Trauma Triggers

Development of Trauma Triggers

Trauma triggers are stimuli that recapitulate stimuli that were present during a traumatic event. In persons with PTSD, trauma triggers provoke reactions similar to those present during the original traumatic event or events. Learning theory accounts for the development of trauma triggers. In learning theory terms, the original traumatic event constitutes an aversive unconditioned stimulus (UCS), which produces intense distress, called the unconditioned response (UCR). Other stimuli that were present during the original traumatic event—such as sights, sounds, smells, thoughts, feelings, or bodily sensations—become associated with the trauma through classical conditioning. These other [Page 739]stimuli, called conditioned stimuli (CS), can elicit distress (the conditioned response or CR) like the original events, even when these trauma triggers themselves are not harmful.

Trauma triggers may rapidly generalize so that a wide range of stimuli can trigger intrusive memories and reexperiencing distress. Trauma triggers can be external stimuli, such as sights, sounds, or smells, but they can also be internal stimuli, such as pain sensations or a body position. Researchers, such as Slawomira Diener and colleagues, believe that the high level of stress during a traumatic event leads to very high degrees of physiological arousal, which in turn promotes highly selective and fragmented affect-laden memories. These initial learning processes in PTSD produce intense distress in response to an extensive network of trauma triggers.

As Anke Ehlers and colleagues have pointed out, trauma triggers do not necessarily have a meaningful relationship to the original trauma. They are often stimuli that have sensory similarities to stimuli that were present at the beginning or during a traumatic event. People with PTSD often do not know what has triggered their intense distress, so the reexperiencing distress may seem to be completely unprovoked.

A case example shows how trauma triggers are stimuli that are associated with the original traumatic event and can provoke ongoing dissociation and distress without the person's awareness of the specific trigger. A 21-year-old man sought treatment for PTSD related to a car accident. After the first three sessions, the therapist's office moved to a location on a high floor of the building near the elevator lobby. The young man complained bitterly about the new location on an upper floor of the building. He became angry and upset when the therapist asked about taking the elevator rather than walking up the 10 flights of stairs. Beginning with the first session in the new office, the young man was markedly more hyperaroused, angry, and distressed than in previous sessions. There were several instances when he suddenly dissociated by staring into space for up to a minute at a time. He could not identify what had triggered these sudden dissociations, and they did not appear to be triggered by anything in the content or process of the therapy sessions. After two more sessions, the therapist noticed that the dissociations seemed to occur when the elevator bell rang to indicate that the elevator door was opening to the lobby outside the office door. When the therapist asked if the elevator bell could be triggering the man's dissociation, he quickly acknowledged that he had a previous trauma that he had not reported during the trauma history interview. He stated that he had been attacked in an elevator in his apartment building and nearly beaten to death. He realized that when he heard the elevator bell, he was reminded of the event and became fleetingly extremely distressed before he “went blank” and dissociated in session. This case example illustrates that a trauma trigger can be a sensory stimulus, in this case a sound, that was initially neutral but during the traumatic event become associated with intense fear, anger, and distress. Initially, the young man was not aware that the sound of the elevator was triggering his distress and dissociation, but as an outcome of psychotherapy, he was able to understand the connection between the trauma trigger and the distress it provoked.

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