Ascellus Blog

When Up is Down and Right is Left: The PTSD Survival Guide

July 16, 2018

Traumatic events shake up the brain. The goal of treating first responders and other injured workers who’ve experienced a horrific event is to get their brains back on track. The first step is to help them figure out which memories relate to the trauma. That prevents, for example, a box of oatmeal from setting off a gruesome flashback to the event.

Memories and Trauma

The way the brain files memories during and after a traumatic event is akin to children running amok in a highly organized women’s shoe closet. Imagine many shoes perfectly arranged by color and variety and all in proper sequence. Now picture a group of young children playing dress up in the closet and creating a topsy turvy mess; a purple flat ends up next to a red heel, a black boot is on top of a sneaker, and all the shoes are on the floor.  That’s how our memories would look in our brains after a traumatic event.

Normally, something mundane such as looking at a grocery list would not be associated with a completely unrelated event that happens soon after. But when there is a trauma, the areas of the brain where memories are processed— the amygdala and hippocampus — become overstimulated. All the memories immediately before and during the event become a big, jumbled disarray. An item on the grocery list can trigger intense fear in the person and make him feel as if he is actually re-experiencing the horror. What the worker needs is to sort out all his memories and recognize which are connected with the traumatic event, a process called debriefing. 

The Debrief

Our hypothetical injured worker comes to us having experienced a terrifying ordeal in the local grocery store. He passed by a box of oatmeal and felt as if he were completely immersed in the mass shooting he witnessed two month before. He was petrified.

The oatmeal is what we refer to as a trigger; a sight, smell, sense, thought or any stimulus that sets off a flashback of the event. Injured workers with PTSD typically have many such triggers, which may lead them to avoid any people, places, or things that are somehow associated with the trauma.

To help the injured worker, we first ask him to relate the facts of the shooting, with no emotionality. We ask him to tell us the who, what, when, and where specifics. Just the facts. We have him do that repeatedly.

This activity helps the brain re organize the memory ‘closet’, and organize which memories are related to the trauma and, more importantly, which are not. The brain dissociates that the oatmeal on the grocery list has absolutely nothing to do with the mass shooting.

This debriefing is a proven way to help someone with PTSD retrain his brain and refile his memories. The memory of seeing the oatmeal on a grocery list eventually is filed correctly in the brain, with no association to the shooting. Ultimately, he is able to sort out all the memories that are jumbled in his brain.

Part of the debriefing process is best done in groups, with others who have had the same experience. This helps them regain a sense of safety and control. That process, social interaction, is another important step in treating injured workers with PTSD and will be a topic in an upcoming blogpost.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at, or Please join our LinkedIn group, COPE with Pain at .


Ascellus logo mark

Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.