Clinical practice incorporates many experiences in addition to touch that may trigger a negative response in a survivor even though they seem innocuous to the clinician. Survivors have described triggers such as the use of water, ice, traction, or ultrasound gel. They also spoke about medical procedures and treatments during which they had to remain immobile or silent or heard others crying out with pain or anxiety, reminding them of abuse experiences.
Survivors may or may not be aware of their triggers and may realize that they have been triggered only after they have had this experience. Individuals may also be triggered whether or not they have conscious memory of past abuse or have disclosed their abuse to anyone.
Survivors have stressed that it is important that all clinicians have a general understanding about triggers and how to respond to an individual who is triggered. Therapists should be attuned to the following behaviors which may be nonverbal indicators of discomfort, distress, or dissociation.
- Rapid heart rate and breathing (breath holding or sudden change in breathing pattern may also be seen),
- Sudden flooding of strong emotions (e.g., anger, sadness, fear, etc.),
- Pallor or flushing,
- Muscle stiffness, muscle tension, and inability to relax,
- Cringing, flinching, or pulling away,
- Trembling or shaking, and/or
- Startle response.
These behaviors are probably best understood as “freeze-fight-or flight” responses to the perception of a perceived threat (i.e., sympathetic nervous system arousal).
 Schachter, C.L., Stalker, C.A., Teram, E., Lasiuk, G.C., Danilkewich, A. (2009), Handbook on sensitive practice for health care practitioners: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada, http://www.integration.samhsa.gov/clinical-practice/handbook-sensitivve-practices4healthcare.pdf