Death Knell for Trigger Warnings?

Trigger warnings don’t help students, and they might even hurt those grappling with serious trauma. That’s the upshot of a new study on trigger warnings published in Clinical Psychological Science.

Concerned about the use of trigger warnings absent clear evidence of their effectiveness, the authors conducted a series of experiments on 1,394 people, a mix of first-year psychology students at Victoria University of Wellington, in New Zealand and internet users. They wanted to know to what extent trigger warnings affect people's ratings of negative material and their symptoms of distress, namely "negative affect," intrusive thoughts and avoidance.

Subjects either watched or read content on topics from car accidents to domestic violence (content involving sexual violence was not part of the experiment -- more on that later). Some got trigger warnings about what was ahead, while others did not. Some reported experiencing traumatic events, such as a "really bad car" or other accident, or domestic abuse.

Afterward, subjects rated their negative emotional states, and the degree to which they experienced intrusive thoughts and tried to avoid thinking about the content. Some subjects were tested on their reading comprehension abilities following exposure to sensitive content.

A “mini meta-analysis” of the experiments revealed that trigger warnings didn’t make any difference. Subjects who saw them, compared with those who did not, judged the videos to be similarly negative, felt similarly negative, experienced similarly frequent intrusive thoughts and avoidance, and comprehended subsequent material similarly well.

By some measures, there was a slight helpful effect for trigger warnings. But the authors say that it was essentially insignificant, was "minuscule" compared to the effects of actual therapy and was possibly influenced by a placebo-like effect of seeing a trigger warning (trigger warnings are not supposed to be a substitute for therapy, of course, the article says). It's worth noting that a very small number of students withdrew from the experiment after seeing a trigger warning. And the existing psychological literature on traumatic stress suggests that avoidance is a coping mechanism that maintains the traumatic stress.

The study notes several limitations: researchers did not specifically recruit people with a history of psychopathology and did not ask about subjects’ socioeconomic status or education level. Plus, they say, trigger warnings “may have nontrivial effects we did not measure,” such as the vividness of intrusions -- not just frequency.

What does it all mean? The authors explore this, writing, “Some might wonder if professors should continue to issue trigger warnings. After all, if the warnings do not worsen distress and students believe the warnings are helpful, then why not?”

Ultimately, however, the authors are against trigger warnings. “Put simply,” they say, “people are not always good judges of the effects interventions have on themselves or others and the chronic effects of trigger warnings may be different from their acute effects. College students are increasingly anxious, and widespread adoption of trigger warnings in syllabi may promote this trend, tacitly encouraging students to turn to avoidance, thereby depriving them of opportunities to learn healthier ways to manage potential distress.”

Lead author Mevagh Sanson, a postdoctoral research fellow in psychology at New Zealand’s University of Waikato, didn’t equivocate Wednesday via email.

“Trigger warnings don’t help,” she said. “And they may still hurt -- the long-term consequences of avoidance have been addressed in related areas, and so we know that encouraging avoidance helps to maintain disorders such as PTSD.”

Drawing a distinction between general trigger warnings, such as at the beginning of a course, and trigger warnings for “imminent” content (such as that included in the experiment), Sanson added, “We do not think that trigger warnings for imminent content are a good idea.”

Trigger warnings were originally used by bloggers to flag content about sexual violence, and much of the academic trigger warning debate centers on texts containing sexual violence -- and students who have suffered it. Asked if the results might be different if content about sexual violence were included in the study, Sanson said, “That is an empirical question, but there’s nothing solid in the scientific or clinical science literature that would lead us to expect trigger warnings should be effective for sexual assault and yet ineffective for other kinds of traumas or content.”

Sanson co-wrote the study with Deryn Strange, a professor of psychology at the John Jay College of Criminal Justice of the City University of New York, who studies memory distortion. Asked if she ever uses trigger warnings, Strange said that she teaches “traumatic content all the time” -- and explains that to students at the beginning of course, so that they are “broadly aware” of what may come up. But, consistent with her recent findings, she does not issue trigger warnings for imminent content.

Co-author Maryanne Garry, a professor of psychology at Waikato who teaches courses addressing traumatic memory, said she makes her topics clear up front and tells students that “there is no way to provide them with alternate readings or assessment while still actually teaching the topic.”

Are Warnings Common?

It’s unclear how widespread the use of trigger warnings is. A 2015 survey of faculty members by the National Coalition Against Censorship found that more than half of professors had had issued “warnings about course content,” such as in a syllabus, and 23 percent said they’d done so several times or regularly. But a majority of professors opposed specific trigger warnings as a threat to academic freedom.

Trigger warning also means different things to different people. Some professors offer what they call trigger warnings at the beginning of a course only and others for imminent content. And some professors who use trigger warnings offer students alternative readings or assignments. That practice is probably the most controversial of all, since critics say it comes at the cost of personal growth and learning. Proponents, meanwhile, say offering alternative assignments may enable learning by increasing access to those who would otherwise shut down.

Richard J. McNally, professor and director of clinical training in psychology at Harvard University, studies anxiety and related disorders, including post-traumatic stress disorder, and wrote in a widely cited 2016 New York Times op-ed that the trigger warning debate ignores the fact that “Trauma is common, but PTSD is rare.”

Still, McNally wrote, trigger warnings are “countertherapeutic because they encourage avoidance of reminders of trauma, and avoidance maintains PTSD.” Severe emotional reactions triggered by course material are a signal that “students need to prioritize their mental health and obtain evidence-based, cognitive-behavioral therapies that will help them overcome PTSD,” he added. So rather than issuing trigger warnings, “universities can best serve students by facilitating access to effective and proven treatments for PTSD and other mental health problems.”

McNally, who chaired a symposium on trigger warnings at the recent International Conference of Psychological Science in Paris, said Wednesday that the new paper is “impressive,” and that, taken together, the experiments suggest that trigger warnings “don’t seem to make much difference.”

In all of his own courses, McNally said that he goes through the syllabus with students on the first day of class to briefly review topics of study and readings. But he does not issue trigger warnings -- even when he taught a course on psychological trauma.

To students in that class, however, he said, “I did mention that enrolling in the course was not a substitute for therapy, even though they would learn how clinicians successfully treat the effects of traumatic stress.”

Over all, McNally said that trigger warnings are a “counsel of avoidance,” and hence “send the wrong message to students struggling with memories of trauma.” Avoiding reminders of trauma maintains PTSD, “despite any temporary relief avoidance may provide.”

Underscoring his consistent message on how a university can “best serve its students,” McNally said it’s by “facilitating their access to evidence-based treatments for PTSD, not by issuing trigger warnings.”

Nancy K. Bristow, a professor of history at the University of Puget Sound who studies racial violence, has spoken previously about the importance of empathy in teaching and learning about such sensitive subjects as the history of lynching. She’s said she flagged her syllabus for students the first time in 2015, for a course on American culture and catastrophe.

The "Note on Course Content" read:

As you know, a course on catastrophe necessarily deals with several topics and sources that discuss, depict and envision difficult subjects. I recognize that for some members of the course personal experiences may make a particular topic very hard to process, and even inappropriate for academic consideration at this time. If you are concerned about our engagement with a particular topic, issue or source, please come see me and we can determine an appropriate route forward. Alternate assignments can be arranged if needed, so please don't hesitate to open this conversation with me. Of course such a discussion would be confidential.

Bristow said Wednesday that she is not “an expert on the psychological literature,” but she remains convinced of the “benefit of letting students know when we will be considering material they may find traumatizing.” She also uses imminent trigger warnings as the need arises.

“We must not assume all students experience our classrooms and the material we teach in the same way,” she said. “Faculty must recognize that the material they teach lands differently depending on a student's background, life experiences and ways of being in the world.”

For those professors who teach material that can be “quite traumatic for our students -- in my case material on the history of people of color, on racial and sexual oppression, on violence and warfare -- reaching out to acknowledge how difficult exposure to certain material can be for our students is an expression of their humanity and ours,” Bristow said. So trigger warnings and conversations about possible alternative assignments offer students reassurance that their instructors “care about their well-being, and suggest we are ready to adjust as needed to ensure they have full access to their educations, regardless of who they are and where they have been.”