Triggers - The Core Root Before Symptoms Are Activated

[The Albatross]

Yeah Alixapain, I can't have anything around my neck still (like the turtleneck you mentioned) I did the flinching thing too for years, but not anymore now.

I flipped out once at work when someone, after I slipped and fell going up the stairs, said, "Grace!" The only one who ever said that to me was my father and I hadn't heard it for around 15 years. The poor girl that said it, came to find me and was so sorry. I had to tell her, she had no way of knowing, and that no one had ever called me that except my father. I went home and when we got a boat, I christened it "His Grace", when I got a cat, I named her Grace, and I literally desensitized myself to that name. I'm okay now.

He called me a bunch of other stuff that can trigger me too... but I didn't want to name a pet "You F'ing B*tch". (grin)..

I think I will have to consider some of the others, like I noticed I triggered on "hospital smells" for years if I had go in one I would faint - just shut down and fall onto the floor. I had a botched tonselectomy at 6 and almost bled to death in the hospital and my mom found me drenched in blood - they had to give me two transfusions.

I have noticed that some smells will certainly do it.

 

[alixipain]

The B word sets me off quickly. I have got to the point that it only makes me mad but not a reaction such as defend myself. The incident this weekend took me back somewhat. Had to speak with my T about it. Although I was in the legal right in defending myself from assault but I still feel guilty inside for the young man did not realize he instigated a fight and assaulted a Disabled Veteran.

Although I do not let others know I'm classified as 65% disabled.

To me it only lasted 2 seconds the witness stated it lasted for about 25 minutes, four hits to me from the young man, the rest was me unleashing on him. I remember shaking violently then he started to say, "You’re so scared you’re shaking." I know it as a warning sign to walk away or someone is going to get killed or injured. I attempted to walk away yet he punched me in the back of head. After the first punch I don’t remember anything.

I know I have what is referred as "Black Rage". The following was stated to the police that had to remove me from the young man, one officer of which was hit as well, and a co-worker: Man 1 hit him in the back of head; he turned around to say something when man 1 hit him in the face and laughed. He laughed back, head butted man1, then kicked man 1 in the nuts, jammed his knee into man1's face, man 1's head went back he laughed and grabbed man 1's head shoving his thumbs into man 1's eyes. Man 2 (Passenger of man 1's car) got out and hit him in the head with a bag. He turned looked man 2 then used man1 to fight off man2. He threw Man 1 to the ground then hit man2 in the throat with his two fingers where man2 hit the ground gasping. He kicked man 2 in the face (this is where my co-worker was hit) I tried to stop him when he hit me in the face (I broke his nose). I stepped away from him when witness 1 stepped in and was hit (witness 1 got co-worker away) man2 stood up when he clamped his hand on man 2's throat, the police officer arrived hit him twice when he hit officer in the face (broke his nose) at which point officer tazzed him. He laughed at officer 1 when officer 2 tazzed him again bringing him down.

I came to in the ambulance strapped to the gurney. I wanted to just go back to work. I and witness's stated to officer what started the incident which was I had been running a sewer machine into a clean out had the road blocked with cones so no one would drive into work area to drive on sewer cables. He removed the cones and drove into work area running cable over. Stopping the cable while it was spinning the cable wrapped around my hand remove the glove from my hand and slapping the side of his car. In which it upset him that the cable dented and removed paint from his car.

The officers released me when I settled down but gave me a summons to go to court over the assault to an officer.

I was at first was going to be charged with assault to an officer, and assault with intent to kill. They spoke to my T and dropped the charges of intent, the assault on an officer are still pending. I'm sure they will be dropped when they get to speak more with my T.

This is the first hand to hand fight for me in 5 years.

 

[shiraz]

My partner and I have worked really hard to identify my triggers over the years and we have successfully altered the way we live to avoid as many triggers as possible. I did try exposure therapy, it was tremendously difficult, I stuck it out for months until my partner said 'enough - I'm losing you'. The re-traumatisation through exposure therapy was too much for me, I was constantly dissociated and beginning to lose the last fragments of my personality and ability to function. Thus, we started illiminating triggers in the home.

sound

1. The sound of the TV - he uses headphones when he watches.
2. Shouting - he tries hard not to raise his voice
3. Footsteps up the passage at night when I am in bed - unavoidable, so he calls to me that he is approaching.
4. door opening when I am asleep - unavoidable, so he calls to me to wake me up before he enters.

sight

1. erotica/sexual material (even underwear ads) - we do an internet parental check on all movies before we watch them and avoid all materials which will trigger me. Eventually we also got rid of the TV as there is no way to avoid this trigger on TV. Don't read magazines, don't go into malls unless it is unavoidable, choose driving routes carefully to avoid billboards. Call ahead to restaurants to make sure they don't have monitors playing FTV or music channels.
2. suffering - don't watch the news, rather listen to it on radio
3. a closed door - we keep all doors open unless we are both in the same room.

touch

1. certain types of touch like someone scratching my back in a certain way and certain sexual contact given and received - we are very careful how we interact.
2. someone leaning over me from behind when I sit on a chair - just don't go there!
3. being cornered, being held down, wrist grasped - those who know me know not to do these things.

smell and taste

1. none I know of - my sense of smell and taste are quite weak.

Over the years many of these triggers have naturally lessened while others remain strong. Shouting does not affect me as much as it used to and I don't wake in a flashback every time he comes to bed any more. I can cope with the mall a lot better now as sexually inspired ads trip me up a lot less than they used to. It always amazes me to see an ad that used to have me completely freaked out and realise that it is not causing such an intense reaction any more, sometimes I can't get my head around why I reacted so badly in the past .... I guess that is healing :)

I am very fortunate to have a partner who is really committed to my healing process. It is simple; if we follow the rules we set out to avoid triggers, I do really well, if we don't, he loses me to PTSD. It is restrictive for him of course and that used to cause such guilt and shame, but as he puts it - 'I want you more than I want TV'.

 

[anthony]

Whilst I could write a short novel to get my point across sensitively, I am going to summate it quickly, which you will likely find harsh:

This list is the most destructive, counter-productive list I have ever witnessed.

You spend more time actively avoiding some every day aspects instead of just desensitizing yourself to the problems so they are no longer triggers. The actual act itself of avoidance, is a constant reinforcement within your brain of the trigger, which is what produces the constant stream of symptoms associated to fear. You are in essence, reinforcing fear within your brain, knowingly or not, that is what your doing.

 

[shiraz]

Harsh? Not at all :)

uhmmm ....what does this mean then?

Whilst avoidance in symptom aspects is not encouraged at all, avoidance of triggers themselves is generally highly encouraged, as these are the core root of PTSD concerns.

Have I misunderstood this quote Anthony?

 

[anni]

I think maybe there's a difference between avoiding everything which makes you at all uncomfortable, which becomes unweildy and out of control and deliberately avoiding triggers associated with the trauma which would only serve to re-traumatize. I'm picking my way through these at the moment-not always incredibly easy. Which is a trigger which requires healthy avoidance and which a mere stressor which should be faced then negated as something avoided on impulse?

 

[anthony]

As Anni stated.

Quite honestly, anything that triggers you should be faced and fought against with everything you have, massive exposure therapy one at a time to desensitize the trigger. It is only the absolute of major triggers that should be left, which should consist of one, maybe two things.... which you have given adequate time and energy into beating, and have failed every single time after months of exposure to them.

Even then, you should come back to them some years after healing the majority of trauma and give them another go, again giving adequate and substantial time and effort into beating, not just, tried it once or twice, hurt too much, gave up.

I will give you a direct example. I have my triggers for massive anxiety fallout down to pretty much one thing now... that is being back around military environments, which includes ANZAC day, which means being around massive amounts of military people, uniforms, etc. I tried this initially by living in a military area, and when I left, my anxiety fell significantly. Every time I expose myself to such an environment for any extended duration, whilst the fallout is less these days due to my working on everything else and reducing symptoms as much as possible in general, I still fallout real bad in such an environment.

Next year however, I must return to the actual location of where I was based and deployed from for all my operations when serving, to attend a mates wedding their. I will use that as exposure therapy for myself, to be around that environment and work on issues that rise, yet have been dealt with, as being just that... they have been dealt with and are purely raising their ugly little head due to being in that environment again.

ANZAC day alone knocks me out for a day or two, from nothing other than Australia as a whole near turns to reflect on the ANZAC tradition for fallen soldiers. It is impossible to escape it.

I started with a much much longer list, though quickly got that list down to one or two things that I just cannot get past "yet" without significant fallout and impact on me, as they are directly trauma related, being mine is all military operations. I can see a soldier or uniform, no issue... its only when in mass it affects me, ie. a military location where a huge base is located and the community pretty much functions on soldiers. ANZAC day tends to just have that affect due to the significance of the day and what it stands for.

Watching military movies used to make me ill, but again, repetitive watching, recognising the feelings, working through it and repeating the exposure to desensitize myself, I no longer get triggered.

This applies to every single person, its not unique. With repeated exposure the brain will desensitize and no longer get triggered for 99% of all triggers. It will be a rare one or two that your brain will just not desensitize too as they will hold the greatest significance to your trauma, which is an emotional connection within your brain.

 

[shiraz]

Thanks Anthony and Anni,

For a wile there, I thought I had misunderstood PTSD healing altogether.

My trigger list used to fill two pages, now, just the triggers mentioned above still persist. As such Anthony, I beg you to re-evaluate this as

the most destructive, counter-productive list I have ever witnessed

and rather see it as more of a condensing of the last few triggers left after three years of intensive healing and as such I am elated.

You mentioned that:

You spend more time actively avoiding some every day aspects instead of just desensitizing yourself to the problems

Let me explain my situation. I was abused with the use of sexual imagery, and this is my one big one that will not shift. The other is the sound of the TV behind closed door when I am not in the room - this was the precursor to the abuse - another trigger I cannot shift even after six months of CBT and exposure therapy.

You mentioned:

I have my triggers for massive anxiety fallout down to pretty much one thing now... that is being back around military environments

My CPTSD works basically the same, as it is based on sexual abuse, being around sexual imagery may cause me to fall down, tamer imagery not so bad any more, more aggressive sexual postering is still a huge trigger. Sex is an every day aspect of life and it peppers, most liberally, most every environment and thus for now, I avoid as much as possible - you can only imagine how difficult that is (I am getting a fair whack of exposure therapy weather I like it or not). Actually South Africa has recently implemented new standards around the use of sex in advertising. I am relieved to see that there are no more naked pole dances on the billboard next to the primary school my niece and nephew attend with the caption 'what's wrong without a thong?' - an ad for a strip club ... obviously. And I am happy to note that I can go and have a meal out without having late night FTV broadcasted on a number of huge monitors found at every possible angle of the restaurant one looks. One really cannot just look the other way.

I guess I might have to try CBT and exposure again at some point for those triggers which stick (terrifying thought). For now though I am working on the being cornered, grabbed and leaned over ones, that is if I can get my man to try them - he did not like the outcome when he did them spontaneously :)

I guess my triggers sound too much like every day life. I wish they were not, but hey, I was abused with what should be a natural part of every day life. Strangely, I have been able to work through the triggers which relate to participation in sex with just a few 'don't go there's' eg. my father called me over to the bed with those exact word 'come and lie with me' and put his hand on the small of my back just like you do, when I came to him. My partner would rather I am not thinking about the abuse when with him and does not mind avoiding these triggers.

also, as I mentioned:

Over the years many of these triggers have naturally lessened while others remain strong. Shouting does not affect me as much as it used to and I don't wake in a flashback every time he comes to bed any more. I can cope with the mall a lot better now as sexually inspired ads trip me up a lot less than they used to

Anthony, you said:

Whilst I could write a short novel to get my point across sensitively....

....that would have been nice - but counter your personality and time constraints so don't sweat it. I hope though, that you are able to understand that the triggers mentioned in my first post are the ones directly related to the trauma and as such, stuck for now. But hopefully, with a lot more time, lots of courage and therapy, not forever.

Here's to moving the BIG, STUBBORN, STUCK ones.
Shiraz

 

[anthony]

I do get that these would be specific to your trauma, otherwise they wouldn't be triggers for you.

Sex is an every day aspect of life and it peppers, most liberally, most every environment and thus for now, I avoid as much as possible - you can only imagine how difficult that is

I actually completely understand what you are saying, and also the work you have done is a great achievement, especially for complex trauma.

Without saying too much else, I would prefer if you could answer a simple question to each trigger, only if you want some ideas on how to quickly remove these from your life, factoring in you have complex trauma, the majority of the below can be removed one at a time.

If you don't want to remove these now, then that is also fine... but if you do, then I will help you get rid of them down to one or two only, and even those... you should hopefully be able to remove in another few years with the help of time.

If you had to rate the below from 1 - 10, one being least severe, ten the most severe reaction, how would you rate them for the actual reaction they provoke in you? Adding to that, what is the symptom/s provoked?

sound

1. The sound of the TV - he uses headphones when he watches.
2. Shouting - he tries hard not to raise his voice
3. Footsteps up the passage at night when I am in bed - unavoidable, so he calls to me that he is approaching.
4. door opening when I am asleep - unavoidable, so he calls to me to wake me up before he enters.

sight

1. erotica/sexual material (even underwear ads) - we do an internet parental check on all movies before we watch them and avoid all materials which will trigger me. Eventually we also got rid of the TV as there is no way to avoid this trigger on TV. Don't read magazines, don't go into malls unless it is unavoidable, choose driving routes carefully to avoid billboards. Call ahead to restaurants to make sure they don't have monitors playing FTV or music channels.
2. suffering - don't watch the news, rather listen to it on radio
3. a closed door - we keep all doors open unless we are both in the same room.

touch

1. certain types of touch like someone scratching my back in a certain way and certain sexual contact given and received - we are very careful how we interact.
2. someone leaning over me from behind when I sit on a chair - just don't go there!
3. being cornered, being held down, wrist grasped - those who know me know not to do these things.

 

[shiraz]

1. someone scratching my back in a certain way
   
   • muscles tighten, freeze response, stop breathing on the out breath, overwhelmed with mixed emotions - tearful/anger, dissociation begins, nausia.
2. wrist grasped
   
   • muscles tighten, stop breathing on the out breath, fear, overwhelm, anger response leads to terror if continued and eventually to dissociation
3. seeing suffering
   
   • dissociation, anger, fear, panic, overwhelm, avoidance, indescribable lingering sadness and intrusive imagery
4. someone leaning over me from behind when I sit on a chair
   
   • muscles tighten, freeze response, stop breathing on the out breath, overwhelmed with mixed emotions - tearful/anger, dissociation begins (now mastered - lasts about 10min), nausia, flight instinct (now mastered, do not run anymore)
5. being cornered
   
   • muscles tighten, freeze response, stop breathing on the out breath, overwhelmed with mixed emotions - tearful/anger, dissociation begins, nausia, flight
6. door opening when I am asleep
   
   • startle, freeze, hold breath, muscles tighten, overwhelm, terror, into flashback, tears, lose control of bodily function i.e pee myself, sob, nausia, adrenal overload, shaking, dissociation (now mastered - lasts about 30min), flight instinct (now mastered, do not run anymore)
7. being held down
   
   • muscles tighten, stop breathing on the out breath, fear, overwhelm, anger response leads to terror if continued and eventually to dissociation and freeze.
8. certain sexual contact given / recieved
   
   • terror, freeze, nausia, sudden crying, overwhelm, dissociation, brain fog, can't speak, shaking, collapse into self (can take many hours to bring myself back), exhaustion
9. a closed door when there is a male on the other side
   
   • fear, panic, flashback, need to 'check' what is happening on the other side, too afraid to go in, takes all my courage and effort to not take flight, if I don't act and go in, eventual dissociation and flashback. Have had some success using CBT processes, but at times it is just too much distress, feeling very vulnerable, tearful and lose speach ability, back spasms.
10. The sound of media being watched when I am not watching
    
    • fear, panic, flashback, need to 'check' what is being watched, too afraid to go see, takes all my courage and effort to not take flight, if I don't act and go see, eventual dissociation and flashback, distress, feeling very vulnerable, tearful and lose speach ability, hide - talk myself out of hiding and going to 'see', can't make myself follow through, flight instinct (now mastered - will not leave the house) ..... this all cycles until I am able to go and see what is being watched. Most times, if I hear media being played, I'll drop everything and go and watch, for some reason I feel less vulnerable if I am also watching. Huge exhaustion and adrenal overload. Will suffer adrenaline rushes for up to 24 hours later and back spasms up to three days later.
11. erotica/sexual material

• dissociation, feeling vulnerable, flashback, intrusive imagery (can last weeks ), innitiates intrusive imagery from prior material exposed to. Each intrusion innitiates a new flashback - very uncomfortable feelings of fear, terror, dread, vulnerability, suicidal ideations, nausia, in and out of dissociation as I am able to control dissociation to some degree. Adrenaline rushes, back spasm (can last for days) shaking, flight instinct (acted on if triggered in public) Emotional overload - can't control emotions, swing between anger,fear,sadness and back again. Takes about three days until I can function well again -very suceptable to further triggering during this time.

 

[shiraz]

Thanks for having a look at this Anthony. something weird with the formatting.

 

[anthony]

someone scratching my back in a certain way

muscles tighten, freeze response, stop breathing on the out breath, overwhelmed with mixed emotions - tearful/anger, dissociation begins, nausia.

Ok, so this gives you the least issues. This is the best place to start, and remain focused only on this one item, until you have removed it.

Have you done anything already to try and remove this trigger? If so, what exactly... please be specific!

Also, in what context in relation to your trauma, did this become a trigger in the first place? If you don't mind me asking? (Don't require graphic details, just an overall summation to understand the logic to ensure I give you adequate feedback to help you to incorporate within the process)