Written by Matt Heafy and Corey Beaulieu, both of whom perform vocals and guitars on the track, it was featured on the band's second studio album Ascendancy in 2005.

According to Trivium frontman Matt Heafy, who wrote the lyrics for the song and co-wrote the music with guitarist and backing vocalist Corey Beaulieu,[1] "A Gunshot to the Head of Trepidation" is written from the point of view of a child who is either a victim of child abuse or a witness to domestic violence, and is described by the vocalist and guitarist as "the punching bag for the underdog".

[2] Speaking in a track-by-track commentary of the album released on Spotify in 2015, Heafy explained that "the outcome of the story of this song was that someone was able to create something out of [being abused]", and that it means "putting that terror away ... by allowing yourself to grow from it and learn from it and not harm yourself or anyone around you negatively from it".

[3] The gang vocals during the later stages of the song were recorded while the album was being mixed at Andy Sneap's Backstage Studios in Ripley, Derbyshire.

[1] Following its inclusion on Ascendancy in March 2005,[4] "A Gunshot to the Head of Trepidation" was released as a promotional single in May 2005 featuring an edited version of the track.