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Do you care about protecting survivors of trauma?
You may want to reconsider your use of trigger warnings. Our new paper, just appearing in Clinical Psychological Science, suggests they may do more harm than good. https://journals.sagepub.com/doi/10.1177/2167702620921341
You may want to reconsider your use of trigger warnings. Our new paper, just appearing in Clinical Psychological Science, suggests they may do more harm than good. https://journals.sagepub.com/doi/10.1177/2167702620921341
The link above is for the published, peer-reviewed version of the paper.
As a note, I previously threaded about the preprint ( https://twitter.com/paytonjjones/status/1148997097057738752) and postprint ( https://twitter.com/paytonjjones/status/1227305023861919746) versions of this paper, before the published version was available.
As a note, I previously threaded about the preprint ( https://twitter.com/paytonjjones/status/1148997097057738752) and postprint ( https://twitter.com/paytonjjones/status/1227305023861919746) versions of this paper, before the published version was available.
To start, let's review what being "triggered" means. Far from the slang that generally refers to an overly sensitive person who becomes angry when their values are challenged, being "triggered" has a quite different meaning for those with PTSD.
When reminded of a past trauma (such as warfare, torture, rape, or sexual assault) those with PTSD can sometimes experience an intense rush of strong emotions, such as an overwhelming sense of danger.
Enter trigger warnings. Advocates of trigger warnings are a bit split on how exactly trigger warnings work (there is no empirical research on their efficacy), but the arguments can be summarized in two main camps:
(1) Weak Version (Prepare/Control): trigger warnings allow people to more effectively brace to face a trigger and control their emotions
(2) Strong Version (Avoid): trigger warnings allow people to completely avoid the triggers
(2) Strong Version (Avoid): trigger warnings allow people to completely avoid the triggers
In our study, we only evaluate (1) the Weak Version [if you are interested in (2) the Strong Version -- stay tuned, I'll address it near the end].
Across all of our analyses, we find no support that trigger warnings help trauma survivors brace for emotional distress:
(1) Trigger warnings have no effect among trauma survivors
(2) Trigger warnings have no effect among those report a PTSD diagnosis
(1) Trigger warnings have no effect among trauma survivors
(2) Trigger warnings have no effect among those report a PTSD diagnosis
(3) When we specifically matched the content to individuals' "worst event", trigger warnings still had no effect
(4) Across each different type of trauma (e.g., sexual assault, other interpersonal violence, etc.), trigger warnings still have no effect.
(4) Across each different type of trauma (e.g., sexual assault, other interpersonal violence, etc.), trigger warnings still have no effect.
(5) When using emotions other than anxiety, trigger warnings still had no effect (or a worsening effect)
(6) Trigger warnings slightly *increased* anxiety for those who met the clinical threshold for PTSD
(6) Trigger warnings slightly *increased* anxiety for those who met the clinical threshold for PTSD
A growing literature has consistently supported this general conclusion. Please see the excellent work by @MevaghS @drlambchop @Toribridgland @brave_billiken @DerynStrange
Besides their inability to help, we encountered some other concerning findings. Specifically, trigger warnings increased the extent to which survivors saw their worst event as central to their life story.
Seeing trauma as central to one's life is not a good thing. Trauma centrality is associated with more severe PTSD, and it even mediates treatment outcomes (that is, people tend to recover as they see trauma as decreasingly central)
Now to briefly touch on (2) the Strong Version of trigger warnings, which we did not address in this study.
If you are interested in this topic, it's very important that you first become well-versed in the topic of emotional avoidance. https://www.verywellmind.com/ptsd-and-emotional-avoidance-2797640
If you are interested in this topic, it's very important that you first become well-versed in the topic of emotional avoidance. https://www.verywellmind.com/ptsd-and-emotional-avoidance-2797640
After a traumatic event, there is often a strong tendency to avoid memories of the trauma. This should come as no surprise, because these memories are often extremely distressing and painful! https://www.ptsd.va.gov/understand/what/avoidance.asp
The problem is that avoiding the memories reinforces the idea that they are dangerous and unmanageable. Avoidance is one of the primary factors that contributes to the development and maintenance of PTSD. https://www.sciencedirect.com/science/article/abs/pii/S0005796798001818
To remove the jargon: those who confront their memories of trauma tend to recover more quickly, those who avoid those memories are more likely to get sick and stay sick.
Given this perspective, I am quite skeptical of the "Strong Version". If trigger warnings indeed encourage people to avoid triggers, this is the exact *opposite* of helpful.
This is an area that could benefit from future research. For instance, it's not totally clear that trigger warnings actually result in increased avoidance -- so the Strong Version may be an entirely moot point.
Please don't misunderstand me: I'm not recommending to flood trauma survivors with exposure outside the context of treatment.
I'm just very wary of policies that could encourage behavior that harms people in the long run. There is a middle ground here.
I'm just very wary of policies that could encourage behavior that harms people in the long run. There is a middle ground here.
If you are reading this thread and finding yourself upset at the conclusions being drawn, I would encourage you to ponder the following: why did you start supporting trigger warnings in the first place?
I imagine it was because you care deeply about trauma survivors, and want them to be happy and healthy. I share your goal! We owe it to them to carefully evaluate which policies are truly helpful. I hope more research in this area will follow.
My recommendation (for now)? Skip the trigger warning and, where appropriate, help your students navigate the difficult process of finding access to evidence-based treatment for PTSD
