132 -Triggers and Cravings
Counselor Toolbox for Mental Health...

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Triggers and Cravings

CEUs are available on demand for this podcast at https://www.allceus.com/member/cart/index/product/id/19/c/

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
~    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

~    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

~    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

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