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Thanks for joining us for today's #PreTermChats about Triggers. 

Kasia Pytlik joins us to answer your questions about your Triggers. Kasia has been an NICU social worker both at Mount Sinai Hospital and Sunnybrook Hospital over the last six years, supporting families with their NICU journey. She currently splits her time between clinical work and parent programming at Mount Sinai Hospital. 

Q. What is a trigger and why do they happen?

A: A trigger is anything that sets off an intense memory or flashback that brings a person back to the place and time of their original trauma. When this happens, a person may have an emotional reaction that is similar to the one he or she experienced at the time of the trauma. Triggers are a very personal and individual thing, and therefore it is hard to pinpoint what might actually be a trigger for you. Triggers are touched off by our senses: sight, touch, sound, smell and taste. For former NICU parents, a trigger may be a smell similar to that of the hand soap that was used at the hospital your baby was at; beeps that sound like the ones on your baby's monitor; or being physically present in the hospital that the trauma was experienced in. Some of these triggers are more obvious than others, but it's important to underline that everyone will experience their past traumas in individual ways triggers, and it might be something that we least expect. It is also important to note that even if you don't experience a trigger that is connected to your trauma doesn't mean that you are "less traumatized" or "emotionally stronger" than someone who does experience a trigger. Everyone processes and assimilates their experiences in their own personal ways.

Why triggers happen is a much harder question to answer because brain functioning and memories are not completely understood. That being said, sensory memory, and the emotions we attach to these memories, is a very powerful thing--and it can be both positive and negative. Hearing our favourite song that we played endlessly during that carefree summer when we were 16, or eating a favourite meal that an older loved one used to always make us will bring us right back to that moment in our life. Positive memories will usually put a smile to our faces as we let ourselves get taken back in time. The brain functioning and sensory memories that are working in these moments of positive memories are the same ones that are at work when we experience a trigger that causes a rush of negative emotions as well.

Q. How long do triggers have an affect on my mental health and happiness?

A: This is hard to pinpoint, again, because trauma and our trigger are so personal and individual. For some people, triggers may be a life-long affliction. My grandmother lived through WWII and still, years after the war and years of living in Canada, she would be struck with fear every time a plane flew over her house.She told me as a young child while she was babysitting me, that she would feel the fear, but then remind herself that she was in Canada and safe, and slowly her fear would subside. There is no right or wrong way to think, feel and respond after experiencing a traumatic event. So don't judge yourself for the reactions you may experience with you have a trigger. Your responses are a normal reaction, to an abnormal event. Allow yourself to feel the emotions that come with a trigger, and allow yourself the time and space to process your traumatic experience. For some people, the trigger happens, and they are able to identify it, contain it and have developed their own way of working through the emotions that come with the trigger, like my grandmother did. Some triggers, however, are linked to Post Traumatic Stress disorder (PTSD) and may actually ignite a PTSD episode. PTSD is a serious and debilitating response to trauma that interferes with living everyday life. For most people though, as time goes on, the intensity of a trigger will begin to fade and/or you will develop your own ways to deal with the triggering event.

Q. Question from a Parent:  I have experienced PTSD from our rollercoaster experience with our little one in the NICU and although I haven't had any issues as of recently, I am wondering how to work through my triggers and PTSD so that a future pregnancy doesn't bring on a series of anxiety attacks or just anxiety and stress in general?

A: For someone who had a traumatic pregnancy and birth, it would be absolutely natural to have some worry and anxiety about their future pregnancy. Worry and anxiety is a normal human emotion, that everyone feels in their everyday life. It is normal to worry or to be scared of something, but it is when chronic worry and intense anxiety that interferes with how we would normally live out our lives that the worry and anxiety becomes a problem. For those women having a subsequent pregnancy after delivering prematurely, they will likely be followed very closely by a physician who specializes in the women who have a history of early deliveries. Speaking to the GTA population, there is mental health support through Mount Sinai's Perinatal Mental Health Team http://www.mountsinai.on.ca/.../maternal-infant.../ , and Women's College Hospital's Reproductive Life Stages program http://www.womenscollegehospital.ca/.../mental-health/RLS/ 

These programs do require a physician's referral, but if you are working closely to with your OB, she may ask if you want a referral to the program without you initiating the conversation. You may also be linked up with a perinatal social worker at your delivering hospital who can support you through the anxieties of your next pregnancy. If your physician doesn't bring up mental health supports, be a self-advocate and bring it up yourself. Having holistic health care means caring for your mental health as well. 

I talk more about ways to minimize the occurrence and impact of triggers with another question--read on for that  :)

Q. What resources are out there for me to speak with others who may be going through the same thing?

A: A first step may be speaking with your family physician about how you are feeling, and any resources that may be available in your community is always a good way to find some support. Additionally, your local public health department will likely have supports available through their Healthy Babies, Healthy Children program (found only in Ontario). Calling Telehealth Ontario is also another option (1-866-797-0000). This is a 24 hours, 7 days a week service available to get confidential and valid health advice and information from a registered nurse. The Canadian Premature Babies Foundation has started an online support group for NICU parents (http://cpbf-fbpc.org or https://www.facebook.com/.../CanadianPreemieParentsSuppo.../ )

If you were linked up with a NICU social worker while in the NICU, connect with her to see if there are any local support groups available

Q. What can I practice at home to help me deal with triggers?

A: Some might groan at this, but exercise is something that can really help stabilize your nervous system. The release of endorphins that come with exercise, along with the physical movement of your body, can help bring your mind back to it's natural equilibrium. Thirty minutes of exercise on most days is what is recommended. Exercises that have total body movement like fast walking, running, swimming, playing soccer or basketball, and even dancing. Bring on the Zumba! 

It's also important to get out and socialize. You're natural inclination may be to withdraw from those around you, but the isolation may make things worse. You don't have to talk about the trauma--doing every day things, and developing a routine may bring some comfort. For some, talking about the trauma may be exactly what they need to do, so joining a support group can help. Hearing about how others coped with triggers, and knowing that you aren't the only one facing the same problems can help in your own recovery.

It may sound cliche to say, but getting enough sleep, avoiding alcohol and drugs, and eating a well-balanced healthy diet can go a long way in minimizing triggers and your ability to contain them when they do occur. 

When you are in the midst of trigger, there are some ways to minimize the impact of them by self-regulating your nervous system. You can calm yourself using techniques such as mindful deep breathing, and grounding techniques. A grounding technique that you could use is sitting still in a chair and focusing all your attention on one item in the room. Make note of the colours, it's size, where in the room it is positioned. After doing this, you may notice that your breathing has slowed, and is deeper, and calmer. Like most things, exploring different ways to control and calm the emotions that come with trigger will help you develop your own ways of minimizing the impact triggers have one you.

Q. A question from a parent: I feel like noone understands me. I get anxious everytime I go to the doctor, and my family makes me feel like there's something wrong with me. Is this normal for a parent who has spent long periods of time in the NICU/Hospital?

A: Absolutely, getting anxious about having to see a doctor after spending a long period of time in the hospital is a normal reaction to have. I'm sorry to hear that your family isn't as supportive as they could be. Our family and friends may not really understand everything that occurred during your baby's NICU stay, and may not truly appreciate how traumatic an NICU admission can be. With any traumatic event, grief comes along with it. Even if the traumatic experience didn't include a death. You're grieving the loss of a long and healthy pregnancy; you're grieving the loss of all that excitement that came along with what you envisioned your pregnancy to be. Many people will not understand your grief, but that doesn't make it less real for you. As well, processing that grief has no timeline. As with a lot of things, the healing that comes from a traumatic event is so personal and individual that some may have a longer or shorter time to process the grief and trauma they've experienced. 

If you are really looking for someone who does understand you, there are support groups available through your public health department. If you're not a group person, linking up with a counsellor, or a therapist may be the thing that you need to help support you through this part of your life. It doesn't mean you'll have to see that therapist forever either; even one or two sessions can help validate some of the feelings you have and provide an outlet to someone who is removed from your everyday life. It's amazing how liberating one feels after a good session of talking it out.

Q. Question from a parent: What if I feel like I cannot deal with it on my own? It's been years, and it's just not going away... who should I talk to? Who CAN I talk to?

A: First off, I'm so sorry to hear that you've not been feeling like yourself for so long! It must be so challenging (and frustrating!) not being able to live your truest self. Your family doctor is someone that you can speak to about this, and she/he can also refer you to a therapist, or counsellor in your community. You can also self refer to a counsellor. Here is a link of where you can find qualified therapists in your area: https://therapists.psychologytoday.com/.../ON/Toronto.html 

Keep in mind that finding the RIGHT therapist is important. It's okay to see a few different therapists to get a feel for what their therapeutic style is. Professional therapists are aware that their frist-time clients do this, and shouldn't be offended if you decide to get support elsewhere. When seeing your therapist for the first time, make a note of some key details: do you feel comfortable and safe when talking about your problems with this person? Do you feel like the therapist understands you, or is making an effort to see where you are coming from? Were your concerns taken seriously, and not minimized? Did your therapist treat you with compassion and respect? You may find it difficult to trust someone right away, but with time do you think you could grow to trust this person?

I think it's also important to note that reaching out for support from a professional does not, by any means, indicate that you are "weak", or 'flawed", or "incapable". There is still so much stigma attached to reaching out to mental health supports in our society. But if you had a broken arm, EVERYONE would be urging you to see a doctor! Our mental health should be no different. It is absolutely hard to reach out for support sometimes. We don't want to be a burden. We want to be "strong enough" to get through it on our own. Sometimes reaching out for professional support IS the strongest thing that you can do. And as mentioned already, just because you link up with a therapist does not mean this is a long term commitment. Sometimes just a few sessions is enough to help us process our experiences in a way that we are able to incorporate them into our life story, so that we are able to fully engage and focus on our current moment in life.

Q: I had my daughter at 33weeks very suddenly, and a week later my sister had a still born at 37 weeks. As a family, I am still dealing with the grief and trauma from both, and while personally I believe my sister had a much more difficult experience, I often find my sister discounting my experience, and my healing from my birth and grieving the loss of my nephew. Do you have any tips on how to handle my sister grief while still honouring my trauma?

A: I am so sorry to hear this, (name). The best thing that you can do for your sister is to listen to her (when she feels like talking about it), and try not judge the thoughts and feelings that your sister is going through. This will be really tough for your entire family to go through, and it will take time for her to heal and process her time. Grief is a natual response to any sort of loss in life, and giving both yourself, and your sister, permission to feel the grief will go a long way in both of your healing journeys. You have a double whammy of having the task of not only being there to support your sister, but also of having to process your own NICU truama and grief. Be kind to yourself, and try to practice as much self-care as you can at this time (while also caring for a newborn). If your sister is not currently receiving professional support, encourage her to do so. And be aware that it may be difficult for your sister to see your daughter, as least in the first little while. This may hurt, but giving your sister her space to process this life experience may be the best thing for her right now.

TB: It's comforting knowing we are on the right track. It's been just over a year, and my sister has always been great with being around my daughter, and now she has a daughter of her own. I'm very open and considerate of how she is feeling, but sometimes if I do something that I feel helps me heal, it triggers for her and I have mixed emotions on the best course of action.

A:  Healing is never a smooth ride--it's messy agonizing ride. I wish I could give you a textbook way to remedy how to naviagate both of your journies at the same time. But, with many things, what may help one person, may be a trigger another person. Which is exactly what has happened between your sister and you. The single best way to minimize the affect of this is to keep your communications with your sister open, honest, and compassionate. Your sister sounds understanding of your own grief. As long as she is able to understand where you are coming from with your own healing techniques, then this may lessen the impact the trigger may have on her. You can even premptively say "I'm going to do something that will help me heal, but I recognize that this may be triggering for you--so I'm giving you an out to not participate in x-y-z and I promise that I won't take it personally".

Wow! This has been a fantastic and supportive chat, filled with tons of information and resources. Thank you Kasia, for your expertise on the topic of Triggers and taking the time out of your day to be here with us.

Parents: This chat will be taken from here and posted as a blong on www.lifewithababy.com in the next few days. This is so those of you who missed the chat or want to refer back to the resources have it all in one place.

Thank you again for joining us and we look forward to chatting again soon for our monthly #PreTermChats!

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