Preparing to Backslide
In This Chapter
- Understanding lapses
- How to identify high-risk situations
- Stopping a lapse in its tracks
- How to make CBT part of your life
You might believe that by the time you finish this book, all your problems should be gone. But this book is just the beginning of your journey to a healthier and happier life. CBT is a lifestyle change, not a “one-and-done” approach to difficulties. Hopefully, you have learned strategies that help you notice negative thoughts and behaviors and address them quickly. The good news is that you can’t ever go back to square one. You now know what to do when feeling depressed, anxious, or negative about life. You can’t unlearn what you have learned. By the time you complete this chapter you will understand what a relapse is, notice the signs you are backsliding, and know what steps to take to bring yourself back to helpful and healthy ways of thinking and acting.
The Difference Between a Lapse and a Relapse
A lapse is a brief return to your old way of thinking and behaving. It is a setback. A relapse is a return to your old way of thinking and behaving. Both lapses and relapses can be triggered by illness, stress, or fatigue.
DEFINITION
A lapse is a temporary setback. It is a brief return to your old way of thinking and behaving. A relapse is when you return to these old ways for a longer period of time.
Suppose you have a fear of dogs. Using the exercises in this book, you learned to use relaxation techniques and coping statements to help you approach a dog. If you have a lapse, you might see a dog and become scared. You might cross the street to avoid the dog. When you get home, you sit down and try to determine what caused you to avoid the dog. You realize that you haven’t been sleeping well over the past few nights because of worry over financial problems. You are tired and stressed about upcoming bills. You think this stress led you to simply cross the street rather than taking some deep breaths and walking toward the dog. You decide you will practice your exposure exercise with dogs so the fear doesn’t build up again.
STOP AND THINK
For CBT to be effective in the long term, you must not only reduce your negative thinking but must also learn what to do if the feelings return. In the example of overcoming a fear of dogs, using exposure techniques helps to reduce your anxiety when you see a dog. However, there might be a time when your fear comes back. Incorporating relaxation strategies and other ways to calm yourself ensures that you can deal with the situation, should it arise.
Suppose you cross the street to avoid the dog but when you get home, you think, “I knew this would be a waste of time. I am never going to get over my fear of dogs. I am right back to where I started.” You see your setback as a failure. You are ready to give up. This attitude leads to a relapse, where you go back to your original thinking and behavior.
To avoid relapses, accept that lapses might occur. You might suddenly ignore everything you learned and go back to your original thinking and behavior. It is your attitude toward the lapse that makes the difference. Pay attention to your reaction to your lapses.
Your Turn: Preparing for a Setback
When you face a difficult situation and fall back into negative thinking patterns, you might think:
This isn’t doing any good.
I am hopeless.
I will never feel better.
CBT doesn’t work.
The first step to making sure a lapse doesn’t turn into a relapse is to accept this is normal. You are going to have ups, downs, and in-betweens. There are going to be times you feel terrible and times you feel great. There are going to be times you are moving along smoothly.
There are a few ways you can prepare yourself for a setback.
Track your progress. Use a graph to track how you feel. In the beginning, or during stressful times, you might want to track your progress on a daily basis; other times you might find once a week helpful. Give each day or week a rating, such as 0 to 10 or use words such as “very good,” “so-so,” “not so good,” and “very bad.” Use words you typically use to describe how you are feeling. Create a graph to help you visually see your patterns. You will probably notice that even though there were times you felt “very bad” there were also times you felt “very good.” This helps you see that the bad times are temporary.
Use coping cards. Pay attention to common patterns of thinking and create coping cards with new, positive ways of thinking. Keep these coping cards with you and in places you see them on a daily basis such as your mirror, your refrigerator, and your desk.
Write down what works. Create a list of important points you learned while using this book and the skills you found most helpful. Place reminders in areas you see each day to review this information on a daily basis.
CBTIDBIT
Remember, even if you temporarily lapse or relapse, you can’t go back to square one. The techniques and strategies you learned are still there. Although you might need to review and practice, you aren’t starting from the beginning.
Accepting that you might have the old urge or old feeling does not mean you have to go full throttle with it. This is where blac-and-white thinking about yourself and your weaknesses can ruin your progress. Suppose you feel angry during an interaction with your partner. You start to yell. Somewhere in the argument you notice you are yelling. You have a choice; you can see it as black and white where you think “It’s too late, I already started yelling. I am not apologizing. Why should I always have to apologize?” Or, you can put your reactions into the grey zone. “Okay, I overreacted. I am entitled to not agree with her behavior, but I can stop yelling and apologize for getting worked up.” Black-and-white thinking can derail any progress unless you think about your reactions in the grey zone, accept that you won’t always be perfect, and take responsibility for your bad behavior.
Knowing you can have a setback and planning for it helps it remain a lapse rather than a relapse. Remember you have a choice. You can continue to think negative thoughts or you can choose to answer and challenge those thoughts.
Warning Signs and Triggers
In Chapter 23, you started a thought log specifically for lapses. You kept track of what was happening around you when you had a lapse. This information can be used to help you determine your own high-risk situations. Some common reasons for a lapse are listed here:
- Negative emotional states such as depression, anxiety, or anger
- Interpersonal problems
- Social pressure
- Feeling overwhelmed with too many tasks
- Trying to please too many people
Lapses also happen when the situation takes you by surprise. Imagine you are walking down the street and a dog runs out of a house and comes running up to you. You don’t have time to prepare or to think about how to react. Your fear kicks in.
GIVE IT A TRY
List some of your high-risk situations. Think about whether you should eliminate, reduce the intensity of, or cope with the situation. Then write one or two steps to help manage the problem.
Do this for each trigger or high-risk situation to help you focus on the solution rather than the problem. Be careful you aren’t eliminating situations by avoiding them, such as removing social pressures by avoiding parties.
Usually, you have some warning signs before a lapse. These warning signs can be in your thoughts, emotions, behaviors, or physical sensations. Many of these will depend on your individual circumstances. Common warning signs include the following:
Thoughts
- Anxious thoughts
- Negative thoughts about yourself or others
- Blaming others
- Becoming defensive about your behaviors
- Paranoid thoughts
- Ruminations
Emotions
- Feelings of sadness
- Irritability or frustration
- Feelings of being a failure
- Pessimism
- Nervousness
- Rituals
- Over- or under-eating
- Avoiding situations
- Arguing with others and using emotional language
- Not being able to let something unimportant go
Physical Sensations
- Stomachache
- Restlessness
- Fatigue
Based on previous exercises, write down your triggers and warning signs. Continue to monitor your thinking patterns. Take 10 minutes at the end of the day to review your thinking. Choose two or three situations that happened during the day. Write down your thinking process during the situation. Was it healthy thinking or did it fit into one of the problematic thinking processes outlined in Chapter 2? Each time you handle a high-risk situation without falling into a relapse, you gain confidence and add to your belief that you can do this.
Your Turn: Create a Relapse Prevention Plan
Relapse prevention is a process, not a single step. The following is an example but your plan should be specific to your situation.
Step 1: Review the exercises you completed. If you kept a notebook filled with your exercises and go through it, paying careful attention to those geared toward the issues you are experiencing. Highlight those you found most helpful. You can also go through this book and highlight exercises you want to return to and review.
STOP AND THINK
Preventing lapses involves three steps: learning coping skills; accepting change as a process that includes setbacks; and making lifestyle changes, such as healthy eating, exercising, meditating, and practicing mindfulness. In addition, an effective relapse prevention plan includes continued practice sessions.
Step 2: Review the skills you need to combat your current problem. For example, if you find yourself falling back into depression, your list might include the following:
- Schedule activities, including pleasant activities
- Work on problem solving
- Work on self-esteem
- Be assertive
- Use relaxation techniques
- Practice mindfulness
Decide which of these strategies is most helpful to you. Practice these skills. Overlearning skills helps you to use them in many different situations. Focus on one skill at a time. Once you feel comfortable, you can move on to reviewing and practicing another skill.
IMAGINE THAT
In one study, people with depression who used cognitive behavioral therapy combined with mindfulness decreased rates of relapse by one-half.
Step 3: Complete thought logs. Reexamine your thoughts and work on coming up with more balanced ways of looking at situations.
Step 4: Write coping statements. Some examples include:
- Today was a bad day.
- This will pass.
- I can use the skills I learned.
- This is a temporary setback.
- I know what to do to stop from getting worse.
- Everyone has bad days.
- Using the skills will help tomorrow be a better day.
Write five coping statements you can carry with you and read at least five times each day.
Step 5: List supports you can use to help you from backsliding. This could include the following:
- Calling to talk to a friend or relative
- Finding a support group
- Talking to a medical professional
Tips for Integrating CBT into Daily Life
Sometimes you work on your skills and the exercises in this book and are able to change your thought processes at that time. But when you face a problem, everything you learned goes flying out the window. You don’t remember what to do or how to do it; you revert to negative thinking. CBT takes patience and persistence.
GIVE IT A TRY
Keep a blank thought record with you. Use it when you feel overwhelmed or when you anticipate feeling overwhelmed. Remember, you might have started using this book to overcome anger, but thought records can be used for any emotion. Learning to generalize your skills, across different emotions, helps you to employ them in many different situations.
It takes practice and consistency for a new way of thinking to take hold. There are some ways to make this process easier:
Treat any attempt at using a skill or trying a new technique as an experiment. When you do an experiment you can’t fail; you just learn from the results. By changing your perception in this way, you remove the word “fail.”
Use real-life examples in your practice. Throughout this book there are many different examples. Read through the exercises and then complete them again, based on situations from your life. Think about upcoming problems and use the exercises to gain perspective on the best way to handle the situation. Remember, though, you don’t want to focus on solving problems that haven’t yet occurred too often as this starts a cycle of worry. Focus on a few “what if” scenarios that have a high probability of occurring to help you look at the situation differently.
Keep a list of what you can do daily, weekly, and monthly to increase your feelings of well-being. Besides CBT techniques, what else can you do to improve your physical and emotional health? You want to focus on your life holistically rather than seeing it in small segments. This helps improve your outlook and keeps your motivation to continue high.
Create a list of questions to ask yourself when you have unhelpful or negative thoughts, feelings, or behaviors. Some examples include the following:
- It this thought consistent with reality?
- Is this thought rigid or flexible?
- Is this thought unhelpful?
- Can I change the wording of this thought to create a more helpful way of looking at the situation?
- Is this thought catastrophizing or overgeneralizing a situation?
Use your common problematic thinking processes to create questions. Write the questions down on an index card and keep them with you. When you are feeling overwhelmed, look at the questions; your answers give you information on how to change the thought.
Think of CBT like learning to play a musical instrument. You practice, alone, until you feel comfortable with your song. Then you go out and play it for other people. CBT is like that. Use the exercises to practice at home, by yourself. As you gain confidence in your abilities to use the techniques, slowly begin integrating them in your everyday life.
The Least You Need to Know
- A lapse is a temporary setback; a relapse is a return to old habits and behaviors.
- Your long-term CBT plan should include steps for identifying and preventing lapses.
- Common reasons for lapses include relationship problems, health issues, social pressures, and the need to please others.
- Relapse prevention is a process, not a single activity. It includes reviewing CBT skills, reexamining your thoughts, and writing coping statements.