Anxiety and Triggers: Overcoming PTSD and Avoidance

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hi everyone Emma McAdam here I'm a licensed Marriage and Family Therapist and in this video I'm going to teach you what a trigger is how they get formed the one thing you do that makes them worse and the basic principle behind how to overcome them real quick just want to remind you I've got some courses on udemy.com check out the link in the description for a coupon code they'll teach you things about basic mental health coping skills and self-care how to change your brain chemistry some alternatives to medication so check those courses out hopefully I'm gonna have a PTSD and a rewiring your anxious brain course up soon they are not completed yet but they're in progress and I'm hoping to have them done by the end of this year okay so let's jump into triggers so a few months ago I took my daughters to free day at the Museum and we rode the elevator up to the fifth floor and of course the emergency call button is right at the eye level of my two-year-old daughter so she pushes it and I'm trying to explain to security that we're fine and we don't have an emergency and the door is open and I'm struggling to get my stroller and the two-year-old out the door of the elevator and my four-year-old was distracted with this conversation with the like emergency personnel on the other end of the phone and the door is shut like super fast with her in the elevator and so suddenly my four-year-old is going down to one of the four floors below and I'm stuck like hitting the call button on the elevator as fast as I can and now we actually like needed the security people to help us and my daughter was I don't know I don't know what happened so then I ride the elevator down and then she rides the elevator back up with the security person and I'm like talking to the security desk people in anyway long story short we were reunited pretty quickly but after that my four-year-old was understandably anxious around elevators she came to the belief that elevators are dangerous and she didn't want to ride them but elevators aren't actually dangerous being separated from your mom in a museum with 5,000 other people may be dangerous but it's not the elevator but basically her brain had made this connection like elevator equals danger like lookout and this is called a paired association or a trigger so a trigger is the common term for a psychological principle called paired association so this simply means anything that reminds someone of previous trauma or danger to be triggered is to have an intense emotional or physical reaction like a panic attack after encountering a stimulus triggers have gotten a lot of attention recently with the word being overused to mean like someone who takes offense or even like using it as an excuse so someone might say oh I was so triggered by your actions so I had to leave or I yelled or I had to get high but today we're not going to be talking about that kind of trigger we're gonna be talking about triggers as they relate to anxiety and PTSD as far as triggers go there's an interesting new trend trigger warnings so this is like you might see it on social media or I've even heard of universities doing this where someone's basically like hey guys I'm gonna be talking about some intense topic so look out like you might want to leave but these warnings may be actually making things worse because most people have no idea what to do with real triggers other than avoid them so to understand triggers let's talk about Pavlov's dogs for a minute in a famous experiment a scientist named Yvan Pavlov was studying digestion and wanted to see what triggered the production of saliva you know what makes your mouth water when you think about food so he hooked some dogs up to a device that measured their saliva output and when they brought the dog food they observed the the presence of food made the dog drool now he was curious about this physical reaction so it makes sense that we make saliva when we eat it helps us digest but what triggers that physical response so he took a neutral object a bell and he rang it and the bell did not cause the dog to salivate then he started to ring the bell when he brought the food to the dog and every time he rang the bell he'd then bring food pretty soon he noticed that before the food was even brought out the dogs started salivating he then started to just ring the bell but no food was involved and the dog started to drool without any food being there the bell had become a trigger it triggered the dog's physiological reflex to salivate with no real food involved he had paired a neutral object of bell to a physiological response drooling so this is called pairing a neutral object a safe object gets linked to a subconscious physiological reaction triggers could be something like associating a loved one with the smell their perfume or a happy memory with a type of food and these trigger a pleasing and calming reaction but most often when we talk about triggers we're talking about the context of anxiety or anger so a soldier who has seen a backpack used as an IED a bomb he might feel anxious when he's back home and he sees a backpack sitting on the sidewalk or someone who was in an abusive relationship with someone who smokes might get stomachaches when they smell cigarette smoke even when it has nothing to do with their abusive partner so that stimulus the backpack or the smoke is paired with that physical reaction the anxiety or the stomachache so these these objects or these experiences are triggering a physiological response that's not really in our control now the big picture is our brain is supposed to be making the links between things that are actually dangerous and the anxiety and avoidance response we are supposed to have a fear and avoidance reaction to rattlesnakes or we're supposed to have a physical aversion to food that made us throw up so like if you ever like one time I ate chili and it made me throw up and for a long time I couldn't eat chili anymore because it made me sick to my stomach just to think about it like I wasn't appetized by chili and that's a paired association they're supposed to protect us from danger like food poisoning but sometimes the brains natural response gets hijacked by trauma and associates something that is safe with that danger response so a trigger is not inherently dangerous it's neutral it just is coupled with the feeling of danger in your head so I've had clients whose fear reaction was triggered by grasshoppers radiators rumble strips and loud chewing noises each of these stimuluses these objects or these experiences these are neutral they aren't inherently dangerous but they were paired to that anxiety reaction in my daughter's case she developed a fear reaction to elevators so her natural reaction was to avoid elevators before we went on an outing she would ask are there elevators there if there are I don't want to go so she had this trigger response now in order to best understand triggers we need to talk about perceived danger so as I talked about in my other video on the anxiety cycle when we avoid perceived danger that feeling of fear only grows so now let's review perceived danger versus actual danger for a second a bomb is actually dangerous a backpack is not an abusive spouse is actually dangerous cigarette smoke is not okay I know cigarette smoke causes like cancer but that's that's not what the fear is about that's not what that paired association was about cigarette smoke is not going to beat you up and that's what that anxiety response is associated with so the anxiety response in reaction to the cigarette smoke had nothing to do with cancer it had to do with that paired association of being beat up by a cigarette smoking spouse so when we talk about triggers that we're trying to overcome it's almost always a fear response to something safe but our typical response to triggers is avoidance and if it's a bomb that you're avoiding that's actually a really appropriate reaction right if you see a bomb in the street you shouldn't run the other direction but if it's a backpack in the street and we avoid going out in the street because there might be backpacks there this typical response this avoidance actually makes things worse the next time it's going to make your anxiety worse next time so when you avoid something that feels dangerous your brain basically says phew the only reason I survived was because I avoided that backpack and your brain is like I better make my human more anxious so they do that again pretty soon anxiety itself becomes a trigger so people get anxious about being anxious they're like oh my gosh if I go out in the street there might be a backpack I might get anxious so I'm worried about going out in the street and then they avoid leaving the house so pretty soon anxiety itself becomes a trigger right people get trapped in these cycles of avoidance and they miss out on life so a soldier won't leave the house because he's afraid of getting anxious if he sees a backpack and suddenly in addition to having PTSD he now has depression too because his life sucks these symptoms like anxiety and panic attacks they feel uncomfortable but they're not actually dangerous when we try to avoid them it's easy to see how our anxiety spirals out of control because we're creating anxiety about anxiety so one of the most common triggers that bother people is thinking about or hearing about people talk about distressing events so if someone had experienced a sexual assault and then had to attend a college class where that was the subject she might feel a strong physiological reaction feeling anxious sweaty or frozen during that class she's having a danger reaction when she's actually safe sitting in a chair in a college class this is one of the essential characteristics of PTSD which is feeling in danger when you are actually safe now just to be clear the moment of sexual assault was actually dangerous but remembering that assault while sitting in class feels dangerous and it triggers that physiological danger reaction that heart rate and the sweaty hands and everything but it's actually safe so understanding that difference between perceived danger and actual danger is one of the keys to learning how to overcome triggers so are we stuck that way are you doomed to feel anxious about triggers for the rest of your life is my daughter doomed to take the stairs for the rest of her life no your brain is made to adapt to change and to grow and to rewire itself over and over this is called neuroplasticity triggers can be reassociated so let's go back to Pavlov's dogs for a minute when he would ring the bell the dogs would salivate even when there was no food they had this really strong paired response but when Pavlov kept ringing the bell for a couple of days but he didn't bring food out pretty soon the dog stopped salivating for the bell the bell became neutral again and that physiological response went away so this experiment demonstrates something that later psychological research has affirmed that when we face our triggers in a safe place when we're exposed to them and nothing bad happens our brain unpairs that physiological response so just like the dogs no longer salivated when the bell was rung the soldier who had anxiety reactions to backpacks when he first got home from Afghanistan if he's frequently around backpacks and he keeps facing that fear eventually his brain relearns that backpacks are safe and he no longer has that anxiety reaction so if it's that easy why does it seem so hard it's because we humans are so good at avoidance avoidance of a fear makes the fear stronger so going back to the anxiety cycle every time we avoid a trigger and survive our brain is like phew let's do that again so it takes our anxiety up the next time there are so many ways to avoid like obviously there's the physical way like not going to class or not leaving the house but there's also things like substances or emotional avoidance trying not to care trying not to think about it endless distraction and even coping skills blame and anger can all be types of avoidance so pause this video for a moment and consider what are your go-to ways to avoid feeling anxious write it down or leave it in the comments below if you want and if you want to rewire your brain to overcome triggers then you need to let go of avoidance when we understand that avoidance reinforces anxiety and PTSD symptoms then we're given the key to freedom from those symptoms gradual exposure to triggers in a safe way is the most effective and long-lasting approach to resolving them instead of feeling helpless anxious and depressed when you face your triggers little by little you start to see yourself as resilient and capable so here's the basic approach to resolving triggers and this is the process you would work on with a therapist so number one notice and name your triggers make a list of them and then check the list to see if any of these are actually immediately life-threatening if they aren't there a perceived threat so going back to my daughter's example our elevators actually dangerous no they're very safe as long as you hold your mom's hand number two write down what your physical and emotional reactions are to your triggers what goes on in your body increase that awareness of things like changes in your breathing or clenching your hands and meditation and mindfulness can really help with this step so for example my daughter may have felt a racing heart tight stomach or sweaty hands now you take this list of triggers and the third step is writing this feels dangerous but actually safe next to each of these or for my young daughter we may just sing it or we I was reminding her elevators are actually safe okay and then out of your list of triggers you want to choose one that you're ready to actively face and you do this in the growth zone you don't throw yourself into the panic zone and you don't keep yourself in the comfort or avoidance zone it may help to ask for support from a friend or a therapist while you do it and it may be helpful to break it down into small steps starting with the easiest so check out my video on an exposure hierarchy to learn some ways to break down these really seemingly overwhelming tasks into small pieces number five is face that trigger in a safe place or with a safe person and you practice relaxing into it sit with it until you feel a tiny bit calmer this is really important you you can do this so with triggering memories sitting with it might look like writing them down telling your therapist about them or doing an art project about them with the fear of backpacks you might spend time in a room with a backpack and then when you feel safe with that you might head over to the local school so with my daughter we practiced riding elevators together holding hands letting her push the buttons until eventually she got comfortable with them again if I had enabled her by helping her avoid elevators then most likely her fear and anxiety around elevators would have grown now because we went back to elevators and we consistently and gently faced them she's not scared of them anymore she actually likes elevators now number six remind yourself that anxiety feels uncomfortable but it isn't actually bad or dangerous tell yourself I am safe I feel some anxiety but that's okay I am safe number seven breathe practice self-regulation techniques so these are things that sooth your body things like progressive muscle relaxation deep breathing safe thinking so that's like reminding yourself I am safe right now or envisioning your safe place but just because these things calm you down it doesn't mean you need to wait until you believe it or until you're calm to act so this whole process only works if you face the trigger and nothing bad happens so with little kids this soothing process looks more like co-regulation they need someone to help them so with my daughter it's me hugging her and me modeling for her that we're safe but for adults this might look like just facing a fear and softening your stomach muscles if you want to learn more about some of these self-regulation techniques check out my anxiety skills playlist but basically two things happen here the anxiety response goes down but at the same time your emotional muscles get stronger so your ability to feel strong emotions and be okay increases and both of these processes help people feel more resilient and more peaceful so again as always I recommend working with a licensed therapist that can help you do this in the safest most efficient way but understanding the process can help you get the work done with them now I want to throw out one last idea really briefly so what do you about triggers that are actually potentially dangerous so for example what about driving so there's a lot of people who had a car accident and then after that they have this really strong anxiety response around driving so driving is something that does actually involve danger you can't really tell your mind nothing bad will ever happen this is 100% safe because the reality of life is that driving a car comes with a very small risk out of the thousands and thousands of times you get into a car every once in a while you may get into an accident so what are we supposed to do with that anxiety response especially if it gets heightened by some traumatic accident well here's where the whole anxiety acceptance comes in so this is a skill from acceptance and commitment therapy and I'm only gonna mention it briefly here today because it's something we could spend a lot of time on but the basic idea is that life comes with risk and risk comes with uncomfortable emotions like anxiety but we can actively train ourselves to get better at feeling allowing ourselves to make an intentional choice about our values and how much risk we're willing to accept so we might say something like being able to drive is uncomfortable for me but that's okay it's worth it because driving gets me to work and that's more important than avoiding anxiety to do this we have to change our rules so instead of saying anxiety is awful or I can't handle it or I won't do anything that makes me anxious we take a more flexible approach like I don't like feeling anxious but I can handle it and be okay or getting to work or driving my kids to school is more important to me than avoiding discomfort now there is so much more to learn about acceptance but I've got to save that for some future videos the takeaway from this video is triggers are when a neutral event or object gets paired with an anxiety response in our body and when we avoid that stimulus our anxiety grows but when we gradually face that stimulus and practice grounding our brain will eventually rewire itself to let go of that paired anxiety response and of course working with a therapist can help that process go more smoothly for you thank you for watching please share this video you never know who might benefit from it and take care
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Channel: Therapy in a Nutshell
Views: 219,614
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Keywords: triggers, ptsd, ptsd triggers, trigger warning, ptsd triggers coping, post traumatic stress disorder, post traumatic stress disorder treatment, ptsd treatment know your options, how to stop being triggered, anxiety triggers, ptsd treatment, what to do when triggered
Id: 13DFLHv1fv8
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Length: 20min 13sec (1213 seconds)
Published: Thu Feb 20 2020
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