A traumatic incident

Seventeen year old Rich was depressed.

He had been taking driving lessons quite happily until an incident occurred when he mounted the pavement.

Although the actual incident had been quite minor, in his imagination he had started playing a film of all the possible consequences of losing control of the car.

He began imagining a major pile up where he had been the cause. ‘If a car had been coming the other way or had been travelling close behind, there could have been injuries or death’, he told me, looking worried.

Although this incident did not actually meet the criteria for Post Traumatic Stress Disorder(1) the high emotion he’d attached to the memory, meant it had been tagged as significant by his emotional memory store.

He was now simply misusing his imagination.

He was pattern matching(2) every time he got into the car for a driving lesson. Just sitting in the driver’s seat reminded him of the incident and all the frightening imaginary outcomes he’d attached to it. He was edgy, nervous and upset whenever he was behind the wheel and now, suffering the effects of depression, was almost at the point of giving up on his driving lessons.

I explained to Rich how memory is stored, how pattern matching occurs and then guided him through an imaginal exposure technique similar to that used by trauma focused CBT practitioners and approved by NICE(3).

This was a one-off session and Rich’s mother happily reported afterwards that it had been completely successful and he was driving again without any further negative reactions.

The Domino effect and depression

Although the original incident seemed quite minor, Rich’s interpretation of what could have happened was sufficient for his brain to tag it as a possible life threatening experience.

He had started avoiding driving lessons but this avoidant behaviour had started to make him experience the effects of depression.
• He now no longer felt safe and secure when in a car.
• Not learning to drive led to loss of status with his friends
• It had also impacted on his sense of achievement, control and autonomy as learning to drive is a significant ‘rite of passage’ into the adult world

The work I did helped Rich ‘unhook’ the emotion from the trauma so that it could be re-encoded by his brain and integrated into his working memory.

So many people misuse their imagination in this way and, as a result, develop fears, phobias and avoidant behaviours which can take them down a winding road into the effects of depression.

How imaginal exposure works

On this occasion, I guided Rich to imagine either watching a TV or being in a cinema watching a film of the car incident from before there was a problem until the traumatic memory faded.

Having watched the film I then encouraged him to imagine floating into the film screen and experience the incident in reverse, very fast as he rewound back to the moment before the event occurred.

Once is often enough but Rich performed the guided task three times as he was uncertain if he had included all the scary thoughts he’d attached to it.

Memory is malleable

To understand why these techniques work, we need to appreciate the implications of malleability of memory. Memory is encoded within the neural networks of the brain and, in recollection, can be re-encoded.

It’s impossible for the body to feel relaxed if the mind is agitated and it’s also impossible for the brain to feel safe if the body is fearful and agitated.

So, if you can feel safe, comfortable and relaxed whilst retrieving previously negative or traumatic memories, that memory can then be integrated by the hippocampus.

It can be a useful self help tool too.

Ten steps to trauma resolution

1.Find somewhere quiet and comfortable where you can sit or lie down for a while.

2.Scale from 1-10 how anxious the memory makes you feel when you recall it, where 10 is extremely anxious.

3.Close your eyes and slow your breathing right down, preferably with the out breath a little longer than the in breath.

4.Progressively relax all the muscle groups, hands, arms, feet, legs, back shoulders, neck, face etc.

5.Bring to mind the incident and consider it as a film which you can watch from a comfortable distance.

6.The beginning of the film needs to be just before there was a problem, like driving along and all is ok.

7.Watch the film on the screen and stay in your imaginary seat. You are on the outside of the memory looking in. Stay detached.

8.End the film when the incident is over, like after a car accident when you realise you’re ok.

9.Now float into the imaginary film screen and, from inside the memory, rewind as fast as possible back to the original starting point.

10.Re-scale 1-10 how anxious you feel when you recall the memory

Repeat if necessary. You will know the traumatic memory has been integrated when you can think of watching it on the screen without an extreme reaction.

This is an easy self-help way to break pattern matches attached to an old traumatic memory.

It is a safe, effective and useful tool for re-encoding memories which may be exerting a negative impact on your life years after the event and causing you both anxiety and the effects of depression if fears, phobias or avoidant behaviour are beginning to dominate your life

Important note: This is only appropriate as a self help technique for mild to moderate incidents.

If you think your ‘incident’ is too difficult to deal with on your own, or that you might have elements of PTSD(1) you should consider approaching a trained therapist who is familiar with imaginal exposure trauma resolution.

Dealing with anxiety, depression, PTSD, advanced imaginal exposure techniques, Cognitive Behavioural Therapy, emotional needs, parasympathetic breathing, progressive relaxation, malleability of memory, scaling and self-help tools are all part of the NCFE accredited Fusion Therapeutic Coaching Diploma and Distance learning skills certificate.(4)

Links

1. PTSD symptoms from MIND UK website: www.mind.org.uk
• Reliving aspects of the trauma
• vivid flashbacks (feeling that the trauma is happening all over again)
• intrusive thoughts and images
• nightmares
• intense distress at real or symbolic reminders of the trauma.
• Avoiding memories
• keeping busy
• avoiding situations that remind you of the trauma
• repressing memories (being unable to remember aspects of the event)
• feeling detached, cut off and emotionally numb
• being unable to express affection
• feeling there’s no point in planning for the future.
• Being easily upset or angry
• disturbed sleep
• irritability and aggressive behaviour
• lack of concentration
• extreme alertness
• panic response to anything to do with the trauma
• being easily startled.

2. Pattern matching and PTSD: PTSD Resolution: Defeating Panic: Reclaiming Life. Masters, F. (2012) . Kindle edition. www.amazon.com › Mental Health › Anxiety Disorders‎

3. NICE: Imaginal exposure tools for resolving PTSD. www.nice.org.uk

4. Training details on http://www.integratedcoachingacademy.com