Don’s Story

Don came in and reported that he thought his mother might have sexually abused him when he was younger. His mother had recently died of cancer, and he had tremendous difficulty reconciling these memories of abuse with his sadness about his mother’s death and his many positive memories of her. He also had experienced frequent emotional abuse by his father, who had often told him he was worthless and incompetent and would never amount to anything. Although he had worked through many of his difficulties in therapy, had improved his relationships with others, and was happy with his job, he frequently experienced intrusive thoughts and memories related to the possible sexual abuse and the things his father used to say to him. Brief images and memories would flash through his mind, he would feel guilty for even having these memories in the first place (as if it were marring the memory of his mother), and then he would experience a flood of thoughts similar to the things his father used to say to him (such as You’re an idiot! Why do you keep harping on that stuff? What’s wrong with you?). These experiences not only were incredibly painful and upsetting, but also made it very hard for him to focus on work or on any pleasurable activity in which he was engaged, such as movies or tennis with friends. As a result, he needed to learn new ways to manage and cope with these intrusive thoughts and memories.

Nightmares are another very common symptom that develops after a traumatic event. Nightmares can have a tremendously negative impact on your sleep and anxiety levels (Spoormaker and Montgomery 2008). The exact cause of nightmares is unclear; however, some people think that difficulty with regulating emotions during the day may contribute to the experience of nightmares (Levin and Nielsen 2009). It could be that your brain is trying to process or deal with emotions you haven’t been able to work through during the day. Therefore, by learning ways to better regulate your emotions and reduce vulnerability to distress, you may be able to reduce the frequency of your nightmares.

In contrast with nightmares, flashbacks occur when a person is awake and feels as though a traumatic event were happening again. Sometimes, a person might act out a traumatic event as if it were happening right then. As if it weren’t bad enough to experience the trauma in the first place, your brain sometimes makes you live through it all over again. The severity of a flashback varies, ranging from being caught up in thoughts or memories (kind of like daydreaming) to being completely unaware of surroundings and losing track of time (sometimes referred to as dissociation). During a flashback, people sometimes hallucinate. Regardless of the severity of a flashback, it can be a very frightening experience. People with this problem may feel disconnected from the present moment and may also have difficulties bringing themselves out of a flashback if one is occurring, increasing their anxiety and fear.

Just as all these experiences (intrusive thoughts, flashbacks, and nightmares) have something in common (they’re intrusive), the types of skills you can use to manage them are all pretty much the same. Mindfulness skills are perhaps the very first line of defense in dealing with intrusive experiences. In all of these experiences, your brain brings upsetting past experiences (intrusive thoughts and memories, flashbacks, or nightmares) or upsetting experiences generated in your imagination (nightmares) into the present moment. Therefore, one remedy for these symptoms is to yank your mind into the real, present moment. If you can focus your attention on the present moment, especially things that are outside of your body, it will be harder for the intrusive thoughts or memories to consume and overwhelm you. When you’re experiencing a flashback, as real as it may seem, the events really are not happening right now. If you get your mind focused on what really is happening in the here and now, you might find that you are better able to ride out the flashback until it ends. With nightmares, you might wake up in a cold (or hot) sweat and find yourself doing things that you don’t intend or want to do. In these cases as well, paying attention to exactly what is happening in the here and now can calm your mind, help to reduce the storm of upsetting emotions that follow the nightmare, and anchor you in the present moment. Similarly, with intrusive thoughts, if you get the spotlight of your attention out of your head and into what you are experiencing or doing in the present moment, you might take some of the power out of those thoughts. You might also notice that you are free to do whatever you want, despite them.

Now, when you practice mindfulness, you can focus either on internal experiences, such as bodily sensations, emotions, and thoughts, or on external experiences, like sights, sounds, and tactile sensations. When it comes to upsetting, intrusive experiences, we have found that the best way to start with mindfulness is to focus on external experiences. Sometimes the storm of internal bodily arousal, thoughts, images, and sensations is simply too much to manage in the moment when you are experiencing a nightmare or flashback. The best way to get grounded in the present is to pay attention to your external environment and external physical sensations.

The following exercise will take you through some step-­by-­step practice in observing, describing, and participating in the face of intrusive experiences. For each step, you start by just noticing your experiences and then move on to describing these experiences, and afterward we take you through ways to throw yourself into the present moment by immersing yourself in your activities. We hope that you find these to be helpful ways to manage distressing intrusive experiences.

Exercise 7.1 Notice and Describe Your Experiences, and Immerse Yourself in Your Activities

1. Do a reality check. Notice when you are either in the middle of a flashback or a bunch of intrusive thoughts or memories, or you have awakened from a nightmare (or even when you have awakened in the morning upset after a night of nightmares). Step back and observe, and clearly state the problem. Here is an example of the problem stated clearly:

I have just been having a flashback or intrusive thoughts about...

I have been having nightmares about...

If you are in a flashback, remind yourself that whatever seems to be happening is not really happening. If you had a nightmare, tell yourself that the nightmare was just a nightmare and is not actually happening. If you are having intrusive thoughts, tell yourself These are just thoughts; a thought is just a thought. If you briefly write or describe to yourself exactly what is happening, this might serve as a reality check for you.

2. Notice your experiences and describe how you feel. Make sure that the lights are on in the room you’re in. Start by sitting up in an alert position, with your feet on the ground. During this exercise, if your mind wanders, that’s perfectly okay; that’s what minds do. Just keep returning your attention again and again to whatever you’re observing. That’s the whole practice of mindfulness. Do this practice for about five to twenty minutes, or as long as it takes for you to feel a bit more grounded in the present moment.

a. Step back and pay attention, and then describe how you feel. Bring your attention to the sensations of your feet on the ground or floor. Simply notice what the bottoms of your feet feel like. Notice any sensations of pressure, temperature, pain, tension, or relaxation. Notice what the surface of the insides of your shoes or the surface of the floor or ground feels like. Bring your mind to the feeling of your bottom on whatever you’re sitting on. Simply notice any sensations of sitting. Remind yourself that you are here, right now, in the present, sitting in a room (or outside as the case may be), and that you are now free of the nightmare or that the flashback is just a flashback, not reality. Now, put your hands on your knees and notice the sensations in the palms of your hands. See if you can notice any other tactile sensations as well. Then, describe all of that—what you just noticed—using the following lines.

b. Notice and describe what you see around you. If you are experiencing a flashback, do your best to observe and look through it at what you really see in your current surroundings. Gently ignore any visions of people, places, or events related to the flashback. Look at the floor and notice what you see there. Spend a minute or two just scanning the floor and noticing what you see there. Then, bring your eyes up to the walls and pay attention to what you see there. Notice the colors of the walls, any artwork on them, the lighting fixtures, the door frames, the doorknobs, and so on. Just step back mentally and notice these things. Also look at the ceiling, paying attention to the textures, colors, and objects you see up there. Finally, look at the chair, bed, or floor you are sitting on. Now, describe all that you just observed, using the following lines.

c. Step back, notice, and then describe what you hear. Listen attentively to anything you hear inside the building, where you are sitting, or outside. Gently ignore any sounds that might be part of the flashback. In a really concrete way, just focus on exactly what you hear. For instance, you might notice the sounds of other people talking or walking around, the birds, the rain, the wind, or your own breathing. Just simply notice what you hear. Then, describe all that you just heard, using the following lines.

3. Get active by throwing yourself into an activity right now. The next step is to really throw your mind into an activity in the present moment. Remember when we talked about distress tolerance skills in chapter 3? Well, here you will use a combination of the distraction or self-­soothing skills with immersing yourself in what you are doing right now. First, decide whether you need soothing or distraction. If your nervous system feels all wired up and you feel a lot of tension or bodily arousal, you might want to choose self-­soothing. Alternatively, if you feel your mind edging back again and again to the flashback, nightmare, or intrusive thoughts, distraction might be your best choice. Ultimately, you can’t go wrong with either, so you might want to try both. Here are some guidelines for how to throw yourself into your activities:

o Do the activity with your entire mind, body, and soul.

o Throw yourself completely into the activity so that you’re completely immersed in it.

o Do the activity with energy and vigor, and whenever your mind wanders, keep throwing yourself back in, almost as if you were jumping back into a swimming pool each time you found yourself crawling out.

If you’re using distraction, choose an activity that will pull your attention away from what is bothering you. So, choose something that is interesting or stimulating, something you can really get into, like the following:

o Doing physical exercise (going for a run or a vigorous walk, or doing push-­ups, sit-­ups, aerobics, or yoga)

o Doing puzzles, crosswords, or sudokus

o Seeing, talking to, and interacting with other people

o Shopping

o Reading a very engaging book or magazine article

o Getting out of your home and riding the bus somewhere

o Doing arts, crafts, or hobbies

o Getting some work or studying done

o Eating (but not too much)

o Doing something that creates strong, distracting sensations, such as biting into a jalapeñ o pepper, eating spicy food, or showering with alternating cold and hot water

If you’re using self-­soothing, choose an activity that will be calming. When you are dealing with distressing events, such as nightmares or flashbacks, it makes a lot of sense to seek a little comfort or soothing afterward (or during). So, choose something that is comforting or soothing to you, something that calms your mind and your body. Here are some examples of soothing activities using your various senses:

o Sound: Listen to calming, soothing music, such as new age or classical music. One way to find such music is to look for the types of CDs people recommend for women who are in labor.

o Sight: Look at art, watch a calming nature show (nothing about hyenas attacking unsuspecting animals on a savanna), go someplace where you can see nature or beauty, look at photographs you find soothing, or look up photos or scenes on the Internet.

o Smell: Use aromatherapy candles or incense, smell flowers, take a bath with scented oils, smell fresh coffee beans, or make a cup of coffee or tea and just smell it.

o Touch: Wear a soft, soothing fabric; wrap yourself up in your favorite blanket; sit in a warm bath; take a calming, warm shower; run your fingers over something that has a nice, calming texture; get a massage or get your hair done; or do soothing physical activities with someone else.

o Taste: Eat comfort food; eat something with a calming, comforting taste or texture; or eat some candy or chocolate very slowly and mindfully.