Indicators versus triggers - knowing about these can help you control symptom expression

In managing chronic physical health or mental health conditions, it is important to know the difference between indicators and triggers.  Identification of the two allows for increased control of symptom expression.

An indicator is something that often (or always) PRECEDES symptom expression.  A trigger is something that CAUSES symptom expression.

Allow me to provide an example from my life.  I have migraines.  When I am exposed to an allergen such as the chemicals in someone's perfume, that TRIGGERS a migraine.  In other words, I have no migraine symptoms, encounter the chemicals, and develop a migraine.  Often, migraine intensity is linked to how much I was exposed to the allergen.

Once or twice a month, I have a random migraine.  This migraine is not tied to ANY trigger I can identify.  However, each time one of these migraines comes along, I feel really, really happy for 48 hours prior to onset of migraine pain.   While I am typically content and positive, I rarely am happy to the point of giggling.  So, I watch for giggling and out-of-my-ordinary happiness.  When that happiness occurs, I can increase my sleep amounts, make to to be extra careful in avoiding triggers, and start taking preventative medication.

Knowing triggers and indicators can allow you to reduce symptom expression.  Another example, for someone who has bipolar disorder, tracking stimulus for several weeks/a couple of months will often show a pattern of how much stimulus results in mood switching.  When I have worked with people who have tracked stimulus, the people typically find that a certain level of "good stimulus" (eustress) and a much lower level of "bad stimulus" (distress) will result in mood change.  With this information, the person can then plan events to reduce likelihood of mood switching.

Specifically, if John Doe can tolerate 2 eustress activities (like going to dinner with friends, and staying up late to watch a movie), but can only tolerate 1 distress activity (finding out he has work that is past due), John can plan to take care of the work over the weekend.  To avoid mood switching, John will have to change the evening out to another weekend.

Sometimes using mood tracking, the person will be able to link intensity of stimulus to length of mood change.  For example, when I was working with a person who had bipolar disorder, that individual found it was possible to predict the length of depressive episodes by tracking how much stimulus was being experienced.  Using this information, the individual was able to attend a week-long, highly-important-to-the-individual event.  The person planned self-care activities throughout that week to reduce stimulus.  And the individual understood the level of stimulus would likely result in a 3 week depression afterwards.  The depression lasted 2 1/2 weeks.

When processing the entire chain of events, the individual was able to state unlike previous depressive episodes, having an expected time frame for the depression and understanding that the depressive episode was part of how his body and brain worked resulted in the individual being able to resist suicidal impulses.  Prior to understanding how the individual's bipolar disorder worked, the individual would self-harm while depressed.  With the tracking tools and education the individual was able to use planning, self-talk, and understanding to reduce anxiety about depressive episodes.

There are excellent tracking applications, websites, and files on the internet.

• Psychologytools.org has multiple worksheets.  
• PatientsLikeMe.com has some lovely possibilities.  
• Latuda (medication for bipolar disorder depression) has a great mood tracker on its website (http://www.latuda.com/bpd/treating-bipolar-depression.html).    
• SparkPeople.com lets you track food and exercise.
• It is also possible to track triggers and indicators just using pen and paper.  

I would suggest, if you are looking for indicators as well as triggers, to track activity, food intake, weather patterns, and as much detail as you can in your life.  Sometimes it can be a combination of things that result in triggering symptom expression.

Sometimes indicators are subtle and hard to identify without enough information to track down the indicator.  For example, one individual identified moon phases as her trigger for symptom expression,  The day after a full moon, she experiences increase in symptoms, with this increase lasting about 72 hours.  The couple days before the full moon, she feels very tired.  The fatigue is an indicator.  The full moon is a trigger.