 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on triggers and cravings. Over the next hour, we're going to define a trigger, discuss the function of triggers, explore triggers for mental health symptoms as well as addictive behaviors, explore how triggers lead to cravings and obsessive thinking or stuckness. If you will in depression sometimes triggers can cause someone to start having obsessive thoughts about a negative experience in the past and they kind of get stuck there. And we're going to talk about that. And then we're going to end by talking about the concept of stimulus generalization and how multiple different scenarios can come to elicit behavior or a reaction, just because it's what you've always done. So a trigger is a physical or cognitive stimulus. Now, behaviorists are probably going, oh my gosh, we're just going to be real loosey goosey with this right now. Physical stimulus is something that you see here, smell, taste, touch. A cognitive stimulus is a thought that you have. Now, a lot of our clients cognitive stimuli for anxiety, depression and anger tend to revolve around those infamous cognitive distortions. If something happens, you know, it's how they interpret it, their cognitive reactions to the situation that end up triggering the depression, anger or anxiety. So it's important to understand that there are a variety of different triggers that we need to look at. It's also important to understand that not all triggers are negative. A lot of times, at least in addiction recovery, when we hear the word trigger, we think of something that needs to be avoided or gotten rid of. But triggers are awesome for triggering positive feelings because you can't be really happy and miserable at the same time. Now, there's that little bittersweet thing in there where, you know, sometimes things happen and it's not exactly like you'd like, but it's not clinical depression either. So I'll take bittersweet over clinical depression any day. So we want to trigger people to have happy moods. So when they get up in the morning, they see something and it makes them smile. Instead of seeing something and going, oh crap. You know, think about those mornings you get up and you put your foot down on the floor and the first thing you do is step in a hairball. If you've got cats, you understand this. If you don't then think about kids and stepping on a Lego or something. That's not the way to start your day. That's a trigger in the environment that can trigger kind of a unpleasant foul mood. So we want to understand that triggers can be good or bad. Mornings when you wake up and the sun is shining and the birds are chirping and you're just like, oh, it's going to be a good day. Obviously, those are positive triggers. So triggers are designed to either repeat pleasure or avoid pain. Both of them are designed for survival in a sense. And, you know, our body's not really all that bright. It's operating on some pretty archaic rules that it has. So it's up to us to figure out if it's the things that we're doing. Yes, they may produce pleasure, but are they in our best interest in the long run. So any pleasurable stimulus is associated with elevated dopamine levels. That is our reward chemical. So when we do something that makes us happy, we're going to get a boost of dopamine and it can be anything from eating to watching a favorite TV show to, you know, something more intense. Anything painful or distressing will trigger the fight or flight reaction. So, again, we're triggering something we're triggering an emotional response and a physiological response. We want to have clients be aware of that, you know, the. If your brain triggers the fight or flight reaction, that's your clue to stop and evaluate the situation. It doesn't necessarily mean that there is a problem. And that's one of those tools we want to help them learn to use is when a negative emotion is triggered. What do they do next. So like I said, the same trigger can be positive or negative depending partly on the frequency of the reinforcement or punishment. So if, you know, I give the example of eating eggs, you know, sometimes you'll eat eggs and I eat eggs a lot because we've got eggs and everything will be fine. And then one time you'll have scrambled eggs or something and it just won't sit right with you. Now, does that mean you're going to avoid eggs for the rest of your life. Well, as long as this just kind of not sitting right probably not because the other 150 times you had them. There was no problem. You can chop it up to something else and move on. But if every other time you had eggs, you got an upset stomach, then you might not want to eat eggs anymore. You might have that thought that eating eggs makes me sick, not going to do it. The intensity of the punishment can also affect how whether you're going to do it again. So sometimes something only happened has to happen once. And you're just like, no, no, not going there again. My daughter when she was five wanted to go to Mo's for her breakfast. I'm sorry for breakfast for her lunch. And we went there. She got something that was really spicy. And it didn't sit well with her. She puked all over the table. She was mortified. Ever since then the thought of eating spicy food hasn't appealed to her at all. So the trigger of the spicy foods has kind of been generalized and she's like, no, don't want to go there. So it's important to remember that if something negative happens. Then any similar situation might also be a trigger in the future. Examples of positives and negatives. The phone rings. I am not a phone person. So if you've had positive experiences with the phone, somebody calls with good news just to say hi don't invite you to go out. And that's what 99% of your phone calls are. Then when the phone rings, you're probably going to pick it up eagerly. If on the other hand, you know, I've never been a phone person. So whenever the phone is rang, it's going to either be a telemarketer or somebody calling with bad news or something stressful. So when the phone rings now, I'm just like, yeah, don't don't want to answer it. That's my reaction based on my experiences. So understanding that everybody can have each person can have a different reaction to different stimuli. Children playing. For some of us who are parents, it may remind us of our children in a positive way remembering how cute they were when they were out playing. We enjoy watching small children play for other people who've lost their children either through through legal means or through death or divorce. It may be very sad for them to hear or see kids playing because it reminds them of their children and then they're overcome with feelings of depression and whatever else. So something is innocuous as you know, driving by a playground and hearing children playing can trigger somebody encouraging people to be aware of when something happens. You know, get through your distress tolerance skills, try to improve the next moment and then at a certain point. When you're in a better mind space, try to figure out what might have triggered that negative mood. Fireplace smoke. For me that signals that it's fall. That's my favorite season. I love the smell of fireplace smoke. I love trying to make fires in the fireplace and you know it's just one of those things that we do at our house. My stepfather lost his family on Christmas Eve to a house fire. So when he smells smoke, not so pleasant, but think about it in and he lives in the upper southeast if you will. So when it gets cool outside, he hears or he smells people starting the wood burning in their fireplace. You can't escape it no matter where you drive. You know, if you go outside, you're going to smell it sometimes. And you know this happened almost 50 years ago, but it still reminds him of the worst day of his life. Being sensitive to those things when you have an encouraging clients to be be compassionate with themselves if there are things that are triggering for them. And to be aware of those things. So what are the goals. Well, as clinicians and you know, we can help people learn how to develop competing responses. And we're going to go through those old acronyms, improve the moment and accept reality in the in the next few slides. But competing responses are things you put in the place that can help you tolerate the distress or change your mood. So it is what it is right now. What can I do to improve the next moment to get unstuck. We also can try to eliminate or counter condition the trigger eliminating it obviously means not having it around. And when you have cognitive triggers, you know, we as clinicians can help people work on eliminating those cognitive distortions and improving their self esteem to eliminate abandonment fears. So some of those cognitive things we actually can eliminate other things you can't get rid of completely, unless you decide to completely live at home or something. Counter conditioning is another step that we take and systematic desensitization is basically what we're talking about here. And we're going to talk about that more. When somebody has a trigger and say it's a trigger something happens it triggers their depression. Well, a lot of times they'll get stuck there they start feeling depressed hopeless helpless stuck in their own thoughts, remembering reminiscing on that situation. How can we help them have that emotion have depression trigger them to use one of the skills we're teaching them. And they start feeling sad. How can we encourage them to remember to use some of their coping skills. And at first this is not easy. It's much more much more easy, much easier. If they've got significant others who are involved in, you know, family treatment who can say, you know, John, it seems like you're really struggling right now. What have you talked about in counseling that you might be able to do to improve the moment. And there's a variety of different visual triggers that they can put up to remind them to do the next right thing and use some of those behaviors. Having a screensaver, because even if they're in a depressed mood they they are probably going to pick up their mobile device at some point. If the screensaver reminds them to use some of their new new tools, it can help them. This is one of the harder ones to put in because when people are depressed. It's hard to get or anxious or angry. It's hard to get them out of that emotional mind and into the wise mind. Breaking the chain, eliminate the trigger completely. So like I said cognitive distortions low self esteem. Those are things we can help people actually get rid of. They are not triggered negatively. And if somebody says something nasty to them. Whether it's directed at them or the person's just having a bad day it doesn't matter the person can let it roll off their back like water off the duck's back. We can help them do that so it's whatever it is is not a trigger anymore it's just a stimulus. To eliminate the negative aspects of the trigger. I've told you before that I am have this irrational fear of bridges. And when I go over bridges now, I focus on driving over the bridge, and you know I kind of rate my anxiety on a scale of one to five. And depending on the type of bridge it may be a little bit higher, but I remember how many times I've driven over bridges that it hasn't caused me a problem. And that I've gotten through it so I know and I can validate for myself that this isn't as much of a trigger anymore. And the less I let myself feed into it, the less it triggers me. My, my dog Kenny passed away, and Facebook sent me one of those reminders this weekend that said you know five years ago you posted this picture and I was like, oh, that's so sad. But instead of sticking with the sadness, I chose to walk the middle path and remembered all the fun things and funny things that Kenny used to do. So we can help clients focus on the positive walk the middle path. The source of resentment. A lot of us have resentments about certain things somebody will say something and you're just like, yeah, that ain't gonna work for me. You can hold something as a resentment. And let it eat you up inside and hold on to that anger, or you can use that same energy as a source of determination to do something positive for yourself to improve the situation. It's encouraging people to choose how they use their energy and choose how they view the situation in order to improve their own happiness. It's not about the other person. It's about choosing what's best for them and their situation. So unconditioned triggers generally survival. When there's bright sun, we squint. It's not something that we were taught to do we do it because our body doesn't want us to burn our retinas. It's something that's coming at your face. You block it, whether it's a ball or somebody's fist. It's just a natural survival reaction in children. Now this one's going to be more relevant to clinical settings and children if they can't access their caregiver, think about the toddler standing in their crib crying. Children just don't have object permanence yet, you know, infants, you know, up to the point that they have object permanence, don't have object permanence. So when they stand up, and they can't see mommy or daddy in their mind, mommy or daddy's gone, all gone forever. So they start to cry, they get freaked out and scared. If it's dark, if they can't see, smell or touch the caregiver, then because they don't have object permanence they may get freaked out. Thinking back for some of our clients what their childhoods were like, and whether they had a secure attachment, a secure caregiver that they could count on to be there for them. You might understand now how certain situations trigger more anxiety. Sound, loud noises, startle any child, startle any baby, startle most of us, because we're not expecting it. So if there's a loud noise, you know, it's like dead silent in my house and I'm working on my computer and all you hear is the tip tapping of the keyboard. Then all of a sudden the dogs see a leaf blow outside and all four of them go ape bananas. I still jump out of my seat. I know exactly what it is. But our body is not prepared to interpret what that is right away so it takes a second for it to get that information in process it and go, oh, it's just the dogs. Now we've been talking about some negative things here, but there are positive unconditioned triggers to like the heartbeat. For infants and small kittens and puppies. The way it sounds is research has shown is soothing. So having access to what they heard when they were in their mother's womb can be a calming, can have a calming effect on the child. Now there are some exceptions if mother was extremely stressed, abusing drugs that made the child more anxious may not have the same effect, but generally it does. It smells. When you smell something that is life affirming, if you will, it smells pleasant food, most foods smell pleasant. When you smell something noxious generally it's not something that is going to help you survive. You know if you walk into a room and you smell a really strong smell of bleach, it typically turn around and walk away, because it's not good to be inhaling bleach in an enclosed room. Our bodies are wired that way. It says you don't want to do that because it's bad for you. Touch, you know, pain is going to tell you not to do something. It's an unconditioned trigger. You put your hand on a hot stove, you're going to feel pain. Certain temperatures, you know, when it gets too hot, you start to sweat. When you get too cold, you start to shiver. But on a positive note, hugs or contact with another living being, and they've shown this is true with cats and dogs as well, companion animals, that contact with another living being actually causes the body to release oxytocin or the bonding chemical. That's an unconditioned trigger. It's not something that we learned. It's something that was present from jump. The same thing is true with taste. And you can see this more with animals than you can with humans, because humans tend to have kind of a finicky palate. But our donkeys will eat, it seems anything, but every once in a while they'll come up to a plant and they'll smell it and they'll walk away. And generally it's, you know, something that's not good for them. And they tend to eat what they need. So, you know, the vets always just been like, well, if she's licking the ashes off the burn pile, probably mean she needs something from it. I'm just like, ew. But it's appealing to her, which is her body's way of telling her that she needs some sort of minerals from that. Condition triggers are things that in themselves have no meaning to the person. So if you show it to an infant, they'll just kind of look at it with this blank look on their face, or show it to someone who's never been exposed to it before, you know, show somebody a controller for the Xbox. And unless they've had prior experience, they're just going to be like, what's that for children, a bottle, you know, an infant doesn't know what a bottle is when they're first born. But the first time they have food from a bottle, then they start to figure out what that thing is and they like it a lot. Snow, when you see snow, it can either be joyful, because it reminds you that you're probably going to get to have the day off from work and get to play in the snow. Or it can be unpleasant because you're going to have to shovel the driveway or the roof, whatever your experience has been. It sounds. Music doesn't have any inherent meaning to it, but some music you can learn that you associate it with positive things and negative things. Now, once you start adding in the words, that's a whole different story, but paying attention to, you know, things like some of your more orchestral music, some of your more instrumental music. Think about how it makes you feel the things that are lighter, have a high, a faster tempo, tend to have a more pleasing and energizing feel to it, then maybe some of Beethoven symphonies on the piano. Just being more aware. We've talked about how smell is a condition trigger. The first time you smell a brownie, you don't know what it is. Once you taste it after that, you know, that's a positive trigger there. Wool sweaters. Every time I see a wool sweater now, I get itchy. I'm just like, okay, yeah, I don't want to buy that. But you don't know that until the first time you put it on. Tastes. Again, depending on your experience, whether it's positive or negative, think about something else like lice. All you have to do is think about lice or bedbugs, and you're going to start itching. And you're welcome for that. But thoughts that you have about certain situations can actually start provoking certain reactions from you. Why? Well, sometimes we've experienced it. You know, if you've had brownies before and it tasted really good and made you happy, then that's going to be a positive association. If you're gluten intolerant or have diabetes, if you've had brownies before, they may have messed up your blood sugar and or given you an upset stomach. So that's not a positive association, and you smell them and you're either going to be neutral or you may actually start getting a bit of an upset stomach. Getting good sleep. You know, for some people it gives them more energy, helps them be in a better mood. When they get good sleep, they're just like score, I can conquer the day. When, for other people, good sleep may actually not be as rewarding because their friends are night owls. So, you know, they have to get up at five o'clock in the morning to get to work. If they get good sleep, that means they have to go to bed by 9pm, which is when their friends are just basically starting to get ready to go out. So getting good sleep equates to less time with friends, which is unpleasant or not as rewarding. Making sure that clients understand, you know, the rewards and the triggers and what maintains behaviors because they're going to choose the behaviors that have the strongest benefit. Observation. We don't have to actually experience something to learn from it. If dad drinks after a hard day and, you know, after five or six beers, he's just, he's chill. He's sitting on the sofa, nothing really bothers him. Junior might see this and say, you know what, that's a pretty good way to deal with stress. When I have a bad day, pop a few beers, I'll be feeling good. On the other hand, if dad has a hard day, comes home, has a few beers and gets a hangover or turns into an angry drunk, then Junior might look at alcohol and go, you know what, that is some very wicked stuff and I don't want to go anywhere near it because I see, I've seen what it's done to other people. Same thing's true with exercise. If dad exercises after a hard day and seems to get in better shape, have more energy, Junior might say, well, there might be something to this exercise thing. If, on the other hand, every time dad exercises, he can't move the next day and he just grumbles about why he has to go to the gym, then Junior's probably going to observe. Exercise may not be all it's cracked up to be because I don't see dad getting any benefits from this. Understanding that we learn, we actually learn a whole lot more from what we observe because think about how many people and how many situations you encounter every day where you observe something happening versus how many you're actually involved in. You know, that's like 100 to one. So you learn a lot from what you're observing and creating your environment or arranging your environment. So you're learning more positive coping skills, learning more positive communication skills, yada yada can actually help increase mood, increase skills. And we can also develop triggers or ideas about something based on just education. If we read something on the internet or somebody tells us, for example, mindfulness increases awareness and reduces stress. I'm all about it. I'm right there. On the other hand, if you read on and you start reading some of the drawbacks to mindfulness. And you focus on the fact that mindfulness can be exasperating for people who have difficulty focusing their thoughts or who have what we call monkey mind. If that describes you, you may hone in on that and go, you know, that mindfulness may not be for me. So as clinicians, we want to present stuff in the most rewarding way. And if there are drawbacks because there's drawbacks to everything, then we want to present alternatives and life hacks, if you will. So if you've got monkey mind, how can you make mindfulness work for you? You know, shorter sessions, write it down, you know, just start talking about different ways to deal with the negative because we want to keep people in a motivated state of mind. So when they think about mindfulness, it elicits a positive motivated reaction. Another example, you know, you'll read sunlight increases vitamin D and can help improve mood. A lot of people read that stop reading right there and say, Okay, I'm going to start bathing in the sun every single day. Other people may read that and go, Well, that's great. I'd love to have the improved mood. But everybody in my family has skin cancer. So you know what the downside to that outweighs the improved mood. Again, as somebody presenting this topic, we could present information, middle path, if you will, how much sunlight do you need for vitamin D and improved mood. And several studies that I've looked at have indicated 15 minutes three times a week. It's not that we need some, you know, five hours a day. 15 minutes three times a week, not during your prime 10 to two hours. Chances of increasing skin cancer, probably very low. Have them ask their dermatologist. But, you know, those are ways we can help people reap the benefits and mitigate the negative aspects. So triggers. If something is a pleasurable trigger or a positive trigger, it either eliminates pain or makes somebody happy. So thinking about on the way home, I'm going to make some brownies when I get home. You can tell I like brownies. Then I start thinking about what I'm going to put into them and I start imagining or remembering what they smell like, what they taste like. And I can't get that thought of brownies out of my mind. So as soon as I walk in the door, I'm like dropping my stuff at the front, front foyer going kids, we're baking. That's kind of what an obsessive thought can be like the same thing can be true for something negative, but we're sticking with the positive right now. Another example people can relate to is a new relationship, you know, new relationship things are exciting things are new. You love being together you can't stand it when you're apart when you're apart all you think about is getting back together again. And it's not a problem. It's not an obsessive problem, unless it starts negatively impacting other areas of life. But when you think about something over and over and over again, you know, it's technically obsessive. The compulsion is agreeing or acquiescing to engaging in the behavior to make it stop or, or to at least get a reprieve from it. So once you make the brownies, and you eat a couple brownies, then you're like, Okay, that was good. I have a reprieve for like 10 minutes and then I want another brownie. But then you're going back to those same obsessive thoughts about how what how good it tasted, and how one more wouldn't hurt. With new relationships, the same thing with gambling or addictive behaviors, the person is wanting relief, they're wanting pleasure they're wanting that dopamine rush. So they're chasing chasing their addiction they're chasing their high. And, eventually, they're going to want to attempt the behavior in order to try to experience that again, for real. But we don't only have pleasurable triggers. We can also have triggers that remind us of pain or distress, you know, something that reminds us of a loss can trigger a sense of hopelessness and helplessness, which can intensify feelings of depression, anxiety, anger or desire to escape. And people may get stuck in these obsessive thoughts thinking about what should I have done, what could I have done, reminiscing dwelling on it, nurturing it, if you will. So one of the things that is clinicians we need to figure out how to do is how to help them, you know, continue this chain. So when they start feeling this way, it prompts them to do something else. It prompts them to say, I don't want to feel this way anymore. What's my next correct step. So by knowing triggers for the behavior to be eliminated, or the mood to be eliminated, we can prevent the client from being triggered and moving on to the obsessive thoughts, the stuckness, or the behavior. At the same time, knowing positive triggers can help create a treatment and relapse prevention plan. A positive trigger for somebody in recovery might be having pictures of their kids on their mobile device or on their desk to remind them of how far they've come and what's important to them and why they want to keep doing the next right thing, even though it doesn't always feel so good and it's hard work. So triggers can be auditory. You hear them. For me, whenever I hear taps, I get really sad. Music can be depressing. We all have those songs that you can put on so you can have a good cry, if you will. Children playing, you know, it depends on the person. But recognizing that sounds can trigger depression, anxiety, and addiction, because addiction results are often pops up when someone is feeling depressed, anxious or angry as a way to escape that feeling. But other things can trigger the addictive behaviors, even if the person's not feeling dysphoric. The sound of a sugar packet, one of my clients pointed out to me one time that it sounded like when you shake down a sugar packet to pour it in coffee, it sounds the same as shaking down a cocaine packet before you use. So it was very triggering for him every time he heard that in our cafeteria and at meetings. So we had to talk about, you know, well, at meetings, I can't make them get rid of the sugar packets. How can you move yourself far enough away where you can't hear it? But encouraging people to understand that sometimes triggers just trigger the behavior, because it reminds you of what you used to do. And triggers happiness can be children laughing. What is it that makes you happy? What sounds make you happy? I love the sounds that little chickadees make, the little black cap chickadees, and they undulate when they fly. So that's visual, but we'll get there. So when I hear chickadees, it makes me smile. I encourage clients to make a list of 10 auditory triggers that make them smile. And then we talk about putting this into accepting reality, accepting the moment, radical acceptance, and improving the next moment. So in imagery, what things do you hear when you go to your happy place, when you are working through guided imagery, what sounds do you hear that help you relax, that help you feel happy? You know, auditory triggers for prayer. You know, you can hear yourself saying the prayer. Other things, church bells, you know, whatever it is that helps you focus on that. When you go on vacation, you know, if you take a mental vacation, you can go somewhere you've actually been on vacation. What things do you hear that make you happy? Maybe you hear the waves coming into the beach. And then hearing encouragement, whether it's a recording on your mobile device or it's yourself giving yourself positive self-talk or calling a friend and going, hey, I'm having a down moment. Can you talk with me for a second? Those are all triggers that can help you feel better, triggers for a better mood that can help you improve the moment. Visual. You know, there are a lot of things that you see that can be depressing, can cause you anxiety. But there are a lot of things you see that can make you really happy, like the things that are important to you, or wild bunnies or beautiful sunrises. Again, 10 things. Make a list. And this is one of those things you can do in stations around the room. Visual triggers that make you happy, visual triggers or auditory triggers that make you happy. And then in a whole different group on a different day, I do happy first, just because I like to give them a positive place to start. If you're doing a group that is unidiagnostic, if you will, you might go around and have auditory triggers for depression and put those up there. And each person can share what their triggers are, how they mitigate them, and you can talk about different ways that as a group you can learn skills to eliminate them. So again, you want to go over to improving the moment and activities. What visual things can you do to remind you that will help you feel better, that will help you push away those unpleasant thoughts, that will help you focus on other sensations. If you have a candle, I don't know why, but I'm still at almost 50 years old mesmerized by the flame on a candle. I can sit there and just look at it and watch the wax drip. Like I said, it doesn't take much. What other things that are visual? I have tapestries, they're actually throw blankets that I've put on curtain rods, but I call them tapestries of Thomas Kincaid paintings all around my house, because I personally think they're beautiful. And I like looking at them, they're very peaceful, serene sort of situations. So that's a visual trigger for relaxation for me. Encourage your clients to do this. And this is something you can do in art therapy too. Maybe they want to draw something or create something that can help them feel more relaxed. Oops. Triggers can be, did I skip over Jeffrey? I did. First time I saw this, my first reaction, as you would expect would be awe. And the kitty says, my name's not awe, my name's Jeffrey. The visual trigger evokes sort of an automatic response from us. It's conditioned, but it's still, you know, there. Smell is one of our strongest memory triggers. So smell is important to pay attention to and too often we don't when we're doing relapse prevention planning. When I work with people who have substance addictions, or, you know, even gambling addiction, we talk about, tell me about all the sites, smells and sounds in that environment, because all of those could potentially trigger you to want to use again. So cigarette smoke is common in a lot of bars. You know, it's not just a trigger for somebody who's trying to stop smoking. If you had a bad experience or you've lost loved ones in hospitals, then the smell of the cleaners and y'all know when you go into a hospital, there's a certain type of cleaner that they use, and it may just differ by hospital chain or whatever. But every hospital I've ever been in smells the same. And it either makes you happy because it reminds you of the birth of your first child or it makes you sad because it reminds you of something else. Cologne and perfume is another big one that we need to talk about with our clients if they've been victimized, if they've had losses. Because colognes and perfumes can, you know, you get onto an elevator 15 people walk on, and there might be a smell that triggers a memory. Encouraging them to understand that it's just a trigger brought on by the smell and as soon as the smell goes away, they can improve the next moment is really important to helping, helping them control their anxiety because their traumatic stress may kind of amp up a bunch when they smell that smell. What makes you happy? What smells make you happy? It doesn't have to be essential oils. It could be pine saw reminds me of my grandmother's house. So I love the smell of pine saw. What is it for your clients and encourage them to figure out how to incorporate those smells into their environment. You can get online and look at different ways to use aromatherapy, putting smells on washcloths, you know, putting a scent spraying a cologne or something on a washcloth and then putting it inside the pillowcase. Sends up the pillow. There are a lot of different creative things that people can do. And it's an empowering activity for clients because then they get excited about improving their environment. Cognitive. Now this is where we shine. We can really help people identify and eliminate their cognitive distortions. Use their cognitive, their knowledge of their cognitive triggers to have counter, counter triggers, if you will, to provide themselves encouragement. So when they start feeling like everybody always leaves, they can provide themselves some encouragement. Addiction usually kind of centers around distress intolerant thoughts. I cannot stand to feel this way any longer. I cannot tolerate it. I'm going to go crazy. I need to feel better, which leads them to self medicating, escape behaviors, whatever you want to call it. So encouraging them to use their distress tolerance skills. And, you know, that's all of these. Again, going through in stations or going through with your client. If you're doing it in an individual, I find going through one letter of each acronym, each session. So that's like 15 sessions. In order to identify different things is less overwhelming than trying to go through everything all at once. So generalization can occur when characteristics of an instance of something are attributed to all instances. Now, in a good situation, you know, you have a positive experience like your ride a roller coaster and you get a rush and you're like, wow, I want to do that again. And then you start looking at things like skydiving and going, ooh, I bet that would be even more fun and rock climbing. So that you expect any of those adrenaline laden activities to produce a rush so you get excited about them. It's a similar sort of negative situation. If you encounter someone who is unpleasant, maybe you get pulled over by a really cranky cop bad experience. You may think that all cops are jerks, which, you know, that's cognitive distortion there, but you're over generalizing characteristics of one instance to the rest. Generalization can also occur when you experience an intense threat reaction because the brain goes, yeah, this reminds me of that time back there, we ain't going there again. So things that remind you of a trauma, for example, may trigger an intense anxiety, depression or anger reaction as simple as a smell or a sight or a sound like a creaking floorboard. So it's important to understand and have our clients understand that there are some things that seem innocuous that may trigger a stress reaction, maybe a slamming cabinet door, how to deal with it. And that's we can help them brainstorm ways to deal with things because you're not going to get rid of all the cabinets in your house. So what can they do when they hear that one of my clients has rules in his house for how you close doors and how you close cabinet doors because that is a big trigger for him. So generalization also occurs when a reminder for the behavior occurs in different settings over time. So for example, when you're at home, maybe you want to smoke a couple cigarettes to relax at night. And then you're at work and you're under a lot of stress, you want to relax you remember hey smoking a cigarette helps me relax. I want to go smoke. And then in the mornings when you're walking into the office not only does that remind you of stress, but the smoking area reminds you of relaxation and you're like, maybe I'll have a smoke before I go in. And then people generally congregate in the same smoking area. So one day you see Sally at the mall. And Sally is the one that usually go to have smoke breaks with after you see her, you may start thinking more about going and having a cigarette even though you're not necessarily all that stress because when you see Sally, the two of you always get together and go out and smoke. So understanding that stimuli can trigger us to do things, not necessarily as survival, but out of habit. So let's think about American eating patterns because we don't do those so well in large part. Birth the three months, an infant eats because of hunger, you know that's why they're supposed to eat. And so sure that's rewarding. But if the parent is not good at differentiating between sleepy, fussy, sick, cold, scared or hungry, and just pop something in the kid's mouth every time they start to cry. Then the child might start responding, if you will, to feeding stimulation with all of those states so when it's sleepy it thinks it's supposed to eat. Well, this is what I'm supposed to do when I'm sleepy, because it's internal states have been invalidated. Now, three months to a year old, the baby's becoming a little more alert, holding his head up, still eating when hungry, but now the baby's probably eating more on times. So, you know, breakfast is at 7am snack is at 10am lunch is at noon, however, the child, the mother or father has structured the day. So the child may come to be used to eating at certain times of day, and their circadian rhythms may kind of flux with that. Not necessarily because they're hungry, but that's just what time it is. You know, I come home from work, it's dinner time. A lot of times I don't even ask myself, you know, am I hungry? It's dinner time, it's time to eat, make the kids some food, let's sit down. So we're reacting to the stimulus of the time of day, not to the stimulus, the actual stimulus of hunger. If the child sees a bottle, we've all been at the playground with our kids or our grandkids, and, you know, one child has been eating and the other another child may come up and all of a sudden want a snack, because they see somebody else eating, not necessarily because they're hungry, but because it looks good, and food is good, and that's rewarding. And we still are eating in response to sleepy, fussy and sick, because that's what we've always done. As a toddler, still eating for hunger, still eating on those sort of archaic circadian rhythms, because that's when it's scheduled into eat. Eat in response to seeing others eating, because remember, eating in and of itself can reduce some, release some serotonin and dopamine. So it's rewarding. So you see somebody else eating, you're like, think about going to the cafeteria. You know, if you go to the cafeteria and everybody else is eating, and you're just kind of sitting there twiddling your thumbs, number one, you feel kind of out of place, but number two, everybody else is eating, and then you start thinking about, that smells good. I wonder what that tastes like. And then you start wanting to eat, even though you're not hungry, you're being triggered to want to engage in that behavior. Smells can trigger you to want to eat. Have you ever walked into a store when I'm at the mall and I walk past Cinnabon? Oh my gosh, it smells so good. And it makes me want to eat. And then I remember how many calories and it makes me not want to eat. As toddlers, we also, or as parents, we also often have toddlers in the car with us and we have a habit they even make special containers. So toddlers can take their juice and snacks with them in a non spill kind of container. So toddlers come to expect to have something to eat. Parents don't want to hear them so they want something in their mouth. And toddlers come to have something to eat when they're in the car. So whenever they get in the car, they come to expect food. For many of us, we can relate to mindless eating when we're watching TV. We already ate dinner, cleaned the dishes, but we're sitting down to watch TV in the evening and might as well have a snack. So we eat out of boredom, out of habit, and the generalization continues. So each time you eat in a new place or you get used to eating in a new place, then whenever you're there, you're going to start thinking, I need to eat. Like movie theaters kind of bank on you having the stimulus kind of set up, you walk in, you smell the popcorn. When you go to the movie theater, you're supposed to get popcorn. That's what the media tells us. So they're expecting that you're going to buy popcorn and eat it even if you're not hungry because that's what you're supposed to do when you go to the movies. So tying this all up in relapse prevention, we really want people to understand that people places things, times activities, feelings and self care can all be triggers for positive things. Can all be triggers for recovery and happiness, but they can also be triggers for unpleasantness. So it's important for them to understand which people and our people places and things are positive and trigger them to do things that are in their best interest. You know, think about a teenager in high school. You know, which group do you want them hanging around with the group that's likely to go out and get arrested and do graffiti, or the group that's likely to get straight As and you know be involved in extra curricular activities. As a parent, I know which group I would prefer. So we want to encourage people to know which social supports are happiness affirming. We wanted them to understand which places are positive and affirming and the characteristics of those places that may be stressful, or maybe relaxing. For me, I don't like the beach, you know, I'm one of those people a because we have skin cancer in my family, but be because I don't like having sand and every crevice. I'm not a beach person, I would much rather be in the mountains somewhere, but I know people who would just give their right arm to spend a week on the beach, because it's totally relaxing. So understanding what places are relaxing to you and how to improve your home, your car and your work environment and I say car because we spend a lot of time there. In order to be as relaxing and positive and happiness affirming as possible with stimuli, attending to as many of our senses as possible visual auditory olfactory. Our times are good for you. You know, we all have more energetic times of day, but we also know that there are certain times certain anniversaries certain holidays, which may be triggers for depression or anxiety. What can you do you can't make hallmarks stop having the holiday. So how can you survive Mother's Day or Valentine's Day or Christmas or some other holiday that triggers a significant amount of dysphoria. What activities can you do that make you happy, but what activities do you want to avoid, because they tend to add extra stress, or, you know, remind you of something that makes you sad. Feelings are an interesting one and we didn't really talk about this but feelings are rarely unique. You don't just have depression. A lot of times people will get depressed, and then they'll get angry about the fact that they're depressed and then they'll feel guilty because they can't don't have the energy to do the stuff that they want to when they're depressed, and it feeds in on itself. So if we're working with somebody who has generalized anxiety disorder, or depression, we want to say okay when you feel that what other feelings does that trigger, because let's deal with those two, let's not be dealing with all these complex emotions. Let's work on some radical acceptance and figure out how to deal and improve the next moment so you don't get stuck in this flurry or avalanche of negative associated feelings. And then self care. You know, good self care generally produces happiness and recovery. Lack of self care generally has negative effect. So having people understand what vulnerabilities they have and which ones are salient for them. My husband is hypoglycemic. So if he doesn't have access to food with regularity, and we can talk about insulin sensitivity later, but you can just see his mood change. And so I know that, you know, it's important to make sure we have access to something. Otherwise, he's going to be a great big old grump. I also knew that when he was on the road as a patrol officer. If he let his blood sugar get too low, he was pretty much destined to draw a complaint. And, you know, a few times when he did draw a complaint, he didn't realize his blood sugar was low. He looked back over and said you know what, it had been 11 hours since I'd eaten. And yeah, that was probably a contributing factor, not an excuse, but a vulnerability that he knew he needed to address. So triggers are stimuli that prompt a response. That's it. They are not positive or negative in and of themselves most of the time. So we can help people desensitize to, you know, some negative triggers. And we can also help people increase the positive triggers. Craving is the repeated thought or sustained desire for a response. So having the brownies being with your, you know, new relationship. You know, drugs, whatever it is for people who are marathon runners or intense exercisers who can get addicted to that endorphin high. There's actually a dysphoric mood that happens when they can't get access to those endorphins. So with addictions and our mental health issues have multiple triggers that we need to help them recondition. So we want to look at what things can we eliminate like cognitive distortions, low self-esteem, abandonment issues, you know, what things can we help them get rid of so that's not a problem anymore. But then of the things that are still left, how can we help them deal with it? Because sometimes life's going to hand you lemons and sometimes you're going to get on an elevator with somebody wearing that cologne. How do you handle it so it doesn't throw you into a downward spiral. Are there any questions? Okay, as you have questions or if you think of questions, please feel free to email me. I love having a discussion about it so cool. If you have things, if you marinate in it for a while and have a few other things to think about or say or input, please feel free to email me and, you know, we can have, we can have a discussion. And I might add it to the next time I do this presentation. All right, everybody have an amazing day and I will see you on Thursday for the pharmacology of opiates. Counselors, therapists and nurses since 2006. Use coupon code counselor toolbox to get a 20% discount off your order this month.