Triggers are the consequence not the cause

Dr. Stacey began an interesting discussion regarding triggers and consequences for us ED folks. It struck me as wrong somehow, so I thought a bit about it, and I’m happy with my response in the comments section. I want to repeat it here.

She described a simple functional analysis of our ED behavior as this:

TriggersàBehaviorsàConsequences

Where the Trigger is the people, places, things, emotions, stimuli, physical symptoms, etc. that lead us to turn to food or not. The Behavior is our particular preference of coping mechanism. And, the Consequences are the positive or negative results of our selected Behavior.

You can read her full post plus several others’ comments here. The below is my response:

I argue that the "triggers" you talk about and that we ED folks fear so much are actually the CONSEQUENCES of our irrational beliefs and interpretations of ourselves and our place in the world. They alone do not cause us to turn to food. At the time we feel triggered, we have already made a big mistake somewhere along the way. The feelings of anxiety, guilt, stress, boredom, fear, regret, resentment, etc. are consequences of our bad beliefs. We turn to food as a last resort to make ourselves feel better. But, if we fix our crap beliefs and learn to make decisions based on rational, reasonable beliefs, we stop feeling those bad feelings. And, subsequently, no urge to turn to food.

I have proven this to myself over and over in the last couple of years since I began working on my crap beliefs. This is the sequence of events:

1)       an irrational, old, subconscious belief leads me to dishonor myself in some way (deny or criticize my own needs or wants, put others’ needs before my own, drive myself to exhaustion, insist on my own perfection, harbor resentment against others, obsessing over my body rather than address something frightening that needs my attention, etc.),

2)       I subsequently feel awful (anxious, guilty, resentful, etc.),

3)       I become paralyzed with my self-defeating feelings and thoughts (as evidenced by my procrastination, lack of energy, depression),

4)       I turn to food for comfort and to quiet the chaos in my head so I can simply function.

5)       Begin at 1) again.

By the time I feel overly anxious or angry or whatever, the damage has already been done. Fighting off the subsequent urge is only temporary. It’s guaranteed that I will get another urge and another until I stop making the self-defeating choice that originally lead me to feel awful and made binging seem like the solution.

When we focus on stopping the coping mechanism, we are failing to deal with the underlying crap that make us feel so bad in the first place that we NEED something to help us cope. We will continue to NEED a coping mechanism until we fight our irrational beliefs that cause us to feel bad.

I’ve found a great book that explains this all very clearly and simply - Self-Defeating Behaviors: Free Yourself from the Habits, Compulsions, Feelings, and Attitudes That Hold You Back.

I believe the functional analysis really should look like this:

Irrational beliefàSelf-defeating decisionàBad consequences (triggers, bad thoughts and feelings)àAddictive behavior

We all know our addictive behavior has horrible consequences (loneliness, rotten teeth, death) but knowing this does nothing to stop us from turning to our coping mechanism. Nothing - except to make us feel worse.

Like I said, by the time we get to the addictive behavior stage, it's way too late. Not many people have the will-power to white-knuckle it through the subsequent urges. I never did. Good thing my recovery was based on fighting my irrational beliefs in stage #1 of the process.

In addition, I think the placement of triggers at the beginning of the process is actually dangerous cuz it leads us to believe that we must avoid anything that might be triggering – stressful situations, a bad day, difficult people, loss, change or uncertainty, new experiences that could be frightening or (God-forbid) overwhelming, or whatever.

But, that’s not realistic or even reasonable at all. To try to avoid these things is to live in a bubble. Is it really living at all?

But, instead, if we fight the irrational beliefs such as the ones we’ve discussed so much in the last few weeks, we’ll find within us just enough courage and self-trust to push through the fear and accomplish what we want and need to. With every tiny little success, we gain courage and self-confidence and fear loses its death-grip of control over us. We soon realize that we can face stress, difficult people, new experiences, hardships, etc. knowing that we’re strong enough and creative enough to get through it just fine.

We make fewer and fewer self-defeating decisions, and so we never have to experience the triggers or addictive coping behavior again. The urges just fade away.

Comments

[Michelle Hope]

By the way, I'm really grateful to Dr. Stacey for thinking to include a diagram like she did. I think it's a fabulous way to help us examine and discuss the ED process in an objective way. I guess that's her education coming through! What do you guys think?

[em]

Whenever I read your blog you make me *think* which I like because I'm used to thinking about my ED in one way (more like Dr. Stacey does I think) but I realise I need to change my thinking to make changes in my life... so thank you for sharing this - you are challenging me to think differently.

[drstaceyny]

Hi, Michelle--thanks for your comments and for addressing my ideas in your post. I actually agree with you--what you present is a cognitive-behavioral explanation (namely, that our evaluation/interpretation--fueled by irrational beliefs and self-defeating decisions, as you suggest--of certain stimuli leads to uncomfortable feelings, which precipitate maladaptive behaviors). However, one may argue that the thought-->feeling part of the equation all falls under trigger, in the simplified functional analysis, since this process ultimately results in the behavior we're trying to overcome--a trigger need not be a simple event, but rather how we make sense of/react to/incorporate that event. Hope this makes sense. . . Dr. Stacey

[Nick]

Hello Michelle,
I just stumbled onto your site about n hour ago and have been reading a bunch of the different links you have to multiple posts. I just read this post and as a college senior male who has been struggling with bulimia since I was 16, I could not agree more with your thoughts. I cannot wait to read more in the coming days and just wanted to say thank you.

[Michelle Hope]

Hi Nick.

Welcome to the blog! Thank you so much for taking a moment to write! I especially appreciate your note because you're a man. I haven't received enough feedback from you guys. If ever you want to write up a post from your perspective, I would be honored to post it here in the blog.

Keep my contact info handy.

I hope you find lots of useful stuff in the blog and the books I've listed.

I wish you the best of luck in everything.

With love and respect,
Michelle

[Jakki Crosser]

Just read this post and I must also agree completely. It made me think a couple of the things when I read this.

First, that this is just amazing, absolutely brilliant Michelle!

Second, that I am amazed at how I ever stopped myself from purging, because as you mentioned, once you have gotten to the point of depression, anxiety, guilt, etc. there is no turning back.

But I stopped when I met Ben, my now husband. Just thinking about it makes me all that more thankful for him. I now realize how he helped me was by making me feel loved no matter what. Of course, I was also ready to let someone love me like that too. I let myself truly believe that he would love me whether or not I looked horrible, or amazing, lost 5 pounds or gained 100. Honestly, for most of the time we were dating, I had no idea why he wouldn't just break up with me already. I was always getting mentally prepared for him to just get sick of me and my moodiness. But the important thing was that I just let myself believe that I could stop purging and trust that everything would be ok.

I feel so much better now that I don't do that, but now I realize that I still never learned how to cope with all those emotions and never got rid of all my other crappy beliefs that are really holding me back. Ben did enabled me to get rid of one huge negative belief (that I have to throw up or I'll be obese and unlovable) and I'll love him forever for that.

Now, I'm still dealing with my depression, lack of motivation, and binge eating which is now my coping mechanism. But because of this website, I have realized the binging is definitely a direct connection to my negative thought patterns.

I am so thankful for this, I only hope I don't lose momentum with the healing process.