Triggers : Removal Or Management?

[Friday]

Ha. Love it when I can do this :D What Anthony said!

Except I haven't gotten rid of all of my triggers. Still chipping away.

 

[anthony]

once you've 'broken through' with a trigger, it becomes a stressor

In some cases... but not most, for me. Most things that used to trigger me, no longer do... nor do they stress me. Some can still be a little stressful, at times, but most of the time I have the right mindset before approaching them. Many other factors stress me, which has no trigger component in my history, yet are still stressors to this very day and only exist due to PTSD. Go figure...

If things that stress me now, did before, they certainly never showed like they do now... but hey, that is PTSD after all -- exacerbation to the max.

 

[BlueOrange]

Thanks @anthony - please forgive the pedantry, I want to get this right...

In my mind, there's a progression that goes like this:

1) Trigger is an 'untreated trigger' and things go badly in an uncontrolled way when it is activated. (I'm reminded of the Bad Thing, and immediately behave/respond in ways that are inappropriate to the current context.)
2) Trigger is a 'coped-with trigger', and things don't go as badly anymore because there is a measure of control when it is activated.
3) Trigger is a 'managed trigger', and methods that are more sophisticated than 'pure avoidance' are used to deal with it. (eg, "I know that I'll be doing X, therefore I will be at risk of being triggered, therefore I will take the following precautions...")
4) Trigger is a 'now a stressor', and does not require any coping strategies that are different from the coping strategies used for everyday life. I don't go into autopilot anymore, but it's still a problem.
5) Trigger is 'no longer a problem', and exposure to it doesn't require any coping strategies at all. I might not like it, but I'm not distressed by it.

A progression like that seems to be consistent with what you said, but it might not match your experience. If that progression seems wrong to you, then that indicates to me that my generalizations are inaccurate or that I don't really understand what 'trigger' means.

Many other factors stress me, which has no trigger component in my history, yet are still stressors to this very day and only exist due to PTSD. Go figure...

One of the things I'm dealing with right now is that I had a number of distressing/frightening experiences because I had PTSD. Being reminded of those doesn't put me on autopilot (which is what I think 'trigger' means), but it does put me under a great deal of stress. I've found reprocessing those just as difficult as reprocessing the original stuff, annoyingly enough. (In hindsight, I wish I'd just made peace with having them around.)

 

[anthony]

You should remember the basics of what a trigger is, and not go further than what it is, into the realm of symptoms. Symptoms / reactions, to a trigger, are not a trigger. They are the outcome, the result, event if you like. A trigger stops at the activating event that causes a sense (five senses) to be stimulated in such a way that it reminded you of some aspect of your trauma. As a result, you then have a symptom of x severity / duration.

The trigger goes not further than the activating sense event.

So, for example. Walking into a crowded shopping centre used to trigger massive anxiety and hyper vigilance for me. Both symptoms were present in other contexts already, just being ex-military with PTSD, those are two near constant symptoms. But because I have specific bad memories linked to crowds, i.e. a grenade gets tossed in at a busy market, crowds and markets (malls or such) were a trigger for me. Just thinking about going to them raised those symptoms, but when I would get to them, those symptoms would get out of control because I became triggered from the experience around me, and they subsequently went out of control and I would have to exit immediately.

When I say exit, I mean I would be pushing my way out due to mass panic overwhelming me.

So, that was the trigger, then I had the symptoms (the event). Trigger stops at the sensory cue, symptoms begin once activated due to the sensory event.

I did a lot of exposure therapy to crowds, progressively removing the trigger with the realism of where I am... normal old society where that type of thing is highly unlikely to ever happen in my presence. It may, but not like the chances of when in a war zone.

When in crowds now, I am no longer triggered. I don't become panicked and push my way out with anxiety and hyper-vigilance. Now, I still have both symptoms, but when going into shops or crowds, those symptoms don't change because I reinforce them constantly with the experience of normal society. Have done for the past 10 years since I started working it out for myself.

The trigger was crowds, and also busy shops. Now, no more trigger. I still get stress at times from too time in crowds, for example, where symptoms may begin to increase, but they aren't being triggered, I'm being stressed by longevity exposure in a crowd. I recognise it, then manage it accordingly, i.e. focus elsewhere, go for a walk, go stand against a wall and take it all in, so forth. Symptoms subside.

Could I still be triggered in a crowd? Sure, anythings possible and PTSD is a cow and bites back at any given time. Do I get triggered now in crowds? No... I haven't for many years now.

I started with shops, worked my way up to theatre and such events, then concerts, then bigger concerts, then massive sporting events with 80k people and such. I still have to manage my headspace going into them, but it is more routine for me to do that now, not forced and conscious. More unconscious act now... automatic pilot to get my head right going into it.

 

[anthony]

If that progression seems wrong to you, then that indicates to me that my generalizations are inaccurate or that I don't really understand what 'trigger' means.

If what is in your head, matches pretty much the definition of a trigger, then how you have rationalised it is here nor there, honestly... as long as its accurate and that you understand it for you. We all process things differently, as long as the root information is the same, how you come around to the outcome doesn't matter, you start at the right spot, you end at the desired outcome for you.

Trying to understand your five stages there... and I guess that could be accurate if you started at the top, and the bottom was the endgame. But the endgame, trigger should just be removed totally, because there is no more trigger, just something that no longer activates you into a symptomatic outcome. It just is part of your normal life now with no repercussions.

 

[BlueOrange]

Thanks @anthony , I appreciate the effort put into the replies. I can see that I could have been clearer, and talked about those 5 stages as 'stages of having/dealing with a trigger'. And I think you're right - that there comes a point where the trigger stops being a trigger; that it might still be 'a thing that happens in the world', but it's no longer a 'button' and it wouldn't be true to say 'pressing the button doesn't do anything anymore', because there is no 'button to be pressed'.

 

[Sandstone]

I started with shops, worked my way up to theatre and such events, then concerts, then bigger concerts, then massive sporting events with 80k people and such.

Trying to unpack in my head how to apply that. It seems to me as if there is a difference between exposure to current events and Prolonged Exposure Therapy for the past events that created the trigger. Are you saying that it is possible to overcome the present day triggers without tackling the underlying events? And for that to be enough, in itself, to tackle the rest of ones life?

I can see how to do it, and have done it for things that are not directly related to traumas. So I have tackled my inability to eat or drink in public, by gradually moving from watching OH have a cup of tea, and can now go out for a meal, provided no-one can pass behind me. That isn't related to a trauma. I can give lots of examples of how I have worked on things like that, and they seem to be about managing the impact of hypervigilance

When it comes to anything more directly related though, I still go from 0-60 instantly. Trying to go with the walking group to a coastal marsh area, similar to the one where I was raped had me running instantly, babbling incoherently because I saw those grasses and smelled that salt. I was under the impression that formal processing treatment was the way ahead for that.

There is also an earlier stage, of identifying the triggers. I thought it was obvious, but I've found that times when I think I'm just " flying off the handle" for no reason are often actually associated with the "trapped, pinned down" trigger, but I don't realise for days or weeks afterwards that it wasn't purely bad behaviour and lack of self control. It might be easier in the long run to deal with the causes of those trapped fears than to work on exposing myself to all the ways I could feel trapped.

 

[Sandstone]

@anthony I think I probably waffled on too much for my actual question to be noticeable. I value hearing what you have to say about it.

Are you saying that it is possible to overcome the present day triggers without tackling the underlying events? And for that to be enough, in itself, to tackle the rest of ones life?

 

[anthony]

Are you saying that it is possible to overcome the present day triggers without tackling the underlying events? And for that to be enough, in itself, to tackle the rest of ones life?

You can tackle triggers by themselves, BUT, if the cause of the trigger is still there, being the trauma, then the work you do will likely provoke your symptoms more, creating worse triggers for you, then you will think exposure work is evil and doesn't work for you as a result.

I have heard this numerous times by people, that exposure didn't help them... but it was not exposure, it was their approach.

Tackling triggers is usually something done in the later stages of healing, i.e. after trauma therapy. You can't have unresolved trauma consistently provoking you during the exposure process, where you have enough to work on as it is.

If the trigger was some minor issue, sure, you could probably get rid of it without touching the underlying trauma. Otherwise, the underlying trauma is the cause of triggers, triggers are the cause of x symptoms. It is a hierarchy in which needs to be approached from the top downwards for longevity effective results.

 

[sedna]

You can tackle triggers by themselves, BUT, if the cause of the trigger is still there, being the trauma, t...

I had zero ability to handle therapy because I had the cause of my trauma still having an effect on my daily life, although not directly, it was through attorneys. I had to be completely done for two years before I could attempt any real work. None of the therapists I went to ever understood that, and some pushed me too far and created more breakdowns. Its good to see someone put that so accurately and clearly here.

 

[anthony]

I had zero ability to handle therapy because I had the cause of my trauma still having an effect on my daily life

That's a catch 22 though, in that you're saying that you couldn't do trauma therapy because trauma was affecting your daily life, where trauma therapy helps you to treat your trauma, so it isn't affecting your daily life.

My first shrink told me as one of the first things, "you need to bury your head under a rock for about 3 years." That didn't mean I should stop seeing them, but that I should remove myself from life whilst doing progressive treatment, basically, with treatment and the severity I was, my only focus was helping myself and reducing stressors as much as possible elsewhere in life.

This is one of the reasons why Prolonged Exposure is still to date, that I last looked, the most effective treatment for PTSD. It is done in a way that you control your exposure to your trauma level, i.e. write it out, what you remember, read over it, add to it, repeat and rinse. That process can be done in a session for a single event, or over a month, at your time when you feel ok to tackle it, knowing the symptoms will spike as a result. It gets the full picture down, filling in all the blanks, forgotten, the mistruths your brain has created, so forth. You sift through it all at your pace. EMDR does the same thing, using exposure, in a different way... but you don't really have control with it, as the fragments are being guided and forced.

PE is what anyone here with a diary, is in essence, already doing. If you write about your trauma, read over it, write more, add to it, so forth, as things come to your memory, that is PE. All the while you are desensitising yourself. Your symptoms spike, absolutely... but over time, they become much less intense when exposed to the same thoughts, all whilst having a complete picture as you remember it for reference.

 

[Sandstone]

That is disheartening. It seems to leave me trapped in a no mans land of being too unstable to do the processing, but unable to remove the causes of that instability, because I need to have processed the trauma in order to do it.

I know that the underlying problem there is that I look OK, everything is Apparently Normal, until we go near the core of it, and then everything is suddenly and unexpectedly not OK. Since thee response of the competent people I've dealt with has been to back firmly away from tackling the trauma, I seem to be stuck.

I had hoped that you were saying there was some hope of getting my life back by an alternative process