 |
This Web site is a component of the SAMHSA Health Information Network. |
|
Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Illness Management and Recovery Workbook
Chapter 7
Practitioner Guidelines for Handout #6:
Reducing Relapses
Introduction
This module helps people examine their previous experience with relapse in
order to develop a relapse prevention plan. Practitioners help people identify
triggers, early warning signs, and steps they can take to help prevent relapses.
People are encouraged to include their family members and other supportive people
in reading the handout, participating in sessions, and contributing to the development
of a relapse prevention plan.
Goals
- Convey confidence that people can reduce the chances of
experiencing a relapse in the future.
- Help people identify triggers and early warning signs of
an impending relapse.
- Help people develop their own relapse prevention plan.
- Encourage people to include family members and other supportive
people in developing and implementing plans for reducing relapses.
Number and pacing of sessions
“Reducing Relapses” can usually be covered in two to four sessions.
Within each session, most people find that covering one or two topics and completing
a questionnaire is a comfortable amount.
Structure of sessions
- Informal socializing and identification of any major problems.
- Review the previous session.
- Discuss the homework from the previous session. Praise
all efforts and problem-solve obstacles.
- Follow-up on goals.
- Set the agenda for the current session.
- Teach new material (or review material from the previous
session if necessary).
- Summarize the progress made in the session.
- Agree on homework to be completed before the next session.
Strategies to be used in each session
Motivational strategies
People who have experienced severe episodes of psychiatric symptoms, which
may have led to hospitalization, are usually readily motivated to avoid future
relapses of their symptoms. Relapses and rehospitalizations are often upsetting
and even traumatic events. Helping people reduce the chances of relapse through
developing a relapse prevention plan can give them greater control over their
lives. Thus, people can be motivated to develop a relapse prevention plan in
order to gain better control over their lives and thereby pursue their goals.
It is important to make direct connections between the content of this module
and how the information might help someone prevent relapses. Although past negative
experiences are discussed, the overriding question is “What can be done
to make things better for you in the future?”
The following suggestions may be helpful:
- For each major topic covered in the handout, practitioners
can help people to identify what their own experiences have been. Most of
the sections include probe questions which can be used to facilitate discussion.
- The questionnaires and checklists in the handout (“Examples
of Common Triggers,” “Examples of Common Early Warning Signs,”
“Early Warning Signs Questionnaire,” “People Who Could Help
Me Recognize Early Warning Signs”) can help people relate the information
to their own experience.
- Practitioners should keep in mind the goals identified
by people in earlier sessions. There are numerous opportunities to connect
relapse prevention with goal achievement. There are also opportunities to
set new goals.
Educational strategies
Educational strategies for this module focus on increasing people’s
knowledge about the key concepts of relapse prevention, including triggers,
early warning signs, and developing a relapse prevention plan. For example,
learning that stress can contribute to relapse may help people understand how
stressful events may have played a part in previous relapses.
The following educational strategies were discussed in detail in Module #1:
- Review the contents of the handout by summarizing or taking
turns reading paragraphs.
- Pause at the end of each topic to check for understanding
and to learn more about the person’s point-of-view.
- Allow plenty of time for questions and interaction.
- Pause to allow the person to complete the checklists and
questionnaires.
- Break down the content into manageable “pieces.”
- Find a pace that is comfortable to the person.
Cognitive-behavioral strategies
Cognitive-behavioral strategies focus on helping people learn more effective
skills for preventing relapses in the future. Developing and implementing a
relapse prevention plan involves systematic practice (rehearsal) of the steps
of the plan, and homework to further rehearse the skills.
At the end of each session, practitioners can help people role-play how they
might practice specific strategies or steps in the relapse prevention plan.
The following examples may be helpful:
- For people who have difficulty identifying triggering events
or early warning signs of relapse, practitioners can encourage them to get
input from family members or other supportive people. Practitioners can help
people role-play what kinds of questions they might ask someone to find out
information about early warning signs and triggers.
- There are many opportunities for using cognitive-behavioral
strategies when helping people develop their relapse prevention plans. For
example, if people decide that decreasing stress is part of their relapse
prevention plan, practitioners can help them role-play deep breathing or muscle
relaxation. If calling a friend is part of their plan, they can role-play
what they would say when they made the call. If increasing medication is part
of their plan, they can role-play talking to their doctor.
Homework
Homework for this module focuses on helping people put into action what they
are learning about relapse prevention.
Practitioners can follow up on homework by asking how it went. They can reinforce
completed homework or the effort people have made to complete homework. If people
are not able to complete the homework, practitioners can gently ask what got
in the way and help them develop (and sometimes practice) ways of overcoming
obstacles.
The following examples of homework may be helpful:
- Talking to family members and supporters about past triggers.
- Talking to family members and supporters about early warning
signs of relapse they observed in the past.
- Reviewing what helped and what did not help during past
relapses or impending relapses.
- Drafting or revising a Relapse Prevention Plan.
- Asking family members, friends and other supporters to
play a specific role in the Relapse Prevention Plan.
- Collecting necessary phone numbers for the Relapse Prevention
Plan.
- Posting a copy of the person’s Relapse Prevention
Plan in an accessible (but private) place.
- Informing relevant people of the Relapse Prevention Plan.
Asking people named in the plan to read the plan and giving them their own
copies.
- Gathering any supplies necessary for the Relapse Prevention
Plan, such as buying herbal tea to drink as part of reducing stress.
- Initiating a component of the Relapse Prevention Plan that
is more effective if done on a regular basis, such as going to a support group.
Tips for common problems
- People may report that they have had no early warning signs
before relapses.
When people don’t remember experiencing early warning signs, it may
be helpful for them to talk to family members and other supportive people
about what they remember. If no one can recall early warning signs, practitioners
can help people identify the earliest symptoms they experienced before a full
relapse.
- People may find that talking about relapses brings back
unpleasant memories.
Practitioners can focus the discussion on identifying important information
for the future, and help people avoid self-blame. When people berate themselves
by saying things such as “I should have known...” or “What
a fool I was...” it is helpful to remind them that it can be very difficult
to predict relapse. It is also helpful to point out their strengths in managing
their illness and praise their participation in developing a plan for improving
things in the future.
- Bringing up these memories and talking about them a little might be helpful,
because the person might benefit from developing a new perspective on prior
relapses (e.g., shifting from self-blame), and may become more motivated to
work on reducing future relapses.
Review Questions
At the end of this module, practitioners can use either open-ended questions
or multiple-choice questions to assess how well the person understands the main
points.
Open-ended questions
- What is an example of a something that might trigger a
relapse?
- What is an early warning sign?
- What is an example of an early warning sign you have experienced?
Other examples?|
- What is an example of something people can do to prevent
an early warning sign from becoming a relapse?
- How can a family member or other supportive person be part
of a relapse prevention plan?
Multiple choice and true/false questions
- Which of the following is a common situation or event that might
trigger a relapse?
Being under stress
Receiving a phone call
Reading
- Which of the following two items are examples of common early warning
signs?
Feeling tense or nervous
Trouble sleeping
Feeling calm
- “Early warning sign” is another term for “side
effect of medication.” True or False
- One thing people can do to prevent an early warning sign from becoming
a relapse is:
Consult with someone on their treatment team
Stop taking medication
Keep the information to themselves
- People often ask family members and supporters to be part of their
relapse prevention plan by:
Taking over and doing everything
Being alert to early warning signs
Ignoring problems they see
Back to top
TOC | PREVIOUS
| NEXT
|
|
