Relapse Prevention

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Dr. Dawn-Elise Snipes PhD, LMHC, LPC
~    Define Relapse
~    Identify Relapse Warning Signs
~    Identify Strengths
~    Learn about how your issue developed
Relapse Definition
~    Relapse is the return to something that has been previously stopped
~    Relapse is multidimensional
~    Emotional
~    Mental
~    Physical
~    Social
~    A relapse is when you start returning to any of these people, places, things, behaviors or feeling states.
Activity: Distress vs. Happiness Worksheet

In your Unhappiness
~    Emotionally
~    Mentally
~    Physically
~    Socially

When you are Happy
~    Emotionally
~    Mentally
~    Physically
~    Socially
~    Triggers are stimuli that set off an event.
~    Triggers can prompt positive or negative event as
~    Triggers can be
~    Visual
~    Auditory
~    Tactile
~    Olfactory
~    Cognitive
~    Temporal (Time or location)

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; anxiety/fear/stress; depression)
~    Things/Media
~    People
~    Places
~    Events
Emotional Relapse
~    Negative emotions make us uncomfortable
~    Identify the emotion, 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
~    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 or improve the next moment
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‚Äôs way of telling us to get off our butts and do something‚ÄĒLike our car‚Äôs 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
~    Identify and put in place triggers for positive emotions

~    List 10 things that you chose to get anxious or angry about over the last week
~    Why did you get upset?  (What was your mind telling you needed to be fixed)
~    Did holding on to the upsetness do any good?
~    What was your initial reaction, and was it helpful?
~    What could you do differently next time to either
~    Change/fix the situation (Improve the next moment)
~    Change how you feel about the situation  (Walk the middle path)
~    Let it go (Radical Acceptance)
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
~    If you had an addiction, you may also be:
~    Thinking about people, places, and things you used with
~    Glamorizing your past use
~    Lying to yourself and others
~    Justifying your behaviors
~    Minimizing the impact of one (drink/hit/bet etc.)
~¬†¬† ¬†‚ÄúScrew It‚ÄĚ attitude

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

Identifying Unpleasant Thoughts
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)

Identifying Pleasant Thoughts
Social Relapse
~    Symptoms
~    You have returned to the old people and places who co-sign on your b.s.
~    You have withdrawn from your social supports
~    You have become self-centered
~    You have withdrawn
~    What triggers your social relapse
~    People
~    Places
~    Things
~    Events
Preventing Social Relapse
~    Contact your social support(s) on a daily basis for the first 3 months
~    Keep a business card in your wallet with the names and numbers of 3 social supports
~    Change your phone number (if possible) and destroy contact information for people who might trigger a relapse
~¬†¬† ¬†Find at least one prosocial activity to do each week —volunteer, church, go to the gym
~    What triggers can you put in your environment to remind you to use these tools?
Physical Relapse
~    Physical relapse is characterized by:
~    Fatigue
~    Increased anxiety
~    Difficulty sleeping
~    Neglecting physical health (sleep, exercise, nutrition, medication)
~    If there was also addiction…
~    Cravings
~    Dreams about the drug

Preventing Physical Relapse
~    HALT
~    Hungry
~    Nourish your body with proper nutrition
~¬†¬† ¬†Nourish your mind with activities and things that increase ‚Äúhappy chemicals‚ÄĚ
~    Angry/Anxious
~    Reduce chronic stress
~    Lonely
~    Nurture social supports to buffer stress
~    Be willing to ask for help
~    Tired
~    Get sufficient quality sleep
~    Address issues such as sickness and pain that prevent quality sleep
Review Strengths
~    What is life like when you are happy?
~    What is different?
~    What is the same?
~    List three ways you cope with stress.
~    What activities do you like to do?
~    What are your positive qualities and strengths?
Review Prior Relapses
~    What was happening before the relapse?
~    What triggered the relapse?
~    Relapses occur when old behaviors are more rewarding or stronger than new ones.
~    What became more rewarding than your recovery program?
~    Before you relapse, what changes in
~    Your emotions
~    Your thoughts
~    Your behaviors
~    Your interactions with others?
~    What have you learned?
Creating the Plan
~    Why do you want to change
~    What are the most common pitfalls for your relapse
~    What you can do to prevent that from happening again
~    What has worked in the past

~    Create a schedule including
~    Recovery activities
~    Work
~    Reflection time
~    Positive health behaviors including nutrition, exercise, sleep
~    Nurturing positive relationships
The Forgotten Parts
~    Two main things people forget when they try to make a change plan
~    We do what we do for a reason, and any substitution MUST fulfill the same function to the same degree
~    You would not go on a diet and replace chocolate with celery
~¬†¬† ¬†It is as more about living a healthier lifestyle, guided by purposeful action, than ‚Äúremoving‚ÄĚ any one behavior
~    If you remove the behavior without an adequate replacement you will relapse
~    If you remove the behavior, but are still around the same PPTs, you may relapse
~    If you are immersed in positive activities, you will have less time to make the wrong choices
Tips for Increasing Motivation
~    Decisional Balance Exercises
~    Increase/Strengthen these
~    The benefits of the new behavior
~    The drawbacks to the old behavior
~    Decrease/Mitigate these
~    The benefits of the old behavior
~    The drawbacks to the new Behavior
~    Find meaning in everything…After you do any activity or read any literature, ask yourself…
~    What was in it for me?
~    What is one thing I can take away from this (even if it only that you were reminded how much you do not want to use again)
Bucket Lists
~    In our unhappiness we often forget what makes us happy, or neglect things we love.
~    All work and no play puts you at risk, even if a lot of the work is on your recovery.
~    Make a list of …
~    Things you enjoy doing  (Scrabble, gardening, exercise, baking…)
~    Things you would like to do or try (hiking, cooking class, playing in a band, reading…)
~    Is there anyone you knowwith similar interests? If not, where would you find them?
~    Do at least 5 per week

Relapse Prevention Planning Highlights
~¬†¬† ¬†Include time in the morning and at night to use mindfulness skills to ‚Äúget grounded‚ÄĚ
~    Identify and prevent or mitigate vulnerabilities each day
~    Avoid alone, idol time if your mind tends to wander to dark places
~    Incorporate positive experiences each day
~    Set realistic daily goals
~    Give yourself credit for positive accomplishments

~    Relapse triggers can be emotional, mental, physical or social
~    For each trigger you identified, describe at least 1 way you can deal with it
~    Practice mindfulness each day can help you become aware of your personal, daily vulnerabilities for relapse
~    For each general category, identify 3 things you can do to continue on your journey toward happiness