On the last track, we discussed the three levels of victimization
of shattered assumptions, secondary wounding, and victim thinking.
On this track, we will examine the effects of triggers
on PTSD clients and also various types of triggers, for example, anniversary
triggers, current stresses, and bodily triggers. We will discuss these
from the perspective of combat and natural disasters.
#1 Anniversary Triggers
The first type of trigger is an anniversary reaction. Obviously,
these triggers include anniversary dates that remind a client of the trauma.
Grant had survived a bloody battle in Iraq against insurgents in May and June. Around
these months every year, Grant reports feeling nervous, anxious, and nauseous. When
he first came to me, he stated, "I don’t know why these months
are so bad for me. I think its allergies or something."
asked Grant if he could check the records regarding his time in Iraq. He
said yes, and the next session I had with him, Grant stated to me, "Hey,
Doc. You won’t believe this! You know how
I said I get real sick every May 19th? Well, that’s the day the
insurgents sent an IED, oh that’s an improvised explosive device, straight
into our Stryker IVC."
Although I was not as surprised as he thought
I would be, Grant found it helpful to know from where his
reactions were stemming. Rather, his body was reacting to the dates during which he experienced trauma.
#2 Current Stresses
The second type of trigger is current stresses. It is
common for the slightest amount of current stress to augment PTSD symptoms
including trigger symptoms. Grant became irritated when he began to have
increased symptoms during months in which no combat took place. Grant
stated, "Nothing happened to me in the war during these months. So
why am I seeing my dead buddies in the room with me all week? I thought
you said I wasn’t crazy."
This time, his triggers had been
unrelated to any specific dates, so I asked him if he had been under any stress
during the week. Grant responded, "My wife lost her job,
and we’ve been having money troubles all month." I explained
to Grant that this extra stress could be what triggered his symptoms this time,
not the dates.
Think of your PTSD client. Do they have an increase
in symptoms even though there is no visible trigger about? Could they
be suffering from current stresses, if so the Trigger Chart described later
on this track may be beneficial?
#3 Other Reminders
In addition to anniversary triggers and current stresses, a third type
of trigger is a bodily trigger. Bodily triggers are those that relate
to the senses.
For instance, the sight of red may
trigger the memory of blood in a veteran’s mind or the backfiring of
a car could trigger a memory of gunshot. Such things as news stories
related to a client’s trauma or even talking to other
people may also trigger a client’s PTSD symptoms.
As you know
bodily triggers include the following:
- Olfactory or smell
- Physical. This can relate to the sensation of movement,
touch, or pain.
Do you need to think of body triggers as a criteria for
you next session or
playing this track during your next session for the client.
Leo, a PTSD client had been in his camper when a tornado
ripped through it. As
a result of his injuries, the doctor’s were forced to amputate his
leg. Just before the tornado hit, Leo had been cooking pasta in
his camper’s kitchen. Now, whenever he smells cooking pasta, Leo
begins to feel sick to his stomach, and has to fight a great urge to flee to
a basement or windowless room. As you can see, Leo is suffering from
an olfactory trigger.
Technique: Trigger Chart
To help my PTSD clients like Grant and Leo identify their triggers more successfully,
I suggested they make a "Trigger Chart". You
might consider trying this technique with those PTSD clients who have trouble
identifying triggers and anticipating triggers in their environment. I
asked Leo and Grant to divide a piece of paper into three sections, each
column labeled: "trigger", "my reactions",
and "traumatic memory".
Under the trigger column, I asked
them to write certain dates, objects, or stressors that cause their PTSD
symptoms to intensify. Under the "my reactions" column,
I asked them to list specific emotions and thoughts that
occur when they come into contact with a trigger. Finally, under "traumatic
memory", I asked them to write a memory of the trauma
that could somehow be linked to the trigger.
Grant, the war vet... wrote
under "trigger", "Someone, an authority figure, tells
me to do something in a disrespectful, rough, or impersonal tone of voice." Under "my
reactions," Grant wrote, "Anger, desire to fight
back, desire to run away instead of hitting the person or having to hide
my rage." Finally, under "traumatic memory," Grant
wrote, "It reminds me of the CO who sent my buddy on a worthless, dangerous
mission that got my buddy killed so that he could look good."
After Grant completed this part of the exercise, I asked
him to divide this and any other triggers he had into four categories:
(1) triggers he felt might be the easiest to endure;
(2) triggers he felt he
might be able to handle after a few more months of healing;
he felt he might be able to confront in a few years; and
(4) triggers he
planned to avoid for the rest of his life.
For those triggers he felt
he could handle easiest, Grant wrote, "hearing a car backfire, seeing bright flashes." For
those triggers that Grant felt he might be able to handle after
a few more months of healing, he wrote, "watching
a movie with explosions in it".
For those triggers he felt he might
be able to confront in a few more years, Grant wrote, "dealing
with other stresses in my life." And those triggers that Grant
felt he could never healthfully confront were, "anniversary
dates". Now that Grant has prioritized his triggers,
he can more effectively face them without being overwhelmed by confronting
them all at once.
On this track, we discussed the effects of triggers on
PTSD clients and various types of triggers: anniversary triggers, current
stresses, and bodily triggers.
On the next track, we will examine three techniques to
help a PTSD client cope with their triggers: trigger coping questionnaire,
writing, and abdominal breathing exercise.
Online Continuing Education QUESTION
What are the three types of triggers?
To select and enter your answer go to .