sense of standing still, and the air around me being still (and not rushing past me).
In other words, my attention was widened to include all the details of the present moment beyond what my mind & body had been hyper focusing on - the visuals of leaping off the building. Interestingly, I could still see the images of the VR experience on a computer monitor on the table next to me, but these were now simply a part of my much wider experience of the present moment - I was no longer cognitively fused with them and could recognise them for the computer graphics they were.
With a flashback our aim is to do something similar. There is no delete button for a painful memory, but we can, with practice, shift our perspective so that we are no longer putting on the headset and becoming immersed in our memory. We can instead allow it to be like the computer game running on a screen in a safe room. We might prefer that it was not there, but it is no longer as immediately threatening to us, and we can redirect ourselves back to what we would prefer to be doing.
How do we do that? We start by acknowledging that we are struggling and experiencing something very painful. Then, we want to use our body, and our attention, to start reconnecting to the here and now. Our aim is to help bring our attention to the present moment and help our minds recognise that it is here, having a memory, and not there, in the memory. We do this by reconnecting with the present moment through our senses. Like taking off the VR headset and noticing the room around us, we can step out of the content of our memories and reconnect with the here and now. It can be useful to carry a sensory prompt, such as handkerchief with a pleasant smell (such as a partner's perfume, for eg), to help you reconnect with the present moment, but is not essential.
The following is a script that you may like to practice. It is based on well-trodden grounding skills but with an emphasis on noticing the memory, and recognising it as such, rather than simply trying to distract from it, which can sometimes lead to it rebounding. It owes much to the exercise known as Dropping Anchor, devised by the ACT therapist Dr Russ Harris.
It may be useful to take a screenshot of the steps so that you have them to hand should you need them. It's also useful to practice the steps regularly so that you can access them more easily if you need them. As they say, it's best not to have to learn to swim in the deep end...
Push your feet into the floor. Notice the sensation of this as you do it.
If you are sat, straighten your back and sit up. Pull your shoulders back and feel the stretch in your body for a moment.
If you are stood up, stand up straight and stretch pull your shoulders back and feel the stretch in your body for a moment.
Shake and wiggle your fingers.
Roll your head and shrug your shoulders.
Acknowledge to yourself that you are having a painful memory.
Name the memory. Say, “I’m noticing I am having a memory of a time when (painful event) happened”
Push your feet back into the ground again. Move your body. Stretch your arms, legs and back. Shrug your shoulders and shake your fingers.
Look around. Notice and name 5 things you can see. Describe them to yourself.
Notice 4 things you can touch. Describe them to yourself.
Notice 3 things you can hear. Describe them to yourself.
Remind yourself that you are having a painful memory of the time the (painful event) happened
Notice that you have the memory AND you can feel your body, AND you can see 5 things around you, AND 4 things you can touch, AND 3 things you can hear.
Notice you have a memory, and there is a body around it, and a room (or place) around you.
Notice that you are safe here and now.
Notice you can choose what you do next here and now.
Repeat until you are able to say you are in control of your actions.
Reconnecting with the present moment is not just useful for dealing with flashbacks. It is a useful skill for all kinds of situations where getting out of own heads and back in to the moment would be helpful. That might be when we are overthinking, worrying, or ruminating or simply when we are distracted and struggling to concentrate or focus on something important or meaningful in the moment, so is definitely worth practicing and applying in our daily lives more widely. And, of course, there is more to addressing trauma, than learning how to effectively respond to flashbacks but nonetheless developing the ability to be less restricted by them can have a profound difference on our quality of life.
Christian Hughes is a Psychotherapist, and former uniformed military mental health clinician, specialising in Acceptance and Commitment Therapy, Compassion Focused Therapy & CBT, with expertise in trauma & PTSD and a special interest in Moral Injury.
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