Monthly Archives: April 2015


Treating Triggers

If you have PTSD, there will be times when you get “triggered”. That means something in your current environment– such as a noise, or what you see, a smell, a place, a person, or an anniversary date–connects your mind to a traumatic memory. Most people try to avoid known triggers, but even when you’re careful, it happens


So what can you do?

Over the years, I’ve learned a number of techniques that help you calm down, ground yourself, and work through the worst of the emotional response. The goal is to get where you no longer react to that trigger. The process of getting there is called “Desensitizing.”

Steps for Desensitizing:

1) As soon as you realize that something has gone wrong, stop and breathe.

Your immediate reactions are suspect, may be driven by old trauma, and could be inappropriate in this current place and time. So give yourself a time-out and just breathe.

Breathing is very important—focus on your breathing, slow and deep, then slower and deeper. This is something over which you have control, and slowing your breathing will normalize your body’s chemistry and avoid a prolonged panic response.

2) Focus on your immediate surroundings. If these are dangerous or uncomfortable for you, get yourself to a safer location.

Inside a building, the nearest restroom may afford some quiet privacy.

Outside, move slowly away from whatever triggered you and find a safe, quiet place.

If you’re driving, you should look for a safe place to pull over.

Keep breathing deep and slow while you move to a safe place.

3) As you continue to focus on your breathing, you need to ground yourself in the here and now. There are a number of techniques that you can use. Test them out at home and see which ones work best for you.

“Where are my feet?” Feel your feet on the floor. Wiggle your toes and shift your weight so you can feel the solidness underneath your feet. You can stand or sit, just focus on the earth under your feet.

“5,4,3,2,1”. Use your senses, open your eyes and look around until you can name 5 different things that you see. Listen, to hear 4 different sounds and voices. Name the things you hear. Touch the things around you: your body, the floor, the wall, furniture with texture, grass, trees, and name 3 things that you can feel. Sniff the air and name 2 things that you can smell. If you have some mints or gum, put them in your mouth and taste the flavor, name 1 thing you taste.

Walking meditation. If you can walk around freely, pick a calming mantra and repeat it, either aloud or silently, as you walk and focus on your steps and your breath. I like the following meditation: “I have arrived, I am home, in the here, in the now, I am solid, I am free, and in the ultimate I dwell.” You can use any part that works for you, or choose a mantra of your own.

Sitting meditation. Choose a mantra and focus on your breathing while chanting the mantra, either aloud or silently. The mantra should be something soothing to you, such as “I am strong”.

EFT’s. This is a technique that uses tapping on acupuncture points in the body, and it actually works well. It’s best described in this introductory video:

Eye movements. Hold your head still and move just your eyes from side to side quickly for several minutes. You can also do other side-to-side behaviors, like tapping your right arm, then your left, back and forth, or tossing a ball from one hand to the other.

4) Take as much time as you need to feel grounded. Remember that it takes at least 10 minutes for the adrenaline in your body to subside.

After you’ve worked on breathing and grounding, take a measure of how upset you feel on a scale of 0-10, where 10 is the worst possible and 0 is completely calm.

If you’re at a 4 or calmer, you can go back to your original activity, if you still want to do it.

If you’re at a 6 or higher, you may want to head home and/or call a safe person to assist you.

It is not safe to drive while triggered!!! Please ask or call someone you know to take you home.

5) Once you are home, take care of your body. Take an inventory of your body’s needs. Is it hungry, exhausted, tense, antsy? Do what you can to make your body comfy. A hot shower or bath can be very calming, but so is walking in the sunshine. Do whatever makes you feel good.

6) Pay attention to emotions. Do you feel Angry? Embarrassed? Sad? Terrified? Put a label on the emotions that you feel. Remind yourself that there’s nothing wrong with having feelings.

While focused on your breathing and keeping your body as relaxed as possible, see if you can sit back and observe your emotions without acting on them.

View your emotions from a distance, like on a movie screen, or picture the emotion floating down a river while you stay safely on the shore.

Remember that emotions are temporary feelings and will pass.

7) Once your body and emotions are calm, it’s time to use your brain to figure out what caused your distress.

Write down what happened. Can you recall previous traumas that were, in some way, similar to this?

You might want to keep a list of triggers, not just to avoid them, but to help you remember the next time you face a similar event.

8) Helpful medicines. Research has uncovered several medications that help you desensitize to triggers.

Two are pharmaceuticals: propranolol, an old blood pressure medicine, and D-cylcloserene, an old antibacterial.

MJ also has been shown to help and is legal in some states.

The latest addition is MDMA, which was used for this purpose back in the ‘70s and ‘80s and continues to show promise as a therapy add-on.

Medications work best if taken right after you are triggered, although anytime in the next several hours can be useful.

Although benzodiazepines (Valium, Xanax, Klonopin, Ativan, etc.) make you feel calm, they do not help you desensitize.

Bottom Line:

It takes practice to get good at calming down. A gymnastics coach once told me that it takes 36,000 repetitions to internalize a new skill, or roughly 100X a day for a year. Luckily, 100 repetitions is roughly all you’ll need to desensitize most triggers, less if you use medicine.

While you’re learning, it’s good to have a “coach”, someone you can call who will walk you through the process. After several successes, you can manage on your own.

Why bother? Because each time you succeed in calming yourself down, you desensitize a little bit more to that stressor. Eventually your body learns that stressor isn’t dangerous, and it won’t trigger you again.


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