Relapse Prevention
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director AllCEUs

What is Relapse
Relapse is the return to addictive behaviors or the recurrence of mood symptoms.  Relapse often starts long before the person uses again when people start getting caught up in day-in-day-out and acting “mindlessly.”  They stop going to meetings/counseling/church/lifeline, begin running out of energy to do new behaviors and then….frustration, irritability and exhaustion set in. (While that is the typical course, it is important to remember that an extreme stressor can prompt “immediate relapse”)

 

Relapse is the return to something that has been previously stopped.  Relapse is emotional.  You start feeling sad, angry, stressed, lonely.  Relapse is mental.  You start having difficulty making decisions, begin acting impulsively instead of considering the consequences and tend to have a more negative/pessimistic outlook on life and things. Relapse is physical.  Your sleeping changes.  You have less quality sleep (even if you are sleeping more hours).  You may gravitated toward comfort foods (high-fat, high sugar).  You start having more aches, pains and headaches and generally feeling rundown and fatigued. Relapse is social.  You may withdraw from friends and family and healthy supports either to be alone or to rejoin with people who will co-sign on your b.s..  You may start being suspicious, holding resentments and doing more blaming of others.

Beginner Tools for Extreme Stress

  • Get support… You are outnumbered!
  • Self-soothing/De-Escalation.  Start being mindful (watch the mindfulness video here) and practicing distress tolerance skills (watch the distress tolerance video here).
  • Systematic Desensitization
  • Cognitive Behavioral Therapy (Video the CBT video here)
  • CPT Note Card
    • I feel… because ……
    • What am I upset about
    • What are the FACTS for and against this belief
    • Am I using all or nothing thinking or jumping to conclusions
    • I need to call _______ to get an objective perspective or what would _____ do

 

Use The 4 Ds

  • Delay – Most urges, feelings and cravings rise and fall like waves in about 20 minutes if you do not “feed” them
  • Distract – Craving time passes more quickly when engaged in a distracting activity for a few minutes.  Use Distress Tolerance Skills to IMPROVE the moment and ACCEPT reality. (distress tolerance video)
  • De-Stress – By reducing your stress and distress, you are allowing your body to maintain higher levels of calming and “happy” chemicals. For more tips, listen to the Happiness Isn’t Brain Surgery Podcast or watch the videos on preventing vulnerabilities.
  • De-Catasrophize – Challenge your thoughts and when necessary, reframe them into more accurate notions, like, “This is really uncomfortable, but I can manage.“  Video on thinking errors

 

Create a Relapse Prevention Card

  •  Fold a paper into four squares:
  • On the first square, write: “Delay, Distract, De-Stress, De-Catastrophize
  • On the second square, write out 5 personally relevant distraction ideas
  • On the third square, write out 3 of your most significant reasons for wanting to recover
  • On the fourth square, write out some negative expectations – accurate predictions for what will happen if you slip (over eat, smoke, drink, say “yes” when you need to say “no”)

Create a Relapse Prevention Plan
Just like relapse is multidimensional, triggers and vulnerabilities are too.

  • What are your triggers in each area: Emotional, mental/thoughts, physical, social, environmental?
  • What are your vulnerabilities in each area…That is, what things, people and conditions make it more likely that you will be triggered by triggers.  When you are rested, surrounded by supportive people and happy, it is easier to deal with triggers than when you are tired, lonely and depressed.  So…what are your vulnerabilities in each area: Emotional, mental/thoughts, physical, social, environmental?
  • Cravings: Compile a list of who you can call, what you can do to distract yourself from a craving and how you could stop a craving altogether. (gambling, smoking, sex, over eating)
  • Healthy tools: Think about what new and old behaviors/tools you can use to keep you on the right track. Some examples include writing a list of consequences should you relapse, attending a support meeting, exercising, journaling, or writing a gratitude list.

Emotional Relapse
In emotional relapse, your emotions and behaviors become negative and unpleasant.  You start finding it difficult to experience pleasure
What triggers your negative emotions (Anger/resentment/jealousy/guilt; depression; anxiety/fear/stress)

  • Things/Media
  • People
  • Places
  • Events

Emotional Relapse
Negative emotions make us uncomfortable. Identify the emotion and explore why you are feeling that way and take steps to fix the problem.

You can become stuck in the emotion, sometimes nurturing and blowing it out of proportion, compounding it with other emotions like anger and guilt, personalizing it, or trying to escape from it.  Remember that emotions are just cues like a stoplight. You feel how you feel in the moment.  You can choose to change/improve the next moment, stew in the emotion or do something to try to escape.  What is going to get you closer to the things and people that are meaningful to you?

Preventing Emotional Relapse

  • Practice mindfulness
  • Increase positive experiences (real and guided imagery)
  • Keep a gratitude journal
  • Avoid personalizing something that may not be about you
  • Remember that negative emotions are the mind’s way of telling us to get off our butts and do something—Like our car’s idiot light or hunger pangs.  Dwelling on, nurturing, avoiding or hiding from negative emotions never makes anything better.  You can *choose* to feel and fix, or relapse and repeat

Mental Relapse
In mental relapse there's a war going on in your mind.  Part of you wants to stay positive, but part of you is struggling with tolerating the distress.
The signs of mental relapse are:

  • Focusing on the negative
  • Having a pessimistic/helpless/hopeless attitude
  • Lying to yourself and others
  • Justifying your behaviors
  • Minimizing the impact of one (drink/hit/bet etc.)
  • “Screw It” attitude
  • If you had an addiction (food, nicotine, drugs, relationship), you may also be thinking about people, places, and things you used with or glamorizing your past use

 

Mental Relapse

What types of things trigger negative thoughts?

  • Things/Media
  • People
  • Places
  • Events

What thoughts do you have that make you feel

  • Angry/irritated/resentful
  • Guilty
  • Envious
  • Scared/Anxious/Worried/Stressed

Connecting Unpleasant Thoughts & Feelings &Preventing Mental Relapse

  • KISS: Keep It Simple Stupid
  • Trying to change too many things at once can lead to failure
  • Often some of simplest things can have the greatest impact
  • Prevent and address vulnerabilities that can make you focus on negative or have a strong, negative emotional reaction
  • Good Orderly Direction: Your life is a road map. The destination is recovery and happiness.  Before you act, think whether that keeps you on the right road, or is an unplanned detour
  • Maintain Head-Heart-Gut Honesty (Rational, Emotional, Wise Mind)

These are just a few suggestions for relapse prevention.

View the Counseling CEU course for this presentation.

This course is also included in our unlimited CEU packages.