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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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Thanks Anthony. Finding a simple grounding tecnique for right then! I will find one or have a few backups that will keep me present and keep my reply simple.
After all these years I finally feel I can stop the pattern. Very simple and doable. Thanks again. Feeling empowered and not frozen
I get your stating it’s a stressor rather than a trigger. I’m relating it to when you’ve had something happen that is significantly out of your control and you perceive you are being controlled by someone else, it brings back that sense of feeling out of control or dis-empowered in the situation. I understand the meaning of a “trigger” having to do with the senses; smell, touch, sounds, etc.
Hi, I am not sure how I found you bit glad I did. Very interesting reading. I was diagnosed with cPTSD 6 years ago. I get triggered by rather environmental things rain, dark, smells of tobacco smoke, and the way some people walk or look. The trigger responses raise anxiety and panic which I have learnt to ground myself with mindfulness and EMDR tapping. What I find most difficult to manage are the body memories which can cause taste, smell, touch, hearing and what i see. Not all at the same time but for instance it rains and I taste blood. Someone may grab a person from behind on the television and I feel my breath constricted and physically gag. I use color and butekyo breathing techniques i try to self meditate using imagination of a safe place but the body memories triggered are stronger than me. I try to work hard on getting better and being kind to myself. What I do notice is if I have not slept well or eaten or had enough to drink then I don’t have as good a grasp on the grounding when the triggers occur. Advice always gratefully received. Thanks
What I do notice is if I have not slept well or eaten or had enough to drink then I don’t have as good a grasp on the grounding when the triggers occur.
That would be my first point of call. How often is your sleep lacking, you’re not eating correctly or drinking enough water?
I have particularly poor sleep. I cannot shut my eyes through fear of the dark as a trigger itself in any form, so i try to use mindfulness and soothing smells etc to help me switch off. Problem is I do not only have difficulty getting off to sleep but also staying asleep so it is very broken. I have serious Nightmares which wake me in the early hours and then getting back to sleep again is unlikely. I have woken from Nightmare straight into Dissociation at times, not great position to be in. I do eat much better and drink water and exercise more. Working on the sleep thing but not easy fix on these things. Everything seems to take sooo much time to work through properly. It took me a long time to accept where I am at because I just want it fixed. It is such a long road and some really difficult working through. But just take one moment at a time. Thanks Anthony for your reply.
I will also say my dogs are so therapeutic for me they ground me all the time. Help me so much as I am sure anyone who has a pet knows. xxxx
I can do okay in the first two hours of being triggered. Hours 3-10 are where I have trouble. Those are the hours where I am most likely to self harm or sleep poorly (sleep is a really big deal for managing PTSD.)
Mandi, from what you have written, you actually have really good skills in place to manage triggers. I would look at the cause of your sleep, and focus work on improving that first, then see what improves as a result of sleep.

After that, maybe you need exposure desensitisation to remove some of your more common triggers, as coping skills are one thing, but removing as many as possible is really the ultimate goal in working with your triggers.
Squirrel, I honestly believe more exposure process is required then, because you’re explaining the very normal symptomatic reaction from being triggered. The immediate time frame after you experience symptoms, then you procrastinate upon the effects, compound symptoms further to worsen, then you may even suffer for days or weeks as they reduce effect.

Cognitive processing skills, combined with exposure techniques (one trigger at a time) and even toss in more advanced grounding and relaxation depending on your severity.
This is a great article on how to keep battling the triggers and not letting them beat you.

People like me who have dissociated much trauma from childhood encounter new and surprising triggers all the time. Knowing how they relate to the trauma is sometimes not easy. Although the trigger usually appears along with the memory also surfacing in flashbacks.

I encourage people to do what Anthony says and keep it simple. Don’t spend time relating your triggers to the trauma trying to figure it out while triggered.

Instead, focus on ways to make it possible to expose without getting too upset now.

For example, being surrounded by tall men who are looking at me is a major trigger to a major trauma. There was a fun Disney ride that exposed me to being surrounded by a crowd, trapped and completely flanked in a queue for about a half hour.

I knew about the trauma, but I was not prepared for just that to be a trigger. It was a Disney queue, for God’s sake!

I noted how it affected me and how long I had to be trapped for the trigger to take effect.

Thus, I made my own exposure by getting a fast pass for that same ride, even though my husband protested that it will trigger me. It didn’t because I was not surrounded.

For this to work correctly, though, I would need a middle ground to slowly increase the wait time in the queue and use breath and grounding techniques to eventually be able to handle the half hour level of being surrounded.

I could practice for that by being surrounded in other crowded areas or having a family member approach me from behind daily, a similar/related trigger.

One question, do you have to do this for all triggers individually like this? Or does gaining the skills go out toward other triggers as well for some people?