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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

34

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