Triggers and Cravings
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com

More resources are available at docsnipes.com

Objectives
Define a trigger
Discuss the function of triggers

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)
Goals
Approaches
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 until they are associated with something positive or negative.
Sight— Bottle, Snow
Sound—Music, Sirens
Smell—Smoke, Brownies
Touch— Hot stove, wool sweater
Taste— Coffee, Reeses ice cream
Thought– Lice, Thanksgiving

What are your Triggers?
Anger
Anxiety
Depression
Happiness
To use unhelpful escape or coping strategies
To use your new skills
Summary
Triggers are stimuli which prompt (trigger) you to do something or react in a certain way
Some triggers are there from birth (cold  shiver)
Some things become triggers because they remind you of something that caused pleasure of pain.
Recovery involves
Eliminating, reconditioning or developing strategies to deal with “negative” triggers
Increasing and incorporating triggers for positive moods and for using new skills

Triggers and Cravings
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
Objectives
Explore how triggers develop
Learn ways to recondition triggers
Learn how triggers can prompt obsessive thoughts and compulsive or escape behaviors

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
Summary
Knowing triggers for the behavior to be eliminated will prevent you from being triggered and moving on to obsessive thoughts or the behavior.
Smoking
Knowing positive triggers can help create a change plan that increases triggers for positive emotions and those which prompt you to use new skills

Triggers and Cravings
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
Objectives
Define a trigger
Explore your triggers
Identify ways to increase positive triggers in your life

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
Summary
Increasing awareness of the smallest triggers can help you refine your relapse prevention plan
Relapse prevention plans are ever-changing documents as you learn more about yourself and develop new skills
If you start to feel depressed/anxious/angry or like you want to use, “from out of the blue” use your distress tolerance skills to ride the wave, then explore the potential triggers
In what way was that situation like old, distressful situations

Triggers and Cravings
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
Objectives
Explore the concept of generalization and how over time a behavior like smoking or eating can be “triggered” by a multitude of things.

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 fight or flight 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
Generalization also occurs when a reminder (stimulus) for the behavior occurs in different settings or over time.

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: American Eating Behaviors
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 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
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