Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered podcast. I'm Dr Neha Pathak, WebMD's chief physician editor for health and lifestyle medicine. Have you ever snapped at someone you love and immediately wondered, "Where did that come from?" Or have you found yourself in a spiral of anxiety over something that, if you're being honest, probably didn't warrant that level of reaction?

Or maybe you've noticed that the people closest to you—your partner, your kids, your family—seem to have this uncanny ability to press the exact button that sends you over the edge in a way that no one else seems to be able to do. What you're experiencing is not a character flaw and not a mystery, though most of us feel that it is.

Today, we're talking about what triggers actually are—not in the buzzword sense of "triggers," but in the real, biologic, body-based sense. We'll discuss where triggers come from and why our closest relationships, the ones we love the most, tend to bring out most of our worst reactions when we are triggered. And, most importantly, we'll talk about what we can actually do in the heat of the moment to stop the cycle, to interrupt that automatic response before it causes damage and we spend days trying to repair that emotional rift.

This is a conversation about understanding yourself more deeply, building healthier relationships, and reclaiming your ability to choose how you respond, even when everything in your body is telling you to react. But first, let me introduce my guest, Lia Love Avellino. Lia Avellino is a licensed clinical social worker, modern love therapist, writer, commentator, and community organizer.

And she hosts The Unprocessed Podcast. Welcome back to the WebMD Health Discovered podcast, Lia.

Lia Love Avellino, LCSW: I'm so happy to meet you again here.

Pathak: Well, I am always very excited for our conversations. I'd love to ask about your own health discovery when it comes to questions around triggers.

Avellino: So I feel like people are triggered right now in many ways, and one hotspot for triggers is romantic relationships. And what we'll get into is our triggers can really ignite around areas where we have past wounds, traumas, or when we experience powerful emotions related to rejection, shame, or overwhelm.

Another key and common trigger I'm seeing is when people start to feel trapped or they can't get out of a situation. So in a volatile political administration or when we're reading about certain people's rights being revoked, all of that can be incredibly triggering to our feelings of being locked in a situation that we can't get out of.

Pathak: So then let's take a step back and just define what we mean when we say "trigger."

Avellino: Yeah, I think that's really important because there are clinical definitions of terms, and then there are more colloquial definitions, right? And so "trigger" can be a buzzword. It's something we're hearing a lot right now. So the way that I define triggers are sensations and emotions that activate experiences and memories of past traumatic events.

And the way that I'm defining trauma here can be seen as too much, too fast, too soon, or a time where we couldn't complete the action, say the word, make the movement, make the request that we needed to complete at the time of the event. And our brain cannot differentiate between a trigger and a threat.

It only knows to ask, "Am I safe here? Where is the presence of danger?" And so what we'll talk about today is how can we slow down and get the data we need in order to ask ourselves, "Is this situation bringing up or evoking a past experience, or is there something really threatening in the here and now?"

Pathak: Help us understand a little bit about what you said about the difference between a trigger and a threat. And why does the brain respond to emotional triggers the same way that it responds to actual threats to our safety in the environment? So actual threats to, I guess I would call, our physical safety.

Avellino: Yes. It can be physical safety, or it can be emotional, psychological safety as well. So the brain only works on past programming. Anxiety, or being triggered, in some ways likes us to believe that it has future-predicting capabilities, right? Like, I have a voice in my head: "Ugh, I know this is gonna go wrong."

Like, if I'm delayed on the subway, I'm gonna be—I'm gonna miss my client, right? So what my brain is doing in that quick moment is saying, "In the past, I was late for a session because of a train delay." But because we often respond automatically, we don't necessarily get the data we need to determine, am I actually gonna be late, or is my brain just using a past experience and scripting that onto the present or future?

Our brain's primary function is survival. It doesn't give a crap about us thriving. It just needs to know that we are safe. And when we act quickly and have an automatic response, we don't have enough time to check in with ourselves and determine, is this happening in the here and now, or is this about a past lack of safety?

And so what we wanna begin to do is question that kind of automatic response so we can determine if there's something now or then. Because what a trigger does is it prevents us from being creative. It prevents me from, in that moment, saying, "You know what? If I hop off the C train, I might be able to get the four or five and get to my office in time."

It narrows the pathway in our brain. There's something called amygdala hijack, where the part of our brain, our amygdala, gets so flooded and lit up that we lose access to the logical part of our brain, and we're all hot and bothered, for lack of a better word. But we don't get access to the other parts of us that may have different information, that might not be scared, that might not feel threatened.

Pathak: Help us figure out how we can tell the difference in the moment between something that is a trigger based on this old emotional wound, or, as you said, our past programming, versus a situation that is genuinely unsafe or unhealthy for us in that moment.

Avellino: Yep, great question. So the first thing is just to set the context. And once we move from judgment to curiosity—from "This is bad. Something is wrong." to, "Huh, what's happening here?"—we open up a whole new set of possibilities.

So first is to be aware that our brain is just doing its job, right? That's what it's here to do. It's to help us navigate safety. When our ancestor saw a lion coming at them, they could say, "Oh, shoot," and that would signal to their body to run, right?

And this is another key thing about the trigger, is it is a body-based experience. But we live in a cognitive world that really values our thoughts and our narratives, and not so much our body-based knowing.

And so we go straight up into our head. So just set this context for yourself of, "Okay, my body's having an experience. My brain is doing what it's supposed to do. It's helping me decide if I'm safe or not, but my brain doesn't quite know."

And so what I'm gonna notice is, A, I'm having an automatic response. And with every automatic response, we have an action tendency.

So, for example, step one: get curious about what that automatic response is or that action tendency. So historically, when I used to get negative feedback, I would immediately start to shut down and feel shame. "I did something bad. I'm wrong. Oh my gosh," right? And so that's an action tendency. That's my body saying, "This negative feedback that you're getting right now from your boss is like all the criticism, all the rejection you've experienced as a young child."

So what we wanna do then is part two, is practice the acronym STOP. S: Stop. T: Take a breath. O: Observe the data. And then P: Proceed.

And so what we want to do is check in with what's happening on the inside, step three, in a neutral way. "Okay, I got this feedback. My heart is racing. My palms are sweaty. I'm scared I'm gonna get fired."

And then step four is begin to look at that as just one part of us, not all of us. So triggers tell us, "I am afraid. Something's going wrong."

Slowing down might tell us, "A part of me is afraid, but let me see what other parts are online."

There's a trauma therapist named Janina Fisher, and she calls this dual awareness: looking at what's happening in the present, sticking to the data, and then being mindful that, "Oh, you know what? This really reminds me of something that happened in the past."

So we're shifting from "I am afraid" to "A part of me feels fear."

What else is present with me? Dual awareness.

Pathak: And so are these triggers, then, always rooted in a past trauma or wound, or is it just that you may have a very low reserve because of everyday stress or you're burnt out that makes you more sensitive to things that you may have been able to process with less stress if you didn't have that lack of reserve?

Avellino: That's a perfect example of what I was talking about at the start of a colloquial versus clinical definition. So if it's a trigger, it's rooted in a past event. I'll give an example. Whenever I dated guys that were quiet, I would automatically assume they were leaving me. Like, my brain was just like, "Oh, the relationship's over," right?

And I would go to the worst-case scenario because when we're going to the worst-case scenario, what we're trying to do is predict the absolute bad situation so that we can prepare ourselves for it. And our brain is always gonna go to the worst situation that it knows from the past. And oftentimes with those triggers, the worst has happened, especially if it's a childhood trigger, because the difference between being triggered as an adult versus as a child is, in many cases, now we have choice.

Those action tendencies that I was referring to, now we can say, "You know what? I don't like being in this room as a woman with all men. I notice that even when I'm going towards my body, even when I'm checking in with the data, I don't feel good here, and now I can leave." Whereas 15 years ago, I might not have been able to leave, right?

So my fear of being left made me go to this more worst-case scenario, I'm under threat place, versus saying to myself, "Okay, maybe that was what happened in the past, but what is this person indicating besides quietness that's letting me know he's leaving me?" So that is a true trigger.

What you were talking about with our nervous system being activated is another really good point. We see and experience the world through our nervous system. So there's a therapist, her name is Deb Dana. She has this phrase, "When I am in blank state," so hyper-aroused, very anxious, or hypo-aroused, very shut down, "I am blank, and the world is blank."

So when I'm on that subway, and I didn't sleep last night, and I had two cups of coffee, and I had a tough morning with my kids, and the subway's delayed, I am overwhelmed and powerless, and the world is too much, right? If I get on that same subway, but I've slept, I had a nice morning with my husband, my kids were delightful, I am running late, and the world is manageable.

And so our nervous system really impacts how we experience the world. And as humans, we also co-regulate. So if we're spending more time online, if we're spending more time alone, that's gonna impact our body's ability to go into that safe zone, or what we call the window of tolerance.

Pathak: And so then let's really focus in on triggers as you've defined them and help us understand some of the most common interpersonal triggers that you see that people experience when they're in close relationships.

Avellino: So one that is, like I said, is very hot is romantic triggers. Romantic triggers bring up so many wounds around being chosen, around being loved, around being accepted. And the funniest thing about these romantic triggers, as a couples therapist, is that we are actually attracted to people that will trigger us.

So it's called an enactment. We pick people that are familiar to us, hoping that this time we can flip the script, right? So I'm gonna pick someone that's aloof, hoping that this time I can make that aloof parent or partner into a present parent, an emotionally close parent. And so we really get activated by our partners and our relationships.

So, for example, my husband might say to me now when he's emotionally distant and he can tell I'm getting amped up and my Italian hands start moving, "I'm not leaving. I'm right here."

And so that helps soothe my trigger and reminds me, oh, what I think is gonna happen based on my past wounds is actually not happening right now. And so one thing that we can identify a trigger as is when our reaction is outsized to the set of circumstances.

And so a client might come in sobbing after she didn't hear from a second date, and what we can speculate together is, in the here and now, spending a total of an hour and a half with someone is probably not gonna trigger a sob, right?

It's probably gonna trigger past wounds around rejection, shame, being chosen. So we begin to kind of learn where are our personal wounds? What are the things that sort of send us into a place? And in those moments, we wanna stay open to this question: Is this about what's happening now, or is this about something that happened in the past that the trigger is reminding me needs tending to?

Pathak: So why does that happen more in romantic relationships than other types of close relationships, potentially?

Avellino: So it's a great question. It's interesting because our attachment wounds often show up in romantic relationships because friendships are sort of fully voluntary, right? Like, it feels good or it doesn't. There isn't that sort of pressure. It's not like you have one, or even if you're in a polyamorous relationship, two or three, right?

There's like, you can have as many as you want, and everyone can come and go. But when we put this sort of expectation about "you're my person," a lot of our wounds that don't get healed from the past get put on partners. And I think we're seeing that more and more. Different therapists speculate about why, and sociologists, with the decline in religion, many speculate, including Esther Perel, that our partners are now becoming like gods.

So if they don't choose us, if we don't choose them, what does that mean? That can send us into a different place than, say, colleagues at work and friendships. And in this case, when we're triggered in romantic relationships, it keeps us looking out. We analyze other people's behavior.

"Oh look, they didn't show up. Oh look, they didn't text me. Oh look, they're not being the partner they said they would be. They must be leaving, or this must be bad," instead of looking in. And so when we're feeling an emotion like shame or rejection or jealousy, that's actually a choice point where we can look in rather than analyzing out, because analyzing out is helping us deter—our brain thinks it's helping us determine if we're safe, but oftentimes those answers are inside.

Pathak: What about our relationship with our children? There are often ways that they seem to trigger us. So why do we feel so triggered by our own kids?

Avellino: So I think for two primary reasons. The first is it's very, very painful to give away something that our children need that we didn't receive.

And there is a way where, when our children may be so comfortable asking for what they want, asking for what they need, demanding attention, but you didn't get that yourself, that is gonna activate pain.

And if you were unaware of those wounds, you might take out that pain and make it about your children, right? And children are also an easier target, sadly, for acting out the emotions we don't own because they're small and they don't pay our bills like our boss, right? And they aren't our friends who get to choose us.

Our children are there, and they're in our family, and we feel very safe with them. And sometimes that means that the emotions that we aren't owning in our relationships with our colleagues or our roommates or our partners then get acted out on a weaker link, like our kids.

Pathak: So then how do we communicate to them? Because there are probably people in this world that we love more than anything that we're feeling triggered without blaming them or escalating the conflict. Because, as you said, when you're coming in hot, it's hard to de-escalate unless you have a lot of practice.

Avellino: So just as I was giving the example of narrating with your partner, this can be a really beautiful way to model for our children. So when my child dropped a sensory glitter toy at bedtime, which was already going not well, and wet glitter was all over the floor, I started to, like, breathe heavily, and I was saying, "I'm feeling hot. I'm feeling overwhelmed. I want you to know it's not your fault. I'm gonna do some breathing. Do you wanna breathe with me? Can we clean this up together?" Right?

So actually narrating my experience, saying, "I am angry, I am tired, I am frustrated," right? Because a lot of times what parents don't know is children are reading us constantly.

They are looking at our facial expressions. That's why, do you ever see someone say, like, "Oh, your kid walks just like you," or, "Smiles just like you," right? Like, they're taking us in all the time, and if we don't help them by being clear about what we're experiencing, they are gonna assume it's their fault.

Children always assume it's their fault if it's not clarified because they depend on us. So if something goes wrong, they can't be angry at us, they have to be angry at themselves. So being really clear of, "I'm angry, but it's my job to take care of that anger, not yours," and, "How does it feel to see me this way?"

You know, when you are resourced enough to go towards that can be really helpful. Also, them seeing you breathe or share your feelings out loud really humanizes you and shows them it's okay to have big emotions, but it's also our responsibility to contain them and not spew them on other people.

Pathak: Okay, that is very helpful. And I'm curious about what you're seeing in your own practice or what the evidence is out there. It feels like people are much more emotionally overwhelmed right now. Why do you think that's happening right now? Is it just because we have this language, there's more awareness around it? Or do you think something has actually changed to create a society in which we're just globally more emotionally overwhelmed?

Avellino: I think it's a combination. I think there definitely is more of a culture around therapy speak and therapeutic terms, right? And that we have more permission to talk about emotions, at least in metropolitan areas. And also, we are living in a world that is unsafe for many bodies, right? Where policies are harmful to people, where rights are being revoked, where certain bodies are not safe.

And so this isn't imagined for some. There is work I do with people to look at the data, and sometimes what we end up at is, "Yeah, that room really was psychologically unsafe for you as a Black woman with all white men, that you did not feel honored, your body did not feel safe, and that alarm bell was letting you know you needed to get the hell out of there or advocate for support," right?

And so I think this is a very important point about this day and age, is that there are some times where you aren't safe, and you need to respond to that as a threat and not a trigger.

Pathak:

Avellino: So then let's go to someone who may be listening who's realizing that they are just constantly feeling activated or emotionally triggered, emotionally unsafe in many parts of everyday life. When do you suggest to them that it's time for professional support and not ChatGPT or not some online tool?

So if somebody is in a state of what I'm hearing, a constant dysregulation, my first question would always be, out of sincere interest, "Are you actually unsafe?" Right? Like, is there something in your environment that is making you go to that state? Sometimes people will come into therapy, and they'll list all these really overwhelming things they're engaging in.

They're like, "Can you help me feel better?" I'm like, "Well, not unless we look at the circumstances here." There's no magic pill. So there may be things that are actually letting your nervous system know, "Hey, this relationship is abusive. That's why I feel dysregulated all of the time," or, "I'm living in a community that doesn't accept my body, so when I leave my house, I am flooded with a feeling of threat."

So that's the first step. The second step is as soon as we can get into authentic connection with another, the better the healing or the reducing activation goes. So if you've been sitting with the question and wondering if you need support, the answer is in the doubt, the question, right? The sooner you can get with a nervous system, whether that's a community group or a really connected and interested friend or professional support, the better that will be for you.

Pathak: Very, very helpful. Well, I just wanna thank you so much for your time yet again for such an important conversation. And I'd like to end our time together by giving you the floor. So just speak directly to our audience and help them with the first next step they should take if they're feeling like what we've been talking about is them and they want to do something to change.

Avellino: So the first thing I would say is if you're noticing that you're triggered and you're noticing you don't like your reaction to those triggers, I am so happy that you listened to this episode. And you likely had things that went wrong for you, and now you're asking the question, "What is wrong? What is wrong? What is wrong?" constantly. And so you're here for a very legitimate reason. It's just that now it's not serving you.

So there will be transformation around shifting from "What is wrong?" to "What is happening right now for me?" You have the choice point of, instead of going out, noticing the part of you that is feeling fear, the part of you that's feeling rejection or shame, and then also what we call the wise parts, who might have other data points that can lead you in a new direction.

Pathak: That is such, such, such important and helpful information. I love it. It's so practical. So thank you so much again for your time.

Avellino: Thank you so much, Dr Pathak. I love digging into this with you.

Pathak: Thank you so much for being with us today. We've talked with Leah Love Avellino about what it means to be triggered and what we can do to interrupt the cycle.

My key takeaways from this discussion are, first of all, one of the most powerful reframes from today's conversation is that when you feel triggered, your brain is actually not malfunctioning. It's doing exactly what it was designed to do, scanning for danger in our environment and trying to keep us safe based on everything that we've learned from our past experiences.

And the problem is that our brain cannot tell the difference between a real threat that's gonna physically harm us that's happening right now and an emotional wound from years ago that a current situation is bringing up but that is not necessarily going to create the level of harm that our body and mind is anticipating.

So the next time we feel that heat rising up or that outsized reaction, that worst-case spiral in our minds, Leah suggests that we try shifting from "What's wrong?" to "What's happening right now to me?"

That one small shift opens up a completely new set of possibilities.

And second, we all have a vision of how we would ideally want to respond in a hard moment: calmly, thoughtfully, with clarity. But getting there requires preparation and not willpower in that moment.

Whether it's splashing cold water on our faces, putting on music, stepping outside, or just pausing and narrating out loud what we're feeling before we start reacting, using grounding techniques and not just soft suggestions, these are the tools that can interrupt this automatic response cycle long enough for us to get back to that rational, creative part of our brain so that we can respond in the way that we know would be more ideal.

And if you share your life with a partner or children, modeling that pause and saying out loud, "I'm feeling overwhelmed right now, and I need a moment," is not a weakness. It's one of the most important things we can do for our relationships.

And finally, healing relational wounds requires real human connection. So in a world where it's easier than ever to turn to a screen or an app or an AI chatbot for support, especially when we're struggling, the conversation today with Leah is a reminder that there's no substitute for actual, genuine human connection because we co-regulate with other people. Our nervous systems are literally designed to calm down in the presence of someone who makes us feel safe, cared for, and who feels like they're really present.

And if you're noticing that you're feeling constantly activated, emotionally unsafe, or stuck in the same patterns again and again, and I think we all do, it's not a sign that something's permanently wrong with us. It's a signal that part of us is asking to be tended to. Whether that means we should turn to a trusted friend, a community group, or a therapist, the sooner we reach toward another real human being, the sooner we can start feeling that the healing is beginning.

To find out more information about Leah Love Avellino and what it means to be triggered and how to stop that reaction, make sure to check out our show notes.

Thank you so much for listening today. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered podcast.