Is Avoidance the Only Issue? A Case Study of "Self-Triggering" in Combat-Related Posttraumatic Stress Disorder

Objective: We explore the emerging concept of "self-triggering" through a case illustration of a Vietnam veteran with posttraumatic stress disorder (PTSD) who engaged in self-triggering for 50 years after his index trauma. He reduced the frequency of self-triggering upon receiving a combination of cognitive processing therapy and behavioral exposure treatment. Method: This article provides a brief overview of the emerging literature on self-triggering, proposes theory for its function, and discusses how self-triggering affected the treatment of this veteran's chronic PTSD. Results: Through clinical intervention that focused on what to approach (i.e., real-world experiences) and what to avoid (i.e., online triggering videos), the veteran stopped one kind of self-triggering but not another. The veteran attributed much of his positive behavior change to desire to honor the life of a young boy whose likely death he witnessed in Vietnam. Conclusions: Though people with PTSD often go to great lengths to avoid reminders of their trauma, there is a subset who seek reminders that trigger distressing reexperiencing symptoms. Such puzzling self-triggering behavior in those with PTSD is seldom studied and poorly understood. The details of this veteran's experience present a compelling case for self-triggering as an attempt to search for meaning in one's trauma, gain control of symptoms, and punish oneself. Implications for research and clinical practice are discussed. Clinical Impact Statement This case study explored the treatment of a Vietnam veteran who engaged in self-triggering: seeking reminders of one's trauma that trigger emotional distress, often motivated by the hope of extracting meaning from one's trauma.