Helping or Harming? The Effect of Trigger Warnings on Individuals with Trauma Histories’ by Payton J. Jones, Benjamin W. Bellet and Richard J. McNally (
preprint) comments
Past research has indicated that trigger warnings are unhelpful in reducing anxiety. The
results of this study are consistent with that conclusion. This study was the first to focus on a sample of people who had survived Criterion A trauma as defined by the DSM-5 (APA, 2013).
Trigger warnings did not reduce anxiety for this sample broadly. Trigger warnings also did not
reduce anxiety among those who met a clinical cutoff for PTSD symptoms, reported a diagnosis
of PTSD, or those who reported that the stimuli matched the content of their past trauma. Trigger
warnings appeared to have trivially small effects on response anxiety overall. When effects did
emerge, they tended towards small increases in anxiety rather than decreases.
Bellet et al. (2018) previously found that trigger warnings increased individuals'
projections of their own vulnerability to future trauma, as well as the vulnerability of others. Our
results suggested substantial evidence that these effects did not replicate. Bellet et al. (2018) also
reported that individuals who endorsed the belief that words are emotionally harmful showed
greater anxiety in response to trigger warnings compared to individuals who did not endorse that
belief. Again, we found substantial evidence that this effect did not replicate. One possibility is that these effects were unique to the trigger-warning naïve (trauma-naïve), crowd-sourced, older
sample used by Bellet et al. (2018). However, given that these effects originally had a small
effect size and did not replicate in larger samples of college students (Bellet et al., 2019) or
trauma survivors (present study), the original results may have been a false positive.
We found substantial evidence that giving trigger warnings to trauma survivors caused
them to view trauma as more central to their life narrative. This effect is a reason for worry.
Some trigger warnings explicitly suggest that trauma survivors are uniquely vulnerable (e.g., " ...especially in those with a history of trauma"). Even when trigger warnings only mention
content, the implicit message that trauma survivors are vulnerable remains (why else provide a
warning?). These messages may reinforce the notion that trauma is invariably a watershed event
that causes permanent psychological change. In reality, a majority of trauma survivors are
resilient, experiencing little if any lasting psychological changes due to their experience
(Bonanno, 2004; Bonanno & Mancini, 2008). Aggregated across various types of trauma, only
4% of potentially traumatic events result in PTSD (Liu et al., 2017). However, trauma survivors
who view their traumatic experience as central to their life have elevated PTSD symptoms (Berntsen & Rubin, 2006; Brown et., 2010; Robinaugh & McNally, 2011). Trauma centrality
prospectively predicts elevated PTSD symptoms, whereas the reverse is not true (Boals & Ruggero, 2016). Decreases in trauma centrality mediated therapy outcomes (Boals & Murrell,
2016). This suggests that increasing trauma centrality is directly countertherapeutic. In other
words, trigger warnings may harm survivors by increasing trauma centrality.
We tested whether the severity of PTSD symptoms in our sample moderated any of our
tested hypotheses. In most cases, we found either evidence for no moderation or ambiguous
evidence. However, we did find substantial evidence that PTSD symptoms moderated the effect
of trigger warnings on response anxiety. For individuals who had more severe PTSD, trigger
warnings increased anxiety. This effect is ironic in the sense that trigger warnings may be most
harmful for the individuals they were designed to protect. We found no evidence that individuals'
prior exposure to trigger warnings moderated any of the previous effects.
A limitation of past research was that trigger warnings were primarily tested among
individuals who were trauma-naïve or in mixed samples. That is, the possibility remained that
despite being unhelpful for most who view them, trigger warnings may have been helpful for
trauma survivors or individuals with PTSD. This study largely puts these questions to rest.
Trigger warnings were not helpful for trauma survivors. For individuals who met a clinical cutoff
for severity of PTSD symptoms, trigger warnings slightly increased anxiety. Trigger warnings
were not helpful for individuals who self-reported a diagnosis of PTSD. Perhaps most
convincingly, trigger warnings were not helpful even when they warned about content that
closely matched survivors' traumas. That is, when considering only the passages which
participants reported as reminding them of past trauma, trigger warnings were still unhelpful.
Public arguments regarding trigger warnings have been politically charged, complex, and
data-poor. Recent research on trigger warnings can importantly inform or perhaps even settle
some of these debates. Trigger warnings are unhelpful for trauma survivors, college students,
trauma-naïve individuals, and mixed groups of participants (Bellet et al., 2018; Bellet et al.,
2019, Bridgland et al., 2019; Sanson et al., 2019). Given this consistent conclusion, we find no
evidence-based reason for educators, administrators, or clinicians to use trigger warnings.
Whether trigger warnings are explicitly harmful is less clear. We found evidence that
trigger warnings increase the narrative centrality of trauma among survivors, which is
countertherapeutic (Boals & Murrell, 2016). We also found that trigger warnings increase
anxiety for those with more severe symptoms of PTSD. Although these effects were
preregistered and found in a large sample, the size of the effects were small and have not yet
been rigorously tested across multiple studies. However, such knowledge is unnecessary to
adjudicate whether to use trigger warnings – if there is no good reason to deploy them in the first
place, we need not require strong evidence of harm before abandoning them. Trigger warnings
should serve as an important caution to both clinical and nonclinical professionals who use
interventions aimed to improve well-being among trauma survivors. Such practices should be
thoroughly vetted via appropriate scientific techniques before they are adopted. Using unvetted
interventions is irresponsible to victims of trauma.
