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.

 

[ladee]

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.

 

[Burnadetta]

I have only been able to work with 2 of my triggers. One of them is headlights that were beaming straight into my face and into my eyes. I have been naturally exposed to headlights and so this method fell into place naturally too. However, I have different reactions to this everytime. It seems to depend on what time of year it is, how close to the day it happened and how vulnerable I feel, how much light actually hits my eyes and certainly it is not just headlights that can trigger me, it has also been the dentist chair whereupon the light is pulled down for dentistry. I struggle continuously, but on the scales of recovery, the intensities of paralysis and fear of full flashbacks, they are getting better. I am going through more of what I would describe as half a flashback, where I can still function (and carry on walking down a street) despite my body telling me otherwise, and despite the pain and torture that overtakes my ability to remain calm and collected.
The second trigger of which is not a flashback consequence but on a trail of negative emotions is a bit more problematic, again I have been trying to deal with it not knowing of the methods stated above. I cannot bear the sight of old men I begin to quake with absolute rage and desperately clamping down all urge to shout accusations toward them. For the simple fact that the attackers were not caught and are still roaming free as a bird. I feel utterly powerless and even mocked as these rapists have got away with it. This is where my rage bubbles over toward any old man who resembles anything close to the brutal attacks I had to endure.
There are the two triggers I wish to combat and am combating with this method. As they are both natural exposures. There are others. Thanks for helping me along the way

 

[Doubted]

One of my triggers is encountering men with dark hair and dark facial hair. Three of my attackers had that....

Wow Hodge you handled it better than me with the diagnosis. Even though I feel bad about it I always find myself telling people off when I feel revictimized. Many times it’s to the wrong person who probably wasn’t trying to, but professionals I hold to a higher standard. I would have seen that as a get back or victimization. I wasn’t believed and made to feel guiltyso I know that plays a role in my I have to defend myself no one else will even if I do feel guilty about it. hostility could have been just over talking about it I would not have apologized or caved to what I would have perceived as a power play by him. But that’s my own triggers I guess if I think about it. Authority, faulting me, names and lies etc

 

[anthony]

Great article. My ongoing trigger is being “scapegoated”. A constant recuring theme in my childhood....

First, have you read the above linked article in relation to triggers v stressors? Saying that, if so, can you please explain a little more on how being scapegoated fits into one of the five senses in relation to a specific from your trauma?

 

[anthony]

I cannot bear the sight of old men I begin to quake with absolute rage and desperately clamping down all urge to shout accusations toward them. For the simple fact that the attackers were not caught and are still roaming free as a bird.

Do you believe all old men are abusers?

 

[anthony]

I have to defend myself no one else will even if I do feel guilty about it

Yes, but defending oneself when required vs defending oneself because you have associated a response with your past, are two very different things. One is assertive, the other would be aggressive and unwarranted, because the cues are based on your traumatic history and not fully on what is actually being discussed in the present.

 

[ladee]

It is hard for me to explain but will try. I will use the situation that brought me here.
I had gone out to eat with a friend and her S/O. We were casually chatting and I made the comment I had unfinished business with my friend. She knew what I was referring to and shook her head yes. Her S\O raises her voice and said “you are being ridiculous!” and went off on a tangent.
All I really remember is feeling gut punched like when I was a kid and dared to stand up for myself.
I I not remember anything else until I found myself at home. I remember feeling like a confused child. I didn’t know what I had said or done to elicit that kind of reaction.
I went into a prolonged depression and somehow found my way here. I do not remember joining.
Feeling attacked for stating a need or want..
Don’t know if I made myself clear. The best I can do so far with this.

 

[ladee]

I realized I have trouble identifying the feelings. Fear. I feel exposed and vulnerable and like I am in the spotlight.
I can remember many times of this happening in childhood, but never remember anything after the intial feelings.

 

[UniqueSunflower]

I have several triggers, some of which I’m more aware of than others. I became aware of being triggered today by a friend “telling” me I should do something and I hadn’t had an opportunity to make a decision on my own as to whether I wanted to do it or not. I find when I perceive my decision making abilities are being taken away from me, I become defensive. Unfortunately I didn’t realize what I was feeling triggered about until after the conversation and we’d hung up the phone. We’ll likely address it though I feel bad about it knowing she didn’t do anything wrong, it was my own perception of the event. I recognize that after having been sexually assaulted, every ounce of my personal sense of control was stripped away from me. It doesn’t make my defensiveness okay though I’m doing my best to recognize where it’s coming from and want to make an effort not to keep repeating it.

 

[anthony]

Her S\O raises her voice and said “you are being ridiculous!” and went off on a tangent.

Ok, so you need to expose yourself to being challenged, and instead of dissociating, learn a new response, such as to process the information and either respond, or respond simply with, “we will agree to disagree.” Leaving it at that.

Learning to pinch yourself or something that will keep you grounded and present, is a prior skill you need to have firmly planted, as mentioned in the article. If you can’t control this first by prior learning, then you won’t control your reactions when working through triggers.

You can’t jump anything, at any stage. Working on triggers is a process. You must have a solid foundation first, then you MUST progressively expose yourself.

Based on what you wrote, that seems to be a pretty normal triggering event. Learning how to move beyond triggers is the point though.

 

[anthony]

I have several triggers, some of which I’m more aware of than others. I became aware of being...

How so? Your friend “told” you that you should do something. What relation does that have directly to your trauma, in that your trauma produced the same / similar results?

To me, reading your full meaning, you’re talking about being defensive to your friend, which is a stressor response, not a trigger with clear traumatic symptomatic response.

Can you explain why this is a trigger and not a stressor, based on having read the linked mentioned article?

 

[hodge]

Another trigger . . . the smell of baking pineapple. One day a friend gave us a pineapple and I decided to make pineapple upside-down cake, which I’ve never done. When I could start smelling it in the oven I got extremely nauseous and had to lie down. It didn’t take long for me to figure out why. My mother would sometimes bake ham with pineapple on top for holidays. And she made every holiday a nightmare. Every holiday, every birthday. She could not get through one without screaming at us abusively for nothing, sometimes to the extent of threatening suicide. I never had a nice calm holiday or birthday until I moved out of her house.

So, I simply don’t bake pineapple anymore. I prefer it raw anyway. My one easily avoidable trigger. If only they were all that easy :-).