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Abstract

Background and objectives: Trigger warnings notify people of the distress that written, audiovisual, or other material may evoke, and were initially used to provide for the needs of those with posttraumatic stress disorder (PTSD). Since their inception, trigger warnings have become more widely applied throughout contemporary culture, sparking intense controversy in academia and beyond. Some argue that they empower vulnerable individuals by allowing them to psychologically prepare for or avoid disturbing content, whereas others argue that such warnings undermine resilience to stress and increase vulnerability to psychopathology while constraining academic freedom. The objective of our experiment was to investigate the psychological effects of issuing trigger warnings. Methods: We randomly assigned online participants to receive (n = 133) or not receive (n = 137) trigger warnings prior to reading literary passages that varied in potentially disturbing content. Results: Participants in the trigger warning group believed themselves and people in general to be more emotionally vulnerable if they were to experience trauma. Participants receiving warnings reported greater anxiety in response to reading potentially distressing passages, but only if they believed that words can cause harm. Warnings did not affect participants' implicit self-identification as vulnerable, or subsequent anxiety response to less distressing content. Limitations: The sample included only non-traumatized participants; the observed effects may differ for a traumatized population. Conclusions: Trigger warnings may inadvertently undermine some aspects of emotional resilience. Further research is needed on the generalizability of our findings, especially to collegiate populations and to those with trauma histories.
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... Trigger warnings -prior notification allowing recipients to prepare for or avoid sensitive content and ensuing distress -are widely encountered in communications (1,2). These advisories are considered to have originated online as an accommodation for survivors of sexual violence or other trauma, and who may experience symptoms of post-traumatic stress disorder (PTSD) (3,4). ...
... In some cases, educators and institutions have shared these sentiments, voicing support and citing rationale for adoption of warnings in practice or policy (8, 9), including desire to curate inclusive learning environments (5,10,11). Support has not been unanimous, with opposition to the construct, underpinning principles and use of warnings in education noted (10).Concerns expressed include promotion of avoidance (12), hypersensitisation of recipients (1,13,14) and censorship effects (12,15). Despite routine use and relevance to classroom settings, current literature regarding trigger warnings is largely derived from opinion pieces based on individual or few-author perspectives and rigorous academic evaluations or empirical evidence regarding trigger warnings remain lacking (16). ...
Article
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Background: Trigger warnings - advance notification of content so recipients may prepare for ensuing distress - feature in discussions in higher education. Students' expectations for warnings in some circumstances are recognised and some educators and institutions have adopted use. Medical education necessitates engagement with potentially distressing topics. Little is known about medical students' expectations regarding warnings in education. Methods: All students from a 4-year graduate-entry UK medical degree programme were contacted via digital message outlining study details and were openly sampled. Qualitative methodology was chosen to explore participant expectations, experiences, and meanings derived from experiences. Students participated in semi-structured interviews exploring perspectives on functions, benefits, and drawbacks of trigger warnings in classroom-based medical education. We analysed interview transcripts using thematic analysis. Results: Thirteen semi-structured, qualitative interviews were undertaken. Themes in the following areas were identified; 1) students' experiences influence understanding of trauma and trigger warnings, 2) warnings as mediators of learning experiences , 3) professional responsibilities in learning, 4) exposure to content, 5) professional ethos in medical education, 6) how to issue trigger warnings. Students recognised the term "trigger warning" and that warnings are an accommodation for those affected by trauma. Students' conceptualisation of warnings was influenced by personal experiences and peer interactions both within and outside education. Students expressed both support and concerns about use of warnings and their ability to influence learning, assuming of responsibility and professional development. Discussion: Diverse student opinions regarding warnings were identified. Most students suggested that warnings be used prior to topics concerning recognised traumas. Incremental exposure to distressing content was recommended. Students should be supported in managing own vulnerabilities and needs, while also experiencing sufficient formative exposure to develop resilience. Greater understanding of trauma prevalence and impacts, and underpinnings of warnings amongst students and educators is recommended to optimise education environments and professional development.
... Furthermore, for those who believe in the 'power of words', Additionally, another study Otero (2006), simple language, as well as local phraseology, should be used to discuss mental health. Finally, when it comes to a slightly distressing exposure, trigger warnings seemed to have no effect (Bellet, Jones & McNally, 2018). ...
... This is similar to policies used in in Nazi propaganda. Furthermore, Bellet, Jones, and McNally (2018) found that the use of trigger warnings may, in fact, have a "soft stigmatizing" effect vis-à-vis trauma victims. ...
Preprint
Conducted systematic literature review to assemble existing knowledge and experience concerning, The effective communication about traumatic events with people suffering from PTSD, guided by the principle of “do no harm”. Specific focus on trauma triggers, the avoidance of stigma and re-traumatization, and communication techniques throughout both traditional and new forms of media. Accordingly, the research question guiding this review is: what is known about the ways to write about psychologically traumatic events, PTSD, and trauma respectfully that would avoid re-traumatization of the victims and would contribute to alleviating stigma? While the ongoing tensions along Ukraine’s borders are the primary motivation for this review, for reasons of feasibility, literature covering a wide range of geographical areas, traumas and academic disciplines considered.
... Furthermore, for those who believe in the 'power of words', Additionally, another study Otero (2006), simple language, as well as local phraseology, should be used to discuss mental health. Finally, when it comes to a slightly distressing exposure, trigger warnings seemed to have no effect (Bellet, Jones & McNally, 2018). ...
... This is similar to policies used in in Nazi propaganda. Furthermore, Bellet, Jones, and McNally (2018) found that the use of trigger warnings may, in fact, have a "soft stigmatizing" effect vis-à-vis trauma victims. ...
... How then can practitioners, public health campaigners, or individuals assess which narratives may be most beneficial, while avoiding potential harms? Although research has been undertaken in related areas, for example, whether content warnings are helpful in avoiding harms for some recipients, 18,19 no existing guidance describes what kinds of recovery narratives might have positive impacts for individuals, and how potential harms may be avoided. ...
... Content warnings have been widely used online and within education and professional training contexts 74,75 to help people avoid the perceived harms which may be caused by certain narrative content. Although some empirical research is emerging, 18,19 there is minimal empirical evidence on whether trigger warnings are helpful or not in managing distress for people who have experienced trauma. INCRESE could be used in future research to identify particularly beneficial or harmful characteristics for particular populations and to generate evidence-based guidance on the use of narratives and their potential benefits and harms. ...
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Objective: Mental health recovery narratives are increasingly used in clinical practice, public health campaigns, and as directly-accessed online resources. No instrument exists to describe characteristics of individual recovery narratives. The aims were to develop and evaluate an inventory to characterize recorded recovery narratives. Research design and methods: A preliminary version of the Inventory of Characteristics of Recovery Stories (INCRESE) was generated from an existing theory-base. Feasibility and acceptability were evaluated by two coders each rating 30 purposively-selected narratives. A refined version was produced and a formal evaluation conducted. Reliability was assessed by four coders each rating 95 purposively-selected narratives. Inter-coder reliability was assessed using Fleiss's kappa coefficients; test-retest reliability was assessed using intra-class correlation coefficients (ICCs). Results: Multiple refinements to description, coding categories, and language were made. Data completeness was high, and no floor or ceiling effects were found. Intercoder reliability ranged from moderate (k=0.58) to perfect (k=1.00) agreement. Test-retest reliability ranged from moderate (ICC=0.57) to complete (ICC=1.00) agreement. The final INCRESE comprises 77 items spanning five sections: Narrative Eligibility; Narrative Mode; Narrator Characteristics; Narrative Characteristics; Narrative Content. Conclusion: INCRESE is the first evaluated tool to characterize mental health recovery narratives. It addresses current concerns around normative recovery narratives being used to promote compulsory wellness, e.g. by identifying narratives that reject diagnosis as an explanatory model and those with non-upward trajectories. INCRESE can be used to establish the diversity of a narrative collection and will be used in the NEON trials (ISRCTN11152837, ISRCTN63197153, ISRCTN76355273) to allow a recommender system to match narratives to participants.
... More recent studies have experimentally investigated the impact of content warnings, especially in educational settings. A randomised study found participants with no trauma history (n = 133) who received warnings before reading passages with disturbing content reported more anxiety than those not receiving (n = 137) warnings, suggesting warnings can undermine emotional resilience [15]. The same authors replicated this finding with a college student sample (n = 462) [16], and also showed in a randomised study of trauma survivors (n = 451) that content warnings inadvertently reinforce the centrality of trauma experiences to identity [17]. ...
Article
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Content and trigger warnings give information about the content of material prior to receiving it. Different typologies of content warnings have emerged across multiple sectors, including health, social media, education and entertainment. Benefits arising from their use are contested, with recent empirical evidence from educational sectors suggesting they may raise anxiety and reinforce the centrality of trauma experience to identity, whilst benefits relate to increased individual agency in making informed decisions about engaging with content. Research is hampered by the absence of a shared inter-sectoral typology of warnings. The aims of this systematic review are to develop a typology of content warnings and to identify the contexts in which content warnings are used. The review was pre-registered (ID: CRD42020197687, URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020197687 ) and used five sources: electronic databases covering multiple sectors (n = 19); table of contents from multi-sectoral journals (n = 5), traditional and social media websites (n = 53 spanning 36 countries); forward and backward citation tracking; and expert consultation (n = 15). In total, 6,254 documents were reviewed for eligibility and 136 documents from 32 countries were included. These were synthesised to develop the Narrative Experiences Online (NEON) content warning typology, which comprises 14 domains: Violence, Sex, Stigma, Disturbing content, Language, Risky behaviours, Mental health, Death, Parental guidance, Crime, Abuse, Socio-political, Flashing lights and Objects. Ten sectors were identified: Education, Audio-visual industries, Games and Apps, Media studies, Social sciences, Comic books, Social media, Music, Mental health, and Science and Technology. Presentation formats (n = 15) comprised: education materials, film, games, websites, television, books, social media, verbally, print media, apps, radio, music, research, DVD/video and policy document. The NEON content warning typology provides a framework for consistent warning use and specification of key contextual information (sector, presentation format, target audience) in future content warning research, allowing personalisation of content warnings and investigation of global sociopolitical trends over time.
... The rationale for giving a trigger warning is that students with prior trauma may experience a disruption in their ability to engage in learning due to their felt sense of safety. Researchers have focused on evaluating the need for and efficacy of trigger warnings and assessing the role trigger warnings play in preventing a re-experiencing of trauma, while others posit that 'being triggered' might be related to a lack of emotional resilience (Bellet et al., 2018;George & Hovey, 2019). ...
Article
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Despite the initial understanding of the word ‘triggered’ as relating to the clinical phenomenon of post‐traumatic stress disorder (PTSD), this language has become a common part of the vernacular today, used by many people to apply to a wide variety of experiences and events. Counselling students are particularly sensitised to trauma, as well as identity politics, and are familiar with trigger warnings at college. They themselves have experienced trauma at high rates. Therefore, we were interested to understand how they might be using the word and interpreting the experience of being ‘triggered’, whether different sources of being triggered are related to emotional reactions, and whether a discourse analysis might indicate how and why the term has become useful and for what other experiences it might be serving as a stand‐in. In this mixed‐methods study, 79 counselling students from around the country shared their definitions and experiences of being ‘triggered’. Participants completed surveys and wrote narratives, which, via thematic qualitative analysis, were coded into five themes. The quantitative analysis focused on the relationship of feelings to themes and the relationship between anger suppression and coping with each theme. Discourse analysis explored how individuals wrote about responsibility and anger. It was discovered that those who wrote about being triggered from a past sexual assault did not discuss anger, nor the responsibility of others to protect them (as those who wrote about microaggressions did), but positioned themselves as overreactors. Results are discussed with regard to training and practice.
... All narratives were characterised using INCRESE by one coder and a second coded for narrative eligibility and content warnings. Content warnings are presented prior to the presentation of a story and notify the participant of potential distress a narrative may cause due to the topics portrayed (Bellet et al., 2018). Content warnings included; Abuse or sexual violence, loss of life or endangerment to life, self-harm, violence or aggression, and injustice, prejudice and discrimination. ...
Article
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Background Mental health recovery narratives are an active ingredient of recovery-oriented interventions such as peer support. Recovery narratives can create connection and hope, but there is limited evidence on the predictors of impact. Aims The aim of this study was to identify characteristics of the narrator, narrative content and participant which predict the short-term impact of recovery narratives on participants. Method Independent studies were conducted in an experimental (n = 40) and a clinical setting (n = 13). In both studies, participants with mental health problems received recorded recovery narratives and rated impact on hopefulness and connection. Predictive characteristics were identified using multi-level modelling. Results The experimental study found that narratives portraying a narrator as living well with mental health problems that is intermediate between no and full recovery, generated higher self-rated levels of hopefulness. Participants from ethnic minority backgrounds had lower levels of connection with narrators compared to participants from a white background, potentially due to reduced visibility of a narrator’s diversity characteristics. Conclusions Narratives describing partial but not complete recovery and matching on ethnicity may lead to a higher impact. Having access to narratives portraying a range of narrator characteristics to maximise the possibility of a beneficial impact on connection and hopefulness.
Article
Trauma is now recognized as a common human experience that has consequences, including adverse effects on learning outcomes. Principles of trauma-informed care include awareness of the impact of trauma and use of strategies to prevent retraumatization. While well-described in medical and mental health care, these principles have been inconsistently applied in the medical education classroom. Content warnings can be part of a trauma-informed classroom approach that notifies learners about potentially distressing topics, allows individuals to employ self-care, and seeks to resist retraumatization. This article describes our experience integrating a content warning about reproductive topics in a second-year medical school course.
Article
Background and objectives Trigger warnings have been described as helpful—enabling people to “emotionally prepare” for upcoming trauma-related material via “coping strategies.” However, no research has asked people what they think they would do when they come across a warning—an essential first step in providing evidence that trigger warnings are helpful. Methods Here, participants from Amazon's Mechanical Turk (n = 260) completed one of two future thinking scenarios; we asked half to think about coming across a warning related to their most stressful/traumatic experience; the others thought about the actual content (but no warning) related to their most stressful/traumatic experience. Results The warning condition did not produce differences in coping strategies, state anxiety, or phenomenology (e.g., vividness, valence) relative to the content condition. Only one key difference emerged: participants who imagined encountering a warning used fewer positive words, when describing how they would react. Limitations Although measuring actual behavior was not our aim, hypothetically simulating the future may not capture what actual future behavior would look like (e.g., an intention-behaviour gap). Conclusions One potential explanation for the consistent finding in the literature that trigger warnings fail to ameliorate negative emotional reactions is that these warnings may not help people bring coping strategies to mind. Although, further empirical work is necessary to fully substantiate this potential interpretation.
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Recent interest in the implicit self-esteem construct has led to the creation and use of several new assessment tools whose psychometric properties have not been fully explored. In this article, the authors investigated the reliability and validity of seven implicit self-esteem measures. The different implicit measures did not correlate with each other, and they correlated only weakly with measures of explicit self-esteem. Only some of the implicit measures demonstrated good test–retest reliabilities, and overall, the implicit measures were limited in their ability to predict our criterion variables. Finally, there was some evidence that implicit self-esteem measures are sensitive to context. The implications of these findings for the future of implicit self-esteem research are discussed.
Poster
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Trigger warnings (TWs) are alerts before media that warn readers who have post-traumatic stress disorder (PTSD) that the content may depict a trauma reminder. Some college students have requested that TWs be on syllabi or otherwise available in classrooms, which has stirred controversy. Proponents comment that TWs help people prepare to deal with trauma reminders. Opponents assert that utilizing TWs is a means to avoid upsetting stimuli, and avoidance is known to maintain the psychopathology experienced by those TWs are supposed to help. The present study explored predictors hypothesized to associate with TW utilization. A sample of MTurk workers (N = 270) completed scales measuring depression, entitlement, post-traumatic adjustment (PTSD, trauma centrality, avoidance, institutional betrayal, post-traumatic growth) and TW utilization. Several linear regressions were run in the general sample and in the sample scoring high on the TW utilization scale. All the trauma related scales positively associated with TW use (p < .05) in both groups. Two stepwise regressions revealed that the strongest predictors in the two groups differed (general sample: avoidance and post-traumatic growth, p < .001, TW users: trauma centrality and institutional betrayal, p = .02). Continuing the TW conversation with these findings in mind is discussed.
Conference Paper
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Trigger warnings (TWs) are defined as an alert before presented material that warns readers of potentially disturbing content. They have become a controversial topic. The present study aims to build on previous TW literature – much of which is opinion-based – in order to assess traits of undergraduates who want TWs, particularly their level of trauma centrality, PTSD symptomology, and physiological reactivity to a TW. An experimental paradigm is employed in which participants will be randomly assigned to see a TW, a movie rating, or no warning before watching a movie clip. The dependent variable will be physiological stress in response to the warning (vs. none), measured by heart rate, respiration rate, and electro-dermal activity. A 3 (TW, movie rating, or control) by 2 (high/low centrality) by 2 (high/low PTSD) ANOVA will be used to test the hypothesis that high PTSD and centrality will positively predict more anxiety when TWs are presented.
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Crowdsourcing has had a dramatic impact on the speed and scale at which scientific research can be conducted. Clinical scientists have particularly benefited from readily available research study participants and streamlined recruiting and payment systems afforded by Amazon Mechanical Turk (MTurk), a popular labor market for crowdsourcing workers. MTurk has been used in this capacity for more than five years. The popularity and novelty of the platform have spurred numerous methodological investigations, making it the most studied nonprobability sample available to researchers. This article summarizes what is known about MTurk sample composition and data quality with an emphasis on findings relevant to clinical psychological research. It then addresses methodological issues with using MTurk-many of which are common to other nonprobability samples but unfamiliar to clinical science researchers-and suggests concrete steps to avoid these issues or minimize their impact. Expected final online publication date for the Annual Review of Clinical Psychology Volume 12 is March 28, 2016. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Article
According to the popular press, students have been increasingly demanding warnings before being exposed to potentially distressing classroom material. The validity of these types of trigger warnings has been a topic of vigorous debate. Based on a review of posttraumatic stress disorder (PTSD) research and closely related topics, this article answers questions that teachers might ask about the validity of the scientific assumptions behind trigger warnings and their use in the classroom. External stimuli causing distress is a feature common to many mental disorders, and trauma-based triggers of distress are an essential feature of PTSD. However, development of PTSD after a traumatic experience is relatively rare. Environmental triggers are often difficult to predict, but warnings may reduce distress among people with PTSD by allowing exposure to be controlled. To the extent that trigger warnings allow avoidance of hyperarousal when trying to learn, they should increase students’ classroom performance. However, avoidance of trauma reminders contributes to the persistence of PTSD symptoms. Although clinical research generally supports the notion of trigger warnings as an accommodation for individual students diagnosed with PTSD, the effectiveness of trigger warnings in the classroom is unknown. In addition, trigger warnings may be a legitimate accommodation for students with psychiatric disabilities, but this does not mean that they are relevant to nonclinical issues.
Article
Recently, a heated debate has risen in Academia following numerous student initiatives petitions for the formal incorporation of rigger warnings in course syllabi. When contextualized within the intersecting politics of disability and feminist pedagogies, a number of fundamental contentions within this debate become apparent. First, grave misunderstandings remain regarding about practices of accommodation and the possibility of establishing the classroom as a “safe space.” Second, resistance within the academy to understand trauma as a pedagogical issue illustrate a failure to consider experiences of and responses to trauma as issues of disability (in)justice. Through an exploration of these issues, it becomes evident that the conflicting approaches to trauma in the classroom demand the more integrated, collaborative praxis of a “Feminist Disability Studies Pedagogy” (FDSP). When approached through this hybrid pedagogy, the conversation shifts from whether we should use trigger warnings, to why trauma itself is an imperative social justice issue within our classrooms.
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We examine the trade-offs associated with using Amazon.com's Mechanical Turk (MTurk) interface for subject recruitment. We first describe MTurk and its promise as a vehicle for performing low-cost and easy-to-field experiments. We then assess the internal and external validity of experiments performed using MTurk, employing a framework that can be used to evaluate other subject pools. We first investigate the characteristics of samples drawn from the MTurk population. We show that respondents recruited in this manner are often more representative of the U.S. population than in-person convenience samples-the modal sample in published experimental political science-but less representative than subjects in Internet-based panels or national probability samples. Finally, we replicate important published experimental work using MTurk samples. © The Author 2012. Published by Oxford University Press on behalf of the Society for Political Methodology. All rights reserved.