Relapse Prevention Planning
There are various forms of relapse prevention training. Most follow a similar pattern with and employ the following common elements:
- Identifying high-risk situations: Symptoms are often initiated by particular times, places, people, or events. For example, a person with agoraphobia is more likely to experience symptoms of panic in a crowded building. An essential key to relapse prevention is to be aware of the specific situations where one feels vulnerable. These situations are called “triggers,” because they trigger the onset of symptoms. While people with the same mental disorder may share similar triggers, triggers can also be highly individual. People tend to react sometimes unknowingly to negative experiences in their past. For example, a woman who was sexually abused as a child may have negative emotions when in the presence of men who resemble her abuser. Because some triggers occur without conscious awareness, individuals may not know all their triggers. Many relapse prevention programs encourage individuals to monitor their behavior closely, reflecting on situations where symptoms occurred and determining what was happening immediately before the onset of symptoms. With this kind of analysis, a pattern often emerges that gives clues about the trigger.
- Learning alternate ways to respond to high-risk situations: Once triggers have been identified, one must find new ways of coping with those situations. The easiest coping mechanism for high-risk situations is to avoid them altogether. This may include avoiding certain people who have a negative influence or avoiding locations where the symptom is likely to occur. In some instances, avoidance is a good strategy. For example, individuals who abuse alcohol may successfully reduce their risk by avoiding bars or parties. In other instances, avoidance is not possible or advisable. For example, individuals attempting to lose weight may notice that they are more likely to binge at certain times during the day. One cannot avoid a time of day. Rather, by being aware of this trigger, one can purposely engage in alternate activities during that time. Strategies for coping with unavoidable triggers are generally skills that need to be learned and practiced in order to be effective. Strategies include but are not limited to discussion of feelings, whether with a friend, counselor, or via a hotline; distraction, such as music, exercise, or engaging in a hobby; refocusing techniques, such as meditation, deep-breathing exercises, progressive muscle relaxation (focusing on each muscle group separately, and routinely tensing then relaxing that muscle), prayer, or journaling; and cognitive restructuring, such as positive affirmation statements (such as, “I am worthwhile”), active problem solving (defining the problem, generating possible solutions, identifying the consequences of those solutions, choosing the best solution), challenging the validity of negative thoughts, or guided imagery (imagining oneself in a different place or handling a situation appropriately).
- Creating a plan for healthy living: Besides being prepared for high-risk situations, relapse prevention also focuses on general principles of mental health that, if followed, greatly reduce the likelihood of symptoms. These include factors such as balanced nutrition, regular exercise, sufficient sleep, health education, reciprocally caring relationships, productive and recreational interests, and spiritual development.
- Developing a support system: Many research studies have demonstrated the importance of social support in maintaining a healthy lifestyle. Individuals who are socially isolated tend to display more symptoms of mental disorders. Conversely, individuals with mental disorders tend to have more difficultly initiating and maintaining relationships due to inappropriate social behavior. For such people, a support system may be nonexistent. Research suggests that support systems are most effective when they are naturally occurring in other words, when a circle of family and friends who genuinely care about the individual is already in place. However, artificially created support systems are certainly better than none at all. For this reason, relapse prevention programs strive to involve family members and other significant persons in the addiction treatment program. Everyone in the support system should be knowledgeable about the person’s goals, what that person is like when he or she is doing well, and warning signs that the person may be on a path toward relapse. The support system agrees on who will take what role in encouraging, confronting, or otherwise caring for that person. Self-help groups such as Alcoholics Anonymous or Moderation Management are often examples of artificially created support systems.
- Preparing for possible relapse: Although the ultimate goal of relapse prevention is to avoid relapse altogether, statistics demonstrate that relapse potential is very real. Individuals need to be aware that, even when exerting their best efforts, they may occasionally experience lapses (one occurrence of a symptom or behavior) or relapses (return to a previous, undesirable level of symptoms or behavior). Acknowledging the potential for relapse is important, because many people consider a lapse or relapse as evidence of personal failure and give up completely. In their widely acclaimed book for professionals, Motivational Interviewing, William R. Miller and Stephen Rollnick cite a study by Prochaska and DiClemente that found that smokers typically relapse between three and seven times before quitting for good. From the perspective of Miller and Rollnick, each relapse can be a step closer to full recovery if relapse is used as a learning experience to improve prevention strategies. Although some argue that such a tolerant attitude invites relapse, general consensus is that individuals need to forgive themselves if relapse occurs and then move on. Some relapwe prevention programs include designing a crisis plan to be put into effect if a relapse occurs. The crisis plan involves specific actions to be taken by the individual or members of the support system.
These elements are common to all relapse prevention programs, but programs can be further customized to meet the particular characteristics of a disorder. For example, prevention of depression or anxiety may focus on becoming aware of thoughts as passing mental events rather than facts about self or reality. Learning to identify bodily sensations that accompany maladaptive thoughts is also important for preventing depression and anxiety. Addictive disorders concentrate on reactions to social pressure, interpersonal conflicts, and negative emotional states as part of a relapse prevention plan.
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