A trauma trigger is a psychological stimulus that prompts involuntary recall of a previous traumatic experience. The stimulus itself need not be frightening or traumatic and may be only indirectly or superficially reminiscent of an earlier traumatic incident, such as a scent or a piece of clothing. [1] Triggers can be subtle, individual, and difficult for others to predict. [2] [3] A trauma trigger may also be called a trauma stimulus, a trauma stressor or a trauma reminder. [4] [5]
The process of connecting a traumatic experience to a trauma trigger is called traumatic coupling. [6] When trauma is "triggered", the involuntary response goes far beyond feeling uncomfortable and can feel overwhelming and uncontrollable, such as a panic attack, a flashback, or a strong impulse to flee to a safe place. [7] [8] [9] Avoiding a trauma trigger, and therefore the potentially extreme reaction it provokes, is a common behavioral symptom of posttraumatic stress disorder (PTSD), a treatable and usually temporary condition in which people sometimes experience overwhelming emotional or physical symptoms when something reminds them of, or "triggers" the memory of, a traumatic event. [5] Long-term avoidance of triggers increases the likelihood that the affected person will develop a disabling level of PTSD. [10] Identifying and addressing trauma triggers is an important part of treating PTSD. [6]
A trigger warning is a message presented to an audience about the contents of a piece of media, to warn them that it contains potentially distressing content. A more generic term, which is not directly focused on PTSD, is content warning.
The trigger can be anything that provokes fear or distressing memories in the affected person, and which the affected person associates with a previous traumatic experience. Just as trauma is not merely an unpleasant or adverse experience, a trauma trigger is not merely something that makes a person feel uncomfortable or offended. [9] [11] Some common triggers are:
The trigger is usually personal and specific. However, it need not be closely related to the actual experience. For example, after the Gulf War, some Israelis experienced the sound of an accelerating motorbike as a trigger, which they associated with the sound of sirens they heard during the war, even though the resemblance between the two sounds is limited. [17]
The realistic portrayal of graphic violence in visual media may expose some affected people to triggers while watching movies or television. [1] [18]
People who have experienced trauma and who have developed trauma triggers may panic when the trigger is experienced, especially if it is unexpected. [7] For example, the noise of fireworks may seem unbearable to a combat veteran whose trauma is coupled with sudden, loud noises as the trigger.
Trigger warnings, sometimes called content warnings, are warnings that a work contains writing, images, or concepts that may be distressing to some people. [19] Content warnings have been widely used in mass media without any connection to trauma, such as the US TV Parental Guidelines, which indicate that a show includes content that some families may find inappropriate for their children. [20] The term trigger warning, with its trauma-specific context, originated at feminist websites that were discussing violence against women, and then spread to other areas, such as print media and university courses. [19] Although it is widely recognized that any sight, sound, smell, taste, touch, feeling or sensation could be a trigger, trigger warnings are most commonly presented on a relatively narrow range of material, especially content about sexual abuse and mental illness (such as suicide, eating disorders, and self-injury). [21]
The idea of giving content warnings to university students about their coursework has been disputed and politicized. [7] Much of the dispute centers around content warnings given to all students about the presence of generally uncomfortable subjects in the curriculum, such as racism and misogyny. [7] There is no significant dispute over providing reasonable accommodations to the small number of students (usually current and former military personnel and sexual assault survivors) who qualify as having a disabling level of post-traumatic stress disorder and whose ability to learn the normal curriculum can be improved, for example, by mentioning in advance that the next reading assignment contains a detailed description of a violent event or that an upcoming ballistic pendulum demonstration will produce loud sounds. [7]
In 2014, the American Association of University Professors criticized the use of general content warnings in university contexts, stating, "The presumption that students need to be protected rather than challenged in a classroom is at once infantilizing and anti-intellectual. It makes comfort a higher priority than intellectual engagement and...it singles out politically controversial topics like sex, race, class, capitalism, and colonialism for attention." [22] This view is supported by some professors such as Richard McNally, professor of psychology at Harvard, and some psychiatric medical practitioners, such as Metin Basoglu and Edna Foa. [23] [24] [25] [26] [27] [28] They believe that trigger warnings increase avoidance behaviors by those with PTSD which makes it harder to overcome the PTSD, create a culture that decreases resilience, and more geared towards political virtue signaling, and are "counterproductive to the educational process". [23] [24] [25] [29]
Since the publication of the American Association of University Professors' report, other professors, such as Angus Johnston, have supported trigger warnings as a part of "sound pedagogy". [30] Other supportive professors have stated that "the purpose of trigger warnings is not to cause students to avoid traumatic content, but to prepare them for it, and in extreme circumstances to provide alternate modes of learning." [31]
Universities have taken different stances on the issue of trigger warnings. In a letter welcoming new undergraduates, the University of Chicago wrote that the college's "commitment to academic freedom means we do not support so-called 'trigger warnings'," do not cancel controversial speakers, and do not "condone the creation of intellectual 'safe spaces' where individuals can retreat from thoughts and ideas at odds with their own". [32] [33] [34] Students at UC Santa Barbara took the opposite position in 2014, passing a non-binding resolution in support of mandatory trigger warnings for classes that could contain potentially upsetting material. Professors were encouraged to make students aware of such material and allow them to skip classes that could make them feel uncomfortable. [21]
Although the subject has generated political controversy, research suggests that trigger warnings are neither harmful nor especially helpful. Among people without traumatic experiences, "trigger warnings did not affect anxiety responses to potentially distressing material in general." [35] Furthermore, studies disagree on whether trigger warning cause transient increases in anxiety in those without traumatic experiences. [35] [36] [37] For participants who self-reported a posttraumatic stress disorder (PTSD) diagnosis, or for participants who qualified for probable PTSD, trigger warnings had little statistically significant effect. [38] [37] Effect sizes on feelings of avoidance, decreased resilience, or other negative outcomes have been "trivial" in controlled research environments. [36] [37]
While trigger warnings have garnered significant debate, few studies have investigated how students typically respond to potentially triggering material. In a 2021 study, 355 undergraduate students from four universities read a passage describing incidents of both physical and sexual assault. Longitudinal measures of subjective distress, PTSD symptoms, and emotional reactivity were measured. Greater than 96% of participants read the triggering passage even when given a non-triggering alternative to read. Of those who read the triggering passage, those with triggering traumas did not report more distress although those with higher PTSD scores did. Two weeks later, those with trigger traumas and/or PTSD did not report an increase in trauma symptoms as a result of reading the triggering passage. Moreover, students with relevant traumas do not avoid triggering material and the effects appear to be brief. Also, students with PTSD do not report an exacerbation of symptoms two weeks later as a function of reading the passage. [39]
Trauma triggers have been recognized by medical professionals since the 19th century. [7]
Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.
Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.
Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences, such as experiencing violence, rape, or a terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se.
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).
Acute stress disorder is a psychological response to a terrifying, traumatic or surprising experience. It may bring about delayed stress reactions if not correctly addressed. Acute stress may present in reactions which include but are not limited to: intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. Reactions may be exhibited for days or weeks after the traumatic event.
A flashback, or involuntary recurrent memory, is a psychological phenomenon in which an individual has a sudden, usually powerful, re-experiencing of a past experience or elements of a past experience. These experiences can be frightful, happy, sad, exciting, or any number of other emotions. The term is used particularly when the memory is recalled involuntarily, especially when it is so intense that the person "relives" the experience, and is unable to fully recognize it as memory of a past experience and not something that is happening in "real time".
Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.
Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed for studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias.
Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.
Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.
Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, sexual assault victims, and refugees. CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD.
PTSD Symptom Scale – Self-Report Version (PSS-SR) is a 17-item self-reported questionnaire to assess symptoms of posttraumatic stress disorder. Each of the 17 items describe PTSD symptoms which respondents rate in terms of their frequency or severity using a Likert-type scale ranging from 0 to 3. Ratings on items are summed to create three subscales – re-experiencing, avoidance coping, and psychological hyperarousal – as well as a total score. All items of the PSS-SR should be answered, and assessment is done by total score. The total score higher than 13 indicates on likelihood of PTSD.
PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.
Richard McNally is an American psychologist and director of clinical training at Harvard University's department of psychology. As a clinical psychologist and experimental psycho-pathologist, McNally studies anxiety disorders and related syndromes, such as post-traumatic stress disorder, obsessive–compulsive disorder, and complicated grief.
Anxiety buffer disruption theory (ABDT) is an application of terror management theory to explain an individual's reaction to a traumatic event, which leads to post traumatic stress disorder. Terror management theory posits that humans, unlike any other organism, are uniquely aware that death is the inevitable outcome of life. When thoughts of death are made salient, such as when a terrorist attack carries those thoughts into the level of consciousness, humans are subject to debilitating anxiety unless it can be "buffered." Humans respond to the anxiety and dread mortality salience produces by clinging to their cultural worldview, through self-esteem and also close personal relationships. Cultural worldviews, with their cultural norms, religious beliefs and moral values infuse life with meaning. They give life a feeling of normalcy and also a feeling of control. There is no way to definitely prove one's cultural worldview, there they are fragile human constructs and must be maintained. Clinging to a cultural worldview and self-esteem buffer the anxiety connected to thoughts of mortality. When thoughts of death are salient, humans are drawn to their cultural world view which "stipulates appropriate social requirements, and standards for valued conduct, while instilling one's life with meaning, order and permanence."
The genetic influences of post-traumatic stress disorder (PTSD) are not understood well due to the limitations of any genetic study of mental illness; in that, it cannot be ethically induced in selected groups. Because of this, all studies must use naturally occurring groups with genetic similarities and differences, thus the amount of data is limited. Still, genetics play some role in the development of PTSD.
The Child PTSD Symptom Scale (CPSS) is a free checklist designed for children and adolescents to report traumatic events and symptoms that they might feel afterward. The items cover the symptoms of posttraumatic stress disorder (PTSD), specifically, the symptoms and clusters used in the DSM-IV. Although relatively new, there has been a fair amount of research on the CPSS due to the frequency of traumatic events involving children. The CPSS is usually administered to school children within school boundaries, or in an off-site location to assess symptoms of trauma. Some, but not all, people experience symptoms after a traumatic event, and in serious cases, these people may not get better on their own. Early and accurate identification, especially in children, of experiencing distress following a trauma could help with early interventions. The CPSS is one of a handful of promising measures that has accrued good evidence for reliability and validity, along with low cost, giving it good clinical utility as it addresses a public health need for better and larger scale assessment.
Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.
Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.
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