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.

 

[Movingforward10]

I'm going to say trigger, but with a caveat. This specific example, IMO, is touchy and can lead to you using this in places where its not a trigger, but stressor, as people doing things as you have outlined, are normal, and some of this is self-esteem, not just trauma triggers. That is my opinion only from what I read, my opinion may change with time and information, but right now, I agree its a trigger, just with caveats to not extend it to normal life interactions and label everything into triggering, when some things may fall more into self-esteem - even though self-esteem may be linked to trauma, trigger, response - its a nasty cycle, you get the idea.

Thanks. That makes sense.

So in terms of exposure therapy to help reduce the intensity of this....that's the bit I'm confused about. How does exposure therapy work for this? how do I create the exposure to it?

 

[anthony]

A lot of this borders around self esteem, so I would focus on confidence building practical activities to build your mindset from “I can’t“ to “I did that, which means I can do anything I put my mind to” and achieve things you thought you couldn’t. Building self esteem first, then as you naturally are faced with situations you need to recognise old patterns that negatively affect you and replace them with your new capacity of self worth.

I actually watched my wife do this and helped her do it by pushing her towards tough situations and then highlighting to her that she did something she said she didn’t think she could before. Nothing bad happened to her. She is now a whole lot more confident in her capacity in dealing with people and whether she feels she deserves shit people give out or she stands up and tells them no, don’t talk to her that way or behave that way, etc.

it took years, but she is confident in herself. We all do good and bad, but we must be confident in whether we deserve x based on that good or bad.

Military training is the easiest way to do this in a short time. Boot camp type course. A persons confidence is reflected in all daily interactions. You don’t need to be more or less emotional, compassionate or other such quality, just more confident. Regulate that confidence once achieved as you see fit.