Understanding Mental Health Triggers

A trigger is a stimulus that elicits a reaction. In the context of mental illness, "trigger" is often used to mean something that brings on or worsens symptoms. This often happens to people with a history of trauma or who are recovering from mental illness, self-harm, addiction, and/or eating disorders. When someone has a history of any of these issues, being unexpectedly exposed to imagery or content that deals with that history can cause harm or relapse.

Many different stimuli can be possible triggers, and they are often strongly influenced by past experiences.

Understanding, identifying, and working to prevent triggers can be empowering and effective, especially in comparison to supporting someone after they have been triggered.

Types of Triggers and responses to them

Triggers vary widely from person to person. Many different stimuli can be possible triggers, and they are often strongly influenced by past experiences.

• External triggers: Think senses - sounds, sights, smells, textures that elicit responses based on past experiences. Example: Smelling the cologne that was worn by a loved one who has passed away can trigger grief.
• Internal triggers: Strong feelings that arise based on past experiences. Example: Making a doctor's appointment after a negative medical experience can trigger fear.
• Trauma triggers: Strong feelings that arise based on past trauma. Example: The sound of firecrackers can be trauma triggers for veterans of war.
• Symptom triggers: A physical change can trigger larger mental health issues. Example: A lack of sleep could trigger symptoms of bipolar disorder.

For some, a trigger might cause a physical response - heavy breathing, sweating, crying. For some, a trigger can elicit an emotional reaction, like thinking “I am being attacked.” For some, a trigger can cause harm or a relapse.

After experiencing a trigger, a person may have big, negative feelings - overwhelm, powerlessness, fear, etc. These feelings can be detrimental to mental health and are often a challenge to effectively address after they arise.

The behavior that emerges after a trigger can range from relatively minimal (crying) to serious (acts of violence). Someone exposed to a trigger may experience impaired judgment or awareness.

Ways to Help Someone Who Gets Triggered

• Be curious. Learn to engage in difficult situations with a focus on maintaining a positive relationship. Learn what is triggering for those around you, and try to avoid causing pain. Remember to respect an individual's right to not share, or share on their own timeline.
• Be empathetic and listen without judgment. Be a safe space for those around you. Avoid taking another's behavior personally nor making negative judgments about someone's feelings and behavior.
• Maintain good boundaries. Boundaries help everyone be clear on expectations, which adds security and predictability.
• Help with coping. Ask about strategies that work for the person to relax and take care of themselves. Encourage more time spent on self-care activities.
• Use trigger warnings if you develop content. Providing a warning before potentially triggering content provides time for people to prepare or if needed, to opt-out of challenging or emotional materials.

Coping Strategies for Those Who Get Triggered

There are many possible coping strategies you can try, but all should focus on reducing the impact of the trigger and the strength of emotional reactions.

Trial and error can help each person determine what works best for them. Remember that different coping strategies may work for different triggers and emotions.

• Learn to identify: Consider reactions to past triggers; who or what was involved, where, when, and why it took place. Observe patterns and obvious signs of risk to prevent a similar situation.
• Make a plan to address: Create a plan to address triggers and emotional reactions. You may want to talk to loved ones or your treatment team to let them know how they can best help you when you are triggered. Be sure to carefully address triggers that occur repeatedly, because each time they do, the emotional reaction may be greater.
• Try problem-focused coping: Confront your stressor directly or try to find a solution to the stressor. For example, commuting past a hospital may cause you to remember traumas from the hospital. You could find another commuting route.
• Try emotion-focused coping: When you cannot eliminate or avoid a trigger, focus on regulating your reaction to a stressor which may help reduce the stressor’s impact. For example, meditation can help reduce stress, anxiety, and depression.
• Communicate if someone is triggering you: A person triggering another person is often unintentional. Talk to them about the impact of their actions to clear up any misunderstandings and consider possible solutions. Have an open, calm, and understanding dialog. Be willing to work with them. If the person who is triggering you refuses to act sensitively, it may be best to set clear boundaries.
• Find the right therapy: Specific types of therapy have been shown effective in addressing triggers such as exposure therapy and EMDR therapy. Support groups can also help the person feel less alone.
• Reality-check your thoughts: To minimize the escalation of thoughts and feelings, it may be helpful to “reality check” thoughts to assess their reasonableness. A few ways to do this include:
  1. Check facts: What is undisputably true and do the facts support your interpretation.
  2. Consider cognitive distortions: Identify faulty or inaccurate thinking, perceptions or beliefs.
  3. Reframe: Reshape automatic negative thoughts into positive thoughts.
  4. Proportionality: Ask yourself, is the reaction disproportionate to the trigger?
• Look for trigger warnings: Triggers warnings can help alert you to triggering material, especially materials related to suicide or violence. Sometimes, an article will provide a trigger warning at the start of the piece. You can even ask others to provide you with a trigger warning about materials they share.
• Practice self-care: Prioritizing your mental health can help build resilience against potential triggers. You can start by talking to someone, such as a loved one, friend, or therapist. You may also want to practice mindfulness, meditation, deep breathing, or journaling.

While it can be difficult to control triggers, those who experience them can learn from past experiences, apply what they learn, and limit the risk of being re-triggered. Avoid only focusing on what happens after a trigger; also focus on what can be done beforehand.

Each time a person is triggered is a learning opportunity that can help manage reactions in the future. If a person can’t control the trigger fully, they may be able to limit the emotional reaction to it before it becomes problematic and harder to address. They might even be able to prevent the trigger by preparing for it. There is always have something you can control. Anything that offers a little control over mental illness can help keep us well.

Adapted from NAMI Blog by Katherine Ponte