Your readers are not fragile: a trigger warning

Converse sneakers. Not violent images, blatant sexism, or even a handsy stranger in a crowd. Converse sneakers. That is what one of my clients, let’s call her Sally, finds to be the worst of her triggers since a man sexually assaulted her here in Montreal. She never did see his face. On bad days, not a pair of shoes around her go unnoticed.

The sneakers, in Sally's case, trigger hypervigilance and debilitating anxiety. She meets criteria for post-traumatic stress disorder (PTSD). Though close to 90% of people will experience trauma at some point in their lifetimes (“such as serious accidents, natural disasters, or an unexpected death of a loved one”), only 9% will develop PTSD (Breslau & Kessler, 2001): yet, in cases of reported sexual trauma the number rises to 43% in women and 17% in men (Breslau, Troost, Bohnert, & Luo, 2013).

The term trigger is at risk of losing a purposeful meaning reserved for the hypervigilance, panic and flashbacks of those battling PTSD.

Trigger warnings are popularly used online to alert readers in advance of potentially shocking material. This is typically seen as “TW/CW” for “trigger warning / content warning”. There is controversy over whether TW/CWs are attempting to protect readers who often actually have been diagnosed with PTSD and do not feel the need to be protected.

“I am not fragile. Seeing TW/CW before a blog post is like being handed a sweater by my Mom when I’m not cold. Being told to take an umbrella when it’s overcast. If I need it, I’ll ask. It’s expecting me to not boundary myself. I am not fragile. If I don’t want to read stuff, I will get the gist and stop reading.”

It is important to distinguish being triggered from being activated (psychologically and physiologically). Activation can be explained as overwhelmingly ignited ethics and values pertaining to topics that matter. These moments are not triggered post-traumatic stress responses but are profound enough to provoke difficult, at times disturbing or disruptive feelings, thoughts, and sensations. Being activated in an online discussion, for example, can elicit feelings of anger, advocacy, sadness, withdrawal, and even empathy. Sally’s friends, siblings, and online acquaintances aware of her assault are likely to feel activated.

Being activated merits substantial attention and, at times, therapeutic processing. When treating those who seem activated I have found it helpful to show criteria B.4 and B.5 of the DSM-5’s section on PTSD. “Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)”, and “marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Knowing that these 2 criteria are clinically valid symptoms does justice to their being activated without needing to use “trigger”, a term reserved for PTSD.

Converse sneakers are not an offensive post or gratuitously violent image; triggers can be random and unexpected. Not all sexual or violent content will trigger a survivor of trauma, likewise not all triggers are sexual or violent. Being activated is vital to the development of effective stress coping skills. Trigger warnings in line with avoidance perpetuate both fear responses and difficult conversations. Learning to regulate oneself down from intense emotions is central to extinguishing flight or fight responses from both triggering and activating stimuli.


How do you determine the content that deserves a trigger or activation warning? You can’t.

Firstly, the exposure therapy used to treat PTSD is effective because it is the opposite of avoidance; you cannot extinguish an avoided response. Secondly, the emotional regulation and distress tolerance skill development used to treat activation can not predict patterns of activation. Both sure do help people get better at being emotional.

Warnings have become a way of declaring empathy for others feelings so as to prevent backlash, and additionally intend to protect others. Bloggers fear accusations of insensitivity from readers. TW/CWs must not be based on the notion that you can provide others the protection you once needed, ignoring the likeliness that others can, in fact, cope.

Of greater importance is the empathy needed for those whose trauma is triggered by non-(typically) violent stimuli. Many readers, including Sally, are resilient and willing to be rendered uncomfortable online upon seeing or reading difficult material. It’s the converse sneakers out there that we must be open to seeing as triggering even if it is not an experience to which we can personally relate.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Breslau, N. & Kessler, R. C. (2001). The Stressor Criterion in DSM-IV Posttraumatic Stress Disorder: An Empirical Investigation. Biological Psychiatry.

Breslau, N., Troost, J. P., Bohnert, K. & Luo, Z. (2013). Influence of Predispositions on Post-Traumatic Stress Disorder: Does It Vary by Trauma Severity? Psychological Medicine.

McNally, R. J. (2014). Hazards Ahead: The Problem with Trigger Warnings, According to the Research. Pacific Standard. Retrieved August 23, 2017 from http://psmag.com/education/hazards-ahead-problem-trigger-warnings-according-research-81946

Medina, J. (2014). Warning: The Literary Canon Could Make Students Squirm. The New York Times. Retrieved August 25, 2017 from http://www.nytimes.com/2014/05/18/us/warning-the-literary-canon-could-make-students-squirm.html

My PTSD (2016). Is The Internet Trigger-Happy? Retrieved August 30, 2017 from http://myptsd.com/is-the-internet-trigger-happy/532/

Newman, E. (2016). It Just Seems Like the Right Thing to Do. The New York Times Opinion Pages. Retrieved August 23, 2017 from http://www.nytimes.com/roomfordebate/2016/09/13/do-trigger-warnings-work/it-just-seems-like-the-right-thing-to-do

Robbins, S. P. (2016). From the Editor—Sticks and Stones: Trigger Warnings, Microaggressions, and Political Correctness. Journal of Social Work Education, 52, 1-5.

Amanda Luterman & Sallamaari Vainio