Triggers and Cravings
CEUs are available on demand for this podcast at https://allceus.com/member/cart/index/product/id/19/c/
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
Objectives
~ Define a trigger
~ Discuss the function of triggers
~ Explore triggers for mental health symptoms
~ Explore how triggers lead to cravings and obsessive thinking
~ Explore the concept of stimulus generalization
What is a trigger
~ Physical or cognitive stimulus
~ Which causes a physical or cognitive reaction
~ To either repeat (pleasure) or avoid (pain) the stimulus
~ Any pleasurable stimulus is associated with elevated dopamine levels
~ Any painful or distressing stimuli trigger the fight or flight reaction
What is a Trigger
~ The same trigger can be positive or negative depending on the:
~ Frequency of the reinforcement/punishment
~ Intensity of the reinforcement/punishment
Goals
~ Trigger
~ Competing response (IMPROVE, ACCEPTS)
~ Eliminate/counter condition trigger
~ Approaches
~ Continue the chain:
~ Trigger Depression Coping Skills (competing response)
~ Break the chain
~ Eliminate the trigger (cognitive distortions, low self-esteem)
~ Eliminate the negative aspects of the trigger (bridge, Kenny, source of resentment or determination)
Unconditioned triggers
~ Purpose: Generally survival
~ Sight—bright sun, something (ball, fist) headed to your face, inability to access caregiver
~ Sound—loud noise, heartbeat
~ Smell—pleasant, noxious
~ Touch— pain, temperature, hugs
~ Taste— Pleasant or noxious
Conditioned Triggers
~ Conditioned triggers are things that in themselves have no meaning to the person.
~ Sight— Bottle, Snow
~ Sound—Music, Sirens
~ Smell—Smoke, Brownies
~ Touch— Hot stove, wool sweater
~ Taste— Coffee, Reeses ice cream
~ Thought– Lice, Thanksgiving
Where do they come from?
~ Learned
~ Experience (Trial and error)
~ Positive/Reward:
~ Brownies Positive feelings
~ Get good sleep More energy, better mood
~ Negative:
~ Brownies Blood sugar crash and upset stomach
~ Getting good sleep Less time with friends
Where do they come from?
~ Learned
~ Observation
~ Positive/Rewarding
~ Dad drinks after a hard day gets less angry
~ Dad exercises after a hard day gets less angry
~ Negative/Punishing
~ Dad drinks after a hard day gets a hangover, grumpy the next day
~ Dad exercises after a hard day cant move tomorrow and cranky
Where do they come from?
~ Learned
~ Education
~ Positive:
~ Mindfulness increases awareness and reduces stress
~ Sunlight increases vitamin D and improves mood
~ Negative:
~ Mindfulness is exasperating with monkey mind
~ Sunlight increases chances of skin cancer
Trigger to Obsession/Compulsion
~ Trigger
~ Pleasure—I really want to do that again because it makes me happy or eliminates pain
~ Smell brownies cant wait for them to be done
~ New relationship & cant wait to see them again
~ Gambling can’t wait to get that big win again
~ Trigger actual or memory of pain/distress hopelessness, helplessness intensification of depression/anxiety/anger or escape
Why Do I Care
~ Knowing triggers for the behavior to be eliminated will prevent the client from being triggered and moving on to obsessive thoughts or the behavior.
~ Smoking
~ Knowing positive triggers can help create a treatment plan
What is a Trigger
~ Triggers can be:
~ Auditory
~ Depression: Taps, music, children playing
~ Anxiety: Sirens, phone ringing, sudden loud noises, creaking floor boards
~ Addiction: Anything that triggers depression/anxiety
~ Happiness: Children laughing, Mojo“talking”
What is a Trigger
~ Triggers can be:
~ Visual
~ Depression: Grandma’s old house, pictures of abused animals/children, television shows
~ Anxiety: Messy house before mom comes, bridges
~ Addiction: Reminders of the substance/activity of choice, emotional/physical pain
~ Happiness: Pictures of things important to me, wild bunnies, beautiful sunrise
What is a Trigger
~ Triggers can be:
~ Olfactory (Smell)
~ Depression: Hospital smell, smell of smoke, cologne/perfume
~ Anxiety: Smell of smoke, smell of hospital
~ Addiction: Cigarette smoke, bar/casino, baked goods, alcohol
~ Happiness: Flowers, cologne/perfumes,
What is a Trigger
~ Triggers can be:
~ Cognitive
~ Depression/Anxiety: Cognitive distortions
~ Addiction: Distress Intolerant thoughts
~ Happiness: Empowerment, Self-Esteem, Hopefulness
The Problem of Generalization
~ Generalization can occur when characteristics of one instance of something are attributed to all instances
~ Engaging in a behavior that produces dopamine release produces a reward, so you are likely to do it again.
~ Roller coaster rush thought of any adrenaline charged activities will rush
~ Experiencing an intense threat reaction will cause the brain to alert to the threat upon exposure to future triggers
~ One bad experience with a dentist/doctor negative perception of all dentists/doctors
~ Eat spicy food nausea aversion to all spicy food
The Problem of Generalization
~ Generalization also occurs when a reminder (stimulus) for the behavior occurs in different settings or over time.
~ Smoke when you are trying to relax at night
~ Stress at work desire to relax desire to smoke
~ Walking past smoking area at work reminds you of smoking
~ At the mall you see Sally, who usually goes on smoke breaks with you desire to smoke
Apply It: Stimulus Generalization
~ Triggers for eating as an infant birth- 3 months
~ Hunger
~ ***Internal states: Sleepy, fussy, sick
~ Triggers as a baby 3months to a year
~ Hunger
~ Time (circadian rhythms)
~ Sites: Bottle, others eating
~ ***Internal states: Sleepy, fussy, sick
Apply It: Stimulus Generalization
~ Triggers for eating as a toddler
~ Hunger
~ Time (circadian rhythms)
~ Sites: Bottle, others eating
~ ***Internal states: Sleepy, fussy, sick, boredom
~ Smells
~ ***Places: Car, store, watching television
~ And… the generalization continues
Relapse Prevention Triggers
~ People
~ Places
~ Things
~ Times
~ Activities
~ Feelings
~ Lack of self care/Vulnerabilities
Summary
~ Triggers are stimuli that prompt a response
~ Craving is the repeated thought or sustained desire for that response
~ Triggers can be good or bad
~ Most people with addictions and/or mental health issues have multiple triggers that need to be reconditioned