Sometimes you can be triggered by your symptoms It is now widely recognized that traumatized people are easily triggered by external things that remind them of the original trauma. But it remains poorly recognized that the internal emotions and body responses that follow trauma also become trigger points.
In 1991, as a teenager growing up in Tel Aviv at a time when Saddam Hussein was landing missiles in our neighborhood, I had to repeatedly put on a gas mask. I was so panicked by fear and the intense weirdness of my family crammed into a small shelter with horrible looking gas masks on our faces that I got sick and threw up. The following days even just the smell of the rubber mask made me nauseated.
After that, any time I threw up I re-lived the panic of those moments when the sirens started screaming. To this day, every time I get the slightest nausea, for a few moments the feelings and fears of that time rise in me. A bad meal, tummy flu, even pregnancy - all send me back to that trauma experience. Over the years I’ve learned what to do when I am triggered, so I can reduce the alarm of my inner defense system.
When we experience trauma we remember the entire experience. That memory includes not just the external things traumatizing us, it includes the ways our body responded to the trauma. Typically, these would be responses like sweating, headache, high pulse, dry-mouth, nausea, feeling hot/cold, dizziness etc.
For some people, these responses of their own body become so associated with trauma that they later become triggers themselves, capable of bringing back memories of trauma, as quickly and intensely as triggers “out there”.
These internal secondary alerts can cause great difficulty in day to day routines. They relate to bodily functions we cannot escape or fully control. Professionals can assist in desensitization strategies but a response that everyone can make with or without professional help is to develop an Individualized Sustainability Plan (ISP).
An ISP is a tool for systematically reviewing the various trauma triggers a survivor carries and mapping out a wholistic plan to support high functioning in all areas of life. Other interventions have short-lived impact if an ISP is not present and I consider it the foundation of sustainable response to trauma.
A simple and effective tool I use in creating an ISP is the Tree of Self-Sustainability. I introduce this activity early in the therapy process as a map for trigger, alerts, vulnerabilities, strengths and tools to self-sustain. Many clients add to it on an ongoing basis.
Tree of Self-Sustainability
The client works with a big sheet of paper - it could be as long as the client is tall.
You can provide a sheet of paper with a tree-print on it or let your client draw a tree.
Start by having your client work on an ordinary sheet of paper for 15 minutes to make a list as follows. Then give another 20 minutes to fill in the tree from that list. Of course it does not have to be a tree, it could be a body-scan or anything that will work for your client context.
Roots: Life experiences that are memorable and shaped who you are today.
Trunk: Internal triggers and stressors (physical triggers, personal perception and self-beliefs)
Internal strengths (for example: open-mindedness, patience, bravery, kindness, sense of justice, modesty, gratitude
Surrounding the tree: External triggers and stressors: economic stress, schedule, relationships, political environment, cultural tension, future, grades etc.
External resources: friendships, family, support group, therapy, children, financial resources, community, spiritual community, etc.
Branches: Personal traits (compassion, curiosity, flexibility, initiative, motivation, communication skills, organization etc.)
Leaves: sustainability methods (healthy diet, sport, movement, music, art, nature, relationships/friendships, spirituality, mindfulness etc.
Fruits: Goals, dreams, wishes.
Conscious awareness of as much of the tree as possible is important and provides survivors a first step out of the ETI “withdrawal” stage. But, awareness is not enough. Self-sustainability can only be maintained if it is practiced on an ongoing basis. Trauma symptoms have a tendency over time to reappear in different manifestations, so ongoing experimentation is required for survivors to maintain the effectiveness of the tools.. This means that there is no such thing as establishing a lifetime set of tools. Over time a variety of self-sustainability tools are likely to be necessary as part of their ISP. These are likely to be drawn from a fixed set of categories like mindfulness and self-compassion practices, sensory and bilateral integration, cognitive processing and behavioral modifications, expressive arts, diet and nutrition and so forth. But based on observation of symptoms, triggers, internal alerts, secondary alerts, and the ongoing journey of trauma integration, the mix of tools drawn from these categories will gradually change, grow and adapt over time.