November 8th, 2018

Avoidance of triggers may have negative consequences

Mary Kay Jankowski, Ph.D

Mary Kay Jankowski, Ph.D

With the public testimony and accusations around sexual assault in the national spotlight in recent months, there has been increased attention paid to how these reports may be triggering psychological responses in the general public.

Reportedly, reading about or hearing testimony from Christine Ford Blasey, Ph.D, a professor of clinical psychology at Palo Alto University and a research psychologist at the Stanford University School of Medicine, has led women and men around the country to experience their own emotional and physiological responses.

Ford testified about her accusations of sexual assault perpetrated during their teen years by Judge Brett Kavanaugh.

It may not be surprising that a very public discussion of what would be a traumatic situation for a 15-year-old child could trigger responses in anyone who has suffered this type of trauma.

And, if someone has never spoken about or sought treatment for the trauma, the image of a woman telling her story to a less-than-sympathetic audience as she testified in front of Senate Judiciary Committee may bring up a variety of symptoms for those witnessing the event.

In some ways, the public airing of accusations can be very helpful to people who have experienced trauma, said Brian Pilecki, Ph.D, a staff psychologist at Rhode Island Hospital and clinical assistant professor at Brown University,

“There are signs that it was a positive experience,” he said. “There were reports that in the days after Dr. Ford’s testimony, there was a huge increase in calls to trauma lines with people coming forward. The message that women are to be respected and listened to is encouraging.”

“Although,” he added, “because of the outcome, maybe the message was that it didn’t really matter what she said.”

Psychological triggers, according to Pilecki, are stimuli that evoke an emotional or physical reaction. The term, however, is often over-used both within and outside of therapeutic settings.

“People in the general public use the term in a variety of ways when something gets them upset,” he said. “Clinically, people talk about triggers doing things that, say may evoke an urge to drink. It is used in many different ways.”

Typically, psychological triggers specifically reference an earlier traumatic event. People can experience a psychological trigger from something occurring internally or externally and a trigger can be very personal.

“For example, a child who witnessed a bad incident of domestic abuse that happened during dinner, so the smell of spaghetti sauce cooking on a stove could be an issue later,” said Mary Kay Jankowski, Ph.D, a clinical psychologist at Dartmouth-Hitchock Medical Center and assistant professor of psychiatry at Dartmouth College’s Geisel School of Medicine.

The most potent triggers tend to be from sensory input, smell, touch and sound, she added and triggers can last a long time if the underlying trauma is not addressed.

The standard of treatment for psychological triggers would be exposure therapy, said Jankowski.

”In general, we would recommend people not try to avoid triggers,” she said. “For one thing, it is almost impossible because things come all the time. Avoidance is one of the symptoms of PTSD.”

Avoidance also leads to a limited life, said Monnica Williams, Ph.D, an associate professor at the University of Connecticut, and clinical director of the Behavioral Wellness Clinic in Mansfield, Connecticut.

“That fear can generalize to other things and may grow out of proportion,” she said.

Williams also warns that therapists need to recognize the many forms that trauma can take.

“Some things are not on the radar of most clinicians,” she said. “Most time when we think of trauma, we think of rape or assault or combat.”

Medical traumas often go under the radar, she explained, along with the trauma faced by immigrants both here and in their home countries and racism routinely faced by minorities.

The use of trigger warnings on college campuses has come under fire recently. Therapists are cautious about commenting on their efficacy.

“It’s contentious topic and hard to make a blanket statement,” said Pilecki, “but in general, some content in a classroom is evocative and it can be a good thing to warn students. But it can also feed into further avoidance.”

Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.

By Catherine Robertson Souter

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