Relapses and how to prevent them!
Relapses happen all the time, indeed most people will have tried several times and not succeeded at many kinds of things in life, love, leisure, work, and business.
The Relapse Prevention model (RP) was originally developed as a behavioural maintenance programme for use in the treatment of addictive behaviours (Marlatt and Gordon, 1980). RP focuses on the maintenance phase of the behavioural change process and from this perspective potential and actual relapses are targets for intervention.
RP treatment approaches include specific interventions such as identifying high-risk situations and enhancing coping skills in those situations, increasing self-efficacy, dispelling myth’s around the changes we're making and their management, managing lapses and restructuring perceptions of the relapse process (Larimer, Palmer and Marlatt, 1999).
The RP approach assumes that the individual experiences a sense of perceived control while maintaining the required behavioural changes, and the longer the period of successful behavioural change the greater the individual's perception of self-control. This perceived control continues until a high-risk situation is encountered that attempts to threaten the individual's sense of control and increases the risk of potential relapse.
Gordon and Marlatt, (1980) identified three high-risk situations that were associated with almost three-quarters of all the relapses reported in their study:
1. Negative emotional states - situations in which the individual experiences a negative or unpleasant emotional state, mood, or feeling, (e.g. frustration, anger anxiety, depression, or boredom) prior to or at the same time the first lapse occurs.
2. Interpersonal conflict - situations involving conflict associated with any interpersonal relationship, (e.g. marriage, friendship, family members, or employer-employee relations).
3. Social pressure - situations in which an individual is being influenced by others, who are exerting pressure on them to engage in the problem behaviour. This pressure may be direct (interpersonal contact with verbal persuasion) or indirect (e.g. being in the presence of others who are engaging in the same problem behaviour, even though no direct pressure is involved).
When someone wants to e.g., quit smoking, lose weight or stop drinking, they contemplate the change and weigh up the pros and cons of change vs the status quo. If the balance tips in favour of the change, they move to a stage of determination, then action and finally maintenance where the change has successfully been made.
When we cope well in managing high-risk situations (e.g. act assertively in the face of social pressures) we will significantly reduce our probability of relapse and be more likely to experience an increased sense of perceived control. Successful management of one problematic situation is also often associated with an increased expectation of being able to cope successfully with other challenging situations (Marlatt and George, op. cit.).
A relapse situation occurs mostly when the person is not expecting the high-risk situation and feels generally unprepared to manage it effectively when it happens. The individual may suddenly find themselves in a situation that quickly feels out of, and beyond, their control.
Professionals adopting this approach with their clients need to select interventions based on a thorough initial assessment and formulation of the client's presenting issue and general lifestyle. Specific interventions should equip the client with the skills to be able to anticipate and manage relapse: to recognize and cope with high-risk situations that may cause a lapse, and to modify cognitions and other reactions so as to prevent a single lapse from developing into a full-blown imminent relapse.
Want to know more about approaches and interventions for managing relapses? Get in touch or schedule a call
Further reading
George, W.H., 1989. Marlatt and Gordon's relapse prevention model: A cognitive-behavioral approach to understanding and preventing relapse. Journal of Chemical Dependency Treatment.
Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford press.
