Trigger Warning – Trigger warnings can be bad for you

Here is an abbreviated list of thoughts that are linked to traumatic stress:

1. I can’t deal with being upset

2. People can’t be trusted.

3. I am a weak person

4. I have to be on guard the whole time

5. You have to be careful because you never know what can happen next.

6. I can’t rely on myself.

This list is a sample of a much larger list of cognitions that are associated with PTSD. The thoughts are both understandable, but unhelpful. Together, the thoughts represent a thinking style that is harmful for people who have been traumatised. This thinking style is associated with negative thoughts about the self, negative thoughts about the world and self-blame. Thinking in these ways is associated with increased  severity of traumatic stress. Thinking in these ways also distinguishes who have been traumatised and don’t have PTSD from those individuals who have been traumatised and have PTSD*.

The beliefs above frame the sufferer as a weak person who lacks internal capacities. They make the sufferer vigilant about danger because they engender a sense that the world is dangerous. They also provoke an idea, and this is the really dangerous aspect, that something is wrong with the very substance of the person. This thinking makes them feel wreaked and ruined, stained and fragile.

It is one thing to be vigilant, to believe that something is wrong with you and believe that you can’t cope with the world, but imagine having a friend actively communicating those things to you. You would rid yourself of such a person would you not? But what if they were a well meaning person who was just…naive? They say to you “be careful” or “you can’t trust others”, or “I’ll protect you”. The intention seems good, but would it be good for you to have a friend like that repeating warnings to you and keeping you in a vigilant state?

Recently researchers at Harvard University gathered together 451 trauma survivors. They randomly assigned these trauma survivors to one of two groups. One group would receive “trigger warnings”, which is a statement that what the participant was about to encounter could be upsetting. The other group did not receive trigger warnings. Both groups read literature that was typical of High School English classes (a passage from Moby Dick, Flags for our Fathers, or Crime and Punishment). The researchers concluded “… that trigger warnings countertherapeutically reinforce survivors’ view of their trauma as central to their identity” **. That is, the trigger warnings helped to confirm that they are defined by the trauma they had been through, and that is the very thing that the trauma survivor is trying to escape.

If you really care about a survivor of trauma, don’t give them a ‘heads up’ that danger is just around the corner. If you do, you are unwittingly creating problems. We need to cease giving people trigger warnings, and stop communicating that they can’t handle life without our protection. If we actually care about friends and family members we will need to stop thinking that they are fragile. Sure they can be rattled, we are all rattled after horrible events. But even if they say, “I can’t cope” we need to say “you can’t cope…. yet“. We need to have faith in them, not faith in us. We need to provide routine and connection, but we also need to increase their exposure to the world with the belief that they will cope given the time they need. Most family members and friends of someone who has suffered do this really well. There remains in our culture people at universities and in media, who need to drop their naive and misguided notion that by giving people trigger warnings they are caring for people when they are making them worse.

Whenever I hear people’s stories of trauma, my heart sinks. After 20 years I’ve heard a lot of them. But my heart soars every time I see a patient learn that they are stronger than they thought and that happens a lot.

 

Dr Jonathan Andrews MAPS FCCLP, Clinical Psychologist.

Brisbane, Australia.

 

* Foa, E.B., A. Ehlers, Clark, D.M., Tolin, DM.F., & Orsillo, S.M. (1999). The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychological Assessment, Vol 11(3), 303-314. https://doi.org/10.1037/1040-3590.11.3.303

**Jones, P.J, Bellet, B.W & McNally, R.J. (2020). Helping or Harming? The Effect of Trigger Warnings on Individuals With Trauma Histories. Clinical Psychology Science. You can find the pre-print version of the full article here

 

From a Psychological Perspective, it isn’t the pandemic you need to worry about.

The Covid Pandemic has created considerable anxiety and this is no surprise to any of us. We wash our hands repeatedly, we check our distances. Vigilance spills easily over into suspicion: strangers and friends alike become potential carriers.

The emphasis that our culture has on protecting our health is pleasing: People matter, and they matter more than the minor things we some times get caught up in our society.

This past week 265 well credentialed economists signed an open letter to the Prime Minister and Members of the National Cabinet, encouraging them to make health, not the economy, a priority. I found this encouraging, all be it a little naive when considering the potential psychological impact of ongoing quarantining.

When we get a virus, a significant portion of us are physically vulnerable. The elderly, the friends and family members who have compromised respiratory functioning need to be protected. Not many of us need to be psychologically protected though. None of us blame ourselves or have our identity ripped apart if we get quite sick. We simply feel physically rotten and say, “I must have got it from such and such a place”. After all, we all get viruses from someone else, or something else…. a stranger who didn’t wash his hands, a tourist from another country, a cruise ship that just docked. The psychological impact of actually getting the Virus will be limited but the ramifications of Covid 19 such as job losses and social isolation, will potentially impact us all.

If there is a down turn in the economy, we as a population will be more fragile than we thought. Many of us pin our identities to our role in life. We see ourselves as providers, as dentists, pilots and academics. We get our sense of self and our value from the things we do. If these roles are taken from us, our sense of self and our value can be stripped from us in an instant.

It doesn’t have to be that precarious. The reality is that there is no better time to keep your heart in your mind.

What is in your heart is the way you define who you are and where you get your value from. If you define yourself by your profession and the economy stops you will lose your identity and your value. You don’t have to define yourself that way, and there is a great opportunity to reconfigure your psychological make up prior to the possibility of a recession.

You can define yourself in other ways. You are not your profession; you are a brother, you are a daughter, you are a mother, a father, a child, a friend and a neighbour. In fact any of these more relational references are much safer ways of defining yourself than your profession.

This is where people of faith are at an advantage. Well over half of the Australian population can find their identity in their creator. They don’t have to invest their identity in their position in society or the money that they earn. They say “I’m a loved child of God”. This identity will protect their heart from the loss of a job, or the loss of money. To be sure, losing a job and the income that goes with it will hurt, but it will not be heart breaking.

That is the naivety and the irony of the letter signed by the 265 economists. It is fine to say “focus on health” but we are a fragile bunch. We do indeed need to prioritise health over money, but let’s not be naive about it. If many of us lose our jobs there will be a new pandemic of people who have lost their identity and value. People who have not examined their hearts prior to a downturn in the economy, may end up feeling lost, they may find themselves questioning who they are and finding they feel worthless. I suspect, even some of those very economists who signed the letter will be examples of this.

Jonathan Andrews
April 2020.

Living in Quarantine: If ever there was a time to ‘guard your heart’, this would be it.

There are many recommendations being made about how to cope with this pandemic. Many well informed people have written about this and I don’t want to add to what other people have said. You can already get good advice here and here by reputable people and institutions. I highly recommend that you use these links and make them known to people around you who you are concerned about.

The purpose of this article is to focus on those factors that other people do not- the factors that might impact on your heart.

The heart is the distinctive feature of all human beings. It is the substance of who we are as people. It is the seat from which all your feelings, thoughts, behaviours and (non-medical) symptoms come from. So important is it, that the ancients told us to “Above all else guard your hearts for everything you do flows from it” (Proverbs 4:23). You can’t imagine a way of emphasising something in a more powerful way….”above all else”. And the justification seems good…..everything comes from it.

It is wise that in times of significant difficulty, such as being quarantined during a pandemic, that we do this. Given what the heart is, this gives us three ways that we can guard it: Keep connected, find your purpose…and realise, this isn’t permanent.

1. Quarantine but don’t disconnect from others. Connection (a warm and respectful rapport) is a must for all human beings. So important is connection to your mental health that it led Bessel Van Der Kolk the Founder and Medical Director of the Trauma Centre in Boston Massachusetts to state, “Being able to feel safe with other people is probably the single most important aspect of mental health”. So tell a joke, listen don’t teach, have fun, and if you’re talking to older children and adults – look for a deeper understanding.

2. See the purpose in what is happening. This quarantine is not aimless. By being at home away from others you won’t get Corona, if you have it and you’re quarantined you can’t pass it on. But see the purpose beyond mere survival. Ask yourself a deeper question like: “How can I grow from this?” and if you have a faith, “How does God want me to grow from this?” We’re taking a turn away from survival here and leaning towards altruism – who around me can I take care of? Are there any elderly neighbours who I can go shopping for? Do they need anything from me? Self isolation provides us with an opportunity to reflect on what is my personal role. This time of slowing down can be a source of productive reflection and consolidation of purpose.

3. Remember, this season is not permanent. It will pass, particularly if we get quarantine right (and vaccinations emerge). Reminding ourselves that this is impermanent will help us all grow in resilience and strengthen our hopes for the future. Hope is vital at this time, and pessimism is something to guard ourselves against. By using our minds in this way, we can prevent our hearts from becoming injured. Researchers at the University of Pennsylvania have shown in 20 well controlled studies, that teaching pre-teens different thinking styles (one of which is to teach children to think that bad things are not permanent), “can prevent and reduce the symptoms of depression and anxiety” when the child becomes a teenager. We can all benefit from such agile thinking. This is not a permanent situation.

So grab this opportunity, not just to dodge a viral bullet, but to really connect, consolidate your purpose, grow in altruism and think in such a way that you might be hopeful and more resilient.

Kind Regards
Jonathan Andrews

After the fire

Australia has always been under threat of bushfires. As the poet said we are “a sunburnt country”. This year feels very different though. The extent of the damage in the 2019/2020 bushfires was serious and harmful in a whole variety of devastating ways. Lives have been put at risk and lost, and livelihoods have been taken away.

My goal in this post is to provide some tips for those trying to help effected families’ recovery from the horrible hardship they have endured.

Connect with people on their own terms

People are more resilient than we realise. For all people who get exposed to a traumatic event, only 20-25% of people exposed to them will be traumatised. With that in mind, we need to have a mindset of being willing to connect with people, but be willing to connect on their terms –  not assuming that they are damaged in some way. Most people will take it in their stride. Some people simply won’t be deeply impacted by it, and that is why they won’t need to talk about it. Still others will be impacted but they may not be ready to talk about it. For a small number of people talking about it will be too difficult.

So, if they want to talk about the upcoming NRL season let them do that. Maybe they want to do that because they don’t need to talk about the fires. Maybe they want to do that because they don’t want to speak of terror. Either way, let them lead the conversation. Connection with others requires that they are able to choose what is true of them and talk about it if they want to.

What hurts most is likely not the bushfire, only related to it.

How is it that some are deeply upset by the fires and others aren’t? What is it that determines whether someone becomes traumatised? Well “dosage” of the trauma is an understandable risk factor. The closer you are to a fire, the more life threatening it is, the more likely it is that you will be distressed by it. This isn’t surprising.

What is surprising is that one of the factors most likely to determine whether or not someone becomes traumatised is not directly related to the traumatic event.

In a review of many scientific studies, researchers examined 14 possible risk factors. What they concluded was that it was the factors after the event, such as level of social support and stress, that were some of the strongest risk factors for the development of traumatic stress.

Of all the needs we have social connection is paramount of them all, especially after trauma.

Natural disasters (fires, tsunamis, earthquakes), affect vast numbers of people but they typically have low levels of psychological penetrance. It often isn’t the fire itself that is upsetting. Typically what does impact people in natural disasters are the personal factors involved. These factors will be the determinants of  distress: Whether or not people are supported or taken advantage of after the event, whether people were empathic and showed they cared or whether they were indifferent.

Understanding this helps us to remember that if we really want to help, the best thing we can do is be a friend. Have a cup of tea, share a joke, go to an AFL game with the kids. And talk, talk if they want to, talk if they need to about what has happened.

The people who need to talk will need a deeper and patient understanding from us, and perhaps time with a professional. Emotions can be big and bossy, and the real reason for distress is often unknown to us. It might be the fire, it might be their future, it might be finances or the family pet. We won’t know until we ask and create the space to listen.

For more information about how to help people, consult the Australian Psychological Society webpage.

 

Jonathan Andrews

Heart in Mind, Brisbane.

February 2020

 

 

The potency of connection

Love has a long and positive reach.

Much time and energy has gone into documenting the impact of negative events in people’s lives. The consequences of neglect and abuse has received considerable attention, and rightly so – the impact of adversity is large and lasting.

Less attention has been given to how love might impact on human beings, and the enduring nature of that impact.

You can estimate the impact that love might have on human beings by reflecting on your own experiences. Consider these questions:

  1. Who did you feel cherished by in your life?
  2. What impact did that person make on you?

Chances are that you are likely to report positive experiences that are related to it: Positive mood states and positive physical states. No wonder human beings are prone to nostalgia. If you’ve been fortunate, you may have had a parent cherish you and the positive impact of this might well be life long.

Being cherished by others has lasting and far reaching consequences. In 1938, 268 men were gathered together and studied as a cohort as they aged. The cohort of men, of which John F Kennedy was one of the participants, were a part of the “The Harvard Grant Study”. It is a longitudinal prospective study, meaning it looks a little like a photo album – photos and snapshots taken of the men at regular intervals for the rest of their lives.

The Harvard Grant Study has some illuminating things to say about the impact of love. Based on the participants descriptions of the relationships with their caregivers, each participant was given a score from 5-25. The scores were then separated into quartiles with the top quartile reporting warm relationships in their early years. They were given the label “cherished”. The bottom quartile reported having had “bleak” relationships. They were given the label “loveless”.

By the time the men were in their seventh decade “the fifty-nine men with the warmest childhoods (the ‘Cherished’) made 50% more money than the sixty-three men with the bleakest childhood (the ‘Loveless’)”*.

The ability to earn an income is not the defining outcome of flourishing, but is one outcome among many others that are prompted by being cherished.

A variety of other positive consequences for having been loved were also found: The cherished were eight times less likely to have been depressed, they spent less time abusing drugs, had higher levels of life satisfaction and were four times more likely than the Loveless to enjoy warm social supports at 70.

This brings about an opportunity that I wish we all felt more urgent about. It is true that love received early in life is a set up for life, but it is more accurate to say that love is a set up for the rest of your life – no matter what age you are. With that in mind we have the power within us, not to make a success of ourselves, but to make a success of others. It need not be anything contrived, you don’t need to organise people you love or develop a plan for people you love. It is far more simple, far more beautiful and far more potent. It is to cherish someone close to you, because when you do you will set them up for a positive future.

*Vaillant, G.E. (2012). Triumphs of Experience: The men of the Harvard Grant Study. Belknap: Cambridge. p113.

The Antidote – What goes right is often more important than what has gone wrong

What would it be like if we could take an antidote that could wipe out almost all the impact of poor treatment we have ever received? I’m sure if a pharmaceutical company could bottle such a pill, it would be a best seller.

There may be such an antidote available, but the the down side for pharmaceutical companies is that they won’t be able to bottle it. The good side is, that this antidote is often a lot closer that you think.

In 2004 Joan Kaufman* and colleagues from Yale University gathered together 101 children. 57 of the 101 children were chosen because of their relational history. Those children had parents or caregivers that had abused them and/or failed to attend to their needs. Their parents were at times in custody or under the influence or drugs or alcohol. The children were that badly treated by caregivers that they were removed from their homes by the state. The remaining 44 children in the study were used as a control group, so that comparisons could be made.

Kaufman and her fellow researchers went on to examine the children who were genetically at risk of mental health difficulties. Having done that, they then went on to quantify the level of depression in all the children (the genetically at risk and the more genetically robust children).

In one way, the researchers found what they expected: Children who were genetically at risk of depression were twice as likely to suffer from depression when they have been mistreated as those who were genetically at risk but not mistreated.

It sounds like a ‘fait accompli’, for these children; fortunately, there was good news to come. And I hope this piece of information speaks to you and gives you hope.

The researchers also found that if the child who was at risk genetically had been mistreated but had one trusted adult who they connected with, I’ll repeat that….. just one adult for even as little as once per month or more, the impact of the abuse was only modest. They experienced the same level of emotional upheaval that was found in the genetically vulnerable children who had never been abused. As little as just one, caring adult. Just one. Once a month. That is all.

The impact of one caring adult all but wiped out the impact of the abuse they had endured. The wise words of George Vaillant a one time lead researcher on the Harvard Grant Study ring true again: “What goes right is more important than what goes wrong”.

For many of us who have been hurt it is up to us to ensure that we seek out positive support from others. For those of us who haven’t been hurt or who have recovered from being hurt, it is up to us to provide that support to others. Positive relationships hold out the promise of real change for us, our families and our churches.

*Kaufman, J., et al (2004). Social supports and serotonin transporter gene moderate depression in maltreated children. PNAS, 101(49), 17316-17321.

“Dirty”

Susan* is a lovely lady. She is 55 years of age with two adult children. She is married, a grandma and actively involved in her church. If you met her  you’d never guess that she walks around in constant low-level apprehension that others will react poorly to her. She is nearly always concerned that others will be disgusted. After a year of therapy she explained why.

Over forty years ago, her mum asked her to take a meal to her mum’s cousin down the road. At his house he would commit violent sexual acts against her that are to this day almost too hard for her to talk about. She was so confused and ashamed at the time that she was unable to report what happened. She felt revolting and dirty. She tried to get out of going back to this relative, but her mother insisted she go and deliver a meal. She thought that her mum would never understand so she complied with her mother’s directions and went back again. And again.

I told her that this man was a criminal and a pedophile who deserved to be locked up for a long time in jail. Even as I said this to her you could tell that it was not nearly as therapeutic for her as being listened to. Being heard precedes being understood or defended. When I thanked her at the end of our conversation for her courage, she thanked me for listening, and for not being ashamed of her, when she was so ashamed of herself.  

Susan is like a lot of people who have been harmed; she began to describe herself in a way that had not existed in her heart until that point. She said, “I am dirty”. For many reasons, people become tagged with similar sad and damaging labels, for example, “I am defective”, “I am weak”, “I’m not a man”. When we consider the experiences that cause us to adopt such negative labels, it is understandable that we might do so. However, these negative labels are hugely damaging. The labels are either given to us by others or we give them to ourselves. Either way, they greatly impact us, affecting the way we feel about ourselves and the way we think others see us.

So what can you do if you have been harmed and you’re struggling? I encourage you to Face what has happened and share it with someone you trust. You may not need to see a therapist if you are listened to and are safe. It all depends on whether or not the incident has got to your heart.

Only when we are known for who we are can we hope to get a sense of acceptance for who we are.

 

* Not her real name. Demographics have been changed.