PTSD Flashback Crisis Management: How to Stay Safe During Severe Episodes

According to research, about 70% of adults in the United States experience at least one traumatic event in their lifetime. And an estimated 20% of these people go on to develop post-traumatic stress disorder (PTSD).^[1]

PTSD can affect anyone. High-risk populations affected by a PTSD flashback crisis include combat veterans, emergency responders, survivors of sexual violence and childhood abuse, and individuals who have lived through accidents, natural disasters, and medical trauma.

Of all PTSD symptoms, flashbacks are among the most destabilizing. They can happen anytime, anywhere, triggered by something as ordinary as a smell. And in a matter of seconds, someone can lose control. This type of PTSD flashback crisis is a neurological response to unprocessed trauma, and, fortunately, it is treatable.

On this page, you will find an evidence-based approach to how you can stay safe during episodes of a flashback crisis, and how to reduce their intensity and frequency through therapy.

What Happens During PTSD Flashbacks?

During a PTSD flashback, your brain’s threat-detection center, otherwise known as “the amygdala”, fires an emergency signal that floods your body with cortisol and adrenaline.^[2] This change in hormonal concentrations causes physical changes in the body, such as:

Feeling like your heart is racing.
Muscle tension.
Shortness of breath.

Aside from this change in hormones, the hippocampus is the part of the brain that should normally organize memories into a coherent past-tense narrative. It, however, gets dysregulated in response to severe stress.^[3]

As a result, the memory of a traumatic event gets “frozen” in your brain without a proper time-stamp. So, whenever it resurfaces, your body responds to it as if it is happening in the present moment.^[3]

Some flashbacks are predominantly visual, as if you are reliving the entire traumatic scene all over again. PTSD flashbacks can also be:

Sounds.
Smells.
Physical sensations.
Overwhelming emotion with no clear image attached.

These are known as “somatic” or “emotional flashbacks.”

Common PTSD Flashback Triggers in Adults

Triggers are sensory or contextual cues that your brain links to the original trauma.

A study found that smells produce the most intense and involuntary trauma re-experiencing.^[4] The olfactory bulb connects directly to the amygdala and hippocampus without the filtering that other senses undergo.

So, a particular cologne, smoke, a food smell, or anything you smelled during a traumatic accident can drop you into a flashback. Loud noises are also a documented trigger in combat veterans and assault survivors.^[5]

Some other triggers include:

Crowded or enclosed spaces.
Conflict.
Raised voices.
Specific dates.
Anniversary of the traumatic event.
Being physically vulnerable, as in illness, fatigue, hunger, or intoxication.
Media exposure that shows violence or abuse.

What to Do the Moment a PTSD Flashback Starts

If you find yourself experiencing flashbacks of your trauma, here’s what to do in the immediate moment.

1. Get Physically Safe

Research says that the presence of additional stressors during a flashback episode can worsen your recovery time.^[6] Therefore, your body needs to be in an environment where it is not processing additional threat signals. If you are in a crowd or near traffic, you need to get yourself to a safe place as soon as possible.

If you are in a work setting, you could step into a private place. Excuse yourself for a moment if you are near other people who do not know what is happening to you.

2. Use Your Breath to Signal Safety to Your Nervous System

When the sympathetic nervous system activates during a flashback, the natural response of the body is to make your breathing shallow and rapid. This sustains the fight-or-flight state since carbon dioxide levels are kept low.

This is why it helps to deliberately slow down your breathing to signal to your body that you are no longer under threat. Here’s how to do it:

Inhale slowly through your nose for a count of four.
Hold your breath for one to two counts.
Exhale through your mouth for a count of six to eight.
Repeat it for at least six cycles.

3. Orient Yourself to the Present Moment

After slowing down your breathing, update your brain out of threat assessment and into current, real-time information.

If you are in a private place, try to speak out loud about the details of the present moment. For example, say:

Your name.
Location.
Time.
Date.

Verbally labeling present-moment info during a PTSD flashback reduces the emotional intensity of the attack. Speaking aloud also recruits the language-processing regions of the brain, which are normally suppressed in trauma states.^[7]

If you are in an environment where speaking out loud is not possible, you could write the same present-moment anchors on paper to help your brain orient into the moment.

4. Use Grounding Techniques

There are many simple grounding exercises that provide your brain with more sensory input to come back to the present moment.

The 5-4-3-2-1 method is known to work for PTSD flashbacks because it recruits all five senses. It involves naming:

Five things around you that you can see.
Four things you can physically feel.
Three things you can hear.
Two things you can smell.
One thing you can taste.

You can also stimulate your body via temperature differences. For example, holding ice, running cold water over your wrists, splashing cold water on your face, and so on.

There are ways to provide your brain with sensory information about your body’s position in physical space, too. Examples include pressing your feet firmly into the floor, holding a textured object, or pressing your back against a wall.

Building a Personal Safety Plan Against PTSD Flashback Crisis

A personal crisis safety plan is a document you create to decide beforehand what you would do if a PTSD flashback crisis hits you. It includes:

Identifying your triggers when you’re outside a crisis state as specifically as possible. Analyze some recent flashbacks and try to think of the exact situational trigger that led you towards a crisis.
The physical and psychological signs you experience during flashbacks.
The exact grounding techniques that have worked for you in the past, since not everyone responds to every technique.
Contact details of people whom you trust and who know about your PTSD. These people should know what helps you during a crisis.
The contact information for your therapist and a psychiatric emergency service nearby.

If you are currently in therapy, your safety plan should be built collaboratively with your therapist. They will help you tailor it to your specific trauma history.

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Recovery and Self-Care After a PTSD Crisis

In the first few hours after a PTSD flashback, you will likely feel extreme fatigue and muscle exhaustion. Many people also feel a hollow numbness immediately following an episode. If the flashback occurs in a public/professional place, you might also get a wave of intense shame, self-criticism, or embarrassment.

Your body needs immediate support during this time to completely recover from the episode. Here’s what you should do:

Hydrate yourself and eat something small.
Rest for a while. You don’t necessarily have to sleep, but at least give your body some time to restore by lying down or sitting in a quiet place.
Go for a slow walk or do some light stretches for about ten minutes.
Avoid any stimulating activities, like scrolling through social media or watching the news.
If possible, reach out to someone you trust for a safe, low-demand interaction.
As soon as you are stable, log the event with all its details. For instance, the triggers preceding it, what helped during the episode, and how long recovery took. This way, you can update your safety plan.

Long-Term, Evidence-Based Therapies to Reduce PTSD Flashbacks

The frequency and intensity of PTSD flashbacks can be reduced via long-term therapeutic work. The therapies with the strongest evidence base for PTSD flashback reduction are:

Eye Movement Desensitization and Reprocessing (EMDR)
Cognitive processing therapy (CPT)
Prolonged exposure (PE)

Together, you and your therapist can determine the one that will work the best for you based on your history and symptom profile.

EMDR

EMDR is one of the most extensively researched trauma treatments in existence. It works by having you recall traumatic material in a safe, controlled environment while you are also under bilateral sensory stimulation, tracking the therapist’s moving finger with your eyes.

Bilateral stimulation during recall is thought to mimic the neurological conditions of REM sleep. This is the state in which the brain naturally processes and integrates emotionally charged memories while you’re asleep.

EMDR is known to reduce the severity of PTSD symptoms as per multiple research studies.^[8] It was found to work in complex trauma populations as well, including those with comorbid psychosis, without any adverse effects.^[9]

For this reason, the World Health Organization recommended EMDR as a first-line treatment for PTSD in its 2013 guidelines.

CPT

Cognitive processing therapy (CPT) targets the beliefs that have been distorted as a result of trauma. It was introduced in the 1980s for sexual assault survivors. Currently, it is endorsed by the American Psychological Association (APA), the Department of Veterans Affairs (VA), and the World Health Organization (WHO) for PTSD treatment.

CPT helps you identify the negative self-beliefs that keep the trauma response activated. It runs for twelve structured sessions and includes both written and verbal components, divided into three phases. These are:

In the early phase, you write a detailed impact statement of the traumatic event.
The middle phase involves learning about your unhelpful thought patterns using structured worksheets.
The final phase addresses safety, trust, power and control, esteem, and intimacy.^[10]

Prolonged Exposure

Psychology says that when you avoid a certain situation/memory, you are constantly under its fear. A gradual, supported contact with the feared stimuli removes the conditioned fear response from your body over time.^[11] Prolonged exposure therapy works on the same principle. It has two components:

Imaginal exposure. In other words, it involves repeatedly revisiting the traumatic memory in detail under the supervision of a therapist.
In vivo exposure, which is the gradual interaction with real-world situations and stimuli that you have been avoiding because of their association with the trauma.

Prolonged exposure therapy has also been recommended by the APA, the VA/Department of Defense (DOD) Clinical Practice Guidelines, and the International Society for Traumatic Stress Studies.

Gain PTSD Flashback Crisis Management Support With Mission Connection

PTSD flashbacks are not something you can get through with just willpower and the hope that the episodes will eventually stop on their own. They can persist for years and worsen if left untreated.

At Mission Connection, our team of board-certified psychiatrists and multidisciplinary mental health professionals provides PTSD care as well as care for several other mental health conditions. Every individual who comes to us receives a comprehensive clinical assessment so that their care plan can be tailored to their needs.

We deliver evidence-based approaches to PTSD treatment, including EMDR, CPT, and PE. Our flexible outpatient treatment program options include in-person treatment, online telehealth, and a hybrid program that combines in-person and virtual care.

Mission Connection also accepts most major insurance plans. Our team will work with you to verify your insurance coverage before you begin treatment.

If you’re ready to find out how we can help you prevent PTSD flashbacks from controlling your life, reach out to us online or call us at 866-833-1822.