How to deal with triggers from trauma

For therapists working with clients on how to deal with triggers from trauma or how to deal with PTSD triggers, understanding trauma's complex nature is essential for effective treatment.

Summary for therapists

• Use structured assessment tools and worksheets to help clients identify their specific triggers.
• Implement grounding techniques and somatic approaches for immediate trigger management.
• Develop comprehensive treatment plans that include relational support and self-care strategies.
• Focus on building resilience and long-term coping skills rather than just symptom management.

Processing trauma is often a cornerstone of therapy, particularly for clients who have experienced adverse events that continue to impact them in a negative way. 

The American Psychological Association (APA) defines trauma as, “Any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning.” 

Importantly, trauma isn’t always determined singularly from an event or occurrence. 

Instead, trauma can be best measured on how the person is impacted. For example, two people could experience the same traumatic event, like a natural disaster such as a fire or flood, however, they might respond very differently depending on social support, resiliency, and protective factors. 

Therefore, when working with clients, it is crucial to not assume the presence of PTSD without further assessment.

Understanding PTSD and trauma triggers

Post-traumatic stress disorder (PTSD) is a mental health disorder that can develop from exposure to intimate partner violence, abuse, war/conflict, and other major events that are life-threatening and have a major impact on emotional well-being. 

The major indicators for PTSD include intrusive thoughts, flashbacks, distressing dreams, avoidance, negative changes in thoughts and mood, irritability, and hypervigilance. 

A common tool to assess for the presence of PTSD symptoms is the PTSD Checklist for DSM-5 (PCL-5). This tool can help clinicians make a provisional diagnosis of PTSD, as well as monitor changes in symptoms over the course of treatment.

For individuals who endorse the presence of trauma symptoms (whether with PTSD or another trauma-related diagnosis), it is common for them to face triggers that can bring up traumatic memories or experiences. 

In this case, it is helpful to support clients in how to deal with PTSD triggers and how to deal with traumatic memories so that they can continue to promote a sense of safety and security for themselves.

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Examples of triggers 

Triggers can occur in a variety of places and situations. 

Understanding specific examples of triggers helps therapists guide clients toward recognition and management.

According to Ryan DeCook, LCSW, categorization of triggers can be helpful for clients to identify themes in what brings up distress for them.

Trigger types can include triggers linked to the past as well as singular or multiple cumulative triggers. Additionally, triggers can arise internally or externally. 

An example of a trauma trigger that arises internally would be the reaction to attending a holiday party with someone who has perpetuated or harmed the client in the past. 

As the person thinks about this situation, they may start to feel fear or worry that then generates a strong physical or bodily reaction like headaches, stomach aches, or tension in the chest. 

An external trigger would be a reaction generated from sensory input, like a smell, visual, or sound. 

For example, if someone who has experienced war hears fireworks, this may bring up traumatic memories related to violence they’ve seen in the past. They might start to sweat profusely, have anxious thought patterns, and begin to feel as if the traumatic event is happening all over again.

Identifying triggers: Assessment tools and techniques

In preparation for helping clients learn how to deal with triggers from trauma, it is necessary to help them identify the triggers in the first place. 

Identifying triggers worksheets are one intervention that can help clients break down the whole picture of how to deal with traumatic memories. 

If a client experiences anxiety as a result of their triggers, they can utilize anxiety-specific worksheets that identify where the anxiety is felt, the intensity level of their anxiety, and associated behaviors and effects of anxiety.

Journaling is also an effective method for trigger identification, especially when using prompts to elicit the full picture of how triggers impact a client’s mood and somatic experience. 

When a client can process their experiences in written form, they can learn how to deal with PTSD triggers through an understanding of patterns and themes for their particular trauma reactions.

How to deal with PTSD triggers 

Colorado-based counselor Zach Verwey, LPC, works extensively with clients on ways to cope with trauma reactions. Verwey specializes in areas that often result in a need for trauma processing, such as religious trauma, eating disorders, relationship issues, and grief and loss.

In reflecting on his process for assisting clients in how to deal with triggers from trauma, Verwey notes that he often takes a somatic approach so that clients gain clarity on their specific response. 

Verwey says he frequently sees clients having either a “panic response or a dissociative response that leads them to become disconnected from their body.” 

This can be known as hypoarousal or hyperarousal, which are opposite reactions to stress. Hypoarousal is a numb or disassociated state where our nervous system can freeze up in reaction to emotional intensity, whereas hyperarousal involves an overstimulated state where we can feel anxious, overwhelmed, or even aggressive.

Verwey’s somatic approach aims to help clients ground themselves and come back to the present moment. 

He recommends a handful of important practices for processing trauma and guiding clients in how to deal with triggers from trauma:

Grounding practices 

Grounding in therapy is focused on helping clients come back to the present moment. 

This is important when you consider how trauma triggers often pull clients back into past experiences, bringing up the same type of cognitive states or emotional sensations experienced during the traumatic event. 

Grounding can involve breathing techniques and utilizing senses to bring clients back to awareness of the present state. 

One example of a grounding technique is the 5-4-3-2-1 exercise, where you name five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. 

An example of a breathing exercise might be coaching clients to utilize down-regulating breathwork, where an individual takes longer exhales than inhales. 

When repeated, this helps a client’s nervous system reach a state of calm and regulation.

Relying on a support system

Verwey values relational strengths in supporting clients in learning how to deal with triggers from trauma. 

He says helping clients identify their supportive people will promote increased opportunities for co-regulation. 

Learning how to deal with trauma triggers in a relationship context is particularly important, as relational support can provide crucial co-regulation opportunities. Since so much trauma happens relationally, it is vital that healing happens relationally as well.

Safe place technique

Verwey also supports clients to manage triggers through the implementation of the safe place technique. He describes this as a trauma-informed tool that clients can use when they are feeling triggered. 

Verwey invites clients to imagine and describe a safe place in their mind. This could be a location where fond memories have occurred or a place they have felt safe and secure. 

As clients imagine this place in great detail, Verwey has them engage in cross-body tapping on the knees or chest to help clients internalize safety in the body.

Self-care

Clients who have experienced trauma benefit greatly from learning what self-care activities support their experiences of joy, resiliency, and strength. 

Therapists and clinicians can help clients learn how to deal with triggers from trauma through the identification of self-care practices. 

For some clients, this may include movement, music, cooking, or connecting with loved ones. 

Processing trauma can include reminding clients to come back to these places of calm so that they can get a break from the impacts of trigger and trauma.

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Creating a comprehensive treatment plan

Verwey shared that it isn’t always reasonable to expect that you can avoid triggers at all times. Therefore, it’s necessary to equip clients with a plan for when they are exposed to triggers or triggering situations. 

Clinicians can collaboratively build a plan with clients that includes the identified triggers and potential responses for clients to utilize when they face identified triggers. 

This could include setting a boundary, drinking water, breathing, or using a calming sensory item to help manage the trigger reaction.

This approach to how to deal with PTSD triggers emphasizes preparation and practical coping strategies that clients can implement in real-world situations.

Focusing on resiliency and long-term recovery 

Guiding clients to gain skills in how to deal with triggers from trauma is a journey and process that can take time and trust. 

As clients build their own capacity, therapists can create a safe space to practice trauma-informed skills that help combat and manage triggers. 

A safe and secure attachment with a therapist is essential for processing trauma and one of the most important gifts we can offer to clients. 

In turn, seeing clients grow and overcome trauma triggers can motivate clinicians to see the value of therapy and trauma-informed work.

Sources:

• American Psychological Association (2018). APA Dictionary of Psychology. Entry for trauma.
• American Psychiatric Association (2024). What is Posttraumatic Stress Disorder (PTSD)?
• U.S. Department of Veterans Affairs. National Center for PTSD. PTSD Checklist for DSM-5 (PCL-5).
• DeCook, Ryan (2023). Using Trigger Worksheets to Cope with Anxiety. SimplePractice.

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