Relapse Prevention: Continuing my Journey
Parents are often afraid that their child will lose the progress that they have made once the MAP work ends, and have what is called a “relapse.” That is, once your child’s symptoms are reduced and s/he is feeling better and no longer in need of daily-weekly MAP work, you want to make sure that s/he can hold on to these positive changes in the long-term. Even if your child is no longer in need of regular, daily, exposure practices, maintaining progress is an important goal. Youth can and do slip back into old habits, and they can lose the improvements they have made. Luckily, there are ways to prevent relapse and get control over lapses.
What is the Difference Between a Lapse and a Relapse?
A lapse is a brief return to old and unhelpful habits or behaviours. It is a common and normal phenomenon. Sometimes lapses are triggered by stress and low mood or a difficult week at school.
A relapse is a complete return to all of your child’s old ways of thinking and behaving when s/he is anxious. Youth who have a relapse are often engaging in the same things that they did before they learned some new strategies for managing anxiety.
KEEP IN MIND: Lapses don’t have to lead to relapses. You and your child can stop a small lapse from becoming a relapse!
Let’s say that your child had a phobia of dogs in the past, but thanks to the hard work you did together, using the tools and worksheets in your child’s M.A.P. outlined on this website, your child is now generally calm and comfortable around dogs. Because of this hard work, your child knows that when s/he sees a dog it is best not to avoid it or run away. Instead, s/he might try to practise some calm breathing, use Balanced Thinking, and gradually approach the dog. However, your child has been under a lot of stress from school and sports recently, and is feeling a little more anxious than usual. On a particular day, your child notices a dog with one of the parents in the playground at after school pickup, and your child avoids it. When the owner and the dog are at school the next 2 days, your child avoids it again. This would be considered a lapse.
If, over the next few weeks, your child then resumed his/her old, unhelpful routines when seeing someone walking with a dog (e.g. not walking near dog parks, avoiding malls with pet shops, refusing to leave the house), then your child is probably having a relapse.
When does a lapse turn into a relapse?
Often, it is what you and your child say after s/he has had a lapse that can either help to get back on track, or lead him/her into a relapse. If your youth sees his/her lapse as a sign of failure, s/he is likely to give up and not try to use his/her tools to feel better. This can lead to a relapse. However, you can help your child understand that the lapse is just a "slip-up," perhaps because life has been a little more stressful or demanding lately or a reminder s/he hasn’t been using his/her tools recently. And even though there has been a "slip-up," expressing confidence that your child/teen can recover by “getting back on track,” will help prevent a relapse.
Going back to our dog phobia example: If your child avoided dogs all day but at the end of the day said to himself: “I guess I was starting to fall into my old pattern of avoiding dogs. This is a reminder I need to do some exposure so that I can get back on track.”
Your child’s lapse would probably stop because s/he would resume facing his/her fears and anxieties in a helpful way.
If, however, your child avoided dogs all day, and at the end of the day s/he said to himself: “Great! All that hard work trying to manage my anxiety was a waste. I’m right back where I started… I’m such an idiot. Well, I guess there is no cure for my anxiety; why even bother trying?”
Your child's lapse will probably turn into a relapse; he will probably stop using his M.A.P. tools and return to his old, unhelpful habits.
Tips for Preventing Lapses and Relapses
TIP #1: Practise, practise, practise!
The best way to prevent a lapse is to help your child to keep practising his/her CBT skills! If your youth is regularly practising, s/he will be in good shape to handle whatever situations arise.
How do you fit in practice?
Sit down with your child and make a schedule or a list of what skills s/he is going to work on every week. This might include exposure, or practising some calm breathing and relaxation, or using Coping Cards. Get friends and family to help! This is no different than when we schedule in a regular time to go the gym each week or a meeting with a friend. Schedule the following important skills into your child's week.
TIP #2: Knowing your red flags
Your child is less likely to have a lapse if s/he knows when s/he is more vulnerable to having one. Stated another way, when s/he can see the warning signs. For example, most lapses occur during times of stress or change.
Make a list of warning signs that will help your child to know when anxiety might be increasing. This list might include:
- More physical feelings of anxiety
- Increased responsibilities at home or school
- More anxious thoughts
- Arguments and fights with friends and family
- Major life changes (e.g. changing schools, starting to date, death in the family)
- Avoiding activities s/he used to do
Make a plan of action. When your child knows what his/her “red flags” or “danger signs” are, s/he can make a plan for how to cope with them. This might involve:
- Practising CBT skills more often
- Taking some time to relax
- Asking others to help with things that seem overwhelming
- Getting good sleep and rest
TIP #3: Coming up with new challenges
Like all of us, there are always things your child can do to improve him/herself and make life more enjoyable and fulfilling. A good way to prevent future lapses is to help your child continue working by approaching new challenges and new feared situations. Together you can make a list of situations that are still scary or cause some anxiety, and work on them in time. This is like having a “monthly exposure ladder” rather than a weekly one. On this “monthly” ladder you and your child can write out what challenges will help your child feel more confident and less anxious over the course of a month. S/he can also review his/her Time Capsule to see what tools worked the best when s/he was doing routine CBT work. Help your youth to start doing these again. With some of these actions in play, your youth will be less likely to slide back into old habits when s/he is continually working on new and different ways of overcoming anxiety.
TIP #4: Learn from your lapses
Remember that it is normal to occasionally have lapses. Remind your youth that in our daily lives everyone has times of greater stress. If s/he is coping with extra anxiety (such as during exam period or when there are challenges in a friendship), this can make your child even more vulnerable to a lapse. The good news is that s/he can learn a lot from these lapses. Try to figure out what about the situation led to your child having a lapse by having him/her ask:
- Was I having upsetting or anxious thoughts?
- Was my anxiety very high?
- Did I do something different?
- Did I know that the situation was going to be difficult or did it take me by surprise?
Knowing why a situation was more difficult for your teen can help him/her to prepare for the next time. Together you can make a plan to help your child cope more successfully with difficult situations in the future.
TIP #5: Knowing the facts!
We know that what kids and teens say to themselves after a lapse has an impact on their behaviour later. If your child thinks s/he is a failure, and that their lapse means all their hard work is a waste, s/he is more likely to give up, stop trying, and end up relapsing. But here are a few facts:
- It is impossible to go back to square one: your child cannot unlearn all the skills and techniques that CBT has given. Being back at square one means having anxiety and not knowing how to handle it. But once your child has started using CBT, s/he DOES KNOW how to handle the anxiety.
- If your child has a relapse, s/he CAN get back on track. It might have taken months of practice to reduce his/her anxiety symptoms, but it won’t take that long to get back to where s/he was before the relapse. When your youth gets back to practising his/her CBT skills, s/he will be mastering the anxiety again in no time.
Like riding a bike…
Think of your child’s CBT skills like learning to ride a bike. While it can take time to learn, once your child knows how, s/he won’t forget! If s/he stops biking for a while s/he might be a bit rusty, but it won’t be long until s/he is as good as before.
TIP #6: Rewards
Make sure you work with your youth to include a reward system if that helped in the past. Your child may need an extra boost to help motivate him/her to get back on track using his/her M.A.P. skills and tools. Remember that managing anxiety is hard work and any progress your child makes is due to hard work and effort. Doesn’t that deserve a reward?