Cautionary Notes: The Science of Trigger Warnings

What is the logic behind using trigger warnings? Do they improve learning outcomes?

In this episode, Under the Cortex hosts Victoria Bridgland of Flinders University to explore her meta-analysis results on trigger warnings. Bridgland’s meta-analysis indicates that, contrary to popular belief, trigger warnings do not have a negative or positive effect on learning outcomes but do increase anticipatory anxiety.

The conversation with APS’s Özge G. Fischer-Baum evolves into implications for cultural differences and the usage of trigger warnings on social media.

See related news release: Caution: Content Warnings Do Not Reduce Distress, Study Shows

Unedited Transcript:

[00:00:13.250] – APS Özge G. Fischer-Baum

Are trigger warnings helpful for learning outcomes? Do they shape listeners’ expectations or do they cause discomfort? What is the logic and science behind using them? This is under the cortex. I am Özge Gürcanlı Fischer-Baum with the Association for Psychological Science. To answer these questions, I have with me Dr. Victoria Bridgland from Flinders University. She is the author of an article published in APS’s journal Clinical Psychological Science. Victoria, thank you for joining me today. Welcome to under the cortex.

[00:00:49.970] – Victoria Bridgland

Thanks so much for having me on.

[00:00:52.290] – APS Özge G. Fischer-Baum

Your research is on trigger warnings. How would you define what trigger warnings are and why do you think people use them?

[00:01:00.450] – Victoria Bridgland

So when I think about the definition of trigger warnings, I really like to think about them in terms of what the purpose of the warning is versus what they look like. Because trigger warnings can come in a number of different forms, so they can be as short as just a simple TW or a CW, like for trigger warning or content warning, but we still know what they sort of mean. And yeah, they are also called different names as well. So people won’t call them a trigger warning, they’ll call them a content warning or a content note. So people sometimes will try and say that they’re not the same thing, but really they are. So that’s why I go for the purpose of what the warning is trying to do. So if what it’s trying to do is warn you about upcoming negative content that may potentially be related to something that you personally find distressing, whether that’s due to a present mental health concern or a past mental health concern or a past negative experience that you might have encountered. If something’s trying to warn you about something that might be related to one of these topics, that’s probably a trigger warning.

[00:02:02.810] – Victoria Bridgland

And also a trigger warning usually has one or two purposes. So the two main reasons people would use a trigger warning would be a to allow you time to mentally prepare yourself to then cope with the upcoming negative content, or b you could completely avoid the content if you feel like it might be really distressing to you. Trigger warnings had these sort of they actually had a very clinical origin story so that the word trigger originates from PTSD, or the notion that past stimuli might trigger somebody to re experience traumatic experiences. So, like, if you had a car crash, you might see car headlights and then that retriggers you to feel all of the emotion associated with the trauma. So that’s the triggering terminology. So they did have these very clinical origins when they first started out and then when they were first used on feminist message boards, they were primarily used for this kind of content associated with traumatic experiences such as sexual assault, but also eating disorders as well. So they started out in this way and then now they’re used for a whole range of different topics. It could be anything from trauma, or it could be things to do with, like political or, say, race, violence, or any negative topic, basically.

[00:03:17.070] – APS Özge G. Fischer-Baum

So how did you first get interested in this topic yourself? Is there a story behind it?

[00:03:22.980] – Victoria Bridgland

Yeah, so I first sort of learned about this topic back in 2016 when I started my honors degree. So it was one of the honors projects that my supervisor was interested in running in her lab at the time. At the time, we had a lot of debates about all these sort of cultural war topics on college campuses. It was sort of the year of the trigger warning had just been I think it was either 2013 or 14. And so there was just so much in the media all the time about why trigger warnings may be good and why they may be bad, these sort of fights about what they may be doing. We thought it would be really great to actually try and strip back some of these theoretical debates and actually just apply a very simple experimental framework, because trigger warnings lend themselves to a very sort of basic framework of if you have two groups of people and you warn one group of people and don’t warn another group of people, how might they react? And so based on all these debates in the news, there was a lot of things that we could test as well.

[00:04:24.600] – Victoria Bridgland

So on one side of the debate, you had the people that were championing trigger warnings and saying that they’re really great, that they foster a culture of care for trauma survivors. They’re about trauma centered teaching and trauma centered narratives. If you see one, you may then mentally prepare yourself to cope with the content. So some sort of bracing effect, or if you want to completely avoid content that might the language they use is, say, retraumatize you or trigger you, then you could avoid that content as well. And then that will make you feel better and you’ll be able to cope better with, I guess, encountering things in daily life. But on the other hand, we had other people who were saying that maybe trigger warnings are doing the opposite. So instead of a culture of care, maybe they’re coddling students and they’re sort of fostering this culture of fear and a culture that’s too centralized around trauma. We know that, say, if you centralize trauma to your identity, it can actually not bode very well for trauma survivors. And so there was a group of people that came out saying that maybe if you encourage people to avoid things, it’s actually going to be maladaptive, not adaptive at all.

[00:05:25.770] – Victoria Bridgland

Because we know that avoidance is sort of one of those key symptoms of a lot of anxiety disorders and also PTSD, and that also it might encourage you to be more fearful about content that you might encounter later. On. So a sort of nocebo effect there. So yeah, there was all these debates and some of them sort of had this clinical origin and some of them had more of a theoretical basis in the literature as to why they may do something or may not. But yeah, we want to strip all of that back and just apply a very basic experimental setup. And that’s what we did in my first ever study that we in my.

[00:05:59.840] – APS Özge G. Fischer-Baum

I definitely remember those debates and they are still going on. So it is good to have some scientific answers to understand what the real mechanism is. So I want to jump into right into your research paper. In your paper you explore how trigger warnings might relate to four basic notions response effect, avoidance, anticipatory effect and comprehension. Can you tell our listeners what these concepts are?

[00:06:31.810] – Victoria Bridgland

Yeah, sure. So to make it sort of easier, I’ll go through as a sort of timeline of encountering a trigger warning. So the first thing that researchers looked at in some of these studies was sort of the emotional outcomes of trigger warnings. And this is divided into two parts. So we have the anticipatory anxiety and also response effect. So anticipatory anxiety is sort of that first thing that when you come across and see a trigger warning, how do you react then? So this is the effect that you feel when you see a trigger warning, but before you see the subsequent thing following it. So the second one leading on to that would be response effect. And so that would be looking at outcomes associated with when somebody sees a trigger warning, how do they then react? And then of course, when you’ve got a two experimental set up you can compare how somebody reacts after they’ve seen a trigger warning and after they see the content versus people that just see the content by itself. So they’re the two emotion side outcomes. And then of course we’ve got avoidance, which is probably my favorite outcome just because it is a bit of an iceberg.

[00:07:37.260] – Victoria Bridgland

You sort of start looking at it and think that maybe it will be a simple answer when in fact it is not. And there’s so much going on with avoidance, but this outcome is just related to when you see a trigger warning. Are you going to be more likely to avoid the content that’s got a warning on it? Or on the other hand, may you be more likely to actually approach the content. And the final outcome which is related to sort of educational outcomes, we called it comprehension was related to studies that have looked at trigger warnings specifically for educational material. So usually it was something like lecture material or sometimes like reading passages and things like that. And they were outcomes related more to how somebody remembered aspects of it. So like factual content on a multiple test or things like the comprehension of an article or how much they understood the content. So those things that might be tested in a traditional educational type setting. So yeah, they were the sort of outcomes that were measured in the metaanalysis.

[00:08:38.390] – APS Özge G. Fischer-Baum

And let’s talk about your results a little bit, but before that, let me tell our listeners that you conducted a metaanalysis on trigger warnings. Could you remind our listeners why people use metaanalysis and why you made this choice for this topic?

[00:08:54.890] – Victoria Bridgland

Yeah, so a metaanalysis is basically where you get a lot of little studies and then you put them together into one analysis so you can look at the effects of all the studies in one group. And the reason why it was exciting to do it with trigger warnings was because, well, when I first started studying trigger warnings, there was absolutely nothing on this topic at all. And so looking for any direction on what the effects might be or what the outcomes might be, we had to really draw on just like random other adjacent literature that might offer some answers. But now it’s really exciting that people have become interested in trigger warnings and there is this small handful of studies and small literature emerging, although it is quite small still. So the metaanalysis only had twelve studies in it, which is tiny, a drop in the ocean compared to when you think of other sort of cognitive phenomena that have been studied. But, yeah, it was exciting to be able to finally see a handful of studies and then draw together all the findings. Because with trigger warning studies and the arguments surrounding trigger warnings, people often like to cherry pick specific findings or pick apart particular studies and say, this is why it’s good or bad, or all that kind of thing online.

[00:10:02.030] – Victoria Bridgland

So it was good to be able to strip away all of those kind of nitpicky things and put all of the findings together. And then that way we can have more confidence in the findings. Because if you’re finding the same thing again and again and again across multiple different research teams, we can be pretty confident that the effect size that we’re seeing is the correct effect size.

[00:10:22.390] – APS Özge G. Fischer-Baum

Yeah. So that’s why we have a debate maybe, right. So people just cherry pick the studies and ignore the ones that they don’t like for their argument. So your study is doing a great service for the trigger warning literature. You compiled all these studies and now we know when we look at all these groups together whether there is an effect or not. So yeah, let’s start with response effect. What are your main results regarding response effect, which I believe one of the most studied notions in the trigger warning literature.

[00:10:56.270] – Victoria Bridgland

Yeah, so it’s definitely the most popular that has been studied. It’s the one that we had the most effect sizes that we could put together in the analysis. So we had these competing hypotheses going in. So if you read online, there was a lot of talk that said that, well, obviously if you’re warned about something, you should be more emotionally prepared to cope with that content because it’s no longer coming as a surprise. You could probably draw upon some kind of mental preparation or coping skills that will then help you cope with the content, and of course, it’s going to be less negative. So there’s a clear hypothesis there. But the other side of the debate was more through, like a, say, response expectancy or no SIBO lens, which sort of said, actually, no opposite probably is going to be true. And if you warn people about negative content, they may feel more anxious about it, and then because they’re feeling more anxious about it and they’re expecting negative things to happen, they may actually experience those effects. So we had these very clear, very testable, competing hypotheses for that, but unfortunately, the data was not so fun.

[00:11:57.340] – Victoria Bridgland

And we found across the board and in the metaanarsis that actually there’s not really anything going on when you look at response effects. So trigger warnings don’t seem to change how people respond to material at all. They don’t seem to be increasing harm, but they don’t really seem to be helpful unless you really look at a few specific cases. So one of the studies that exclusively studied trauma survivors did find that trauma survivors were slightly more anxious when they viewed material with a trigger warning than without. So that’s something definitely to keep in mind. But that is the opposite of what advocates would say should happen. We can’t really find any evidence for this emotional preparation thing, which I read about all the time, can’t find any evidence of this at all. In one of my studies, we just stripped it back even further and we just asked people what they’re doing when they see a trigger warning. And people very rarely said that they were bringing any of these kind of strategies to mind. I’m very skeptical of the notion of emotional preparation.

[00:12:52.790] – APS Özge G. Fischer-Baum

All right, so let’s move on to the other three notions. What about the findings on avoidance, anticipatory effect and comprehension?

[00:13:02.810] – Victoria Bridgland

Yeah, so as I said before, avoidance is probably my most favorite outcome just because it’s so interesting. This side of the debate really focused on the idea that trigger warnings probably do lead to avoidance. So both sides were paradoxically saying that, but they were saying that it would lead to different outcomes. So the advocates were saying, yes, trigger warnings probably do lead to avoidance, but it’s a good thing, because if you might be potentially, say, retraumatized or really harmed by seeing negative content related to your trauma or related to a mental health concern, then. Yeah, you should just avoid that because it’s going to make you feel better and you’re going to be able to cope with things in life more easily. Whereas the people that were on the other side of it. More of the clinicians voices, I guess, were saying, well, actually, no, because avoidance is sort of like counter to our main therapies that we have for, say, PTSD, which is exposure therapy. So avoidance is sort of counter to all the ideas within these kind of gold standard therapies for treating trauma and maintaining avoidance behaviors is obviously it’s associated with more maladaptive outcomes.

[00:14:06.760] – Victoria Bridgland

It’s a key symptom of PTSD, and it maintains the disorder, and it’s also key to a lot of other disorders as well. But the hypothesis for both sides would be that you’d find a clear pattern that trigger warnings on things will lead people to avoid them. But actually, we didn’t find that at all. So across the board, again, we found that trigger warnings rarely lead to avoidance. They don’t really seem to do anything again, but in some specific cases, they seem to potentially be having the opposite effect. They might be attracting you towards content. And this is known as the forbidden fruit hypothesis. It’s a form of psychological reactants. It happens when your freedom to engage in an activity is restricted in some way, and so you just want to do that thing more. There’s a few fun effects in that realm, actually. So in some of the studies, one of them in particular that did find an effect for avoidance was within, again, trauma survivors themselves. So in this study, they had a group of trauma survivors that experienced sexual assault. They had a series of articles that were related to sexual assault and actually found that trauma survivors picked the articles with trigger warnings more than the ones without.

[00:15:15.780] – Victoria Bridgland

And this relates to also this other stream of literature that my colleague Ben Bella is very interested in. So he’s also a co author on the current paper, and he sort of started looking into this idea about self triggering within PTSD as well. So the idea that sometimes trauma survivors, rather than just always avoiding stimuli associated with their traumatic event or things related to it, they might actually seek out things related to it. And, yeah, it’s called self triggering. And it’s also something that we found in my studies which weren’t included in the metaanalysis because the outcomes weren’t the type of outcomes we could add into the metaanalysis framework. But we have started looking at instagram sensitivity screens. So these are a screen that you put on a negative photo online. It blurs the photo, and then they add a line of text that’s like, this photo might be distressing. And you can either avoid looking at that distressing thing, or you can click to uncover it and surprise, surprise, when you sort of blur things that are negative and make them sort of a bit oh, what’s that curious. It does seem to foster this sense of, I guess, burning curiosity.

[00:16:20.340] – Victoria Bridgland

And people keep exposing themselves to this negative content again and again and again. So in one of our studies, which is just published, actually just came out. We gave people this mock Instagram feed and they saw a number of these sensitive photos in the feed. They could leave them, they didn’t have to uncover any of the negative photos. They could have just skipped past them and not seen any. Some people, you might think, oh, maybe they would want to curiously test one of them and then leave the others. So curiously testing one, they would then very quickly find that it was hiding some of the Nastiest, IAPS and Naps photos, which if you’re familiar with those, they’re really quite graphic nasty photos they’re used for analog trauma paradigms. But even after seeing one of them, people continuously kept uncovering them. And in fact, 53% of the people in the study uncovered every single screen they saw and less than 5% avoided. And yeah, when we asked them, why did you do that? They mentioned this morbid curiosity I wanted to see. I was very curious. It was enhancing my curiosity. And the other outcome that we need to talk about I think is anticipatory effect.

[00:17:23.890] – Victoria Bridgland

So anticipatory effect, as I mentioned before, is the effect that you feel when you see a trigger warning but before you see the subsequent thing following it. And the results on this one is pretty clear as well. And it’s the only sort of outcome measure where we’re actually sort of finding a consistent result that’s not a null effect. And basically what we’re finding is when people see trigger warnings, they do tend to feel a sense of anticipatory anxiety. It is a small effect when you look at it in terms of the sort of raw effect size compared to other types of stresses. But it is there and we can also find it with physiological measures as well. So not just like self report, how anxious are you feeling? But also measures of galvanic skin response and heart rate and things like that. So yeah, when people see a trigger warning, it does make them feel anxious. But as I mentioned before, that anxiousness doesn’t seem to translate to any more negative interpretation of the material for most people and it also doesn’t seem to help people. It’s not a sign of somebody emotionally bracing themselves to cope with the content.

[00:18:26.080] – APS Özge G. Fischer-Baum

What about comprehension?

[00:18:30.380] – Victoria Bridgland

Yeah, comprehension. Yeah. So that’s the last one. So that one hasn’t been studied as much as some of the other ones. But yeah, there is a few studies have looked at this and this is primarily centering on the claims made around educational contexts. So say how trigger warnings might impact university students or college students in the classroom. There’s sort of these, again, two sides of the debate. First side would say, well, trigger warnings should emotionally prepare you, which I’ve talked about, and therefore you’ll be better able to engage with material in class and it should lead to sort of superior education outcomes. So you should be able to understand the material better because you’re ready or avoid the material or whatever. And then the other side of the debate was sort of like, oh, well, actually because trigger warnings might make you feel anxious, which we know they do, so that is true, then that may actually make you worse off. When you go to view the material or learn the material in class because you’re feeling in anxious state and you’re not ready to learn. So the studies have looked at this, have looked at more instead of just ratings of emotion or avoidance or things like that, it’s looked at more things like more factual content.

[00:19:42.060] – Victoria Bridgland

So like whether or not people remember things better and then they’ll do better on a multiple choice test or whether or not people have better comprehension of some of the ideas in an article. And basically across the board of the studies, there has been a few studies now that have looked at this don’t find any difference. So giving a trigger warning before distressing educational contact doesn’t seem to improve or impair learning outcomes in any way, which I guess is a good thing to.

[00:20:13.270] – APS Özge G. Fischer-Baum

Yeah, if some of our listeners are educators or professors. So now they can know that it doesn’t matter if they use a trigger warning or not. It doesn’t have any effect on the learning outcomes. All right, so Victoria, my last question to you is about cultural differences. Do you think there are cultural differences in using trigger warnings? Is it a western oriented phenomenon in your opinion?

[00:20:42.510] – Victoria Bridgland

Yeah, it’s entirely a western oriented phenomenon. I don’t know about them in any other non westernized context and I have just anecdotally asked other colleagues that I’ve met, say at conferences, I was at a conference in Japan recently and some of the people I was talking to said that they don’t really use trigger warnings. And then I also know I was recently on a TV show talking about trigger warnings and some of the panel members they had on there were saying that in their cultural experience in their own countries, where there’s a lot of, say, war and just a lot of traumatic events always in the media, that they’ll just show those things like dead bodies and horrible things without a trigger warning. And then in some cultural context they don’t even have a word for trauma. So probably using trigger warnings that might not make sense either because trigger warnings are very much wrapped up in this trauma sort of centered idea that things that trauma survivors should be, I guess, protected in a certain way in society or that we should afford them the warning because it’s very courteous to do so. And it’s wrapped up in these kind of ideas about what the best thing is to do for other people.

[00:21:52.690] – Victoria Bridgland

So yeah, I really think it’s an entirely western concept, but it probably is spreading online to other contexts as well, or just with the globalization of media and all that kind of stuff. So probably they are beginning to be used maybe in more online newspapers and things like that. But yeah, in terms of a cultural concept, they’re entirely rooted within the Western sphere.

[00:22:15.770] – APS Özge G. Fischer-Baum

Yeah, your answer makes sense to me because some cultures, they are not confrontational. Some cultures experience trauma day to day, so it becomes their routine. So everything is a trigger or not after a while. Well, Victoria, thank you very much. It was a very informative conversation. Thanks for joining us today for our podcast.

[00:22:38.690] – Victoria Bridgland

Thank you so much for having me on.

[00:22:40.930] – APS Özge G. Fischer-Baum

This is Özge Gürcanlı Fischer-Baum with APS, and I have been speaking to Dr. Victoria Bridgland from Flinders University. If you want to know more about this research, visit psychologicalscience.org.