On the last track, we discussed identifying the way trauma affects a client
concerning the extent of the trauma; feelings of anger; and feelings of guilt. We
will also present two techniques: The Trauma Questionnaire, Benefits
and Costs, and the "If I could do it over" Technique.
On this track, we will examine the three ways clients
re-experience a traumatic events in the areas of sleep disturbances; flashbacks; and emotional
recall. We will also include a technique to help you identify what type
of trauma re-experience your client is undergoing. In this track, we will
discuss PTSD as a result of natural disasters and combat.
3 Ways of Re-experiencing a Traumatic Event
Re-experience #1 - Sleep Disturbances
Have you found like I, that the first way a client may re-experience trauma is
through sleep disturbances such as dreams, nightmares or insomnia? Clients
who exhibit sleep disturbances may have dreams or nightmares about the traumatic
events. Sometimes, these dreams play out the event exactly. Other
dreams or nightmares may just replicate the feelings experienced during the
trauma such as guilt, anger, and, of course, fear.
In many instances
of clients experiencing trauma nightmares, shaking, shouting, and thrashing
about have been reported. Even though they don’t remember the nightmare
when they awake, the feelings that transpired while asleep may stay with them
throughout the day, as you know. With Katrina insomnia manifested itself
through difficulty in falling and staying asleep. As you know this, may
also indicate a biochemical depression.
Katrina, a 19 year old college
student living in a dorm on campus with a roommate. Earlier that year,
Katrina had been on a plane that had nearly crashed when the landing gear failed
Since then and all throughout the school year, Katrina’s
roommate has been woken up almost every night to Katrina groaning and
crying in her sleep. Finally, the roommate told Katrina about the night
terrors that were verbalizing themselves while she slept. Katrina felt
that her nightmares most likely had something to do with her escape from death,
and she decided to seek help. During therapy, Katrina reported that when
she woke up, she often felt afraid that she was in danger.
As you can
see, Katrina’s nightmares were bringing the emotions that
she felt during the plane accident to the surface.
Do any of your clients ever experience nightmares or dreams about their trauma? Do
they ever report having trouble falling asleep or staying asleep? Perhaps
PTSD might be considered.
Re-experience #2 - Flashbacks
The second way a client might re-experience a trauma is through flashbacks. As
you are aware, flashbacks occur when the client feels as though they are physically
transported back to the time and location that the trauma
took place. Vividly, they remember the trauma and react to it. As
you know this kind of re-experiencing is common among war veterans who went
through difficult or bloody combat.
Often, these flashbacks are accompanied
by the same smells, sounds, and sights as the traumatic event. Are you
treating a war veteran like Seth that would hear the bomb
shells and even smell the gunpowder.
Seth, a 25 year
old PTSD client of mine, had flashbacks of his short time in Iraq. He
stated that, although he doesn’t always consciously know when he
is experiencing a flashback, his friends or the people that he is around at
the time, tell him later that he had been acting strangely. They
say that he begins to cry and sometimes to shout, "Oh my god! Oh
Seth stated, "I saw a friend of mine torn apart
by insurgent bullets. Another buddy, one I knew since I was a kid, was
killed by a homemade gasoline grenade. I saw him burned alive. It
was awful. Sometimes, when I smell gas, that’s when they tell
me I get a scared look on my face."
To help Seth articulate the trauma he had been re-experiencing, I asked him to write daily
in his journal about the event, adding in details he remembered along the way. As
he gradually faced the event more and more, Seth experienced
the flashbacks less and less.
Many times, this simple journal technique
may be helpful in other instances of clients re-experiencing trauma, including
sleep disturbances and the next type of reexperiencing, emotional recall.
about your PTSD client. Would he or she benefit from daily writing in
a journal or notebook?
Re-experience #1 - Emotional Recall
In addition to nightmares and flashbacks, the third and final type of re-experiencing
trauma is, as you know, emotional recall. Emotional
recall is similar to a flashback, except that it is more unconscious than
a regular flashback. It occurs when a trauma client manifests the
emotions he or she felt during the event such as anger,
fear, or irritability; even physical pain associated with the trauma may
be experienced. These emotional recalls never seem clearly related
to any memory of the trauma.
Many clients feel that these emotions
are just reactions to arbitrary circumstances.
a police officer was going through this emotional recall. Frank stated, "I
can understand why I sulk or explode about
hearing about another cop being killed in the line of duty. But many
times I get moody or angry for no reason at all."
Frank didn’t understand, and what I explained to him,
was that his mind was reacting to the deaths or injuries
of officers that he has personally known. Also, Frank’s sudden
emotional tumultuousness may be a result of his fear that
he too might one day be the victim of violence.
Technique: Trauma Re-experiencing Quiz
Many times, I have found that a client who experiences nightmares,
flashbacks, or emotional recall does not even know he or she is re-experiencing
a trauma when they first come to me. To help clients who I believe
are suffering from PTSD, I ask them to fill out a "Re-experiencing
Trauma Quiz" to help me and them understand
just how the trauma is manifesting itself and affecting
I ask clients to answer the following questions that relate
to their traumatic event in detail:
- Do you, on a persistent or recurring basis, find yourself having intrusive or voluntary thoughts of the traumatic event? Do you
find yourself thinking about the trauma when you don’t mean to
or when you are trying hard not to think about it? Do visions or
pictures of the trauma pop into your mind?
- Do you have dreams or nightmares about the event?
- Do you have dreams or nightmares that are not replays of the
actual event, but that take place in the location where the event occurred,
contain some of the actions involved in the event, or include
some of the feelings you felt during the event?
- Do you find yourself suddenly acting or feeling as if you were
back in the original trauma situation? For example, do you
have flashbacks, visions, or hear sounds of the event? Do
you have waves of strong feelings about the trauma or otherwise feel as
if you have just lived through the trauma again,
even without having a flashback or a vision?
- Do you become extremely upset at people, places, or events
that resemble an aspect of the original trauma?
- Do you become distressed around the anniversary date of
On this track, we discussed the three ways clients re-experience
a traumatic events: sleep disturbances; flashbacks; and emotional recall. We
also included a technique to help you identify what type of trauma re-experience
your client is undergoing via the "Re-experiencing Trauma Quiz"
On the next track, we will examine four types of
adaptation reactions to trauma. These are emotional numbing, trigger
avoidance, and hypervigilance and the calming breath technique.
What are three ways that a client might re-experience trauma?
To select and enter your answer go to .