Dr. Dawn-Elise Snipes is a Licensed Professional Counselor and Qualified Clinical Supervisor. She received her PhD in Mental Health Counseling from the University of Florida in 2002. In addition to being a practicing clinician, she has provided training to counselors, social workers, nurses and case managers internationally since 2006 through AllCEUs.com Triggers and Cravings in Addiction Recovery
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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
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
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
~ 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.