I am walking towards the Post Office with humdrum thoughts roiling in my head of things I need to do, wondering if I’ve got everything I need for tea, pondering a response to an email: the flip-flop ordinariness of everyday worries and concerns. Nothing unusual, nothing remarkable. And then. And then. I can’t even tell you what happened next because it’s snap-click-snap, in a moment, in an instant, and I’m not conscious of it happening at all. But my heart wants to burst like ‘Alien’ out of my chest, there is a rage of energy rippling up my legs and I can feel myself falling inwards and losing touch with myself.Then it is minutes later, maybe even hours – time has no meaning, and my brain is scrunched up inside my skull with weariness and confusion. What just happened? It was a man with a camera, a dog, a child crying … I don’t know what it was. But I was triggered by something and it’s seriously messed up the last few minutes or hours or even days of my life and I feel indignant and huffy with myself for it happening, and in roll the accusations and the razor-like mental barbs … You’re stupid, why did you have to react like that, what’s the matter with you, you’re pathetic, get a grip, this is ridiculous and then, like glaze on the top, the despair … I’m never going to change, I can’t do life like this, this is hopeless. And, possibly just for good measure, a dollop of panic … I’m never going to get my work finished now, everything’s going wrong today, I can’t cope with all of this!!!
One of the hardest things I found in dealing with triggers was the aftermath: the shame, the self-blame, the sense of failure and powerlessness that once again something had happened that I’d had no sense of control over. Learning to manage my critical self-talk and self-soothe rather than lacerate myself after being triggered was a key waymarker on my journey of recovery. When I felt ashamed and powerless, I would set myself up for a double-dip and trigger myself again with my own self-directed abusiveness. But once I realised that triggers made sense, that my reactions were automatic and had been hard-wired into my brain, I began to be able to take control of my triggers and reduce my self-hatred for being afflicted by them. In this article I want to explain what triggers are, what happens in our brain when we are triggered, and why they’re not therefore our ‘fault’ or an appropriate source of self-blame.
Like most people with a dissociative disorder, I hate being triggered. I will do almost anything I can to avoid triggers and other reminders of my trauma. In fact, a very straightforward way of looking at dissociation is that it’s primarily about avoidance: of the trauma we suffered, of reminders of that trauma, of feelings, of intimate relationships, and even of other parts of ourselves.
I have reasoned with myself for a long time that life would be fine if I could just keep that avoidance going. But triggers are like little psychic explosions that crash through that avoidance and bring the dissociated, avoided trauma suddenly, unexpectedly, back into consciousness – complete with all the bodily reactions and emotions that we would have had at the time. In the blink of an eye we are catapulted into a fight-flight-or-freeze response and that trauma (that was so overwhelming that we had to dissociate from it at the time just to survive) envelopes us like a king-size duvet around an ant. Not surprisingly, therefore, we can end up orchestrating our life in order to avoid triggers. But that has its own long-term and damaging impact: life becomes constricted as if we are living surrounded by a million unknown landmines and we must step very carefully in case one blows up in our face. It’s little wonder that we are so often so stressed!
But there were a couple of things on my therapeutic journey that I learned about triggers which at first surprised me. The first is that they can be managed – our brains don’t have to be our enemies but can instead be our friends, and we can tap them for their genius rather than just being hijacked by them. And the second is that triggers can actually be helpful – because they are clues, scraps of information, precious insights about what we’ve dissociated. They can therefore become guides on our therapeutic journey to discover what we have segregated or kept separate from our main consciousness, and what it is that we need to process and resolve so that we can recover and heal. Triggers provide these essential clues to the source of our post-traumatic response where we can resolve the underlying cause so that we don’t have to live this ‘split’ life any more of multiple parts of our personality – parts that know, and parts thatdon’t know about the trauma. Rather than avoiding the trauma, we can face it. And rather than being overwhelmed by it or stuck in it, we can process it. Triggers provide key information that we can use as a starting point to conquer the trauma that haunts us.
WHAT IS A TRIGGER?
Triggers are internal or external stimuli which remind us of past traumatic experiences. Trauma is the root experience of dissociative disorders, and even though we may have kept our traumatic experiences safely locked away (or ‘dissociated’) in another part of our minds, it is still there, however much we have tried to forget it or push it away. A ‘trigger’ is like pressing a button on a jack-in-the-box so that suddenly the memory or re-experience of that trauma pops out again – except it’s rarely as innocent and fun as a multi-coloured clown causing us to giggle with delight.
Paul Dell (2006) says that dissociative phenomena are “unbidden, jarring intrusions into one’s executive functioning and one’s sense of self.” And this is what triggers are – something which causes these sudden, unasked-for, jarring intrusions of the trauma of the past to clatter right back, unwelcomed, into the present. A flashback – that immersive, it’s-happening-right-now memory that is experienced not as a past event but as a present re-experiencing – can often be caused by a trigger, one of these current-day reminders of something from the past. We might be consciously aware of what these triggers are, or they could affect us at an unconscious level so that we react but we don’t even know why. A trigger might be a sight, a sound, a taste, a smell, a touch – in other words, some form of sensory input – or it might be something about the situation we’re in (such as being powerless, being in some way ‘in trouble’), a location, even a body position (such as lying down) or a body movement (like bending over).
During my most difficult period of time a few years ago, after the ‘breakdown’ that turned my ‘apparently normal’ life into a daily trek for psychological survival, I was being constantly triggered. I didn’t realise that trees were triggering until I was walking through some local woods one day and then suddenly I was elsewhere and time had fallen down a rabbit hole: I had switched to a much younger part of me, who hurtled back to there-and-then and our trauma amongst trees. That part of me was panicked and disoriented and was lost for several hours. It was only when this had happened several times that I began to recognise that there was a clue here, and gradually in therapy we traced this trail of breadcrumbs back to its source and the trauma I had experienced in some woods near a farm. Similarly, I didn’t know that babies were triggering, a reminder of my own direct trauma with infants when I was a child and then a teenager. And I didn’t know that communion was triggering – until on more than one occasion I went to church and found myself throwing up in the toilets during this part of the service for no apparent reason.
Triggers were everywhere and caused massive destabilisation in my life. I felt that I was ‘going mad’ constantly as I was tripped into a highly agitated state by normal, everyday things. But before my sudden, life-altering ‘breakdown’ in 2005, it was as if I’d had solid walls in my mind that were strong and stable enough to keep the trauma at bay, so none of these triggers managed to penetrate through to my consciousness. As a result I was ‘apparently normal’ and got on with life, with my career and with my marriage. But then in 2005, literally overnight, there was this sudden, total collapse, as if the walls in my mind had crumbled under the weight of too much pressure over too many years. A build-up of factors over at least a decade had chipped away at my walls until eventually there were too many gaps and breaches, and these “unbidden, jarring intrusions” were able to get through.
At the time, of course I viewed it very negatively. These flashbacks, these states of intense dysphoria and distress, were ruining my life and I wanted them to stop! I was ashamed of my inability to control them, and terrified of what might happen in a public place. But I now understand that they were the trauma trying to heal, giving me clues about what it was that was hidden in my unconscious. Unfortunately, while I viewed the flashbacks and triggers as the enemy, I didn’t hear what they were trying to say to me, and I missed the signs that could have eased my work in therapy. The more I avoided the trauma, the more I worked to edge carefully around every potential trigger – staying indoors in case I came across dogs and trees, isolating rather than engaging with people and their babies, for example – the more these triggers and reminders kept plaguing me. They were like a very insistent postman who was knocking on the door trying to deliver a message, and I was just turning up the music louder and louder to drown out his knocks! I began to make progress only when I opened the door and opened the ominous package with my name on it.
Of course we have to do this at a pace and in a way that we can manage – we cannot have a reckless, ‘gung-ho’ approach to life and act as if there are no triggers or that they won’t affect us. That’s just another form of denial and avoidance. But if we have been living with a certain trigger for a while and we are building our life around avoiding it, then we need to see that, like the postman knocking on our door, we are in fact allowing ourselves to be held prisoner. It takes a lot of energy to organise our life around avoiding triggers and reminders of trauma all the time, and eventually we will get to the point where we realise that the cost of facing it outweighs the cost of avoiding it.
LEARNING TO RESOLVE TRIGGERS
Over the last 6 or 7 years, I have had to work hard to identify my triggers, and learn how to manage them, as well as how to resolve them. That work of resolution is what is often referred to as ‘phase 2’ work in therapy – processing trauma. That, for me in relation to triggers, is the end goal. But in the meantime we can learn to manage them, as we put in place the first phase of our work in therapy which is ‘safety and stabilisation’. There are many triggers that no longer have any impact on me because I have opened the package – the dissociated trauma – and so the ‘postman’ has stopped knocking. In this case, traumatic memories have become ‘associated’ rather than ‘dissociated’ – they have linked up again with the rest of my autobiography, my personal narrative, my view of my self and the world, and my feelings. But on a daily basis there are still some things which catapult me back to 30 years ago, and while I’m still working to ‘associate’ that trauma, I’ve had to learn to manage triggers so that I don’t have to avoid them altogether and remain a prisoner in my own home.
PART FOUR: WHAT DO TRIGGERS MEAN?
So I’ve had to learn what triggers are all about, what is going on in the brain when they happen, and how I can use my brain to manage my brain. The basis for that is what I and other people, for the sake of simplicity, often refer to as the ‘front’ brain and the ‘back’ brain. This piece of psychoeducation is probably the single most helpful thing that I have learned over the last 8 years, because with dissociative disorders a large part of the problems we face are caused by a lack of connections (or ‘associations’) between different parts or structures of the brain. Trauma causes damage to many aspects of our brain functioning. For example, the pathway between the right and left hemispheres of our brain, the corpus callosum, is ‘eroded’ by trauma – brain scans show that it is less dense in trauma survivors. That may explain at least in part why many of us have reduced ability to integrate left-brain and right-brain processes and why certain therapeutic interventions that include ‘bi-lateral stimulation’ such as EMDR (Eye Movement and Desensitisation Reprocessing) can be effective in treating trauma. We also tend to have fewer connections between our thinking ‘front’ brain and our survival-based ‘back’ brain.
THE FRONT BRAIN AND THE BACK BRAIN
The ‘back’ brain refers to two evolutionarily-distant parts of the brain known as the reptilian brain and the mammalian brain, also known as the limbic system. The reptilian brain deals with automatic, instinctual functions such as making our heart beat, keeping our lungs breathing, and regulating our blood pressure, hormones and digestion. It’s not a thinking part of the brain at all – it just responds at quite a distinctly biological level to ‘instructions’ and stimuli. The mammalian brain sits on top of this and is our emotional and body memory system which helps us to survive threat. So the ‘back brain’ is unconscious, automatic, and based around keep us alive.
The ‘front’ brain by contrast refers to the neo-cortex which largely consists of the folds of grey matter that we typically think of as the ‘brain’. A baby is born with very little ‘front brain’ and the first five years is a rapid development and growth of these neurons and synapses: the neo-cortex grows and forms connections almost entirely in response to its environment – as a result of the experiences it has. The ‘front’ brain controls many aspects of our conscious life including movement, co-ordination, speech and thoughts. It is our learning, thinking, self-aware brain, and by using the simplistic term ‘front brain’ I am in particular referring to the frontal lobes that are involved in learning, thinking and planning – all the sensible stuff! Just this simple distinction between an automatic, survival-based ‘back brain’ and a thoughtful, reasoning, reflective ‘front brain’ can help to explain a lot of our behaviour when we are triggered and also give us strategies of how to manage better when we are tripped up by traumatic reminders.
THE AMYGDALA – THE BRAIN’S ‘SMOKE ALARM’
The brain takes in a wealth of sensory information all the time and most of this incoming ‘data’ is streamed to the thalamus, and from there it goes to a tiny almond-shaped area of the brain called the amygdala (‘amygdala’ is the Latin word for almond). The amygdala is part of the limbic system, the emotional alarm system of the brain: the ‘back brain’. And the amygdala’s function revolves around our fear response and it acts, in metaphorical terms, as a kind of ‘smoke alarm’. When incoming data from our environment is channelled to the amygdala, it is a first line of defence: in the blink of an eye – in around 7 thousandths of a second – it scans this information for threat or danger. It does this outside of conscious thought because this is the ‘back brain’ – not the thinking-based ‘front brain’.
If the amygdala senses threat, it sets off an alarm in the body and initiates the body’s fight-or-flight system, the sympathetic nervous system. Within moments our hearts start beating faster, our lungs are gulping in more air, our blood pressure is increased to squirt blood at a greater rate around our body and the bloodstream is flooded with sugar for energy: everything we need for an instant and energetic physical response. And when this happens – when the smoke alarm sounds – the ‘back brain’ becomes very active, and the ‘front brain’ shuts down. And this is what is happening when we are triggered – outside of conscious thought, the body is ramped up for immediate evasive action. We don’t sit around thinking, “Oh, maybe in a minute this dog might bite me, so maybe I ought to do something about it.” We don’t think at all! The body sets off the sympathetic nervous system to be ready to respond before we have even had a chance to think about the danger.
This is a very good system that has meant that for thousands of years we have been designed to be alert to danger and to respond instantly in order to survive. But unfortunately, if we have suffered a lot of trauma, especially during our early years when our brains are at their most impressionable, then our amygdala – our ‘smoke alarm’ – becomes oversensitive. The amygdala is a very basic bit of brain kit – it doesn’t think, it doesn’t spend long processing incoming information, and it’s not smart. It is just a smoke alarm – it only responds to what it perceives to be smoke. So it cannot tell the difference between burnt toast and the house being on fire. Or between a snake-shaped stick on the path ten metres ahead and a real snake. And the more traumatic experiences we’ve had, the more our amygdala is wired towards assuming the worst.
That might seem inconvenient now, but at the time, as a child, this was ‘adaptive’ – it helped us to survive a threatening environment. By being sensitive, even over-sensitive, the amygdala gave us the maximum possible amount of time to respond to threat – to respond with fight, flight or (if all else fails) freeze. The problem is that this level of responsiveness isn’t so adaptive or helpful as an adult. If the abuse is behind us, if we’re living in a world that is at least relatively safe, then we don’t need to have such quick responses to guard against threat: we don’t need such a sensitive smoke alarm. But having been in repeated fires in childhood, many of us have been left instead with a smoke alarm that reacts to the merest whiff of smoke as if it’s an inferno. And sometimes it goes off just in case – better safe than sorry! It’s this oversensitivity that can plague our lives – why we can be so tense and stressed, why we can react so dramatically to triggers, and in everyday life be jumpy and irritable and even aggressive.
THE HIPPOCAMPUS – THE CONTEXT STAMP
There’s another part of the ‘back brain’ that is important and that is a seahorse-shaped structure called the hippocampus. This is concerned with short-term memory processing, organising, sequencing, and mental maths, and is heavily involved in the processes of memory storage and retrieval. In this latter role it acts as a kind of ‘context stamp’, providing data such as time, location and context. So it ‘tags’ memories with this additional information, allowing you to remember not just what happened, but where it happened and when, and what the context for it was. However, when the amygdala (smoke alarm) has been set off because of high levels of stress such as trauma, the hippocampus shuts down. Memories of traumatic events may therefore be encoded or stored without their full context. This partly explains why, after the event, memories of abuse may be so fuzzy and indistinct – why we’re not quite sure whether they happened or not, or when and where they took place. It is as if they float free of anchors in our minds, and it makes them very difficult to bring into verbal, narrative memory.
So when something traumatic happens, the smoke alarm goes off and that deactivates the hippocampus. The memory of that traumatic event may then be encoded or stored without information about the context for what just happened. Imagine that our attacker was wearing the colour red. If that colour information is detached from the overall context, then ‘red’ may be stored as a ‘trigger’ in the future – a smoke warning sign that there’s imminent danger. The hippocampus didn’t get to ‘tag’ the memory with contextual information to show that the ‘red jumper’ wasn’t a key part of what happened, so ‘red’ becomes a conditioned response to the trauma: it becomes a trigger, something that will set off the smoke alarm.
THE THREAT CASCADE
All of this presents a huge challenge to us as trauma survivors. There is a cascade of processes that happens in our brain and body when the amygdala detects a threat, and it all happens before we’ve even had to think about it. When the amygdala smells smoke, the front brain switches off and the back brain switches on. This back brain alarm floods the body with stress hormones like adrenaline and cortisol which gear us for instant action, to fight or flee. They make us tense, pumped up, aggressive, so we end up with lots of overreactions to tiny reminders of the trauma, and a generalised ‘stressiness’ that is hard not just for us but for the people around us too.
At the same time as this is happening, however, the front brain – the thinking part – has decreased bloodflow and shuts down. At a survival level, there is a good reason for this, because if we’re about to be attacked by a tiger, we need lightning-quick reflexes and to be ready to run or fight. We don’t need to be slowed down by our ponderous thinking brain which wants to weigh up all the options and figure out what kind of tiger it is and scroll through all the associations we’ve had with tigers in the past. While we’re still weighing up those options and recalling the differences between Bengal tigers and Siberian tigers, we’ll already have been eaten! So when it’s a matter of threat and survival, the back brain fires up and pours stress hormones into our bloodstream ready for action, and our front brains are switched off to stop us faffing.
We are all familiar with the effects of adrenaline – the surge of energy, the pounding heart, the tensed muscles, clenched fists, alert attention. And many of us will also be familiar with the effects of high levels of stress: it may be less exotic than being hunted by a tiger, but public speaking has a similar impact on our autonomic nervous system! It is often touted as the number one fear because the very thing that we are supposed to be doing – speaking, and thinking about what we are going to say next – is inhibited by the stress response as our front brains shut down and we can’t get our minds into gear.
There is another area of the brain that is relevant here, called Broca’s area. It is concerned with language and speech – with words. Like the hippocampus, it is also shut down when the smoke alarm is sounding. That is why in a state of terror, like a flashback of trauma, it is so difficult to get our words out. In a situation such as public speaking, at the moment that we most need to speak fluently, our mind goes blank and we literally cannot think of anything to say. This isn’t some random occurrence – it is caused by Broca’s area having reduced bloodflow in moments of high stress and so being ‘turned off’. It’s what Judith Lewis Herman calls the “wordless terror” of trauma.
But the flipside is that if we can get ourselves talking, or focusing on words such as through puzzles like wordsearches or crosswords, or by reading or journaling, we will be coaxing our brain to restore its bloodflow back to Broca’s area again. And by doing that, it will start to turn on the front brain as a whole again. When a therapist gets you to talk about the weather, or football, or what you had for tea last night, it’s not because they can’t cope with your flashback or re-experience of your trauma – they’re getting you out of a back-brain, triggered state by turning your front brain back on again. Some therapists are smarter than they look!
So when we are triggered, a very simple but powerful process is at work. Before we have even had a chance to think about it, within 7 milliseconds, our ‘smoke alarm’ has detected smoke, and has set off a bodily alarm system to pump stress hormones into our bloodstream to enable us to take immediate evasive action. The front brain switches off so we can’t think and the back brain switches on so all we want to do is act. To me, that suddenly made sense of how I can be so rational, so normal, so competent some of the time and then, when I’m triggered, I become a jumpy, rabbit-caught-in-headlights, speechless wreck. And understanding that, that it’s an automatic process based around survival, and that it happens outside of conscious thought within the blink of an eye, made the world of difference to me: it’s not my fault. It’s not because I’m attention-seeking, or pathetic, or just plain ‘bad’. It’s my brain with its automatic wiring trying to keep me safe. I am more easily triggered by other people because I have an oversensitive smoke alarm from being in way too many fires as a child, not because there’s something intrinsically defective about me.
Armed with this new knowledge, I stopped beating myself up when I got triggered. It didn’t prevent me from being triggered, but it diverted the backlash afterwards, the tornado of critical thoughts and accusations that would make a bad situation even worse. And gradually I realised too that this self-blame, this tirade of self-denigration, was in itself triggering – that my own abusiveness, even though it was only ever voiced in my head, also smelled ‘smoky’ to my amygdala. So I was triggering myself with my own self-hatred – and that in itself had been spinning me time and again into a vicious circle of being triggered and then triggered again by my own disgust at having been triggered.
BEING TRIGGERED IS NOT MY FAULT
Understanding that being triggered is automatic and not my fault therefore helped me to become kinder towards myself, and by soothing myself and speaking kindly to myself after a triggering incident, I improved my ‘recovery time’. Over a period of months I therefore noticed that I was getting triggered less often, and – just as significantly – when I was, it wasn’t taking me so long to come back to a state of balance and equilibrium. It was the start of a new way of relating to myself based not on the old models of attack-and-abuse but based on the new models I was learning in therapy of comfort-and-accept.
In the next part of this article, I will look at what we can do to manage triggers and how we can develop strategies for turning our front brains on and our back brains off – and also how we can turn down the sensitivity of the smoke alarm over time.