Do trigger warnings on TV do more harm than good?

In fact, 90 per cent of people age 16-34 included in Ofcom’s most recent audience attitudes research – the biggest study of its kind in the UK – weren’t offended by anything on-screen in the past 12 months.

And while in 2003 more than half of Brits thought there was “too much” violence on TV, today that's shrunk to one in three. It’s the same story with sexual content: 15 years ago, 44 per cent of people thought there was too much nudity, now it's only 33 per cent.

Yet something strange is happening. Although most viewers aren’t shocked by what’s on the box, the clamour to protect audiences has never been louder. In particular, the rising demand for shows to embrace a special safeguard for viewers: the trigger warning.

Not only have broadcasters introduced ‘the following may not be suitable’ warnings after a backlash from certain sectors of their audiences – 13 Reasons Why being the prime example here – but viewers themselves are flagging troubling scenes for others.

Streams of tweets are now highlighting potential 'triggers' for behaviour such as self-harm and suicide attempts, or for reliving traumatic experiences, in shows from Tiger King to Jeffrey Epstein: Filthy Rich. Entire blogs are dedicated solely to spotting ‘triggering’ content and there’s even Feerless, an app that adds an extra layer of trigger warnings to your Netflix.

And it’s important to point out these aren’t your usual pre-show advisories. They’re not just informing audiences of troubling scenes to manage their expectations. They’re not built for the benefit of parents watching TV with kids up past their bedtime. These warnings are supposed to target those who have experienced the trauma portrayed on screen – the people most likely to be ‘triggered’ – and deter them from watching.

Some commentators have shrugged off the concerns for trauma victims with notions like “life doesn’t have trigger warnings”, while others point to the significant number of vulnerable viewers these cautions could aid.

And the logic from the latter seems simple: surely it’s better to warn the millions of sexual assault victims (an estimated 3.4 million women and 631,000 men in the UK), those with suicidal thoughts (about 7-8 per cent of young people) and victims of serious violence (1.7 per cent of all adults) that troubling viewing lies ahead?

Perhaps not. Although a number of psychologists who treat trauma victims are in support of trigger warnings, others aren’t just sceptical of how effective they can be, but also argue that these messages could actually harm more than help.

Why isn’t everyone on the same page? Well, to answer to that question we first have to tackle another first…

What exactly does the ‘trigger’ in trigger warning mean?

Probably not what most of Twitter thinks. Rather than just causing negative emotions, getting ‘triggered’ is a concept that first emerged when treating post-traumatic stress disorder in the 1970s. And it’s a word, which, just like ‘trauma’, has become much more colloquial than psychologists intended.

“Being triggered is to remind somebody of a traumatic event. It is any stimulus that transports a PTSD sufferer back to the scene of their trauma,” explains Professor Metin Basoglu, former head of Trauma studies at King’s College London, founder of the Istanbul Center for Behavior Research and Therapy and renowned authority on mental health.

“These triggers, or ‘trauma cues’, can cause fear or anxiety or flashback episodes. In a flashback, somebody will feel like the trauma is happening again. A person can get detached from reality and display emotional and physical behaviour like they are reliving the event.”

In some cases, these episodes can actually bypass a sufferer’s logical thinking and lead them to plans of suicide. Worse still, a trauma victim could act on that trigger – often in an alarmingly short space of time.

And we mean short. One study found the time between thinking about suicide and acting on those thoughts was less than five minutes for 24 per cent of participants. And for 5 per cent, the time was only a single second.

It’s the impulsive nature of a small but significant percentage of suicides that make trigger warnings the sole safeguard for many viewers. Because even if a show such as 13 Reasons Why is released alongside extensive support materials such as Beyond the Reasons and 13reasonswhy.info – resources that Netflix “worked with charities, mental health professionals and support groups across the globe to develop and implement” – a percentage of triggered viewers are still dangerously at risk before the end of a distressing episode.

13 Reasons Why showrunner appeared to finally agree with this point, deciding in 2019 to edit out the show's controversial suicide scene (two years after the show's original debut) to "mitigate any risk for especially vulnerable young viewers".

Fortunately, the majority of people who experience trauma won’t develop long-term PTSD and a vulnerability to suicide. In fact, the World Health Organisation Mental Health Survey suggests only 4 per cent of overall trauma survivors will suffer from the condition.

But the 4 per cent that do see an onset? They’ll contend with a range of unpredictable triggers. “They can be objects, they can be smells, they can be sounds, they can be tastes,” says Basoglu. “People who have experienced trauma can be reminded multiple times in the course of the day by apparently mundane things.”

He also points out that although a TV show portraying a similar trauma to a survivor’s experience is very likely to be triggering, so too are a variety of trauma cues that at first appear completely unconnected to the incident itself.

For example, one of his patients, a woman from the Congo, was triggered each time she went to the hairdresser. This, Basoglu found, stemmed from being dragged by her hair before she was raped. Another torture survivor he treated couldn’t put on a pair of white socks without experiencing a flashback to being forced to sign white confession papers.

Sufferers like this have many more triggers to contend with each day – as Basoglu has found. In most cases of trauma, survivors are likely to develop 35 separate trauma cues. But there is no upper limit.

“They wake up in the morning and they might start thinking about the event – they leave the house and get reminded immediately,” says Basoglu. “It's all the time. It’s impossible to avoid.”

Why some people think trigger warnings are a bad idea

To some, the widespread nature of trauma triggers makes all the more reason to add more warnings to TV, not to take them away. If somebody’s suffered an entire day of trauma reminders, they shouldn’t have to endure any more when turning on the TV, right?

Not according to Basoglu. It might sound horribly cold and uncompassionate at first, but he proposes that the best way of protecting vulnerable people is simply not to. Because trigger warnings, however they’re constructed, spread an idea that could actually harm trauma survivors.

“The message implicit in them is avoidance, basically. And anything that promotes avoidance is not in the interest of trauma survivors,” Basoglu explains. “An overly-protective environment prevents opportunities to build up resilience against stress.

“These warnings are possibly in contradiction of everything we know about recovery. The very principle is counter-productive. [With trigger warnings] you are transmitting that message to the public, to millions of people.

“If you're promoting or reinforcing an avoidance culture on a massive social level then you're actually blocking that natural recovery process. There's a chance a person can recover by themselves – and you're blocking that chance!”

This isn’t just opinion. Basoglu’s four decades of trauma research and treating victims have suggested time and time again that avoidance culture is a trauma survivor’s biggest roadblock to recovery.

One study in particular underlines this, a clinical trial that invited refugees and rape victims, all PTSD suffers, to watch documentaries about mass trauma events: war, violence and rape.

It may sound like a cruel experiment, but it emerged that the group that watched the films – the one actively trying to get triggered – was significantly more successful in treatment. A staggering 93 per cent were “much recovered” after 12 sessions (the group not exposed to triggers was merged with the treatment group after six weeks for ethical reasons as only 4 per cent had shown signs of improvement).

It’s findings like this that convince Basoglu that trigger warnings – a phenomenon only found in select countries – is a symptom of a society statured with avoidance. Our society. “In western culture, any possible anxiety or discomfort is something to be avoided at all costs,” he says.

“Yet anxiety and stress are natural feelings. It's normal to feel distress – people should learn to cope with it. They should be allowed to build up resilience against it. It’s this message that should be conveyed to the public.”

Basoglu is not a rogue researcher here – similar conclusions have been reached by experts on our shores too. “One of my concerns [about trigger warnings] is that they add to the idea that if you've had a traumatic event you in some ways aren't resilient enough to cope with it,” says Dr Nick Grey, a clinical psychologist specialising in trauma at Sussex Partnership NHS Foundation Trust. “All the evidence suggests people are resilient enough to deal with it.

“If trigger warnings are to be given they should come with a health warning themselves saying these are the topics that are going to come up, but what you need to do is not avoid it.

“For some very vulnerable individuals, trigger warnings will be incredibly helpful, but we don't know if it's helpful on a large population basis. There might be some unexpected consequences of those warnings [in terms of avoidance].”

Of course, some broadcasters are actively inviting exposure and opening up a conversation about trauma. Take Netflix: not only did they release bonus material for 13 Reasons Why that invited discussion, but anorexia-based film To The Bone was accompanied by videos of the cast stating “a conversation needs to be started” about eating disorders.

If enough viewers actually watch this supplementary content (Netflix doesn’t release all viewing figures), this might help break down avoidance culture. In fact, one study of 5,000 people (albeit commissioned by Netflix and relying on online self-completed questionnaires – a format that always carries validity issues), suggested half of teen viewers went on to discuss issues raised in the show with their parents.

That could be a huge leap forward. Yet broadcasters as a whole still generally misunderstand and underestimate just how pervasive triggers are for PTSD sufferers. And you don’t have to push their logic about trigger warnings too far before the argument rolls downhill.

For instance, if TV producers really aim to prevent triggering trauma victims then shouldn’t shows like The Grand Tour and Top Gear roll out advisory messages too? Car-related trauma cues could affect some of the estimated 24,000 people suffering serious injury in UK road accidents each year, with hundreds of those projected to develop PTSD. Don’t they deserve protecting too?

And, taking this further, if broadcasters truly have a duty to shield PTSD sufferers then shouldn’t they display a list of possible triggers before every show? Isn’t that the only surefire safeguard to the wide-range of trauma cues people experience?

Fortunately, there’s no great demand for a blanket rollout. And nor should there be, according to experts like Dr Grey, when TV has a much less-damaging way to demonstrate a duty of care for their audience.

“If individual teachers or broadcasters wish to give some warning, I can see why trigger warnings are kind and compassionate and thoughtful – but it's more helpful to say 'if you've been affected, here's where you can get help' at the end.”

Why some people think trigger warnings are completely necessary

Though trigger warnings are quickly dismissed by many researchers, others are just as quick to applaud how useful they are to PTSD sufferers currently in treatment – specifically those undergoing CBT (Cognitive Behavioural Therapy).

Although a recovery process criticised by Prof Basoglu, it’s this treatment that’s widely-employed by the NHS and favoured by experts like Siobhan O’Neill, Professor of Mental Health Sciences at Ulster University.

“As part of CBT, trauma victims may be encouraged to pay attention to trigger warnings and potential triggers for their own mental health,” she explains. “We know how we think influences how we feel. We can get into a positive cycle or we can get into a negative cycle. If you watch things on TV that are negative, that is going to drive you into a negative cycle.”

Remember, for PTSD sufferers, it may be a matter of minutes before their downward spiral becomes life-threatening. And that’s a huge problem if you consider the number of people likely to be triggered by an increasingly present part of TV drama: scenes of sexual violence.

Although the chance of an average trauma survivor developing PTSD is low (4 per cent), the likelihood spikes for rape victims is much higher – approximately 19p per cent will develop PTSD. That’s a greater PTSD risk than being kidnapped or witnessing a war atrocity.

And that figure is even more worrying considering the estimated 21,000 rape victims in the UK (which would result in a projected 4,200 PTSD sufferers) and 17.7 million in the USA (3.5 million PTSD sufferers).

It’s these numbers that lead some to claim that trigger warnings are vital – if only to prevent these rape victims from reliving their experiences too soon. Because as, O’Neill argues, overexposure could be the real enemy.

Contrasting with Basoglu, she and others claim that instead of hiding from exposure, many of us live in a world with an abundance of trauma talk, a climate leaving many exposed to a negative cycle.

“There was this idea that talking and debriefing after trauma exposure can prevent PTSD or mental illness. But we now know that it actually doesn’t work,” O’Neill says.

“At first, it’s always better to leave somebody in their own support networks and their own resources rather than giving them counselling straight away after a trauma. They’ll find their own way and that may actually make them stronger and help them grow.

“Although it might be a problem in other cultures, avoidance may not be a big issue here where details of trauma tend to be spoken about. By going in straight away and saying ‘you need therapy’ or ‘you need to talk in detail about the impact of this’, it can disempower people and lead to mental health problems in the long run because they’re forced to memorise it again and again.”

It’s here O’Neill’s opponents point out it’s not actually clear how effective trigger warnings are at halting somebody’s negative cycle – as Basoglu says, “trigger warnings do not act as a therapeutic intervention. They’re just a warning!” – but we can’t ignore their potential to not only aid PTSD sufferers, but to prevent the condition from first developing in trauma victims.

After all, the trigger warning is an evolving form and it may only take a few subtle changes to transform it into something truly potent. Just consider the 13 Reasons Why advisory message that’s delivered by cast members out of character.

“It grounds the viewer into the reality that this is only acting, this isn’t real. Anything that reminds people this is only a story can only be a good thing,” O’Neill explains.

And that’s just one minor change, according to O’Neill, that could make a huge difference. It might not be certain at this point, but there’s every chance more improvements could help develop trigger warnings into the most potent mental health safeguard we have.

So, should TV shows use trigger warnings?

Weighing it up, there’s no easy answer. Should the potential benefits of trigger warnings – however questionable – to a significant number of PTSD sufferers take priority? Or should we drop anything that contributes to a culture of avoidance, one that could potentially lead to more mental health difficulties in the long run?

Unsurprisingly many experts don’t want to claim a black or white solution in this very grey area. However, every psychologist we spoke to was sure about what trigger warnings are lacking: evidence.

“The thing we need to focus on is 'what is the evidence?'. There are a lot of opinions flying around and not a lot of evidence to back it up really. And evidence is that crucial thing,” says Grey. “I would argue that it is incumbent on people that are strongly supportive of such warnings to find evidence for their value.”

However, as with most studies on trauma, definitive evidence is hard to come by. Data revealing how many people stopped watching a show directly after the trigger warning would be a start, but there are even more issues ahead. How can you even quantify how a pre-show notice strengthens a culture of avoidance? And how do you measure how many suicides didn’t happen thanks to a trigger warning?

And that’s not even the major problem. Suppose we could hurdle all these obstacles and work out exactly how effective trigger warnings are: would we really find these second-long warnings cancel out the impact of the next hour of viewing?

Because even if it turned out trigger warnings halted a good percentage of PTSD sufferers from watching, that still means a significant number of viewers will still watch triggering scenes. And, to many, that’s where the real problem lies.

“The real issue is that [trigger warnings] are used in a way that gets producers off the hook, where they avoid taking responsibility for the content in the way they depict violence,” says O’Neill.

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“If they break the guidance they can just put a trigger warning on it, which is an easy way of avoiding their responsibility in how they portray things.

“Putting on a trigger warning? It’s just not enough.”

If you have been affected by the issues raised in this article please contact the Samaritans on 116123 for support or visit the website at www.samaritans.org.

Or visit rapecrisis.org.uk. You can call 0808 802 9999 between 12 noon - 2.30pm and 7 - 9.30pm every day of the year for confidential support and/or information about your nearest services.

A version of this piece was originally published in 2018