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Section 8
Managing Intrusive Thoughts

Question 8 | Test | Table of Contents

In the last section, we discussed the eye movement technique that can be used by your PTSD client as a quick distraction and a way to gain temporary relief from distressing thoughts.

In this section, we will discuss the Feelings Dial and Containment Skills. Both of these techniques offer PTSD clients a way to manage intrusive thoughts, images, feelings, or sensations.

Michelle, who we discussed in the previous sections, told me, "I’d get in line at the grocery store, and I’d have to leave the cart and get out of there. I’d lie and say I’d forgotten an item, and then I’d just book out of there, as fast as I could. Sometimes these intrusive feelings just sneak up on me. It is usually something that seems completely unrelated to my traumatic experiences but I suddenly get these panic attacks that take over. How can I control this?"

Feelings Dial Technique:
One technique I shared with Michelle to gain control of intrusive feelings is the Feelings Dial. This is an imagery exercise so to begin I verbally walked Michelle through the steps.

This is what I repeat to my clients: "This technique will not let you avoid or get rid of your intrusive feelings but rather allow you to turn down the overwhelming feelings. We will begin the exercise by imagining a volume dial. It has numbers from 1 to 10, 1 being the least intense and 10 being the most intense. Pay attention to details about the dial such as how it feels and what it is made of. Now think of an unpleasant feeling. What number on the dial best reflects the intensity of this feeling? What are you experiencing going through this feeling at this level on the dial?

Now imagine what the experience would be like to be on the other numbers on the dial? A 1 on the scale? An 8 on the scale? Now turn the dial down lower and lower until it goes down a number. Continue to keep turning it lower and lower. Keep going nice and slow until you go to the desired intensity. It is important that you repeat this process several times so you can master it. Do easy deep breathing. Time the breathing so that every time you exhale, you turn the dial a little lower."

I state to my clients that they can use this technique every time they have negative feelings that are too intense. This is a great way for my clients dealing with panic attacks to feel that they are in control of their emotions. Michelle found this technique helpful for the feelings she had surrounding her PTSD flashbacks.

As Michelle felt more comfortable with the exercise, she was able to go through the steps on her own. Do you have a client, like Michelle, who is having trouble dealing with their intrusive feelings that could benefit from the Feelings Dial?

We will now move on from the Feelings Dial Technique to discussing the Containment Skills which is another technique for your client to manage intrusive thoughts, images, feelings, or sensations surrounding his or her traumatic experience.

Containment Skills:
During our sessions, Michelle voiced that she felt that her "outbursts"- as she called them- of feelings and thoughts were slipping out of her control. Michelle and I went over the following four specific containment skills to help with managing these PTSD thoughts and feelings. Each of the following is an imagery exercise.

1. Split Screen: For this technique I state, "Imagine that you are watching two sports game on at once on the same screen. Think of the TV screen as your mental TV screen and the two games are your past and present. Now you can use your remote control to mute, fast-forward, turn off and anything else to your two screens. Imagine all your difficult memories being recorded as I count from 1 to 3. Once I reach 3, turn the TV off, take the recording out, and store it in a safe place. Place it there until you are able to take it out and deal with it."

2. Freezing: For this technique I have my clients visualize their intrusive thoughts, feelings, and images as ice cubes that they stored in my office. I state, "Visualize a scoop that picks up the ice cubes and puts them in a plastic container. See the containers stored in a freezer outside my office. We can retrieve the ice cubes, whenever you want and use them in an appropriate way to help your therapy progress."

3. Dirty Laundry: For this technique I have my clients imagine their thoughts, feelings, and images as dirty clothes that need to be laundered. I state, "Visualize yourself taking the clothes and putting them in a laundry bag. Imagine a laundry truck arrives and you place the laundry bag in it and you watch it drive away. The cleaner that the truck takes your laundry to is right next door to my office so you and I can pick up your laundry together whenever you like. When we pick it up, we can sort it and use it in an appropriate way."

4. Shrinking Techniques: For this technique I state, "Picture that you are looking at your images, thoughts, and feelings through a reverse telescope. When looking through the telescope your images, thoughts, and feelings seem far away and small. Or you can think of yourself taking off in an airplane and watching your material shrinking in the window as you leave it. You are in control of how far away and small your material appears to you."

These are only four techniques that your clients can use to manage their intrusive thoughts, feelings, and images. It is important that they identify an image that they can recognize and is useful for them to control their thoughts, feelings, and images. Michelle and I experimented with different containment skills until she found one she was comfortable enough doing on her own.

In this section, we discussed the Feelings Dial Technique and Containment Skills. Both of these techniques offer PTSD clients a way to manage intrusive thoughts, images, feelings, or sensations. With the Feeling Dial Technique, your client uses the image of a dial with a scale of 1 to 10 to gradually lessen the intensity of their feelings with regards to a specific distressful situation. The four Containment Skills that were described in this section are split screen, freezing, dirty laundry, and shrinking techniques.

In the next section we will give a review of EMDR as a means of beginning the conversation about EMDR therapy with your PTSD client.

Schiraldi 141-143 Naparstek 103
Reviewed 2023

Update
Unpacking the Relationship between Fear Motives and Self-Control Strategies among Managers: The Mediating Role of Intrusive Thoughts

Bakaç, C., & Kehr, H. M. (2023). Unpacking the Relationship between Fear Motives and Self-Control Strategies among Managers: The Mediating Role of Intrusive Thoughts. Behavioral sciences (Basel, Switzerland), 13(5), 384. https://doi.org/10.3390/bs13050384


Peer-Reviewed Journal Article References:
Brooks, M., Graham-Kevan, N., Robinson, S., & Lowe, M. (2019). Trauma characteristics and posttraumatic growth: The mediating role of avoidance coping, intrusive thoughts, and social support. Psychological Trauma: Theory, Research, Practice, and Policy, 11(2), 232–238.

Hyman, I. E., Jr., Cutshaw, K. I., Hall, C. M., Snyders, M. E., Masters, S. A., Au, V. S. K., & Graham, J. M. (2015). Involuntary to intrusive: Using involuntary musical imagery to explore individual differences and the nature of intrusive thoughts. Psychomusicology: Music, Mind, and Brain, 25(1), 14–27. 

Marks, E. H., Franklin, A. R., & Zoellner, L. A. (2018). Can’t get it out of my mind: A systematic review of predictors of intrusive memories of distressing events. Psychological Bulletin, 144(6), 584–640.

Zhao, C. J., & Stone-Sabali, S. (2021). Cultural discussions, supervisor self-disclosure, and multicultural orientation: Implications for supervising international trainees. Training and Education in Professional Psychology, 15(4), 315–322.

QUESTION 8
What are the four containment techniques you can share with your client to help them manage their intrusive thoughts, feelings, and images? To select and enter your answer go to Test.

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