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Trigger Warnings and Mental Health: Where Is the Evidence?

Examining whether trigger warnings protect mental health.

Source: Pixabay

Recently, there has been a growing push for the use of "trigger warnings" on college campuses. A trigger warning is a brief opening statement that lecture (or reading) content may provoke an adverse reaction in some people. The nature of the potential reaction is left unspecific; but can conceivably refer to disturbing and distressing thoughts, emotions and behaviors.

Supporters argue that trigger warnings may be helpful for people suffering from mental illnesses such as Post Traumatic Stress Disorder (PTSD) or anxiety disorders. For instance, a veteran with PTSD may appreciate advance notice that a lecture will include a video with war scenes. The veteran can then act accordingly, either leaving the lecture or mentally preparing for the video.

As the debate around trigger warnings intensifies, it is worth examining the evidence supporting their use, as well as the consequences of using such language in the context of mental health.

The Evidence

Some may assume there is considerable evidence suggesting that trigger warnings are effective in diminishing mental stress, given the strong push for their widespread utilization. In fact, there is no evidence whatsoever that trigger warnings are beneficial in this regard.

Indeed, a review of the psychiatric literature shows no studies that link trigger warnings to either short-term or long-term mental health outcomes. As such, trigger warnings are not an evidence-based intervention and are not supported by the scientific literature.

On the contrary, related studies indicate that avoiding phobic experiences can be detrimental to individual mental health. Avoidance can increase sadness and worry, which in turn can constrain everyday behaviour and prevent personal growth.

In fact, evidence suggests that the best way to tackle undue fear is through exposure, rather than avoidance. Hence this is the basis for many evidence-based interventions for phobia and anxiety.

An Unfortunate Metaphor

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Guns have triggers—do humans? The use of the phrase "trigger warning" is an unfortunate metaphor in many ways.

One of the most harmful stereotypes is that people with mental illness are dangerous. Indeed many people erroneously conflate mental illness with gun violence, even though statistics indicate that people with mental illness are much more likely to be a victim of crime than a perpetrator. Such stereotypes are sedulously propagated by certain sensationalist media.

Associating the word "trigger" with mental health perpetuates damaging myths that people with mental illness are constantly on the verge of "snapping." Indeed a culture of trigger warnings can contribute to common misperceptions that people with mental illnesses such as PTSD are akin to Pavlovian dogs, lacking self-control and prone to emotional outbursts at the least provocation. This can contribute to the considerable stigma already experienced by people with mental illness.

Trigger warnings can also contribute to patronizing stereotypes that emerging adults are part of a pampered "snowflake generation." They imply that young adults are overgrown fragile children who need protection from hard and cold reality. This could theoretically lead to discrimination in the job-market, with young people passed over in favor of (perceived) tougher older people.

An Alternative Approach

Should young people be confronted with material in class that is disturbing and distressing? Yes, if we want to solve disturbing and distressing social problems such as crime, war, and illness. Should there be resources in place for those who find such material overly distressing? Yes, if we want caring and compassionate campuses. These are not mutually exclusive goals.

For example, I recently taught a session on suicide to undergraduates. This included discussion of high-risk groups including men, homosexuals and Indigenous peoples. As a Professor of Psychiatry, part of my mission is to ensure the next generation knows about (and ultimately tackles) suicide. Otherwise, this enduring social problem may persist and expand under the radar of society.

Instead of giving a trigger warning, I took a more old fashioned approach. I acknowledged to the class that the session may be disturbing. I told them that I had lost friends to suicide, using these tragedies as fuel to try and help address the problem. Finally, I stated that anyone who feels disturbed at the end of the class could join my assistant and I in a local café for chat, comfort and moral support. This approach may be more meaningful than a trite one-second trigger warning.

The Way Ahead

Some have advocated the wide use of trigger warnings to promote mental health. However, there is no concrete evidence that they help in any way. An unintended consequence of trigger warnings may be further stigmatization and demonization of people with mental illness. Finally, trigger warnings are an easy option. But the easy option is not always the best option. Actions speak louder than words.

People should carefully consider all of the above before issuing trigger warnings.