Working with triggers

Triggers are part and parcel of Post Traumatic Stress Disorder (PTSD). If you have PTSD, you have triggers of some kind that cause a symptomatic reaction. The positive to triggers is that with time and effort you can remove them or lessen the symptomatic impact to non-distressing levels.

Many years ago, I wrote about stressors vs. triggers due to the confusion that stemmed from the use of these terms. If you are unsure about the difference, you should read that article first, as we directly discuss triggers on the assumption you fully understand what they are and that you understand them in the correct context.

The how to for trigger removal is the easy part. Going through the process of removing triggers is the challenging part. Removing triggers is done through a combination of exposure and cognitive behavioral therapy (CBT) techniques. Exposure is the doing process, while CBT teaches you self-management and assessment of the situational exposure.

This process was designed by trauma experts and should not be deviated. You can adjust exposure intervals based on individuality, but you cannot adjust the process itself. Professionals too often like to adjust this process in the belief they know better, and then, when it doesn't work, it is the sufferer who is treatment-resistant. Let's stick with the top experts in the field of trauma who developed the techniques, not those who think they know better.

The most important part of working with triggers is that at no stage is your exposure to be dangerous, whether environmental or emotional. There are always alternatives to dangerous situations and methods to remove triggers in a safe manner, just as there are always implementation strategies to ensure your emotional distress is never raised to dangerous levels. I will discuss these later so you have examples to build your own safe methods.

Preparation to removing triggers

First, you must have a list of your triggers. The best way to do this is to keep a simple trigger log that outlines:
  1. what you were doing when triggered,
  2. what symptom/s occurred as a result of being triggered, and
  3. the intensity.
Pretty simple, right?

Enter CBT techniques. You must understand why these are triggers for you, how they relate to your trauma, and order them from least to worst. You need to have established grounding/relaxation techniques in place so that you can self-soothe when beginning exposure to triggers.

Exposure process

Taking the trigger you find least distressing and begin testing your preparation process. Think of this as a test and adjust period to establish not only your process but how well you have prepared to deal with the symptomatic outcome caused by intentionally triggering yourself.

Exposure must start small and progressively, increasing at a duration and intensity aimed to induce no more than a medium symptom intensity.
  • Durations may be a minute or less per day, building daily to longer intervals, and
  • Intensity can be managed by exposure at a distance, closing in towards the real fear each day.
Examples speak best

Examples always speak best. What you should take from these examples is a rough guide for your application towards any self-help you perform.

Trigger: Entering locations with lots of people (grocery stores, malls, other busy markets)

Initial exposure may be to park outside the location. Take note of your thoughts. Is anything bad happening to you by being parked outside? Is there any real threat to your life? Try and be parked for a set time, then leave. Repeat this process daily, increasing the time as required, until you have no reaction to being parked.

Now increase your exposure to the source. Get out of your car and walk to the entrance yet no further. Repeat the above cognitive process and question what is happening within you. Then leave. Repeat this process, and time interval, until you can stand at the entrance with little to no reaction.

So far this could have taken you a week, a month, or more, depending on your reaction to the trigger. All the while you're processing the reality of the situation in relation to your safety, determining whether your thoughts are rational or irrational.

This process continues, setting small benchmarks to achieve. You may identify a shop just inside, making that your daily goal. You may then set a distance into the location, stand and look around, then exit, increasing time with each exposure.

See the pattern? It is a gradual, repetitive exposure process that never elevates your distress beyond 50%. You constantly process your thoughts, whether your fear is rational or irrational. You never get ahead of yourself and ensure you have an improved status before progressing your exposure.

Trigger: Yelling, screaming, threats of violence

The first question really is, how do you perform exposure to these safely? Answer, have someone record specific phrases you know trigger you, then listen to them within a controlled environment where you can ground and relax. Even use them in therapy so you have your therapist present.

The process replicates above, with the exception you can't ease your way into this type of exposure so readily. However, you can ease yourself into what is said. You can also ease yourself into the volume when using digital equipment.

Back to creating your list. What words or phrases trigger you? What circumstances? Starting at the lowest again, you begin controlled exposure to recordings, audio or video, or with your therapist, close friend or family member who you trust.

This type of exposure is not about desensitising you to domestic violence or such, but to minimise / desensitise you to your present experience of negative affect, such as going out and someone yells which triggers you into a symptomatic reaction. This type of exposure is often harsher and done when you have an experienced grasp on grounding and relaxation with exposure.

A promising exposure technique to the threat of violence is through self-defence classes. One-on-one instruction with a professional can really help desensitise, whilst giving you skills to protect yourself. You may then be able to enhance your scope within a group class.

Movies with domestic violence may also help you for exposure. You are safe and sound during all exposure, which is one of the primary cognitive rationales you must have in place.

Ongoing work in progress

Triggers are a work in progress and will likely be such as you uncover and address them. You may get through your worst triggers to find new ones that you never knew existed, yet you discover them due to more severe triggers being removed. As you work through your initial triggers, you will find yourself knocking triggers down faster with each one. Your mind will become more proficient with the process, strengthening with every unrealistic fear you remove.

I hope that people post their examples to comments, allowing further discussion of situations affecting you now. Triggers do not need debilitate you on a daily basis. Triggers are normal and part of trauma and PTSD, they can be removed and the symptomatic suffering minimised or removed entirely.
 
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sylvia

triggers are the bane of my life still- in all other respects my PTSd has completely dissolved and I can function pretty normally now- for nearly 7 years I could not though – but whatever I try and do or not do every so often someone behaves in ways that echo my childhood – or more precisely the way ,my parents behaved towards me – and I am either turned into a shaking wreck who wants to curl up on the floor or else a shouting defensive who feels completely attacked. Sometimes it can even just be a tone of voice or an attitude which triggers. You are right that they have got more and more subtle over time though and it seems these finely tuned ones are the hardest to shift. People sometimes think I am angry but I am not – just scared and loudly defensive.

I completely know what these triggers are and how they will affect me, and every time I think I have defused one of them some thing happens to show I am mistaken and back to the drawing board. I a lucky in that I had practiced meditation and mindfulness and studied it in depth before my illness broke me open, and even in that it has been a blessing of sorts and I have embraced a full forgiveness and acceptance of everything just being the way it is. I have really done all the work one could do on ones own and in UK there is no help any more except for people about to be dangerous to themselves – the NHS is being eroded so fast politically it is ridiculous.

I am very happily married with lovely sons and a step daughter and a few friends who get what I went through but I have lost many more who just were unable to cope with who I became whilst ill. whilst I cannot afford endless specialist therapy I am not poor either – so my life is great apart from this one aspect which inhibits so much and is making me into a recluse. what is the tail end of this treatment process.

how do I snip those last few connections between past and present that still hold in thrall – I know they are not real and all the rest of it, I know they cannot hurt me etc too, deeply know this – I have no fear of death or dying even. I don’t mind physical pain that much either, so I don’t feel actively threatened but the little traumatised girl is still kicking out and I still do everything I can to soothe her but my amygdala responds to her far more quickly than it does to me and then I am left feeling ashamed at how it got me yet again and I have to try and put things right.
 

songcat

New Here
I am having unusual trigger situation. I am being asked at work to write reports that are not true, essentially to lie about how the clients are doing to make the agency look good. My mother was very abusive to me throughout my childhood and is the main cause of my PTSD. She was a habitual liar and it took a lot of my llifetime to sort out what was true or not about my family, friends and background. I cannot abide lying and I am basically unable to be dishonest. Being asked to do something that I consider to be wrong, unethical, immoral, against my beliefs is setting off depression, anxiety, PTSD episodes and a fear I will become dissociative again because I need my job to survive ( I will turn 70 soon and getting a fulltime job with the pay and benefits like I have is near impossible and I am barely getting by on my earnings and social security while supporting a daughter in school who lives with me and has her own severe depression and anxiety disorder). It does not feel right to try to get over being honest but I am caught in such a box of fear I am becoming frozen about doing the notes I have to do at work. Any suggestions?
 

Changing4Best

MyPTSD Pro
I have a trigger when profanity is used, in writing or worse yet, spoken. It does not even have to be directed at me! I grew up in a home that was filled with cussing. My parents constantly argued and cussed at one another. Sometimes my father cussed at me or my sister too, but usually it was at mom. I loved my mom. She could do no wrong in my eyes (and to this day I don’t ever recall her doing anything wrong. When she cussed, she was simply defending herself)! I know I need to work on this. I will speak with my therapist about it….
 

Enaila

MyPTSD Pro
Police officers are a trigger for me and I have been working over two years on minimizing my response to this trigger. I first looked at pictures of badges on Internet and used lots of self talk if I saw an officer in a vehicle. I worked up to sitting with my support person where we saw officers. Lots of exposure to officers in the community through community events, work, etc. Today, for the first time ever, I was able to go up to officers at a school fair, accept a handshake, and request information and his name! While I felt like crying after and was sick to my stomach, I still had done it without a support person and on my own!!:-)
 

anthony

Founder
What about complex Ptsd?
Complex affect has no consequence in relation to dealing with triggers. The process does not change. Complex sufferers would have simply done more intensive grounding, relaxation and dissociative control prior to taking on triggers, such as via DBT where sound results have been first achieved.

Triggers are triggers, removing them does not change for trauma type or complexity. Prior preparation is the difference, like the article outlines, “You need to have established grounding/relaxation techniques in place so that you can self-soothe when beginning exposure to triggers.”

Triggers are not a starting process in your therapy / self-help journey. Complex sufferers have years of DBT to achieve before trauma therapy processes.
 

anthony

Founder
triggers are the bane of my life still- in all other respects my PTSd has completely dissolved and I can function prett...
Hi Silvia, you may not ever remove last minor amounts of triggers or their resulting affect. There is good reason why PTSD has no cure… once you have it, its for life. Whether that be residual after effect, sitting dormant awaiting your next trauma to come back worse, or you have permanent debilitating symptoms for the rest of your life.

Saying that, there is never a reason to just quit though, and I like that you’re focused to wanting to remove residual affect. Personally, I would strategise a plan for just one trigger, then get into it with more vast exposure to really push your response, then rationalise, relax, rinse and repeat, and go for total desensitisation of just one trigger.

If you can’t get rid of that residual one trigger after a month or two of hitting it hard, then chances are you simply need time, or that residual left-over is with you for life / a long-time.
 

anthony

Founder
I am having unusual trigger situation. I am being asked at work to write reports that are not true, ess...
Hi, there is an order I would assign here.

#1 – You’re 70 and admit being sacked would impact you financially, and have little chance of being reemployed.

Yes, I agree that lying is not right. I will also admit that business can tend to fudge things to make themselves look better than they are. They’re in business after all, they employ people, and at the end of the day morals can be tossed out the door for the sake of gaining income for the business, thus you, an employee.

I would use the process as your exposure therapy, because honestly, for that trigger it doesn’t get any more realistic for you as exposure, than actual similar position, just not personal this time, but as an employee. I would structure some realistic phrases for self use to reassure yourself that you are not in harms way at work when doing this to perform your duties inline with your companies policies.
 

anthony

Founder
Police officers are a trigger for me and I have been working over two years on minimizing my response to...
Enaila, congratulations and really well done. Good on you for structuring this process into your life and being proactive and progressive with your implementation. Very proud of you for taking on your triggers.
 

Enaila

MyPTSD Pro
Thank you Anthony. Your articles and encouragement from this site have helped me take my therapy further and improved my emotional health significantly!
 

hodge

MyPTSD Pro
One of my triggers is encountering men with dark hair and dark facial hair. Three of my attackers had that. I was not remotely aware of how extremely this was a trigger until the first time I met my current psychiatrist, who has facial hair, not real dark hair, but not blond, either. I was rudely woken up to the fact when he diagnosed me with a personality disorder at our first meeting, which shocked me. I was in my late 40s and have never gotten that diagnosis, despite being in and out of therapy since I was 15. At the next visit I asked him why, and he said I was very hostile toward him. I was shocked! I had absolutely no awareness of this. Within a couple minutes I had figured it out and told him and apologized profusely. He then rescinded the diagnosis, as I guess it was the only thing he detected. I was mortified, because one thing I pride myself on is being friendly to people, even when I don’t feel like it. He is a great guy and we have a really good working relationship. But it was a big wake-up call for me.

Now I always keep it in the back of my mind to be extra mindful of how I come across when I encounter non-threatening men with dark facial hair. I still have to do a lot of self-talk before every appt. with my psych, as I only see him every three months. I also did a lot of self-talk before my stepdaughter and her SO visited us with our new granddaughter a few months ago. He shaves his head, but has, of course, dark facial hair. I don’t remember being that self-conscious for years, but I wanted to make sure he felt welcome and certainly did not want to give off any weird negative vibes simply because of his appearance.

Luckily, I live in a part of the country settled by mostly Scandinavian Americans so there are not a lot of men around here with dark hair and facial hair, but it’s still a really good thing I became aware of it being a trigger for me. And there are a handful around here.

Other triggers I have long since identified and work on, but my reaction to this one totally took me by surprise.
 
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