Trigger warnings, which are statements intended to warn people about being exposed to potentially upsetting material, have garnered much debate as to their effectiveness at protecting people from emotional distress. New research published in PLos ONE suggests that reading about triggering traumatic material did not result in an increase in trauma symptoms in both people who did and people who did not have PTSD symptoms.
Some of the arguments against the use of trigger warnings are focused on the potential adverse, rather than beneficial, effects they have on people. “While a trigger warning may allow individuals to benefit from avoiding potentially distressing material, arguably they also preclude coping with their trauma, potentially adding to their psychological distress,” wrote study author Matthew Kimble and colleagues. “In addition, theory related to expectancy effects and self-fulfilling prophecies suggests that trigger warnings may make individuals more likely to respond poorly to upsetting material or lead them to interpret normal, brief, and appropriate distress as pathological.”
Some research on this topic supports this notion and suggests that receiving a trigger warning might actually increase feelings of vulnerability and anxiety when compared to people who do not receive trigger warnings. Some research even shows that trigger warnings have little effect at all, positive or negative.
Researchers were interested in contributing to the body of research on this topic by assessing students with actual PTSD symptoms, looking at whether triggered responses are dependent on type of trauma, and looking at how often students avoid triggering material.
They recruited 355 undergraduate students enrolled in Introductory Psychology across four universities to participate in this study. Participants were randomly assigned to read one of two passages from Toni Morrison’s The Bluest Eye. One of these was the “trigger passage” as it described sexual and physical assault and the other was a neutral passage of equal length. Participants who were assigned to read a trigger passage were also given the option to read the alternate neutral passage.
Participants were measured for exposure to traumatic life events at the start of the study, which took place over 14 days. Researchers used this measurement to categorize participants into those who had and have not had trauma associated with physical or sexual assault.
Participants filled out measures of distress on Days 1, 2, and 14 to measure current feelings of distress over time. They also filled out a general PTSD checklist and a specific PTSD checklist toward the study reading material on the first and last day of the study. Researchers also measured participants’ general emotional responses to the study.
Results show most participants (over 96%) opted to read the triggering passage even if they had exposure to traumatic events or scored high on the PTSD checklist. Those higher on the PTSD checklist experienced more emotional responses to the trigger passage than those with lower scores. Further, participants in the trigger passage condition reported feeling significantly more distressed than those in the control condition, but only on the first day of the study. This difference was not seen in the later measurements indicating the distress was not long-lasting.
Results also show that trauma type was important in that those who had also experienced trauma related to assault reported more PTSD symptoms in the first two days of the study compared to the other participant groups.
Not all the results were consistent with the researchers’ expectations. “We were surprised to find that there were no differences in avoidance between those with [assault-related trauma] and/or [PTSD symptoms],” commented the researchers. “At a minimum, we expected that individuals with [PTSD symptoms], which include symptoms of behavioral avoidance, would avoid triggering material in a context where there was no penalty for doing so.”
Interestingly, those with assault-related trauma did not report more distress after reading the trigger passage compared to the other participants. All participant groups reported high distress right after reading the triggering passage, but this effect disappeared over time.
“Those with a [assault-related] trauma, at least compared to those with other traumas, as well as those with provisional PTSD scores reported more symptoms tied to the passage than did those without PTSD or other traumas,” noted the researchers. “This suggests that those with [assault-related] traumas and/or PTSD found themselves thinking about the passage after they had left the session.” Importantly, researchers note that the passage did not necessarily exacerbate symptoms as indicated by the little change in PTSD scores over time.
The authors mention several limitations of this research such as using written material only and the overall small sample size.
The study, “Student reactions to traumatic material in literature: Implications for trigger warnings“, was authored by Matthew Kimble, William Flack, Jennifer Koide, Kelly Bennion, Miranda Brenneman, and Cynthia Meyersburg.