The psychosomatic conundrum: Should trigger factors be avoided?

Paul R. Martin PhD
Innovation Professor, Royal Melbourne Institute of Technology University
President, Australian Psychological Society

For a range of ‘psychosomatic’ disorders including migraine, asthma and epilepsy, the traditional medical advice is that the best way to prevent ‘attacks’ is to avoid the factors that trigger attacks. Sounds logical doesn’t it? But are there any disadvantages to this strategy? We know from the anxiety literature that avoiding stimuli that engender anxiety results in a sensitization process. That is, avoidance results in increased anxiety in response to future presentations of the stimulus. Put more precisely, short exposure arising from escape/avoidance behaviors results in sensitization, and is considered to be an important process in the development and maintenance of phobias; whereas prolonged exposure results in desensitization, and is the basis for treatments such as systematic desensitization, implosion and flooding.

This paper will first review the author’s research program on how trigger factors acquire and lose the capacity for precipitating headaches. Then the equivalent literature for asthma and epilepsy will be reviewed. Conclusions will be drawn for the etiology and management of psychosomatic disorders. A key theoretical proposal that will be advanced is that there are optimal parameters of exposure to trigger factors that enable the individual to develop ‘defenses’, ‘coping’, ‘resistance’, ‘immunity’, or whatever. Exposure below the optimal parameters does not allow the ‘education’ process to take place, and may result in sensitization. Exposure above the optimal level may result in the requisite system being overwhelmed. The traditional medical advice to avoid triggers needs re-evaluation, as it may lead to fewer attacks in the short-term but result in more attacks in the long-term, due to an insidious sensitization process that decreases tolerance for trigger factors.