“Trigger Warnings: Exploring both sides of an ongoing debate”

By:  Allison Olmsted, Student Pharmacist

“Trigger warnings” are statements that warn an individual of potential disturbing content that may be encountered in literature, media, and/or course content in an academic setting. According to the National Coalition Against Censorship (NCAC), “trigger warnings” can be applied across a spectrum from material that may cause students to experience “milder” emotions such as distress or discomfort to course material at the opposite end of the spectrum that may cause PTSD-like physiological or psychological symptoms.  Trigger warnings are reportedly becoming more commonplace in academia due to the concern that students may experience these intense emotional reactions.¹ 

The increasing prevalence of trigger warnings has launched a debate over whether these warnings benefit students. Faculty members have voiced differing opinions, and academic institutions have published statements regarding the use of such content warnings. The American Association of University Professors (AAUP) released a statement that warns institutions about the potential negative implications of trigger warnings on freedom of speech in the classroom. The AAUP views trigger warnings as “a current threat to academic freedom in the classroom” and states that “the presumption that students need to be protected rather than challenged in the classroom is at once infantilizing and anti-intellectual.”

Potential Negative Effects of Trigger Warnings

Researchers at Harvard University published a study examining whether trigger warnings would be beneficial to survivors of trauma. Participants (n = 451) were assigned to either receive or not receive a trigger warning prior to reading a potentially distressing passage from world literature. Emotional responses to each passage were recorded and results demonstrated that the use of trigger warnings may have instead reinforced the trauma survivors’ view of their past trauma as central to their personal identities.  Based on their findings and previous research in the area, the researchers concluded that there is an overall lack of scientific evidence to support the use of trigger warnings in academia.

Additionally, authors of an article in The Atlantic explored the negative implications of trigger warnings on mental health. They suggest that the use of trigger warnings takes the opposite approach of well-validated medical treatments for PTSD and other mental health disorders, such as cognitive behavioral therapy (CBT). CBT requires the patient to work to “reframe” their emotional responses by confronting harmful external stimuli rather than actively avoiding such triggers. Of note, the U.S. Department of Veterans Affairs also supports the use of trauma-focused psychotherapies as validated medical treatments for individuals with PTSD.²

Proponents of Trigger Warnings in Academia 

Conversely, there are faculty members, students, and administrators who have voiced their support over the use of trigger warnings in academic settings. In an opinion piece published in The Guardian, Dr. Gust, a Professor at the University of Nottingham, argues that trigger warnings are not meant to censor faculty nor coddle students; rather, he posits, trigger warnings are meant to give students additional time to prepare for and reflect on difficult course material that they may encounter in his class. 

The University of Michigan also has published a “trigger warning guide” which includes a statement that explains that trigger warnings are meant to cultivate more inclusive learning environments for those who struggle with mental health disorders, such as PTSD, by allowing students to be accountable for their own health and learning, rather than simply avoiding the topic.

How can pharmacy educators navigate these conflicting views?

Both advocates and opponents of trigger warnings ultimately want what is best for students, which may leave some faculty confused about if/when to use these warnings. Additional research is warranted before a definitive conclusion can be drawn on the benefit versus harm of trigger warnings; however, there are considerations that pharmacy educators can make to support student success and well-being while navigating conversations of sensitive course content: 

1. Do not avoid difficult topics solely out of fear of potentially evoking negative emotions among your students. In a recent survey of medical students’ opinions on the use of trigger warnings, researchers noted that the majority of students agreed that they would have to learn how to cope with difficult and unexpected situations in clinical practice.³ Similarly, student pharmacists must learn how to strengthen their emotional resiliency in preparation for clinical rotations and their careers and should not avoid difficult topics that arise in the curriculum.
2. Provide trigger warnings as an academic accommodation if requested by individual students with documented mental health disabilities, such as PTSD.⁴
3. Provide resources offered by your institution for students who are struggling with mental health disorders if they ask for guidance.⁵

Continue this discussion by sharing your personal experience of teaching sensitive content. By sharing your thoughts about concerns and approaches you used, we can continue to add to possible approaches and student resources as an academy. 

Acknowledgements:

The author greatly appreciates the guidance, editing, and revisions provided by her preceptor, Dr. Jeff Cain, EdD., MS. 

References:

1. Rathje, S. Do trigger warnings help or harm? Psychology Today. August 1, 2018.   
2. U.S. Department of Veterans Affairs. PTSD treatment basics.
3. Beverly EA, Díaz S, Kerr AM, Balbo JT, Prokopakis KE, Fredricks TR. Students’ Perceptions of Trigger Warnings in Medical Education. Teach Learn Med. 2018;30(1):5-14.  
4. Boysen, Guy. Evidence-Based Answers to Questions About Trigger Warnings for Clinically-Based Distress: A Review for Teachers. Scholarsh Teach Learn Psychol. 2017;3(2):163-177.
5. McNally, RJ. If you need a trigger warning, you need P.T.S.D. treatment. The New York Times. 2016 Sep 13. Accessed September 15, 2020. 

---

Author Bio:

---

Pulses is a scholarly blog supported by a team of pharmacy education scholars