Table of Contents

• The Basics
• Breathing Skills
  • Calm Breathing
  • 2-to-1 Breathing
• Grounding Skills
  • Statements of Presence
  • Body Engagement
  • Body Scan
  • 5-4-3-2-1 Skill
  • B.O.L.R.A.I
  • Grounding Objects
  • Katniss Skill
• Bilateral Stimulation
  • Bilateral Tapping
  • Meditative Walk
• Progressive Muscle Relaxation
• Misc. Coping Skills
  • Movement
  • Splash Cold Water
  • Distraction

The Basics

1. Feel emotions & have thoughts. When we deal with flashbacks and panic attacks we tend to want to make the emotions go away or immediately stop the anxious thoughts. But this will have the opposite effect. The better way is to recognize you have this thought or feeling, and try and let it go. Validate your experience, but don’t act on it.
2. Practice! For these to be most effective as they have to be muscle memory. We can get to a point where these coping skills will kick in and be easier to handle due to having just done it. In practice, this means use them even when not at a crisis level.
3. They won’t always work, you won’t always remember and it might only be partially effective. Don’t beat yourself up over it, just do them as you can and be patient with yourself.
4. Honour your pain, your body is struggling with dysregulation, you were hurt, that matters. Try best to not belittle your trauma or anxiety. It’s not crazy or weak, you are strong enough to do this.
5. Rest: After having a flashback, panic attacks or dissociative episode the body has been through stress. Rest is important!

Breathing Skills

This is the baseline to all coping skills and more effective then we often understand. Controlled breathing is powerful as it activates both the sympathetic and parasympathetic nervous systems by doing this it promotes relaxation and connection to our bodies. Being able to bring ourselves back within a regulated state is useful in life generally and key during crisis moments of flashbacks & panic. Dissociative episodes are helped via the body-mind connection.

Calm Breathing:

Calm breathing involves taking smooth, slow, and regular breaths. It’s a good basic skill that is easy to remember and allows us to easily bring our breathing in our control.

Avoid clenching your muscles and make sure you are using diaphragmatic breaths. This means your stomach should be expanding and not your lungs. These breaths bring in more oxygen and it’s harder to hyperventilate a common effect of anxiety and flashbacks.

Sitting up straight is the best for because it allows for the most room for our lungs to expand, laying flat is the second best. Please avoid slouching or turning in ourselves. If possible remove the stress off your shoulders by supporting your arms on the side-arms of a chair, or on your lap, grounding your feet is also important.

Steps:

1. Take a slow breath in through the nose, breathing into your lower
2. belly (for about 4 seconds)
3. Hold your breath for 1 or 2 seconds
4. Exhale slowly through the mouth (for about 4 seconds)
5. Wait a few seconds before taking another breath
6. About 6-8 breathing cycles per minute is often helpful to decrease anxiety but find your comfortable breathing rhythm.
7. Take a slow breath in through the nose, breathing into your lower
8. belly (for about 4 seconds)
9. Hold your breath for 1 or 2 seconds
10. Exhale slowly through the mouth (for about 4 seconds)
11. Wait a few seconds before taking another breath
12. About 6-8 breathing cycles per minute is often helpful to decrease anxiety but find the breathing rhythm best suited for you.

2-to-1 Breathing:

This is a practice that helps give us a path to regularity and best engaging the parasympathetic system. It also requires a powerful redirect of focous to our breathing and the way that it feels. Knowing how proper breathing feels is good to know when we have started to become dysregulated. This is generally hard to do during flashbacks or mid panic attack, most effective before or after the most extreme point.

Remember diaphragmatic breaths, and try to either sit or stand as straight as possible!

Steps:

Count the duration of both exhalation and inhalation as you breathe normally and adjust it gently so you are exhaling and inhaling for the same amount of time. Most people are comfortable with a count of 3 or 4 counts for each exhalation and inhalation. So one full breath lasts for a count of either 6 or 8. So you are breathing in 4 and exhaling 4 counts.

Now, without altering the duration of the total breath cycle, adjust your breathing by slowing the exhalation and gently quickening the inhalation to achieve a 2-to-1 ratio. For a breath lasting 6 counts, this means exhaling for 4 and inhaling for 2. For 8 you can adjust slightly exhaling for 6 and inhaling for 3.

Grounding Skills

Grounding skills are used to deal with dissociative symptoms, flashbacks and panic attacks. It’s specifically helpful for dissociation because it brings you back into your body and the moment. The main goal of these is to have an awareness of the internal and external world. Grounding is part of what as known as “mindfulness” but here we are focused on grounding as an intervention method for triggered episodes of flashbacks & panic and what can be useful for chronic dissociative episodes.

As CSA survivors these are crucial because dissociation is an incredibly common experience as we have a high rate of freeze and fawn responses in our nervous system. Grounding is the gold start skill for dissociation. Flashbacks are also an experience that is both hyperarousal in the nervous response to trauma but also engages dissociative tendencies due

Statements of Presence/Affirmations:

When looking at them in a grounding context these are used to try and bring a sense of control and invoke some of our power. It can connect us with the present time and location versus where the trauma happened in cases of flashbacks. Bet when used in conjunction with breathing

Notice the flashbacks/dissociative episode: This is a flashback, it’s not right now. For dissociation, I’m experience dissociation I understand what this is. This step puts the situation more in our control.

Remind yourself where you are: I am in new york, in my apartment, at the kitchen table, I’m not at my childhood home.

Remind yourself when you are: I am not a little kid, i’m an adult, it’s the morning, abuse is not happening now.

Invoke your power: My emotions and fears are real, but not stronger than me. I can’t control the past, but I can have power over myself now. 

Note: Good for waking up from nightmares

Body Engagement:

• Press on your legs, rub your arms, stomp your feet, walk, dance, rub your palms together, etc. This helps engage the brain-body connection, gives sensory input, proprioceptive input (awareness of self and movement) and allows our body to release some tension.
• There are often things we do out of habit when stressed like rock or pinch ourselves (some damaging some not) to have the best effect we need to add some deliberate movement.

Body Scan:

1. Get comfortable. Sit in a comfortable place and fully relax your body. You don’t need to be lying down, but it helps, particularly if you’re doing a body scan meditation before you fall asleep.
2. Take a few deep breaths. Let your breathing slow down, and start breathing from your belly instead of from your chest, letting your abdomen expand and contract with each breath. If you find your shoulders rising and falling with each breath, focus more on breathing from your belly, as though a balloon is inflating and deflating in your abdomen with each breath.
3. Bring awareness to your feet. Now slowly bring your attention down to your feet. Begin observing sensations in your feet. If you notice pain, acknowledge it and any thoughts or emotions that accompany it, and gently breathe through it.
4. Breathe into the tension. If you notice any uncomfortable sensations, focus your attention on them. Breathe into them, and see what happens. Visualize the tension leaving your body through your breath and evaporating into the air. Move on when you feel ready.
5. Scan your entire body. Continue this practice with each area of your body, gradually moving up through your feet until you reach the top of your head. Notice how you feel and where you’re holding your stress. If there’s any tightness, pain, or pressure, continue to breathe into any tightness, pain, or pressure you’re feeling. This can help you release tension in your body now, and be more aware of it in the future so you can release it then, too.

This can also be useful to understand where tension is being held and in the case of trauma or related to triggers where our traumatic stress is being held. This can be practised when dealing with any stress and even during downtimes.

5-4-3-2-1 skill:

• 5 things you see
• 4 things you hear
• 3 three things you can touch/feel
• 2 things you smell
• 1 long deep breath

When you start to feel anxious or might be dissociating you go through these in that order and list them. This engages our senses, allows us to be aware of our surroundings, focous on the current situation. If you can talk safely then saying these out loud is best because the connection from our mind to our mouth can be disrupted by dissociation.

B.O.L.R.A.I:

A skill to deal with dissociative episodes of stress and feeling lost or confused. When our emotions and physical sensation are pulling us from the world we can move forward. Coined by the lovely Kristen she as a youtube channel Kristen Chronicles.

• Breathing: Take deep and slow diaphragmatic breaths
• Observe: check how you are feeling inside, your thoughts and physical sensation.
• Let Go: let the feelings and sensation exists but don’t act and breath our to have the feeling leave
• Redirect: put our thoughts in a new place
• Affirm: Set an affirmation to give yourself. An example: I am here and I am safe
• Empowerer: Choose the next act to take that can move you forward.

Grounding Objects:

Think of the movie Inception the token sthey carry with them to help them remember who they are and what they are doing. Emotional ties to objects can be effective as well as the sensory input they can offer.

Comfort Objects:

Stuffed animals, blankets, necklaces or other objects that we have a deep emotional tie to can have this function. They can overlap with the SIT type as well if the way the object feels or how we hold it can be part of why they work. They can also reduce anxiety or stress too.

Don’t be afraid to carry something someone might call “childish”. That judgment sucks and sometimes we have to bow to it, but if you need put it in your backpack. You deserve to feel as safe as possible.

Sensory Integration Tools:

Sensory integration tools otherwise called sensory aids or toys are objects that calm people down via acting on the senses to affect the nervous systems in stress states. These can help with anxiety, hyperarousal symptoms (from PTSD/C-PTSD), fibromyalgia, Autism, ADHD, Sensory processing disorder, Chronic Fatigue and anyone else who experiences problems related to sensory integration.

In this context, when we are panicked or left dysregulated after flashbacks these objects can bring our bodies back into a state of regulation. It can also prevent ending up hyperaroused and combat anxiety. The sensory input can promote brain-body connection which can help those of us who are dissociated.

You can read about examples of these tools in or article on this topic specifically and which types relate to what input. Coping Skills: Sensory IT

Katniss Skill: 

Something we came up with based on a scene in the book Hunger Games: Mockingjay. This consists of reminding yourself of the facts you know and that we aren’t in the abuse. This can redirect our thoughts, combat the flashbacks need to pull us back. For us, we find it helps with depersonalization and identity issues. Combine this with breathing exercises for the best result.

An Example:

” My name is sally, I am in London, I have a sister named Kelly, I am 19 years old, I am sitting in my living room, I have a cat”

Bilateral Stimulation

Bilateral stimulation is a method based in EMDR treatment for (c-)PTSD to process memories but versions of it can be used to regulate our nervous system via the engagement of the parasympathetic nervous system and ability to connect the hemispheres of our brain. It can decrease the hypoarousal, especially when combined with breathing. And combats dissociative tendencies via the engagement of our brain disallowing hyperarousal.

It also has the effect of redirecting thoughts from stress points and increases the ability to think clearly and engage the imagination. This attention and thought processing effects are part of why it works in EMDR.

The activation of the brain can help us during flashbacks because it aids our brains in disengaging from the memories of the past. The imagination portion allows us to think of something new. Hyperarousal is also tied to flashbacks inherently.

Bilateral Tapping:

Place the right hand on the left upper arm and the
left hand on the right upper arm or place the hands
on top of each other at the centre of the chest.

1. Alternate the movement of your hands tapping one
2. arm or side of your chest and then the other like the
3. flapping wings of a butterfly. Or press into your thigh.
4. Your eyes can be closed or partially closed.
5. Breathe slowly and deeply.
6. Focus on letting the traumatic memories or feelings be recognized but then let them pass.
7. Bring focus to breathing and movement.
8. Continue until you feel calm and your thoughts have settled.
9. Practice when not stressed to ensure the best results during stress.

Meditative Walk:

Walking and movement, in general, can help release the excess energy from hyperarousal and if in hypoarousal (dissociation) act as grounding to connect with our whole body. If you walk in a regular pattern and breath with the steps you can help best activate both hemispheres of our brain and promote regulation. This can also be paired with meditative practices like visualization.

Peripheral Vision Engagement:

When you start to feel stressed and triggered focus on widening your field of vision. Breathe deeply and let your jaw muscles relax. Look side to side of this visual field. This exercise activates the parasympathetic nervous system, which calms your body. You can combine this with walking as long as you stop to make sure you don’t hit a tree.

Progressive Muscle Relaxation

This exercise can take a while and will need to be done a few times for it to be as effective. It can be uncomfortable to start with if you have a lot of trauma associated with certain body parts. You can skip it if extremely triggering but it’s also amazingly healing to release the stress you trauma has you carrying it.

1. Start by finding a safe place to relax. Laying down or sitting in a comfortable chair. Take five deep slow breathes.
2. The first step is applying muscle tension to a specific part of the body. This step is essentially the same regardless of which muscle group you are targeting. First, focus on
3. the target muscle group, for example, your left hand. Next, take a slow, deep breath and
4. squeeze the muscles as hard as you can for about 5 seconds.
5. As you tense the muscle group breath in and as you let the tension our breath our with it.

The full version is hard if you are in a crisis, but modified versions of tightening muscles and deep breathing can be done and have similar effects.

Misc. Coping Skills

Movement:

When in hyperarousal we have heightened energy in our bodies. Moving can allow this to come out. This can be as basic as shaking out, imagine being a dog or other animal. Because of the nature of our nervous systems, this discharge will act as regulation.

Dancing, jumping, walking or any other action can act powerfully to hep out fight-flight response naturally come down to a regulated state because we took the action (ie flight) our bodies need to.

Splash Cold Water:

Splashing cold water on to our face can be calming. This triggers the parasympathetic nervous system via the vagus nerve. When we do this it essentially breaks the pattern of hyperarousal. This is something we can do in junction with other skills if you have access to a sink.

Distraction:

This can be nice to help prevent the thought spiral factor in anxiety and rumination we can experince after flashbacks.

• Word games, puzzles, Sudoku or colouring games can all be effective. Because these activities require our brain to be engaged actively it will help prevent thought spirals from worsening or hanging around after an attack. Might be hard if exhausted, when you are first triggered is the best time.  
• Reading, again good for engaging our brain, books also have the visualisation aspect. Can take more energy then the previous one might not be best if exhausted, however great if the activity is naturally calming for you.
• Music. Music can be good to redirect our thoughts and engages our sense of sound. The ability to trigger emotions can be a double-edged sword, try and not play the music that could re-trigger fear or flashbacks. Also if you are struggling with dissociation this could be hard on its own but be great in tandem. Good for sleep anxiety. 
• Tv/Movies. Has the problem of being something we might check out doing like music, and might promote dissociation. But is good for hen exhausted and watching shows that have a calming or positive emotional effect can be wonderful. Immersive and relaxing experiences can be good after flashbacks.