If you’ve read stories in recent years about free speech on college campuses, you’ve more than likely encountered the phrase “trigger warning.”

Used as an alert to individuals who are about to read, watch, or listen to content that may cause emotional distress, trigger warnings have prompted a fair amount of debate.

Some argue that these warnings are unnecessary and are creating a “coddled” generation, one that is unable to properly interact with potentially upsetting subject matter. Many of these individuals would also argue that this is a slippery slope toward censorship on college campuses.

Meanwhile, there are those who firmly believe that the use of trigger warnings is necessary because they allow those who have experienced past trauma to successfully navigate certain content without causing themselves distress.

There’s also the issue of choice. Many of the same individuals would also argue that, for those who have experienced trauma, choosing whether or not they want to engage with the information in the first place is equally as important. Without these warnings, that option is removed entirely.

Regardless of where you stand, it goes without saying that this is a subject worth discussing.

To further this narrative and to answer some of the more common questions surrounding this hot-button issue, we asked the opinion of three medical professionals: Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT, an associate professor and holistic healthcare practitioner; Timothy Legg, PhD, PsyD, CRNP, ACRN, CPH, a board-certified geriatric and psychiatric mental health nurse practitioner and licensed psychologist; and Dillon Browne, PhD, an assistant professor and clinical psychologist .

Here’s what they had to say.

How does a trigger warning provide emotional or psychological support?

Debra Rose Wilson: A trigger warning alerts people that the material they are about to be exposed to may trigger an emotional response. This is now being used in higher education. Much of what we teach can be sensitive and elicit emotional responses.

When I teach psychology and nursing students about childhood sexual abuse, for example, I tell them it is coming. I remind them of the statistics of child abuse and assure the class that several students in the room will be adult survivors of childhood sexual abuse. This allows a student, who will later work with this population as a health professional, a moment to acknowledge their own trauma and prepare for their emotional response.

The warning isn’t intended for the student to avoid the emotional response, though students who are feeling unable to prepare themselves may choose to skip that material and seek another way of getting the information needed.

While this is not the practice of all faculty, I believe this approach shows a caring and holistic way to educate and allow for the student to learn self-reflection. There needs to be more research on trigger warnings before we fully understand their effectiveness.

Timothy Legg: Trigger warnings are messages that warn an individual that material about to be presented may be distressing. The concern is that it may trigger symptoms in some individuals who have had trauma or diagnosis of post-traumatic stress disorder (PTSD). The efficacy of such warnings, however, remains the topic of considerable debate.

Dillon Browne: Trigger warnings are intended [as] messages of caution that alert students, readers, or viewers to the possibility that upcoming material may be of a distressing or disturbing emotional nature. The usage of trigger warnings on university campuses is a source of tremendous controversy.

On [the] one hand, certain left-leaning liberal advocacy groups, health professionals, and academics remark that it is in the university’s mandate to warn students that they may encounter conversations that upset or, worse, serve as traumatic reminders. In other words, trigger warnings are a source of student protection.

On the other hand, many moderate or conservative advocacy groups, proponents of academic liberty, and intellectual purists note that trigger warnings amount to the “coddling” of an already vulnerable generation, fostering the avoidance of anxiety-provoking content, and stifling students’ ability to engage with emotionally laden topics. Stated differently, trigger warnings disrupt the functioning of the academy.

At the crux of this debate lie underlying assumptions surrounding the fundamental purpose of higher education institutions (partially, in relationship to student satisfaction.)

To oversimplify: Should universities educate by providing their “customers” with emotionally congruent “safe spaces,” thereby elevating the pleasurableness of student experience, or should universities challenge students to traverse intellectual “brave spaces,” thereby emphasizing the next generation’s future ability to negotiate a harsh and unsafe world outside campus.

For what conditions are trigger warnings advisable?

DRW: Common sensitive subjects that might trigger the emotions associated with a past trauma are sexual abuse, war, violence, rape, incest, eating disorders, suicide, as well as physical and mental health illnesses. And many of these can cross over in personal experience.

What is important to know is that it will be impossible to warn all students all the time. Talking about cancer might trigger grief from a student who just lost her mother to ovarian cancer. There is no way to predict that, but I already reminded them in the beginning lectures that they would experience emotions.

I would suggest counseling and journaling as options for self-reflection, learning, and personal growth as a health professional.

TL: Individuals who have lived through traumatic events may have their own response to this question. For instance, people who may have been traumatized by sexual or physical violence may be traumatized by seeing it on TV or discussing it in a classroom lecture.

Similarly, others who may have been traumatized by a vehicular accident may be traumatized if seeing or discussing a vehicle accident on TV or in a classroom. Ultimately, the answer depends on the individual.

I once had a student who told me that they had severe anxiety each time they saw a cat because when they were young, their uncle used to tell them that if they didn’t behave, they would put them in the basement with the “big black cat.” I don’t know that we can ever prepare people for all potential triggers which could cause anxiety.

DB: Trigger warnings are appropriate in any setting where reasonable individuals would not expect to encounter information, content, or stimuli of a potentially distressing nature. It is hard to imagine how this would ever be the case in a university setting.

Can a professor teach a course on abnormal psychology without speaking to topics of mental illness, trauma, and PTSD? Can a lecturer cover a course on American history without speaking to indigenous genocide, slavery, racism, poverty, and white privilege?

These issues are inherently the content for which such courses are intended. Furthermore, I have never seen a half-decent instructor who does not first introduce their course overview at the beginning of the semester and also introduce the day’s topic at the beginning of the lecture. Thus, the formalization of “trigger warnings” is often redundant and serving to bias student’s emotional reaction toward alarm.

Is the popular use of trigger warnings a misappropriation of the concept?

DRW: There is much debate in academia. We do have a role in protecting students who might be disabled by their trauma, and we also have a role in educating and preparing these students for the real world, where their trauma will be triggered.

More than just giving them warnings, we should be teaching them to reflect and use their emotional response to better understand themselves and their role in the health care of another. I believe it is the student’s responsibility to do the self-work.

I, however, will educate and support them and [shed] some light on their issues so they can work toward healing.

TL: I think that more and more, people are doing it as a way of avoiding legal issues. The actual efficacy is something — as mentioned above — which remains the topic of clinical debate. It would be impossible to warn about every potentially upsetting stimulus, but a commonsense approach would dictate that some trigger warning should be used in certain situations.

DB: One of the major functions of the university is to cultivate critical thinking, not to indoctrinate opinions or facilitate blind emotional reasoning (i.e., reactivity and intolerance of dissent).

It is imperative that students encounter multiple competing views — especially ones with which they do not agree. Look at, for example, where the filter bubble has gotten us.

Moreover, students must experience the emotional responses that accompany debate and controversy. For the majority of students, the university is the last formal socialization setting before entering the workforce. Thus, degree-granting institutions must prepare students for a world that does not necessarily agree with their personal moral politics.

How do trigger warnings differ from exposure therapy?

DRW: Trigger warnings help give the learner a chance to prepare for a potential emotional response.

Using breathing, reflection, stress management, and other approaches may reduce the impact of the emotional response. But having an emotional response also provides an opportunity for self-learning and healing, and as practitioners, they will need to work through their own stuff.

Exposure therapy has the same intent and allows reflection in a caring, supportive, and safe environment. Exposure therapy is one option to healing through trauma.

TL: When one is receiving exposure therapy, they first learn relaxation techniques. Then exposure therapy begins with exposure to stimuli that is related to, but which causes less fear or anxiety than the actual feared object or event.

For instance — a person with a fear of elevators would first begin by talking about elevators with their therapist. When they began to feel “anxious” they would then employ relaxation techniques to combat symptoms such as increased heartbeat and rapid breathing. These responses are known as autonomic activation and occur when confronted with the feared stimuli.

Next, they may look at pictures of an elevator, and again, use relaxation techniques to combat the increased heartbeat or rapid breathing. This would continue until the discussion or pictures no longer caused a fear response. The therapist would continue to work with the person until they were able to be in the feared situation or confronted with the feared object without experiencing the anxiety symptoms that were previously troublesome.  

Trigger warnings simply tell people, “Look, this is coming up. If you don’t want to see it, do something about it,” where exposure therapy represents a way of treating the fear.

DB: When an individual is receiving exposure therapy from a psychologist, they have entered into a professional relationship with a licensed health professional who now has the responsibility of providing evidence-based care and operating by a specific set of ethical principles.

Professors — though professional and regulated, to a different extent – have a very different type of relationship with students. Sometimes professors are health professionals, but they do not “treat” their students, as this would be called a “multiple relationship” and is unethical.

Trigger warnings may encourage avoidance of feared “stimuli” (any form of information), which only fuels the anxiety response. However, university classrooms are not treatment settings and should not be considered as such.

Can trigger warnings and exposure therapy work together?

DRW: Yes. Gentle and caring exposure as well as trigger warnings help the learner tune into personal thoughts and emotions. Becoming aware and employing ways to reduce the anxiety can be effective.

For deep and profound trauma, exposure therapy may not be the first option. I think there are numerous ways to heal through trauma, and exposure to triggers may not be the best way for everyone.

I would advise those with trauma to seek counselling, educate themselves about options for healing, and use the triggered responses as an opportunity to use anxiety-reducing tools and self-reflection.

TL: I believe so. The person can use skills learned in therapy, such as relaxation techniques, to control their response to the trigger. Again, this would depend on the trigger itself, the nature of the persons relationship to the trigger, and how far along they have come in therapy. The ultimate goal of exposure therapy is to help the individual achieve freedom from the feared object or situation.

DB: As I stated above, trigger warnings typically occur in classrooms and exposure therapy occurs in a professional and therapeutic relationship (i.e., it is a regulated health service).

Students who are in therapy for anxiety or trauma should work with their service provider on how best to navigate their university experience. This may involve talking with the instructor about accommodations or working with the university counselling and wellness center.

It is worth noting that the mere notion of trigger warnings is extremely presumptuous surrounding what types of information students find triggering. In the case of post-traumatic stress disorder, triggers are often raw and sensory (i.e., a particular scent, sound, image, or object).

Working diligently with a medical or mental health professional will make individual students much more resilient to the array of potential triggers that they may specifically encounter.

Reducing a student’s stress to course material unduly minimizes the magnitude of concern that exists on campuses today. This requires treatment, not censorship.

Dr. Debra Rose Wilson is an associate professor and holistic healthcare practitioner. She graduated from Walden University with a PhD. She teaches graduate-level psychology and nursing courses. Her expertise also includes obstetrics and breastfeeding. She is the 2017–2018 Holistic Nurse of the Year. Dr. Wilson is the managing editor of a peer-reviewed international journal. She enjoys being with her Tibetan terrier, Maggie.

Dr. Timothy Legg is board-certified as both a geriatric and psychiatric mental health nurse practitioner and is also a licensed psychologist. He graduated from Touro College in New York with a doctorate in health sciences research and education, and from California Southern University in Irvine, California, with a doctorate in clinical psychology. He’s currently a university professor and clinician in private practice. He’s certified in addiction counseling, public health, health education, and is also an AIDS-certified registered nurse. Tim is a vegetarian, and in his free time, he’s an avid weight lifter and jogger.

Dr. Dillon Browne is a clinical psychologist and an assistant professor at the University of Waterloo, Department of Psychology. He completed his PhD in psychology at the University of Toronto and has written numerous articles in the domains of children’s mental health, human development, and family studies. Dillon enjoys playing the guitar and piano, cycling, and fitness.