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Imagine a survivor who must book an appointment with his doctor for a flu vaccine . He needs the flu vaccine but hates syringes and is intimidated by doctors and overcrowded waiting rooms . He plans ahead . First of all , he asks a person he trusts to accompany him , who can talk to him and distract him from his anxiety . This will also help him to stay in the here-and-now . Second , he books an appointment at a time when there are fewer patients . Third , he forewarns the doctor that he has an antipathy to syringes , to make her more aware of his anxiety . Fourth , he makes sure that he does something immediately afterwards that he can look forward to .
If he ignored his fear and played “ tough ”, he would probably lose control or disconnect to the point that he might not be able to function . Instead , he manages a difficult situation by planning , acknowledging his anxieties , and placing boundaries round them .
Imagination exercises
Faced by a situation that makes them anxious , some survivors will find it helpful to play out the situation in their imagination beforehand . For example , the survivor described above might imagine that he attends his consultation with the doctor and feels calm . He imagines calming himself when he begins to feel anxious . He imagines that he has all the support he needs . He imagines his friend encouraging and supporting him .
Alternatively , he might imagine that he wears a protective suit of armour and therefore feels strong and protected from triggers . The story is not important : what matters is whether it helps . When we are about to experience a stressful event , we are apt to conjure up all our fears of failure . It is a good idea to imagine stories of success .
HELP AND ACTION
Finding alternatives
Being triggered makes a survivor feel trapped and helpless . He needs to find more choices and establish some control .
In the example above , our survivor may still be triggered by his injection . If this happens , he can leave the doctor ’ s office . Or ask a nurse for help to calm down . Or close his eyes and imagine he is elsewhere . If he needs to know exactly what is happening in order to cope , he can concentrate on the syringe . Or he can ask the doctor or nurse to tell him everything they do during the day so that he is distracted from what is happening . He can also ask if someone he trusts can accompany him , or telephone someone he trusts if he becomes anxious . There are usually many choices ; they are limited mainly by our lack of imagination .
Gradual exposure
Survivors of sexual violence , including male survivors , develop so-called “ inner phobias ” about specific memories , specific emotions or bodily reactions that are associated with the traumatic event . As a result , they often also develop a phobic relationship to triggers . Avoidance is central to the development and maintenance of a phobia ; but when feared objects are constantly avoided , fear of them deepens . Phobic reactions can be reduced and eliminated by “ gradual exposure ”.
Neutralisation of triggers
To neutralise the effect of triggers , techniques aim to distance the emotions and physical experiences that a trigger can cause . Methods to neutralise include :
• Imagine wearing a “ protective suit ” or other protective clothing .
• Do Exercise No . 1 ‘ Safe Place ’. ( See Appendix 1 .)