11 votes

Helping or harming? The effect of trigger warnings on individuals with trauma histories

22 comments

  1. [14]
    Grzmot
    Link
    This posted on r/science not too long ago and I think it shows that it consciously or subconsciouly feeds someone's trauma further if we as a society show them with trigger warning that the fear...

    This posted on r/science not too long ago and I think it shows that it consciously or subconsciouly feeds someone's trauma further if we as a society show them with trigger warning that the fear is legitimate, which it is not. At some point you will have to face your fears and traumas and grow as a person, or you'll remain in their grip forever.

    Related to this is the article shared on Tildes ~2 months ago about children with anxiety in that coddling and accomodating everyone's fears just isn't the way to go. A lot of this is a counter-movement that probably comes from the fact that the generations before us just would not fucking talk about mental health. Good luck if you were a man with a mental problem, cause talking about it would make you feminine or whatever and if you were a woman well then you fuck right off to asylum and never be released ever again.

    So now the pendulum has swung far into the other direction where everything and everyone has something and you should better go talk to a therapist about your issues, and they're valid and no don't worry, everyone is insane now. I don't want to go back to things were, and it's good that we talk about everything, but constant accomodation is not going to lead us anywhere but into disfunctionality.

    11 votes
    1. [3]
      moonbathers
      Link Parent
      Helping you face your fears and traumas is the entire point of therapy. No one goes just to get affirmation that they don't need to change anything. A lot of people do have something, though. The...

      At some point you will have to face your fears and traumas and grow as a person, or you'll remain in their grip forever.

      Helping you face your fears and traumas is the entire point of therapy. No one goes just to get affirmation that they don't need to change anything.

      So now the pendulum has swung far into the other direction where everything and everyone has something and you should better go talk to a therapist about your issues, and they're valid and no don't worry, everyone is insane now.

      A lot of people do have something, though. The world's a messed up place. This is the exact same argument that gets used for LGBT people being more common now, would you say that a lot of them are actually straight and are just being accommodated? "They're not actually trans, it's just a phase" or "they just say they are because their friends are". Calling people who go to therapy insane is incredibly uncompassionate.

      We don't tell people with a broken leg to walk it off, why should we tell people with depression or anxiety to walk it off? If you have a physical issue, you go to a physical doctor, and if you have a mental issue you should go to a mental doctor (i.e., a therapist). No one is being coddled or accommodated, no one's being told that it's ok to live in fear forever. We're just telling people that it's ok to be open about your struggles and that it's ok to get help dealing with them. A climate in which people feel more comfortable talking about their issues is one where people can get past them better.

      15 votes
      1. [2]
        Grzmot
        Link Parent
        Yes but that's not the point of trigger warnings, is it? And yet, mental health issues are rising in places where the world is safest. Queer people are as common as they always have been, but I...

        Helping you face your fears and traumas is the entire point of therapy. No one goes just to get affirmation that they don't need to change anything.

        Yes but that's not the point of trigger warnings, is it?

        A lot of people do have something, though. The world's a messed up place.

        And yet, mental health issues are rising in places where the world is safest.

        This is the exact same argument that gets used for LGBT people being more common now, would you say that a lot of them are actually straight and are just being accommodated? "They're not actually trans, it's just a phase" or "they just say they are because their friends are".

        Queer people are as common as they always have been, but I don't think by comparing them to mental illness you're doing yourself any favours. Mental illness is something you want to get rid off if possible or at least cope with it if you can't, that isn't the case with the former.

        Calling people who go to therapy insane is incredibly uncompassionate.

        Actually, I called everyone insane. It's called hyperbole and is literary device. Before you lunge at me; no I don't actually believe everyone is insane.

        We don't tell people with a broken leg to walk it off, why should we tell people with depression or anxiety to walk it off? If you have a physical issue, you go to a physical doctor, and if you have a mental issue you should go to a mental doctor (i.e., a therapist).

        I was referring to the fact that children who do not learn to deal with their own problems usually grow up into some mental issue, usually anxiety and that by the research done it seemed that the more people accomdated their fears (like making sure that someone was always in the room with them because otherwise they would cry and demand that someone be close to them) and that those children then grow up into adults who have genuine problems who then may need ya know, actual therapy.

        We're just telling people that it's ok to be open about your struggles and that it's ok to get help dealing with them.

        Where do we draw the line here, though? When is an issue something that a person should have the ability to fix on their own and when is it something that requires intervention?

        A climate in which people feel more comfortable talking about their issues is one where people can get past them better.

        We agree on that.

        3 votes
        1. moonbathers
          Link Parent
          The point of trigger warnings is to give people a crutch. Hearing about suicide in class right after a close friend died from suicide and you haven't worked through it yet isn't going to help you...

          Yes but that's not the point of trigger warnings, is it?

          The point of trigger warnings is to give people a crutch. Hearing about suicide in class right after a close friend died from suicide and you haven't worked through it yet isn't going to help you at all. At worst it's going to rip that wound back open.

          And yet, mental health issues are rising in places where the world is safest.

          I feel like it's a safe assumption that that's happening because people feel more comfortable to get help for their issues rather than suck it up. People in Syria or Afghanistan probably aren't going to therapy or reporting their mental health issues as often.

          Queer people are as common as they always have been, but I don't think by comparing them to mental illness you're doing yourself any favours. Mental illness is something you want to get rid off if possible or at least cope with it if you can't, that isn't the case with the former.

          My argument is that mental illness is also as common as it has always been, people are just being more open about it now, just like LGBT people are.

          Actually, I called everyone insane. It's called hyperbole and is literary device. Before you lunge at me; no I don't actually believe everyone is insane.

          Fair. It just came off as callous to me.

          I was referring to the fact that children who do not learn to deal with their own problems usually grow up into some mental issue, usually anxiety and that by the research done it seemed that the more people accomdated their fears (like making sure that someone was always in the room with them because otherwise they would cry and demand that someone be close to them) and that those children then grow up into adults who have genuine problems who then may need ya know, actual therapy.

          That's fair.

          Where do we draw the line here, though? When is an issue something that a person should have the ability to fix on their own and when is it something that requires intervention?

          I don't know, but I don't think disclaiming something with a trigger warning is too much of a problem. I don't think it's any different than attaching a rating to movies or video games and explaining why.

          7 votes
    2. [10]
      radiator
      Link Parent
      what? where are you getting this impression?

      So now the pendulum has swung far into the other direction where everything and everyone has something and you should better go talk to a therapist about your issues, and they're valid and no don't worry, everyone is insane now.

      what? where are you getting this impression?

      4 votes
      1. [9]
        Grzmot
        Link Parent
        The fact that mental health issues are rising and the Tildes discussion I linked.

        The fact that mental health issues are rising and the Tildes discussion I linked.

        4 votes
        1. [8]
          radiator
          Link Parent
          and you think the reason for this is giving too many accommodations, thus weakening people's resilience to hardships in life?

          The fact that mental health issues are rising

          and you think the reason for this is giving too many accommodations, thus weakening people's resilience to hardships in life?

          7 votes
          1. [7]
            Grzmot
            Link Parent
            I think the open conversation around mental health has certainly increased the amount of detected mental health issues simply by exposure, and that maybe teaching resilience has been left a little...

            I think the open conversation around mental health has certainly increased the amount of detected mental health issues simply by exposure, and that maybe teaching resilience has been left a little to the wayside. I don't want to blame anything in particular, it's a very complicated dicussion, but as I said, especially with children it's been shown that constantly accomodating their fears and treating them like every single one of them is valid doesn't let them become functioning adults because they don't know how to deal with the common problems of life and get paralyzed by every single decision coming their way. I also think that a shitton of mental health problems are valid and require professional help.

            What do you think?

            9 votes
            1. [2]
              tindall
              Link Parent
              I'm really interested in what you mean by "teaching resilience." This phrase is used a lot to mean "forcing people to be exposed to things that will harm them because I, personally, don't...

              teaching resilience has been left a little to the wayside

              I'm really interested in what you mean by "teaching resilience." This phrase is used a lot to mean "forcing people to be exposed to things that will harm them because I, personally, don't understand why that's the case", and I think it's really important to avoid that mindset.

              Resilience is the ability to adapt in response to a changing situation. We don't temper steel by breaking it.

              10 votes
              1. Grzmot
                Link Parent
                By teaching resilience I mean showing someone that yes, they can deal with problems on their own. This does not mean leaving people on their own with their problem, but showing them how to deal...

                By teaching resilience I mean showing someone that yes, they can deal with problems on their own. This does not mean leaving people on their own with their problem, but showing them how to deal with something and then letting them deal with it.

                We're talking in real abstracts here, and I fear my post in this thread has been misunderstood as a general condemnation of therapy and treatment for mental health issues, which is not how I meant it.

                6 votes
            2. [4]
              radiator
              (edited )
              Link Parent
              i've started framing anxiety/fear as a mismatch between a person (i.e. their abilities, preferences, thoughts, and feelings) and that person's environment. (i.e. the rules, expectations, and norms...

              i've started framing anxiety/fear as a mismatch between a person (i.e. their abilities, preferences, thoughts, and feelings) and that person's environment. (i.e. the rules, expectations, and norms surrounding the person)

              to reconcile this, either the person can change to fit the environment (e.g. by learning to cope with discomfort/pain, by building new skills, or by correcting misconceptions) or the environment can change to fit the person. (e.g. by providing accommodations, by carving out spaces of safety, or by changing things on an institutional/systemic level)

              i think both types of change can be helpful, and both types can be harmful. what works best varies so much from situation to situation, though. that's why i've bristled at your bold, sweeping statements here. you've commented on society as a whole (implied by inclusive we's and you's) when i just don't think that's helpful. fearmongering about "too many accommodations" reinforces that fear in your readers' minds, making it more likely that down the line, someone who could be helped by accommodations will have their concerns dismissed.

              i just think there's a more delicate way to suggest "let's take a closer look at this complex problem so we can find a good balance" than you've done, is all.

              5 votes
              1. [3]
                Grzmot
                Link Parent
                That's a very interesting way to look at it and while I do agree that there are simply toxic environments you need to leave behind, the only thing you always carry with is, well, you and it's the...

                i've started framing anxiety/fear as a mismatch between a person (i.e. their abilities, preferences, thoughts, and feelings) and that person's environment. (i.e. the rules, expectations, and norms surrounding the person)

                to reconcile this, either the person can change to fit the environment (e.g. by learning to cope with discomfort/pain, by building new skills, or by correcting misconceptions) or the environment can change to fit the person. (e.g. by providing accommodations, by carving out spaces of safety, or by changing things on an institutional/systemic level)

                That's a very interesting way to look at it and while I do agree that there are simply toxic environments you need to leave behind, the only thing you always carry with is, well, you and it's the only thing you have complete control over when it comes to improving yourself and your skills. I've always felt that in general anxiety stemmed more from the person's perceived ability to deal with the problems life throws at them and if you actually develop the skills to deal with those problems then the underlying cause for the anxiety loses ground to fester in your mind. I'm oversimplying here for the sake of discussion, but that'd be my general (amateur) take on it.

                i just think there's a more delicate way to suggest "let's take a closer look at this complex problem so we can find a good balance" than you've done, is all.

                I did call the problem very complicated and I'm not suggesting there is a grand solution to this like How to adult 101 classes. I probably overgeneralized, and judging by the general vibe of the replies, I did make a few to grand statements about the situation.

                3 votes
                1. radiator
                  (edited )
                  Link Parent
                  the problem i have with this is, it's often not as simple as changing your perception; some problems in life truly are insurmountable. sometimes a problem is so big and tangled that the burden of...

                  I've always felt that in general anxiety stemmed more from the person's perceived ability to deal with the problems life throws at them and if you actually develop the skills to deal with those problems then the underlying cause for the anxiety loses ground to fester in your mind.

                  the problem i have with this is, it's often not as simple as changing your perception; some problems in life truly are insurmountable. sometimes a problem is so big and tangled that the burden of solving it is too heavy for one person to carry.

                  sometimes asking someone to change themselves is unreasonable, too. think in terms of disabilities -- in some cases, we accept that certain functioning is an innate part of someone that can't be easily changed. where do we draw that line, though? does someone need a diagnosis? what about the people who don't have access to health professionals? at what point do we give people the right to say 'no' to changing themselves?

                  as well, sometimes people don't want to change themselves. maybe functioning in a certain way is a critical part of their identity. "building a skill" in that sense means "rewiring part of your brain to function in a different way" which could be framed as "changing who you are and becoming someone else." that feels invasive to me, as if we're warping others to fit a narrow ideal. when we put the onus on the individual to change, sometimes that implies that what that person wants isn't important -- what matters is whether they can perform in a way society has deemed acceptable. that's why imo, changing a person's environment to fit the person (when reasonable) does a better job at preserving the liberties of others.

                  tl;dr in many cases, expecting someone to solve their own problems is setting them on a path lined with hardship. it happens more often than you might be aware of; it's not just about toxic situations. and, in many of these cases, making small modifications to a person's environment can be an easier solution.

                  (fwiw, i subscribe to the social model of disability, and do not agree that all mental illness should be treated and gotten rid of. my opinions have been informed by my personal experiences as a disabled person. i think differences between the social model and the medical model are at the heart of this conversation.)

                  As a simple example, if a person is unable to climb stairs, the medical model focuses on making the individual physically able to climb stairs. The social model tries to make stair-climbing unnecessary, such as by replacing the stairs with a wheelchair-accessible ramp. According to the social model, the person remains impaired with respect to climbing stairs, but the impairment should no longer be considered disabling in that scenario, because the person can get to the same locations without climbing any stairs.

                  6 votes
                2. Gaywallet
                  Link Parent
                  I'm not sure how studied you are, but I would highly recommend that you speak with a professional on the matter. Exposure may help patients with PTSD recover faster but even in artificially safe,...

                  but that'd be my general (amateur) take on it

                  I'm not sure how studied you are, but I would highly recommend that you speak with a professional on the matter.

                  Exposure may help patients with PTSD recover faster but even in artificially safe, extremely well controlled studies, there's a lot that can potentially go wrong. I believe you are extrapolating far too much from the study in the original post. In fact, even among studies which show exposure therapy to be viable for PTSD studies, the way the patient presents under duress varies and some types of presentation are not well studied. A review on exposure therapy to PTSD had the following to say:

                  Unlike trauma-related cognitions, where the majority of individuals with PTSD report the presence of negative cognitions, both the presence and extent of anger and dissociation symptoms are more variable. That is, not every individual with chronic PTSD presents with elevated levels of anger and dissociation. Thus, treatment effects on these variables may be obscured due to lower scores for some individuals. Consistent with this idea, Cahill and colleagues found prolonged exposure to be effective in reducing symptoms of anger, particularly for those with higher levels of anger at pre-treatment (Cahill, Rauch, Hembree, & Foa, 2003). Similar reductions have been also been reported by other investigators (e.g., Taylor et al., 2003). Even less is known about PE treatment effects on dissociation (Feeny & Danielson, 2004), though Taylor and colleagues reported reductions in dissociation with in vivo and imaginal exposure (Taylor et al., 2003).

                  Finally I'd like to mention that therapists need to be trained in exposure therapy in order for it to be useful. The client needs to be engaged with the content in a specific way for it to be beneficial. In a review paper this is highlighted throughout the passages of clinician expectations - for example with regards to client engagement

                  fear activation must occur in order for exposure to be effective. Clients must be at a level of engagement where significant, yet tolerable, distress is experienced. As a clinician, often the most difficult task is to help increase (not decrease) clients’ engagement with the trauma memory. Existing clinical manuals thoroughly discuss handling both underengagement and overengagement. There are simple techniques that the therapist can use to help reduce or enhance engagement with the memory (e.g., shift from present to past tense during revisiting). Thus, contrary to common clinical expectations, one of the main therapeutic issues is handling underengagement rather than handling the much more rare experience of extreme distress or panic.

                  This is further expanded upon in the same paper with a lot of really good narrative in the "Common Challenges in Learning Exposure Therapy" section. In particular I'd like to draw attention to the case involving a woman in Virginia.

                  As Virginia’s case illustrates, when a therapist does not have prior experience listening to traumatic events, it is often difficult to determine whether the client is successfully revisiting a painful memory (which is what we want to see), or whether he or she is reliving what happened (which is not what we want to see), and needs to be less engaged in the memory. Prior to obtaining direct personal experience, new therapists can follow general guidelines on how to recognize optimal engagement and identify overengagement so as to know when it is appropriate to intervene.

                  I would encourage you to read the narrative in this section as well because the client is presented with the same exposure multiple times and the levels of engagement differ. Even a trained therapist struggles with getting the client to engage in the right way so that they may heal, rather than the wrong way which will reinforce their ideals (the importance of this is highlighted in the very first narrative of the section as it results in a client leaving therapy and not coming back).


                  I bring this all up because I often see people talk about mental health issues in a way that they connect with. It is very possible that you went through a traumatic event, developed PTSD in your past, and got over it via self-exposure. I am not discounting this possibility. I am simply pointing out that people are varied and their presentations vary and what will solve a problem for one individual will not solve it for all individuals. Even when we talk about effectiveness of a style of therapy, that's speaking broadly across humans - just because exposure therapy meets statistical significance does not mean it will work for any one individual.

                  The goal of studies like this are to tell us a little bit more about methods and tools we can use to help people, not to make broad statements like "At some point you will have to face your fears and traumas". While this may be true for some, it's not true for all, and we need to be extremely careful about broad strokes.

                  6 votes
  2. [8]
    Anwyl
    Link
    Why do they still have the person read the passage after the trigger warning? Isn't the point of them to allow them to bypass that part? Other studies fix most of the other issues I'd have with...

    Why do they still have the person read the passage after the trigger warning? Isn't the point of them to allow them to bypass that part? Other studies fix most of the other issues I'd have with this one, but that part seems to apply to every study of these.

    10 votes
    1. [3]
      knocklessmonster
      Link Parent
      I was able to get the paper through my school, and the abstract (as they generally do) left some details out. They wanted to test changes in anticipatory anxiety (after the warning, before the...

      I was able to get the paper through my school, and the abstract (as they generally do) left some details out.

      They wanted to test changes in anticipatory anxiety (after the warning, before the content) and reactive anxiety (caused by seeing the content). What they found is trigger warnings heightened anticipatory anxiety in people who were going to view the content, but no changes in reactive anxiety, plus some of the effects mentioned in the abstract.

      They did find it helps with avoidance, but it seems to be the only benefit that can help with traumatized subjects, but at the cost of reinforcing identity with the trauma (but, that's in the abstract). All participants had PTSD, and were tested according to their event, and other content as a control.

      6 votes
      1. [2]
        radiator
        Link Parent
        just to restate what @anwyl said, isn't this the point of trigger warnings? i.e. they're not meant as a long-term solution for folks impacted by trauma, but more as a way to make life more...

        They did find it helps with avoidance

        just to restate what @anwyl said, isn't this the point of trigger warnings? i.e. they're not meant as a long-term solution for folks impacted by trauma, but more as a way to make life more bearable while those folks also tackle trauma through other avenues, if they're able. (which isn't always the case at every moment)

        i feel like the paper misses the point when it says

        We found no evidence that trigger warnings were helpful for trauma survivors

        because it's operating on a narrow definition of "helpful". something can be unhelpful in a long-term sense, yet still helpful in a short-term sense.

        6 votes
        1. knocklessmonster
          Link Parent
          Yes. However, the study was trying to look at the whole picture, and generate useful data on the topic. They explore the therapeutic implications of trigger warnings, as well as reactions to them...

          this the point of trigger warnings?

          Yes. However, the study was trying to look at the whole picture, and generate useful data on the topic.

          They explore the therapeutic implications of trigger warnings, as well as reactions to them in all stages of exposure to the content. As far as them being "helpful," it's in a context of alleviating anxiety related to the content in all stages of exposure. They dedicate a part of the discussion to this, and therapeutic outcomes.

          3 votes
    2. [4]
      tindall
      Link Parent
      Yes. The point is to put the person in control - even if they don't skip the section, having the option to is the point.

      Why do they still have the person read the passage after the trigger warning? Isn't the point of them to allow them to bypass that part?

      Yes. The point is to put the person in control - even if they don't skip the section, having the option to is the point.

      5 votes
      1. Gaywallet
        Link Parent
        I believe the main point of content warnings is to allow people to avoid content they don't want, especially during times they are particularly stressed or feeling bad and don't want to go down...

        I believe the main point of content warnings is to allow people to avoid content they don't want, especially during times they are particularly stressed or feeling bad and don't want to go down that rabbit hole.

        I understand why they had the person go ahead and read the content anyways, but it would have been a good idea to have another group with the chance to refuse viewing the content and doing anticipatory/reactive measuring for those individuals whether they read the passage or not.

        7 votes
      2. [2]
        pallas
        Link Parent
        Of note here, for this study, is that the trigger warning text they used was so completely vague and generic, giving no sense of what the content contained, that I don't think a reader could...

        Of note here, for this study, is that the trigger warning text they used was so completely vague and generic, giving no sense of what the content contained, that I don't think a reader could reasonably make an informed choice on whether or not to read the text:

        TRIGGER WARNING: The passage you are about to read contains disturbing content and may trigger an anxiety response, especially in those who have a history of trauma.

        However, the paper does reference a study suggesting that specificity in trigger warnings is also potentially not useful.

        6 votes
        1. tindall
          Link Parent
          This is usual in such studies - for instance the UChicago study that infamously prompted them to send a "fuck you" letter to all their students about content warnings. As always, those trying to...

          This is usual in such studies - for instance the UChicago study that infamously prompted them to send a "fuck you" letter to all their students about content warnings. As always, those trying to study us don't bother to consult with us.

          2 votes