Trigger Warnings

[cara susanna]

Hey all,

So I've been following a lot of the essays and arguments about requiring trigger warnings in college curriculum/syllabi. I think that psychologists and psychology students in particular would have a lot of great insight to offer, with having experience in both academia and mental health. So, I was wondering what people here think about the issue.

A lot of the comments have also pointed out the lack of empirical research on "trigger warnings" and symptomology, so there's that to consider as well.

Just in case people haven't been following the conversation, I'm posting one article that's for and one article that's against:

http://www.insidehighered.com/views...rigger-warnings#sthash.PVD70lmx.KRI73JHV.dpbs - against

http://makemeasammich.org/2014/03/05/trigger-warnings-its-about-empathy-and-choice/ - for

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[MCParent]

This is an interesting topic to me, because I teach sex and gender courses. Often, in these courses sexual assault is one topic covered, and many people who teach those courses make this a voluntary class (completely voluntary; if you let only persons with unresolved sexual trauma skip, they would have to disclose that to you and their absence would make it obvious to everyone in the class that they had experienced some trauma).

At the same time, "trigger" has been expanded to "things I don't want to take about," if you read some of the online forums about this kind of thing. As in, you can't talk about obesity as a health crisis because that's "triggering," etc. (your "for" article mentions slut- or fat-shaming, racism). That extension is ridiculous, in my mind.

 

[463951]

Cara - good topic to bring up! We were just talking about this at my practicum a few weeks ago. What jumped out to me was that students would have to disclose very private information about past trauma to their professor. Also, students with trauma histories are going to have very different triggers, based on the type of trauma they have experienced. A person with a trauma history may not react at all to one book, by may react to a different book. Would any books that could be a "trigger" be flagged? Who determines this? I have been wanting to read more about this and hear others' opinions.

 

[CheetahGirl]

Thanks, cara susanna. I will def read & may comment when time permits.

 

[Ollie123]

Quickly scanned both, but it seems the usual rehashed debate about being sensitive to others. One side thinks its perfectly fine to completely disregard other human beings, the other side thinks we should be continually restructuring the entire world to prevent each and every individual from ever having to be upset (the quote at the end of the "for" article unfortunately destroyed any credibility the woman had for me). Most reasonable, intelligent human beings fall somewhere in the middle. At some point we seem to have expanded the definition of trauma to encompass any and all "negative life experiences". The CC I did practicum at was obsessive about this...anything remotely bad we were encouraged to tiptoe around until they brought it up, rather than being direct, for fear of "Re-traumatizing" them. Utter BS with zero evidence to back it and pretty horrendous care, but that's a discussion for another day.

I'd be supportive of the general principle of including some up-front warnings about this in class. Every class I took that discussed difficult topics did this so folks walked in prepared. I think its fine to include that information on the syllabus. I think its important this not turn into a "pass" to skip certain topics and I think that's the issue we are likely to run into in its implementation. I think our field is the best example of that...should a graduate student in mental health be allowed to skip the suicide assessment lecture because they have a history of depression? I suspect we would all agree the answer is ABSOLUTELY not...we hopefully can all empathize with their situation but its critical information the person needs to learn and they will not get to pick and choose when any future patients bring up the topic. Some things are critical to learn and discuss.

The problem is not the principle, the problem is its implementation and the many grey areas. I'll say it - I genuinely want students to leave my classroom upset on occasion. That's a sign we discussed a difficult emotional topic and they were engaged. That is the essence of the college experience and usually the best learning that occurs. Its ideal. "Trigger warnings" should be about preventing situations that might cross into an issue of safety/health. Problem is 1) We have no way of knowing exactly where to draw that line, 2) Many students will abuse the crap out of any opportunity to avoid work and 3) Covering all possible situations is difficult/impossible. I routinely incorporate hot-off-the-press topics for discussion...I don't think the freedom to do that should be removed and its going to quickly get overly cumbersome if I provide specific warnings about each and every one.

Personally, I see little need to formalize the process. Blanket warning in the beginning of class if there is the possibility of encountering some disturbing topics along with some examples. In most cases, this should be a "duh" from the course title. Students who do not think they can handle that for whatever reason can drop. Respect students enough to grant them the freedom to excuse themselves if/when something becomes too much for them to handle - whether that is because of trauma or because they just ate a big lunch and a gruesome picture bothered them. They are responsible for the material regardless (no free passes). What exactly is the issue?

 

[MCParent]

Respect students enough to grant them the freedom to excuse themselves if/when something becomes too much for them to handle - whether that is because of trauma or because they just ate a big lunch and a gruesome picture bothered them. They are responsible for the material regardless (no free passes).

I dunno. So, they should not show up on the day that I do the sexual assault section? That's conspicuous. I don't want them to have to tell me personal medical/sexual history information, but I also don't want that info to be communicated implicitly. I remember when I was in UG and my social psych professor mentioned the just world hypothesis or something, and used the example of a cop telling a woman who was sexually assaulted that she was "asking for it" by how she dressed. A girl seated in front of me got up and left the room crying. That would make me feel gross if I'd been the instructor.

I *don't* think the make-the-sexual-assault-day-optional policy is ideal, to be clear. I just can't think of a better way of handling it. I'd concede that perhaps I'm being more soft-headed than soft-hearted on it.

 

[Ollie123]

I dunno. So, they should not show up on the day that I do the sexual assault section? That's conspicuous.

I guess a lot will depend on the nature of the course. I'm primarily used to teaching large undergrad classes. With 250 students they are lucky if I know who they are, let alone whether or not they showed up for class on a given day. This would obviously be very different in a 5 person graduate class, but then again so would my expectations for their ability to cope. That's why I favor a blanket statement up front - "Here are things we WILL talk about, here are the things we are likely to talk about, if that's a problem for you I understand, but you should think hard about whether this is the right time for you to be taking this class". If the class is required, there may be some challenges to work out that should likely be handled by disability services. I'm extremely reluctant to ever create classroom situations where material I consider critical is "optional" for any reason.

I'd also have felt very bad in the event I got that reaction to an example I presented in class. The problem is that it could very easily happen spontaneously (student asked for an example...prof didn't have one prepared and used the first one that came to mind). Including a "trigger warning" followed by enough time to allow students to address it without "outing" themselves would be incredibly disruptive. So the only solution becomes to avoid talking about it. That seems far more likely to be harmful than helpful in the long run.

Obviously, I'm not trying to convey a lack of empathy for the situation. Its incredibly difficult for folks who have legit traumatic experiences (not the "This topic makes me sad and uncomfortable" scenarios we mentioned before) and I can't imagine what its like to encounter those situations. I do think reasonable accommodations need to be made, but I'm very reluctant to allow anything to dictate what I can and cannot include in my courses. Making something optional is essentially me signing off on students completing my class without knowledge of a certain topic. Were I teaching a class on gender, I'd feel extremely uncomfortable saying "Its okay if you don't know anything about violence against women", which is not all that different from making it optional. I think an upfront warning is reasonable, precautions about particularly difficult scenarios (e.g. videos) fine. I think any expectations beyond that start to render things unreasonable.

 

[CaliMac]

Some things are critical to learn and discuss.

The problem is not the principle, the problem is its implementation and the many grey areas. I'll say it - I genuinely want students to leave my classroom upset on occasion. That's a sign we discussed a difficult emotional topic and they were engaged. That is the essence of the college experience and usually the best learning that occurs. Its ideal. "Trigger warnings" should be about preventing situations that might cross into an issue of safety/health. Problem is 1) We have no way of knowing exactly where to draw that line, 2) Many students will abuse the crap out of any opportunity to avoid work and 3) Covering all possible situations is difficult/impossible. I routinely incorporate hot-off-the-press topics for discussion...I don't think the freedom to do that should be removed and its going to quickly get overly cumbersome if I provide specific warnings about each and every one.

Personally, I see little need to formalize the process. Blanket warning in the beginning of class if there is the possibility of encountering some disturbing topics along with some examples. In most cases, this should be a "duh" from the course title. Students who do not think they can handle that for whatever reason can drop. Respect students enough to grant them the freedom to excuse themselves if/when something becomes too much for them to handle ... They are responsible for the material regardless (no free passes). What exactly is the issue?

I agree with so much of this. For reference, I have only a BA in psych from ages ago so I am the opposite of an expert. That said...

In most cases in psychology, there is some threshold defined (somewhat arbitrarily, depending on the knowledge base surrounding the topic). So why not make an educated guess and define such a threshold here? How many people are we willing to possibly affect by this decision (meaning, to flag or not, which topics, etc.)?

Now consider the population. Late teens, early 20's most of the time. Also people with past trauma (who tend to be attracted to psych) may represent a sizable portion. Many females.

Now consider the issues. Which are most highly charged? You, the professors and researchers, can answer that one. I am guessing sexual assault lands high on that list, along with a few other trauma types.

Now apply the issues to the population. The most common age range of sexual assault for women is 17-24. They have some where between a 1/3 and 1/5 chance of being assaulted. For men, the 1/6 who are assaulted have an 80% of this happening before they turn 18. So this means, for the affected subset of the population in question, that their trauma will be relatively recent.

Can this type of thought educate some formalization? Does it clarify how relevant flagging something like the class meeting MCParent mentioned is relevant to say, flagging the elder abuse talk or the SMI classes? And maybe, if a student chooses to skip a section, then a visit to the campus counseling center is in order. If they are so hurt by even hearing about it, they clearly could use some help processing their wounds.

Thoughts?

 

[cara susanna]

I guess a lot will depend on the nature of the course. I'm primarily used to teaching large undergrad classes. With 250 students they are lucky if I know who they are, let alone whether or not they showed up for class on a given day. This would obviously be very different in a 5 person graduate class, but then again so would my expectations for their ability to cope. That's why I favor a blanket statement up front - "Here are things we WILL talk about, here are the things we are likely to talk about, if that's a problem for you I understand, but you should think hard about whether this is the right time for you to be taking this class". If the class is required, there may be some challenges to work out that should likely be handled by disability services. I'm extremely reluctant to ever create classroom situations where material I consider critical is "optional" for any reason.

I'd also have felt very bad in the event I got that reaction to an example I presented in class. The problem is that it could very easily happen spontaneously (student asked for an example...prof didn't have one prepared and used the first one that came to mind). Including a "trigger warning" followed by enough time to allow students to address it without "outing" themselves would be incredibly disruptive. So the only solution becomes to avoid talking about it. That seems far more likely to be harmful than helpful in the long run.

Obviously, I'm not trying to convey a lack of empathy for the situation. Its incredibly difficult for folks who have legit traumatic experiences (not the "This topic makes me sad and uncomfortable" scenarios we mentioned before) and I can't imagine what its like to encounter those situations. I do think reasonable accommodations need to be made, but I'm very reluctant to allow anything to dictate what I can and cannot include in my courses. Making something optional is essentially me signing off on students completing my class without knowledge of a certain topic. Were I teaching a class on gender, I'd feel extremely uncomfortable saying "Its okay if you don't know anything about violence against women", which is not all that different from making it optional. I think an upfront warning is reasonable, precautions about particularly difficult scenarios (e.g. videos) fine. I think any expectations beyond that start to render things unreasonable.

One of the arguments that seems to be pervasive throughout the debate is the question of what the trigger warning is meant to do. Some individuals are claiming that it's just meant as a "head's up" so they can prepare themselves for coping with the class that day. Others are claiming that, although unstated, the idea of a trigger warning is synonymous with avoidance. Speaking as someone who works with trauma clients, I frankly see it both ways--I'm sure that some students would simply use it as a way to brace themselves, but there are others who would see the warning and avoid class that day. And then of course the question becomes: how does an instructor respond to avoidance? Should the student have to make up the course content in some other way?

Btw, I wanted to share this article, which makes some interesting arguments: http://valeriamsouza.wordpress.com/2014/05/21/triggernometry/

To summarize the author's main points:

1. Identifying trigger warnings is something that therapists typically help clients do, therefore is a therapeutic technique and does not belong in the classroom. If you claim that it does, then you should also be okay with behavioral exposure in the classroom.
2. Avoidance behaviors maintain symptoms (as we all know).
3. Why should accommodations for PTSD be different from any other disability accommodations offered in higher ed?

 

[Ollie123]

To the extent that its a "head's up", I would have little issue with it. That's not what the first "pro" article seems to be asking for...it seems to be asking for permission to engage the material only when they are ready. Which is fine if they don't take the class, but if they do they have to engage it in when everyone else is ready as it is not just about them.

I suspect many/most professors provide some sort of warning before particularly evocative stimuli/topics (I always do). Frankly...trauma or no, some things we discuss can be difficult. Plus, evidence suggests dimensionality for PTSD (at least from what I've read). I favor it up front to avoid situations like what Mike described, where people may get caught between "outing" themselves or being triggered. Beyond that, if it happens it happens and the student will have to deal with it as best they can. I'll be supportive and understanding, but the responsibility for handling it lies with them, their loved ones and their treatment providers. I will never sign off on someone not having to learn about a given topic for any reason. If I didn't think it was important to learn about, I wouldn't include it in my course in the first place. Give them an inch and they'll take a mile...slippery slope...yada yada.

 

[MCParent]

3. Why should accommodations for PTSD be different from any other disability accommodations offered in higher ed?

But disability accommodations expressly DON'T allow students with disabilities to escape course material (unless it involves field work in a marsh and a student uses a chair, or something). I'm not aware of, for example, a class being moved to a different room because the current room only has doors facing away from the seats and a combat veteran has anxiety about that (maybe that has happened but I've never heard of it).

In thinking about my own position, it becomes hard to defend, really. I don't allow people with recent family deaths to skip material on bereavement. To me an ideal solution would involve privacy (so, not requiring a student to divulge a trauma history to the professor), get all course material in for everyone, and not trip something in a student. I'm not sure how to do all those things at once.

 

[MCParent]

This thread sounds like a timely Teaching of Psychology article to me, btw, given that these trigger warning things are getting some press. ;-)

 

[cara susanna]

Definitely! I'd love to see a lit review or some original research on the topic. For instance, do trigger warnings actually assist with emotion regulation following a trauma trigger?

What's also interesting is that, technically, psych research has "trigger warnings." A consent form has to give someone a head's up about any sensitive material in the study. I wonder how you could have a control condition of "no trigger warning" in a study--perhaps by being vague on the consent form?

 

[Therapist4Chnge]

This thread sounds like a timely Teaching of Psychology article to me, btw, given that these trigger warning things are getting some press. ;-)

Good idea!

I would approach the "trigger" issue with a general disclaimer, clear delineation of topics in the syllabus, and my standard absence policy: can miss up to 3 classes if 15wk course, and adjusted down based on course length. I don't care why someone misses because we are all adults…hangover, child sick, overslept, funeral, etc. Extreme circumstances can be discussed as needed, but they really should be a very rare occurrence. If someone misses more than 3 classes, then the person's grade would be negatively impacted bc of a lack of participation.

 

[chman]

But disability accommodations expressly DON'T allow students with disabilities to escape course material (unless it involves field work in a marsh and a student uses a chair, or something). I'm not aware of, for example, a class being moved to a different room because the current room only has doors facing away from the seats and a combat veteran has anxiety about that (maybe that has happened but I've never heard of it).

In thinking about my own position, it becomes hard to defend, really. I don't allow people with recent family deaths to skip material on bereavement. To me an ideal solution would involve privacy (so, not requiring a student to divulge a trauma history to the professor), get all course material in for everyone, and not trip something in a student. I'm not sure how to do all those things at once.

This is where the "trigger warning" argument starts to lose ground for me (aside from the fact that I think we might be furthering pathology through enabling avoidance)..

I have done a lot of RA work in trauma and I am certainly very empathetic and aware of the issues surrounding sexual assault. However, it is impossible to account for every psychological issue that a student may have in a class. Take just PTSD for example. People with PTSD can be triggered by all kinds of things, depending on the trauma. Are we going to warn the class each time before a video of a car accident? Are we going to provide a trigger warning in an atmospheric sciences class because someone has PTSD from a weather disaster? What about those phobic of spiders? Or those with social anxiety that have to present in front of the group? The examples I could provide are endless really. It is simply unrealistic and preferential. It is saying one's psychological plight is more than another's.

Now, should students be warned before especially graphic or risky material is discussed in class? Certainly. That is quite reasonable and something that professors often did in my classes.

 

[PsychBiker]

As a therapist, generally speaking, I attempt to guide individuals to not avoid what they fear or what makes them uncomfortable.

As a student, and someone mentioned this, since I signed up for the course, I knew what I was getting myself into.

As a (vulgar) lay person, I would tell to others to not be a ***** and deal with whatever comes up in life.

As someone with PTSD, even when violent or graphic content related to my trauma was shown in class, I was never offended. Actually, the only thing I can remember seeing that bothered me was an autopsy, which is not related to my PTSD. Here is some more self-disclosure: I am also disabled, but I would not begin to compare my PTSD to my physical disability; however, I am just one person.

To bring it all together, both sides have valid points, but I favor allowing freedom for academic discourse without any restriction. The reality is that everyone has a problem with some thing. For example, in a graduate psych course, a freshman complained during a lecture that she did not like it when the professor talked about rape and asked him not to - this was in a doctoral clinical psychology course! I was not the professor or her supervisor, but I was very concerned that someone would have a problem with the word "rape" used in an academic setting when we were all planning to become psychologists; I wondered how she would deal with a patient who was raped, or even worse, a patient who had raped someone. Moving on, the issue was that the professor did not continue the discussion because of one persons problem with one word. While this is an isolated incident, and she may have had trauma that involved rape (I dont know), the problem is that if we start babying particular students, then we are taking away from others as a whole.

 

[smalltownpsych]

This was a post I made in the psychiatrist's forum regarding this same issue.
A good example from my own clinical practice regarding triggers. My patient returned from the war, friends pressured him into watching movie that was triggering, he got triggered, the MPs had to be called. Fortunately, they understood what my patient was dealing with and chastised his "friends" instead of arresting my client. We do need to have some understanding of trauma responses and educate people about that. Will lazy/unethical/cheating people use it as an excuse? Of course. People like that will use anything as an excuse. Makes it hard for the people who really are trying to cope with and heal from their trauma.

 

[LupaCupcake]

At my hospital we ask new patients to identify any triggers they are aware of and this is often updated by the treatment team as we learn more about them. Sometimes this gets abused and the PTs will state that hearing someone else talk is a trigger therefor they should be allowed to stay in their room all day and not attend group because it is a trigger. One PT said someone looking at them is a trigger and requested that all staff look at the floor while talking to them (I absolutely did not oblige them on that). It becomes an excuse sometimes ..."I punched the wall because he triggered me! It is his fault!" and they take no responsibility for the actions they performed because suddenly they bear no blame if a trigger was involved. I have triggers, everyone does to some extent, I prefer the idea of facing those triggers and learning coping skills to appropriately react rather than throwing a chair or stripping naked (inpatient hospitals are interesting). I am not trying to say that triggers are BS and people must be forced to face them head on..no....it is a process and some people need more time and help than others, but in the real world you can't just avoid what you don't like 24/7.

 

[smalltownpsych]

It is also important to distinguish between a trigger for a trauma response and a trigger for a substance abuser. The former tends to be less of a problem, as far as looking for excuses, than the latter.

 

[dale.gribble]

I'm interested as to how the real-life implementation of this would be different from that seen online. What I see online is predominantly a mechanism of avoidance/maintaining sxs for the sake of comfort, as well as a sort of catch-22 which, when someone gets caught in it, they're berated with a bunch of -isms and the like.

I guess I just don't see the point. When did the "being a decent human and giving a heads up" and "taking responsibility for your reactions and avoiding situations you know are provocative" methods stop working all of a sudden? I could see the rationale if calculus professors were using graphic rape metaphors as the premise for word problems, but in general you should know what you're signing up/paying for before you do so, and not expect others to alter their own behavior after telepathically understanding your phobias.