Managing triggers: part one – why triggers are nothing to be ashamed of
Then it is minutes later, maybe even hours – time has no meaning, and my brain is scrunched up inside my skull with weariness and confusion. What just happened? It was a man with a camera, a dog, a child crying … I don’t know what it was. But I was triggered by something and it’s seriously messed up the last few minutes or hours or even days of my life and I feel indignant and huffy with myself for it happening, and in roll the accusations and the razor-
PART ONE: BEING TRIGGERED
One of the hardest things I found in dealing with triggers was the aftermath: the shame, the self-
Like most people with a dissociative disorder, I hate being triggered. I will do almost anything I can to avoid triggers and other reminders of my trauma. In fact, a very straightforward way of looking at dissociation is that it’s primarily about avoidance: of the trauma we suffered, of reminders of that trauma, of feelings, of intimate relationships, and even of other parts of ourselves.
I have reasoned with myself for a long time that life would be fine if I could just keep that avoidance going. But triggers are like little psychic explosions that crash through that avoidance and bring the dissociated, avoided trauma suddenly, unexpectedly, back into consciousness – complete with all the bodily reactions and emotions that we would have had at the time. In the blink of an eye we are catapulted into a fight-
But there were a couple of things on my therapeutic journey that I learned about triggers which at first surprised me. The first is that they can be managed – our brains don’t have to be our enemies but can instead be our friends, and we can tap them for their genius rather than just being hijacked by them. And the second is that triggers can actually be helpful – because they are clues, scraps of information, precious insights about what we’ve dissociated. They can therefore become guides on our therapeutic journey to discover what we have segregated or kept separate from our main consciousness, and what it is that we need to process and resolve so that we can recover and heal. Triggers provide these essential clues to the source of our post-
PART TWO: WHAT IS A TRIGGER?
Triggers are internal or external stimuli which remind us of past traumatic experiences. Trauma is the root experience of dissociative disorders, and even though we may have kept our traumatic experiences safely locked away (or ‘dissociated’) in another part of our minds, it is still there, however much we have tried to forget it or push it away. A ‘trigger’ is like pressing a button on a jack-
Paul Dell (2006) says that dissociative phenomena are “unbidden, jarring intrusions into one’s executive functioning and one’s sense of self.” And this is what triggers are – something which causes these sudden, unasked-
PART THREE: TRIGGERS AND THE BREAKDOWN
During my most difficult period of time a few years ago, after the ‘breakdown’ that turned my ‘apparently normal’ life into a daily trek for psychological survival, I was being constantly triggered. I didn’t realise that trees were triggering until I was walking through some local woods one day and then suddenly I was elsewhere and time had fallen down a rabbit hole: I had switched to a much younger part of me, who hurtled back to there-
Triggers were everywhere and caused massive destabilisation in my life. I felt that I was ‘going mad’ constantly as I was tripped into a highly agitated state by normal, everyday things. But before my sudden, life-
At the time, of course I viewed it very negatively. These flashbacks, these states of intense dysphoria and distress, were ruining my life and I wanted them to stop! I was ashamed of my inability to control them, and terrified of what might happen in a public place. But I now understand that they were the trauma trying to heal, giving me clues about what it was that was hidden in my unconscious. Unfortunately, while I viewed the flashbacks and triggers as the enemy, I didn’t hear what they were trying to say to me, and I missed the signs that could have eased my work in therapy. The more I avoided the trauma, the more I worked to edge carefully around every potential trigger – staying indoors in case I came across dogs and trees, isolating rather than engaging with people and their babies, for example – the more these triggers and reminders kept plaguing me. They were like a very insistent postman who was knocking on the door trying to deliver a message, and I was just turning up the music louder and louder to drown out his knocks! I began to make progress only when I opened the door and opened the ominous package with my name on it.
Of course we have to do this at a pace and in a way that we can manage – we cannot have a reckless, ‘gung-
Over the last 6 or 7 years, I have had to work hard to identify my triggers, and learn how to manage them, as well as how to resolve them. That work of resolution is what is often referred to as ‘phase 2’ work in therapy – processing trauma. That, for me in relation to triggers, is the end goal. But in the meantime we can learn to manage them, as we put in place the first phase of our work in therapy which is ‘safety and stabilisation’. There are many triggers that no longer have any impact on me because I have opened the package – the dissociated trauma – and so the ‘postman’ has stopped knocking. In this case, traumatic memories have become ‘associated’ rather than ‘dissociated’ – they have linked up again with the rest of my autobiography, my personal narrative, my view of my self and the world, and my feelings. But on a daily basis there are still some things which catapult me back to 30 years ago, and while I’m still working to ‘associate’ that trauma, I’ve had to learn to manage triggers so that I don’t have to avoid them altogether and remain a prisoner in my own home.
PART FOUR: WHAT DO TRIGGERS MEAN?
So I’ve had to learn what triggers are all about, what is going on in the brain when they happen, and how I can use my brain to manage my brain. The basis for that is what I and other people, for the sake of simplicity, often refer to as the ‘front’ brain and the ‘back’ brain. This piece of psychoeducation is probably the single most helpful thing that I have learned over the last 8 years, because with dissociative disorders a large part of the problems we face are caused by a lack of connections (or ‘associations’) between different parts or structures of the brain. Trauma causes damage to many aspects of our brain functioning. For example, the pathway between the right and left hemispheres of our brain, the corpus callosum, is ‘eroded’ by trauma – brain scans show that it is less dense in trauma survivors. That may explain at least in part why many of us have reduced ability to integrate left-
The ‘back’ brain refers to two evolutionarily-
The ‘front’ brain by contrast refers to the neo-
The brain takes in a wealth of sensory information all the time and most of this incoming ‘data’ is streamed to the thalamus, and from there it goes to a tiny almond-
If the amygdala senses threat, it sets off an alarm in the body and initiates the body’s fight-
This is a very good system that has meant that for thousands of years we have been designed to be alert to danger and to respond instantly in order to survive. But unfortunately, if we have suffered a lot of trauma, especially during our early years when our brains are at their most impressionable, then our amygdala – our ‘smoke alarm’ – becomes oversensitive. The amygdala is a very basic bit of brain kit – it doesn’t think, it doesn’t spend long processing incoming information, and it’s not smart. It is just a smoke alarm – it only responds to what it perceives to be smoke. So it cannot tell the difference between burnt toast and the house being on fire. Or between a snake-
That might seem inconvenient now, but at the time, as a child, this was ‘adaptive’ – it helped us to survive a threatening environment. By being sensitive, even over-
There’s another part of the ‘back brain’ that is important and that is a seahorse-
So when something traumatic happens, the smoke alarm goes off and that deactivates the hippocampus. The memory of that traumatic event may then be encoded or stored without information about the context for what just happened. Imagine that our attacker was wearing the colour red. If that colour information is detached from the overall context, then ‘red’ may be stored as a ‘trigger’ in the future – a smoke warning sign that there’s imminent danger. The hippocampus didn’t get to ‘tag’ the memory with contextual information to show that the ‘red jumper’ wasn’t a key part of what happened, so ‘red’ becomes a conditioned response to the trauma: it becomes a trigger, something that will set off the smoke alarm.
PART FIVE: THE CHALLEGE TO TRAUMA SURVIVORS
All of this presents a huge challenge to us as trauma survivors. There is a cascade of processes that happens in our brain and body when the amygdala detects a threat, and it all happens before we’ve even had to think about it. When the amygdala smells smoke, the front brain switches off and the back brain switches on. This back brain alarm floods the body with stress hormones like adrenaline and cortisol which gear us for instant action, to fight or flee. They make us tense, pumped up, aggressive, so we end up with lots of overreactions to tiny reminders of the trauma, and a generalised ‘stressiness’ that is hard not just for us but for the people around us too.
At the same time as this is happening, however, the front brain – the thinking part – has decreased bloodflow and shuts down. At a survival level, there is a good reason for this, because if we’re about to be attacked by a tiger, we need lightning-
We are all familiar with the effects of adrenaline – the surge of energy, the pounding heart, the tensed muscles, clenched fists, alert attention. And many of us will also be familiar with the effects of high levels of stress: it may be less exotic than being hunted by a tiger, but public speaking has a similar impact on our autonomic nervous system! It is often touted as the number one fear because the very thing that we are supposed to be doing – speaking, and thinking about what we are going to say next – is inhibited by the stress response as our front brains shut down and we can’t get our minds into gear.
There is another area of the brain that is relevant here, called Broca’s area. It is concerned with language and speech – with words. Like the hippocampus, it is also shut down when the smoke alarm is sounding. That is why in a state of terror, like a flashback of trauma, it is so difficult to get our words out. In a situation such as public speaking, at the moment that we most need to speak fluently, our mind goes blank and we literally cannot think of anything to say. This isn’t some random occurrence – it is caused by Broca’s area having reduced bloodflow in moments of high stress and so being ‘turned off’. It’s what Judith Lewis Herman calls the “wordless terror” of trauma.
But the flipside is that if we can get ourselves talking, or focusing on words such as through puzzles like wordsearches or crosswords, or by reading or journaling, we will be coaxing our brain to restore its bloodflow back to Broca’s area again. And by doing that, it will start to turn on the front brain as a whole again. When a therapist gets you to talk about the weather, or football, or what you had for tea last night, it’s not because they can’t cope with your flashback or re-
So when we are triggered, a very simple but powerful process is at work. Before we have even had a chance to think about it, within 7 milliseconds, our ‘smoke alarm’ has detected smoke, and has set off a bodily alarm system to pump stress hormones into our bloodstream to enable us to take immediate evasive action. The front brain switches off so we can’t think and the back brain switches on so all we want to do is act. To me, that suddenly made sense of how I can be so rational, so normal, so competent some of the time and then, when I’m triggered, I become a jumpy, rabbit-
Armed with this new knowledge, I stopped beating myself up when I got triggered. It didn’t prevent me from being triggered, but it diverted the backlash afterwards, the tornado of critical thoughts and accusations that would make a bad situation even worse. And gradually I realised too that this self-
PART SIX: UNDERSTANDING TRIGGERS
Understanding that being triggered is automatic and not my fault therefore helped me to become kinder towards myself, and by soothing myself and speaking kindly to myself after a triggering incident, I improved my ‘recovery time’. Over a period of months I therefore noticed that I was getting triggered less often, and – just as significantly – when I was, it wasn’t taking me so long to come back to a state of balance and equilibrium. It was the start of a new way of relating to myself based not on the old models of attack-
In the next part of this article, I will look at what we can do to manage triggers and how we can develop strategies for turning our front brains on and our back brains off – and also how we can turn down the sensitivity of the smoke alarm over time.