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Working with triggers

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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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I have tons of triggers and stressors (that are related to trauma but not actual triggers). One trigger that I have regularly is the smell of mint, like those white mint lollies or toothpaste smell. The man who abused me for years as a child always had these mint lollies and him and his house always smelled strongly of them. I have been triggered every day of my life since then every time I brush my teeth. I have panic attacks, sometimes vomit, full on flashbacks etc. It also happens when I smell that smell at other times – like other people near me eating things like mints, mint slice biscuits etc. I would love to work on this trigger as it makes brushing my teeth such a horrible experience but I don’t know how to do it. I currently mentally prepare myself for the smell by self talk – I’m going to smell mint, nothing bad is going to happen, I’m an adult, I’m safe in my own house etc. Is there anything else I could do to reduce or eliminate this trigger? I don’t quite know what to do…I expose myself to the trigger daily but it still happens. I’ve never had an option to gradually expose myself to the smell because I can’t not brush my teeth
 
@Blurred : There’s non-mint toothpaste available at some stores (lemongrass, vanilla, rose, parsley, cinnamon, & cardamon are some of the flavors I’ve bought), or you can make your own And flavor it -or not- however you wish. If you want fluoride treatments? They come in about 2 dozen flavors, and can be purchased directly from your dentist.
 
Ok – so the safest route through all of this is avoidance of any triggers!!! Just Sayin – judge me if you want – don’t really have time for any of that exposure bs – I have two kids with busy schedules!!! I need to survive this so that my struggle is invisible to them!!! So my counseling with a trauma specialist has taught me the skills I need to recognize when I need help!!! Yes – when I need help – I ask – no shame – I need to stay alive for my kids!!!! This shit is real – only others suffering know the real deal!!!! Joe Cool is done!!! ❤️??!!!
 
Thank you! I am in the stage of faster healing from triggers! I wish I had this help two years ago or so. I faced triggers quickly, not understanding and in panic. That was terrible for me.
 
Great article. My ongoing trigger is being “scapegoated”. A constant recuring theme in my childhood. Being the youngest in the insanity , it fell on me. Not being able to defend myself always leads to dissociation.
It is worse if I am in a public place. Such an episode is what brought me to the Forum. I do not remember signing up here. But very grateful to be here.
It’s like I get blindsided , I get so overwhelmed and disassociate every time.
I have been working on paying more attention if I am around hostile people or if I pick up discord with someone. I
then get myself out of the situation.
It is hard to pick up clues all the time. I sometimes resent that I have to be so I vigilant in social or work envionments
I feel this is one that I will have to work on forever.
Being here I have learned a lot and do a lot more self care than I did. Espcially after I have been triggered . I don’t stay in the upset feelings as long.
This is an ongoing lesson for me.
I get triggered like this as well, even if someone is joking I automatically look serious and it feels awful, even though I know they are joking, I think it’s from being a scapegoat and being teased
 
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