Psychological studies on trigger warnings

May 20, 2015 2:25 PM

I was just told that trigger warnings are either useless or do more arm, without any citations. Do you know any serious study that either proves or disproves this hypothesis?
posted by francesca too to Society & Culture (4 answers total)

Best answer: "Controlled exposure" to triggering items is generally considered to be the appropriate treatment for trauma/PTSD. Avoiding the triggers entirely reinforces and strengthens anxiety, and being exposed to the trigger without any control of it reinforces and strengthens anxiety.

The arguments that I've seen against trigger warnings focus on the dangers of the former and ignore the dangers of the latter, not seeming to understand that "controlled exposure" is not at all the same thing as "exposure." Trigger warnings are a mechanism that allows a trauma survivor to control their exposure.
posted by jaguar at 2:42 PM on May 20, 2015 [9 favorites]

Best answer: A study is mentioned in How trigger warnings could really work [WaPo]:

“Trigger warnings aren’t much help in actually overcoming trauma,” [Jonathan Chait] wrote, “an analysis by the Institute of Medicine has found that the best approach is controlled exposure to it, and experts say avoidance can reinforce suffering.”

He’s right, though the Institute of Medicine was talking about combat veterans, writing that “the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD.”

More extensive research is referenced in this older post: Trigger Warnings, Quentin Tarantino, and the College Classroom [Vitae]

[...] a study published by The American Society of Criminology, is perhaps most valuable: “giv[ing] victims, as well as other students, control over their educational experience [...] is crucial,” the authors write, and “thought to help improve victims’ psychological health.”

In The American Society of Criminology article linked above, "Teaching About Victimization," several studies are referenced:

Creating a safe space means considering alternatives you would allow if students have trouble with aspects of the course. It also means, from day one, being clear about what content is going to be covered, how it may affect students, and that being affected in these ways is normal (e.g., Zurbriggen, 2011). This gives victims, as well as other students, control over their educational experience (Black, 2006; Newman, 1999). Feeling in control is crucial, as victimization may undermine an individual’s feelings of control over themselves and the world around them (Janoff-Bulman & Frieze, 1983). Restoring a feeling of control is thought to help improve victims’ psychological health (Janoff-Bulman & Frieze, 1983).

Trigger Warnings

When lectures, guest speakers’ presentations, multi-media demonstrations, activities, class readings, or other course materials hold the potential to trigger emotional reactions, warning students ahead of time provides them the opportunity to make decisions regarding how and when to engage with those materials (Jones, 2002). Warning early and often via multiple mediums provides students maximum opportunity to engage in informed decision-making and feel that they are in control. The first trigger warning should be on the first day of any course that includes information with the potential to emotionally trigger students. Trigger warnings should be given in at least the two classes before the presentation of potentially triggering material (or engagement with it outside of class, if that is the case), as well as at the beginning of the day when the material is presented. If an assignment is going to be shared with others, include that detail ahead of time (e.g., Hollander, 2000), so students can control how much of their experiences they share. These steps allow students time to think about what they need to do for self-care (see below) and give them an opportunity to talk to the instructor about their concerns and possible alternate arrangements.

posted by Little Dawn at 5:41 PM on May 20, 2015 [3 favorites]

Best answer:

“Trigger warnings aren’t much help in actually overcoming trauma,” [Jonathan Chait] wrote, “an analysis by the Institute of Medicine has found that the best approach is controlled exposure to it, and experts say avoidance can reinforce suffering.”

He’s right, though the Institute of Medicine was talking about combat veterans, writing that “the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD.”

That article makes the exact mistake I mentioned, in that the author assumes "controlled exposure" and "exposure therapies" (which are based on controlled exposure) are the same as random exposure. Exposure Therapy actually requires a very controlled, limited approach to dealing with triggers, guided by a trained therapist, and only done after the client has learned techniques (like deep breathing or grounding exercises) that lower their physiological reactivity. It's not a "Throw 'em in the deep end, assume they'll learn how to swim" thing (though some crappy therapists treat it that way, but that's not the protocol).

Prolonged Exposure (PE) is one exposure therapy that works for many people who have experienced trauma. It has four main parts:

Education. PE starts with education about the treatment. You will learn as well about common trauma reactions and PTSD. Education allows you to learn more about your symptoms. It also helps you understand the goals of the treatment. This education provides the basis for the next sessions.

Breathing. Breathing retraining is a skill that helps you relax. When people become anxious or scared, their breathing often changes. Learning how to control your breathing can help in the short-term to manage immediate distress.

Real world practice. Exposure practice with real-world situations is called in vivo exposure. You practice approaching situations that are safe, but which you may have been avoiding because they are related to the trauma. An example would be a Veteran who avoids driving since he experienced a roadside bomb while deployed. In the same way, a sexual trauma survivor may avoid getting close to others. This type of exposure practice helps your trauma-related distress to lessen over time. When distress goes down, you can gain more control over your life.

Talking through the trauma. Talking about your trauma memory over and over with your therapist is called imaginal exposure. Talking through the trauma will help you get more control of your thoughts and feelings about the trauma. You will learn that you do not have to be afraid of your memories. This may be hard at first and it might seem strange to think about stressful things on purpose. Many people feel better over time, though, as they do this. Talking through the trauma helps you make sense of what happened and have fewer negative thoughts about the trauma.

With the help of your therapist, you can change how you react to stressful memories. In PE, you work with your therapist to approach trauma-related situations and memories at a comfortable pace. Usually, you start with things that are less distressing and move towards things that are more distressing. A round of PE therapy most often involves meeting alone with a therapist for about 8 to 15 sessions. Most therapy sessions last 90 minutes.

That "comfortable pace" part is key, and it's what tends to get ignored when people concern-troll (which Chait absolutely does) against trigger warnings.
posted by jaguar at 6:55 PM on May 20, 2015 [6 favorites]

Response by poster: I could not have received better answers! Thank you so much.
posted by francesca too at 6:54 AM on May 21, 2015 [1 favorite]