More Harm Than Good: Why ‘Trigger Warnings’ Should Come with Their Own Caution

 
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‘Trigger warnings’ – messages indicating that upcoming information may be emotionally distressing - are increasing regular features of social media and, so I hear, teaching environments. They are used with the expectation that they will reduce the risk of a reader/student (especially one with a previous experience of trauma) being emotionally harmed by some aspect of the message. So you might imagine that, as a psychologist with a presence on social media, I would be in favour of using trigger warnings. Quite the opposite; not only is there no evidence of the protective function of trigger warnings but they may in fact be doing more harm than good.

Where did they come from?

Yet, the notion of a trigger warning may indeed have its roots in the consulting room. When working with people with Post-Traumatic Stress Disorder (PTSD), for example, helping a patient to control/recover from their flashback means helping them to identify what aspects of the environment (or their minds) precipitated the event. Thus, if someone develops PTSD following an assault in the park a flashback may be triggered by later speaking to a someone with a similar voice as the attacker, seeing someone in similar clothing, or passing similar looking trees in another part off the town.

Ironically, the aim when working with these patients is not to help them avoid their triggers but to support them to develop the coping skills that enable them to recover; to continue living their lives and to thrive in spite of these experiences and to not conceptualise themselves as permanently damaged by them.

Since then the idea of trigger warnings (and safe spaces) has escaped the therapeutic setting and ‘triggers’ and ‘trigger warnings’ have undergone a mission creep so that a term that originally referred to a very specific set of events for an individual in treatment now often means ‘anyone encountering anything that might opportune psychological discomfort or difficult emotions’. In short, it is used too often for too many people.

Okay, so the term may have drifted from its original meaning, why is that a problem? To get a clearer sense of why ‘trigger warnings’ might hinder more than they help it is necessary to have a working knowledge of a couple of other psychological principles:

  1. Priming

  2. Behavioural Confirmation aka the Self-Fulfilling Prophecy

Priming

When we think of being ‘primed’ we mean the state of being ‘ready for action’. Sprint athletes lining up for a race are primed to push out of the blocks as soon as they hear the starter pistol. Similarly, in psychology, priming describes activities or environments that prepare or bias the mind towards specific psychological actions. In priming studies, showing participants a stimulus (information) will unconsciously influence later choices, processing, emotions or behaviour.

Presenting someone with the target word CAT speeds up the rate at which they recognise the word LION or DOG and slows down recognition of unrelated words like POTATO or SKY. The word CAT ‘warms up’ the semantically related areas of the brain, preparing them for activity.

Internal states can also influence these priming effects. For example, if you take a big group of people, some who suffer from insomnia and some who do not, and show them a series of images to remember, those with insomnia are much more likely to remember sleep-related words and images (PILLOW, BED, EYE MASK) than those who sleep well. Here, the experience of insomnia creates a preoccupation with sleep-related stimuli, priming their brains to preferentially look out for and retain this information.

People with a diagnosis of depression tend to have a ‘negativity bias’, that is to say that their brains selectively attend to negative stimuli in the environment. In experimental studies depressed individuals recognise and remember angry and sad faces more quickly and easily than do non-depressed individuals. Their minds are primed towards the negative. This can very quickly lead to a feedback loop in which where a mind primed for negativity finds it more easily, which then ‘confirms’ the negative assumption. However, and importantly, the bias doesn’t just increased speed of identification, it actually increases reactivity; the stimuli create higher levels of distress. Now the vicious cycle is a vortex that becomes harder and harder to escape.

Self-Fulfilling Prophecy

I have spoken about the risks of the Self-Fulfilling Prophecy here.

Perception

Another salient feature of an individual’s vulnerability to psychological harm is their attitude towards the event and their beliefs about their capacity to tolerate it and recover. For example, people going in for surgery who are optimistic about the prognosis tend to have better outcomes than those who are pessimistic or doubtful. This might be for a number of reasons: the optimists might be more likely to adhere to recovery and rehab advice, or they may have lower stress levels than pessimistic patients.

In therapy we try to make an assessment of the client’s beliefs about recovery and improvement . ‘Do you think things can change? Can you imagine a time when you do not feel like this? as this will influence the person’s willingness and ability to engage with - or disengage from - the process.

Putting this together we get a better sense of why the research to date has found that not only do trigger warnings not reduce levels of distress but may actually increase them.

First, the person reading that some upcoming content may be distressing is primed for emotional distress. Their brains warm up the neural networks associated psychological pain. The ubiquity of cautions about psychological vulnerability contribute to a sense that one should be expected not to cope. In this way, the belief that one is vulnerable can actually increase vulnerability. Then, potentially, understanding that people with their experiences should have been distressed they may unconsciously behave in a way that confirms this expectation.

The trigger warning, based on the Fragility Assumption, has actually increased the likelihood and severity of a negative reaction.

What’s that? What’s the Fragility Assumption?

I’m glad you asked. The Fragility Assumption is my term for some of the more concerning psychological behaviours that I’ve noticed, particularly on social media.. The Fragility Assumption is that the human mind is constitutionally fragile and at risk of breaking in the face of distress. It is the idea, for example, that witnessing a distressing event will definitely and immediately lead to serious and sustained emotional trauma. This is simply not true.

In the first instance, we know for sure that one of the worst things that you can do when someone has been through a distressing experience (such as a house fire) is foist counselling on them. To do so actually undermines the person’s innate resilience. What is advised instead is that we identify the people who might be at greater risk of emotional trauma (e.g. those with a pre-existing mental health condition or with a limited support network) and then…wait. Watchful Waiting means giving the person adequate time to recover under their own steam and only intervening when there is evidence of decline.

Secondly, the Fragility Assumptions contradicts evidence for the capacity for recovery and resilience (see Bonanno), and Post-Traumatic Growth.

And this makes sense from an evolutionary perspective, right? (don’t forget that our brains evolved too). The human species would not have made it very far if we were fragile to adversity. (Taleb’s concept of ‘Anti-Fragility’ is useful here.)

I position the Fragility Assumption against the Resilience Assumption; simply that most people will be resilient to adversity in neutral circumstances. Of course, there will be individuals whose innate constitutions mean they are more vulnerable than the average (and equally, there will be those at the other end of the bell curve who seem impervious). There will also be those who experience more intense and more chronic distress than most. All of these people are deserving of our compassion and support. Nor I am not suggesting that you should try to ‘tough it out’ if you are really struggling, in a bid to prove you are resilient. Of course not. But I am cautioning against the assumption the most people are psychologically fragile and at risk and that exposure to uncomfortable material will harm them. The majority of people have a reasonable level of innate resilience to the typical adverse events they will encounter in life. This is something that should be valued and supported.

Assuming population-wide constitutional fragility actually undermines people’s psychological resources and lowers our expectations of other’s recovery. This is the antithesis of what we are trying to do in mental health care, and given the growing evidence against it, it’s a practice that should probably stop.

References

https://www.ncbi.nlm.nih.gov/pubmed/18482107

https://www.ncbi.nlm.nih.gov/pubmed/21796742

https://www.tandfonline.com/doi/abs/10.1207/s15327965pli1501_01

https://osf.io/axn6z/

Bonanno