(This is an episode of Counselor Toolbox I thought would be helpful for you)
Relapse Prevention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHCExecutive Director AllCEUsObjectives~ Define relapse in terms of addiction as well as mental health~ Examine relapse prevention techniques~ Explore needs of the person: Psychosocial and MaslovianWhat is Relapse~ Relapse is the return to addictive behaviors or the recurrence of mood symptoms~ Relapse often starts long before the person uses again~ Get caught up in day-in-day-out~ Start acting “mindlessly”~ Stop going to meetings/counseling/church/lifeline~ Begins running out of energy to do new behaviors~ Frustration, irritability and exhaustion set in~ Caveat…an extreme stressor can prompt “immediate relapse” 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.Extreme Stressors ~ Those things that overwhelm an individuals ability to cope~ Thrust them into the fight or flight~ New coping skills and support resources may not even be considered, or only half-heartedly~ Have clients identify or practice dealing with these types of situations in group~ Divorce~ Death~ Job Loss~ Diagnosis of a terminal or chronic illness (Cancer, ALS, HIV)Beginner Tools for Extreme Stress~ Get support… You are outnumbered!~ Self-soothing/De-Escalation~ Systematic Desensitization~ Cognitive Behavioral Therapy~ 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
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. DBT 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 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 errorsRelapse 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”)Creating a Relapse Prevention Plan~ Triggers and Vulnerabilities are multidimensional~ Emotional~ Mental~ 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~ EventsEmotional 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 momentPreventing 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
Activity~ 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 (food, nicotine, drugs, relationship), 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.)~ “Screw It” 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
Connecting Unpleasant Thoughts & FeelingsPreventing 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)
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~ EventsPreventing 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 gymPhysical 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 “happy chemicals”~ 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 sleepRelapse Prevention Planning~ 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?~ How can you use this information to prevent relapse.Relapse Prevention Planning~ Review Prior Relapses (and recoveries)~ What was happening before the relapse/recovery?~ What triggered the relapse?~ Change occurs when old behaviors are more rewarding or stronger than new ones.~ Relapse: What became more rewarding than your recovery program?~ Recovery: What made doing the hard work of recovery so rewarding?
Relapse Prevention Planning~ Review Prior Relapses (and recoveries)~ Before you relapse, what changes in~ Your emotions~ Your thoughts~ Your behaviors~ Your interactions with others?~ As you recover, what changes in~ Your emotions~ Your thoughts~ Your behaviors~ Your interactions with others?~ What have you learned?Creating a Relapse Prevention Plan~ Relapse Warning Signs~ Warning Sign: Feeling unable to cope~ General Coping Strategy: I will learn how to say no to taking on extra projects, limit my work to 45 hours per week, and learn how to use relaxation exercises and meditation to unwind.~ Warning sign: Irrational thoughts~ Irrational Thought: I need to try harder in order to get things under control or else I will be a failure.~ Rational Thought: I am burned out because I am trying to hard. I need to time to rest or I will start making more mistakes.Relapse Warning Signs~ Warning Sign: Unmanageable Feelings (Humiliation, embarrassment, Failure)~ Feeling Management Strategy: Talk about my feelings with others. Remind myself that there is no reason to embarrassed. I am a fallible human being.~ Warning Sign: Self-defeating Behavior: Driving myself to keep working even thought I know I need to rest.~ Constructive Behavior: Take a break and relax. Ask someone to review the project and see if they can help me to solve the problem.Relapse Prevention Planning~ 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 relationshipsSelf-Esteem~ A sense of pride in who they are~ Acceptance of strengths and weaknesses~ Lack of self-esteem can lead to a need for external validation~ Self-Esteem workbooks abound to develop positive self esteem~ Eradicating harsh, self-critical self-talk is the second part (Taming the Critical Inner Voice)~ Be aware of the imposter phenomenon.
Mindfulness~ Relapse often begins when mindfulness ends~ Mindfulness is being aware of ~ Who you are~ How you feel (emotionally, mentally, physically)~ What you want (and what you actually need)~ Are you eating because you are hungry or stressed~ Are you sleeping because it is time or because you haven’t been sleeping well?~ What not getting wants met mean to you~ Activities~ Morning and evening journals~ Behavior Interruption esp. regarding substitute addictions
Mindfulness ACT Matrix Summary~ Relapse prevention begins with remaining aware of your wants, and needs~ Relapse begins when the old behaviors start to surface~ Avoidance~ Minimization~ Rationalization~ Denial~ Numbing~ Anger/resentment/regret~ People need to learn how to self-govern as a part of recovery