Relapse Prevention for Mood and Addictive Disorders | Essential Webinar for Counselors

Foreign. Hey there, everybody, and welcome to today's live webinar. I hope you are having an absolutely wonderful week. It's a little chilly here in Middle Tennessee, but I'm expecting it to warm up a lot by Sunday. All right? So without further ado, let's go ahead and get started. You I'd like to welcome everybody to today's presentation on relapse prevention for mental health and addictive issues. I'm your host, Dr. Donnelly Snipes. In this video, we're going to define relapse, identify relapse warning signs, identify strengths, and help people learn about how their issue developed. Relapse is the return to something that has been previously stopped. And this can be true, for example, with psychosis. When someone is in a remission period from psychosis or when their medications are have them stabilized, that is what we would call a remission period. And then if they start to have symptoms again, that would be relapse. And we're going to talk about a lot of different things that may contribute to relapse of psychotic symptoms. Same thing is true for mood, mood disorders, addictions, and pain. It's important to remember that relapse, like everything else, is multi dimensional. We can have physical relapse where our body starts hurting more or our body starts feeling more fatigued, or we can't sleep. We can have interpersonal relapse where we start behaving towards ourselves and others as we did during the problem, or we start having relationships that are unhealthy or unsupportive. Emotional and cognitive relapse going back to how we feel and think when we're in an episode. Environmental relapse is surrounding yourself with things that you typically surround yourself with when you are in an episode. And spiritual relapse really refers to a lack of a sense of connection, meaning, and purpose. It's hopefully when you're asymptomatic or when you're in remission, you have a sense of meaning and purpose and connection to others. But when you go into a relapse phase, you may start feeling disconnected not only from others, but also yourself. So a relapse is when you start returning to any of these people, places, things, behaviors, or feeling states. What's important to recognize is a lot of times in addictions we talk about relapse as when somebody started using again. Relapse happens long before that. When they started using again is just when they lost complete control of it. But relapse actually probably started weeks or months before that, which is why it's important to pay attention to all of these areas where you may be relapsing and becoming more vulnerable to using or having another episode. And vulnerabilities, as we've talked about in other videos, are states or conditions in which a person is more vulnerable to relapse. For example, if you're sleep deficient, you are going to probably be more likely to be irritable, to be agitated, to feel fatigued. You may have more difficulty controlling your thoughts and have more problems with ruminations, which can trigger a relapse in any of those things that we talked about, whether it's mood disorders, addiction, psychosis, or even pain. Nutritional deficits. If you're hangry, you're going to be more vulnerable to reacting stronger to distressful triggers in your environment. Pain. Same way if you're in pain, you're probably going to be more likely. You're already primed, your stress response is already going, so you're going to be more likely to respond with a stronger reaction than you necessarily would if you weren't in pain. So you're more vulnerable to those triggers in your environment. And then HPA axis dysregulation. When your HPA axis isn't working well, when it's dysregulated and you go from flat to furious or flat to frantic, you can see how that might contribute to things that increase pain, like muscle tension and things that increase mood disorders. When you go from kind of flat, which is no fun anyway, to either furious or frantic, that that's not fun either. So you can have an increased sense of helplessness, hopelessness, disempowerment. Interpersonally, vulnerabilities tend to revolve around feeling insecure in your relationships, and that includes your relationship with yourself. So it's intra and interpersonal and conflict again with others. When you're having disagreements with your people in your support system or even with people who aren't necessarily in your support system, but you feel like the world is antagonistic, it can contribute to feeling stressed, which can make you more vulnerable. Emotional vulnerabilities include dysphoria and I'm just kind of lumping everything in there. Anger, grief, guilt, all that stuff. And euphoria. Now, euphoria is more. More of a vulnerability for people with addictions, but it can be true for people in any area. My mother, for example, she used to be on antidepressants. And as soon as she'd start feeling better, she'd start feeling good. She'd quit taking her meds, and then she'd very quickly go go back into not feeling well again. So euphoria can be as deceptive in some cases as dysphoria. With addictions, when people feel euphoric, it reminds them how they felt when they were using. And they may continue doing things that give them those adrenaline rushes and stuff which may be counter to what they need to do in their recovery process. So they start slowly working away from following good orderly direction and back into those old behaviors. Overconfidence in your own skills about managing either the psychosis or the pain or the mood issues can also can make you more vulnerable. If you think, hey, I got this, I can do these things that I used to do. And yeah, it may be stressful, but I got this. Do you though? And a lack of motivation is another vulnerability. Recovery is not always fun. And regardless of what you're recovering from, open heart surgery to addiction, it's there are parts of it that are not fun. So it can be hard to stay motivated to follow good orderly direction and do the next right thing cognitively. People who think with cognitive distortions, all or none thinking, personalization, mind reading, jumping to conclusions, we've talked about all of them. But when you think in unhelpful ways, it tends to contribute to stress and then stress tends to contribute to relapse. Same thing with attention and problem solving. People who are stressed out, who are having more difficulty with attention are going to have more difficulty paying attention to risky situations. They may be more on autopilot. And when you're in fight or flight, when you're stressed out, your executive executive control really isn't engaged. You're in fight or flight mode, not problem solving. Think about it. So when people start feeling distressed, their problem solving goes down. When their problem solving goes down, it makes them more vulner vulnerable to reacting strongly to stressors. Environmentally sensory triggers can make you more vulnerable. I think we've all been in this position where we've been either hot, way too hot or way too cold, or in an environment that was way too noisy all the time or way too busy. It's just people are everywhere all the time, moving around and it's just stressful. And when you're already have that stress response primed, it is going to contribute to feeling more vulnerable. And then spiritual. A last lack of connection or meaning and purpose. When you don't know why you're getting out of bed in the morning, when you don't know why you're doing these things, when you don't feel connected, you don't feel like anybody understands you, you don't feel see how your behaviors impact anything, then it can be hard to get motivated to do the next right thing. One of the things we're going to talk about a lot in relapse prevention is mindfulness. Mindfulness can help people become more aware of themselves and the current moment to better understand their vulnerabilities, thoughts, and needs in the moment, which goes back to that attention thing again, go back to your own recovery. If you've recovered from a muscle strain or an illness or addiction or depression or something else, you know that early in the process, you're very focused on your recovery and doing the next right thing and following your plan. And then somewhere along the way, you can start sort of taking it for granted and being mindless in your behavior. And it's really important that we check in with ourselves. Even if you've been in recovery for 20 years, it's important to check in with yourself. So anything that could make you more vulnerable is addressed before it becomes a relapse trigger. Evening mindfulness can also help you reflect on your day, identify the things you did well, and learn from the things that didn't go so well. Again, even if you've been in recovery for 20 years, you probably have days where something happens and you may hold on to this resentment for a minute, or you may make a choice that's not in the best interest of your recovery. So being mindful reviewing your day doesn't have to take long. Two, three minutes in the morning to get your head on straight, and 2, 3 minutes at the end of the day to learn from anything, as well as to recognize how well you're doing to help you feel empowered and safe in your own skin can go a long way in relapse prevention. Physical relapse is characterized by any of the following. Fatigue, difficulty sleeping, increased pain, increased physical symptoms of stress. Now, I intentionally didn't say anxiety here, because what we're talking about is the racing heart, the faster breathing, the sweaty palms, any of the test chest tightness, any of those things can be a potential sign of impending relapse. It can be a potential sign of activation of the stress response, which we know is pretty much going to underlie most of our ultimate relapses. Neglecting physical health, such as your sleep, your exercise, your nutrition, and your medication can also make you more vulnerable to overt relapse. But it can also contribute to your symptoms, your physical symptoms of relapse. So when you were in an episode, psychosis, pain, mood, Addiction, whatever that episode is. How did you take care of your physical health? Most people with any of those issues probably neglect their physical health some. So we need to look at that and we say, okay, your physical health behaviors have relapsed, have returned to where they were when you were in an episode. What do you need to reinstate in order to get back on the right track? If there was also addiction, the person may experience cravings, dreams about the drug or whatever they were addicted to and ultimately using. This is full blown relapse. When somebody goes out and uses again, they are back in a full blown episode. However, again, relapse happens long before somebody picks up. Relapse happens with pain conditions, for example, long before the person is in so much pain that they can't get out of bed. And we'll talk about some other examples of that later. But it's important for people to be cognizant to be conscious of how they're feeling and how these symptoms contribute to potentially causing an episode or resurgence or relapse of their problem. Encourage people to think about their vulnerabilities for physical relapse. So we'll just take mood disorders, we'll take depression. What physical vulnerabilities, what physical conditions make you more vulnerable to to feeling depressed? What interpersonal situations like feeling unsupported and low self esteem may make you more vulnerable to feeling completely helpless and hopeless or depressed? What emotional vulnerabilities such as holding on to anger and resentment or a whole lot of anxiety make you more likely to eventually have a depressive episode? Cognitively, what thinking styles, what attitudes do you notice that make you more vulnerable to having a depressive episode? And a lot of these vulnerabilities can also serve as what we call relapse warning signs. When you notice, when a person notices that they are being less mindful, when they notice that they are using a lot of cognitive distortions, that's a clue. That's a clue that hey, something changed and we need to figure out how to address these things so we're not vulnerable to stressors and not moving down the path toward relapse. Environmentally, what are your vulnerabilities for physical relapse? What, what are your vulnerabilities for that fatigue, that pain, that just physical, physical symptoms, recognizing what sort of things, if you're in a noisy environment a lot of the time or when you go to visit X and so relative, if you know that that tends to stress you out and make you more vulnerable to depression, be aware of that and take Appropriate steps. And then spiritually, what spiritual symptoms do you have that can make you more vulnerable? When you, as I mentioned, when you start feeling disconnected and it feels like nothing you do ever makes a difference here, those cognitive distortions, it can be really easy to slip into a feeling of helplessness and hopelessness, which is one the core issue. What we're talking about with depression, but different from vulnerabilities are triggers. What are triggers for physical relapse? What triggers might make you. If you're physically feeling pain, you know, that can be a vulnerability and a trigger. You know, all of these can be generally both be vulnerabilities and triggers because what we find in relapse, remember I said your relapse started long before you actually have an episode. These relapse triggers, these stressors start building up and adding up and complicating the picture and leading you away from good, orderly direction. Interpersonal triggers for physical relapse. Well, for example, if you're already feeling like you've got low self esteem, you're already feeling disconnected and misunderstood, and then you get into a fight with your best friend, oh, that's going to hit a lot harder probably than if you were feeling supported and good about yourself and you got into a disagreement with your friend. You're likely going to perceive it very differently. Emotional triggers for physical relapse. I know you're like, how's that work? When you feel depressed, when you feel angry, that burns up a lot of energy. And people who feel anxious and angry a lot burn through a lot of energy. They disregulate their HPA axis, which can lead to a whole cascade of physical symptoms, not the least of which are sleep difficulties and pain and, well, sleep difficulties and pain. Cognitively, what are your triggers for physical relapse? If you're already thinking using what we call in addiction, circle stinking thinking. If you're already thinking in negative terms, pessimistic, helpless, hopeless terms, you've set the stage to feel vulnerable to any threats that come your way. So then your boss walks down the hall and says, I need to see you in my office in 20 minutes. How does that affect you and how does that affect you physically? You know those increased stress symptoms are going to happen because you were already stressed out. You are already feeling vulnerable and helpless. Environmental triggers. If you have things that cause you to feel. Since we're sticking with depression, I've talked about them in a lot of other videos. Those ASPCA commercials, can't take them, just can't deal. They make Me too sad. And they trigger my feelings of depression and hopelessness and helplessness when I see this poor puppy. So I know in my environment that as soon as those things come on, I'm changing the channel. Likewise, if you're recovering from addiction, if you are putting yourself in situations in which you're surrounded by that addiction, that's probably a trigger. And spiritually, if something happens that makes you feel just suddenly cut off from your sense of meaning and purpose, that can trigger stress response. And that stress response will trigger those physical symptoms. Preventing physical relapse. One of the acronyms we use in addiction recovery is halt. There are a lot of ways to prevent physical relapse, but this covers a lot of them. Hungry. Make sure to nourish your body with proper nutrition. If your body is not getting the nutrients it needs to make the neurotransmitters and keep everything working well, then, you know, crap in, crap out. So it's important that people pay attention in their relapse prevention plan to maintaining adequate nutrition. I'm not saying you've got to be, you know, a foodie. I am just saying you need to make sure that you are giving your body the building blocks it needs and nourish your mind with activities and things that increase your happy chemicals. It may not make you feel elated, but it's good to force yourself to turn your attention to things that are at least mildly amusing. Whether it's videos on the Internet or butterflies or watching birds. Whatever it is for you that promotes a sense of contentment, that helps release gaba, that helps release serotonin and endorphins in your system. Even if you're not feeling giddy, it can help you feel more balanced, if you will, in terms of angry and anxious. Reduce chronic stress. Stress is a part of life. Pain is a part of life. But there are chronic stressors that we can eliminate. For example, in your environment, you can eliminate access to your to your mobile device or to your computer or something in the evening when you're more likely to start doom scrolling when you don't have something else calling your attention away. Whatever it is that people can do to reduce unnecessary stress is going to be helpful. People who have chronic pain are likely experiencing chronic stress. Well, you can't get rid of that chronic pain, but developing tools to deal with that chronic pain is going to help the person feel more empowered and, and may help buffer against the stress response so the brain gets the message. All right, this sucks. But we are not super vulnerable right now, so we don't need to trip off the stress response. Encourage people to develop distress tolerance skills so they can downregulate. When they start getting stressed out, they can downregulate their stress response and get into their wise mind so they can better problem solve. Remember that for a lot of people, whether it's mood, addictions, pain or psychosis, stress is a huge underlying factor that starts throwing the endocrine system all out of whack and can lead to. Lead to at best breakthrough symptoms, at worst, a full fledged relapse. So all of these things reducing stress, physical, interpersonal, emotional, cognitive, environmental, spiritual, reducing stress in each of those areas is essential for relapse prevention. Now how each person goes about that is going to be very individualized and improved problem solving skills is another aspect for angry and anxious. A lot of people I've worked with over the years have struggled with problem solving skills, especially surrounding their, their issue. But for people with depression, we're sticking with depression here. They may feel helpless and hopeless. Well, the opposite of that is empowered. And looking at what do I have the power to solve, what skills and tools can I use? A lot of people who are struggling with addictions and mood disorders and even to some extent, pain, chronic pain conditions may just simply not have the skills to handle that. They may not have any clue what a cognitive distortion is or the inner child or any of those things that we talk about. Helping people identify the thoughts and things that trigger their anger or their anxiety and then help them figure out, okay, how can you best deal with that in the moment? What is the best way to use your energy to deal with that? Lonely. We're designed to be interactive. We're designed, we, we've got a bonding hormone for a reason. Encourage people to nurture social supports, including with themselves, to buffer stress. And that's a radical notion here for a lot of people. They don't have any clue who they are and they certainly haven't been their own best friend. But that's part of the recovery and relapse prevention process. Not relying on other people to build you up. Now, yeah, it's great to have support, but it's also important to feel like, you know what, I deserve to be happy. I deserve to be treated with respect. And hey, I'm going to treat myself respect with respect. Imagine that. And being willing to ask for help. A lot of people, not all, but a lot of people who are in an episode, whatever that episode is, may feel like they're a burden, may feel like it is shameful to ask for help. There's a lot of reasons people don't ask for help. However, asking for help can actually increase oxytocin. Providing help can increase oxytocin levels. And when one person's oxytocin levels are up, the other person's oxytocin levels tend to respond in kind. So it's good in, in many ways to be willing to ask for help. There are people out there who have been down that road before or who may have skills that you don't. And typically when people are nurturing those social supports and willing to ask for help, they feel less isolated, they feel less lonely and tired. Well, of course, get sufficient quality sleep. If your pain, if the hallucinations, if your mood, if your intrusive thoughts are keeping you from getting sufficient quality sleep, then that's going to be a problem and we need to figure out how to address it. But we also know that if you don't get sufficient quality sleep, all of those things can increase and address issues such as sickness and pain that prevent that quality sleep. This is true even when, if you're just having a moment, maybe you've got a virus. 4, 6, 10 days of not getting good sleep can have a significant impact on mood and cognitive control and a whole bunch of other things. So it's important for people to not minimize what's going on and, and be more mindful of how is this impacting me and how can I be compassionate with myself today. Interpersonal relapse. You've returned to the old people and places who co sign on your bs. Let's go with anxiety for this one or addiction. Likely you nurtured a peer group or a set of relationships that thought similarly to you. So if you were, if you're recovering from having a lot of anger or anxiety, chances are you're probably, you've probably surrounded yourself with people who also feel a lot of anger and anxiety and so they co sign they, they actually reinforce your beliefs. In addictions, people do a lot of minimization, justification, denial, and they surround themselves with, with other people with addictions who will validate their minimization, justification and denial so they don't have to face it. Recognizing if you're withdrawing from people who tell it like it is and going towards those people who are going to nurture the negative stuff. Paying attention. Other symptoms of interpersonal relapse. You've withdrawn from your social supports, you felt vulnerable, you started wanting to withdraw into that that known even though depression is exceedingly painful, sometimes it feels more comfortable and, and I know some people are really going to argue with that. But having dealt with depression throughout my life, I can tell you there are times where it just seems easier to be depressed than to do what you got to do. And you may withdraw from your social supports that are saying, come on, you gotta get up, you gotta get showered, you gotta do it. So that's also important to notice. If you start shutting people out that are good for you, if you become self centered, it's all about me and I don't care about anybody else. That can be another sign of relapse because you're trying to control other people, you're trying to make them, if you will focus on you, you be become disconnected from yourself and started acting on autopilot. You're not even in a relationship with yourself anymore. You're not being mindful, you are just going through the motions based on if you're not mindful, then you're going on urges. And that is a recipe for disaster in terms of relapse. And sometimes people become more suspicious or argumentative during interpersonal relapse. Why? Well, let's go back to that stress response. Some situations occurred that made you more vulnerable. You, you already felt a little stressed. When we feel vulnerable, it primes that stress response. And then you were triggered by something that caused you to feel really vulnerable, caused you to feel a threat. Well, how do we respond when we feel threats? We become suspicious and argumentative. So, or you know, we fight or flee. So it makes sense that people who are struggling may be withdrawing. It makes sense for a lot of people when they are in recovery, if it just doesn't seem like things are moving fast enough or it doesn't seem like it's doing well, even though objectively an outsider might be able to say, yeah, I've seen some changes. If the person's not feeling that, they may not be motivated to continue to do that hard stuff, which can mean they want to withdraw, they don't want to have that shoved in their face. Behaviors, communication. When we start withdrawing from people that are good for us, surrounding ourselves with people that bring out the problems, then we need to consider what is that behavior? Saying and, and why is it that I don't want to, why is it that I'm not motivated to do the next right thing, to give myself that love and respect? So again, asking people what are their vulnerabilities for interpersonal relapse. Physically, if you feel, you know, those stress feelings, the racing heart and all that, okay, if you're in pain, it can cause you to feel hopeless and helpless if you're fatigued. You know, it's really hard to want to engage with others when you're exhausted. And it's even harder to tolerate something that they may do that you feel is threatening in some way. Inter or intrapersonal. So again, your relationships. What vulnerabilities in your relationships make you more vulnerable to worsening those relationships make you more vulnerable to disconnecting from the healthy supports emotional and cognitive. What feelings and thoughts tend to be more prominent when you decide that people are just. They're not safe and the situation's not safe and I just don't want to hang out with them. I want to go back to the old. To the old peer group or I want to go back to being all by myself because people are just people environmentally. Are there vulnerabilities for interpersonal relapse? When you're feeling stressed environmentally, it can be really tempting to withdraw from others and going through the same thing with the triggers for interpersonal relapse. What physical things might happen that make you withdraw from from others? If you used to go out with your friends and go rock climbing all the time and you're having an episode of pain, or you get diagnosed with fibromyalgia and you just can't do that anymore, then when they go out rock climbing because your your pain is too bad and you can't go, then you may feel depressed, you may feel hopeless, you may feel helpless, and you may decide that, you know what, I don't want to hang around with them anymore. They go do stuff without me and that's not okay. I'm going to go over here. But going through each of these things. Preventing interpersonal relapse. Practice daily mindfulness both in the morning and in the evening. What is it that you want? How you're going to use your energy to move towards your rich and meaningful life. And in the evening. How did I use my energy well today? And what can I learn? Address insecure attachment issues. When people are insecurely attached, they are almost always triggering that stress response. They're almost always a lot more vulnerable to stressors that come their way in any of the areas. Define and develop skills to maintain boundaries. Here's the kicker. Without guilt. Oh my. So many people have been taught that guilt is. Or boundaries are not okay. It's not okay to say I'm too tired right now or I don't want to do that. So this is a learning process and it's a stressful learning Process. Setting boundaries, especially initially, is a change in the dynamics of your relationship. And a lot of times there's some turmoil before things settle out. And it's important for us to make sure that people understand that so they go into it under with with their eyes wide open. Encourage people to contact their social support or social supports on a daily basis for the first three months, whether that's your sponsor, your coach, your best friend, whoever it is, reaching out with regularity starts establishing that habit. Keep a business card in your wallet with the names and numbers of three social supports. One can be your therapist, one can be the crisis hotline, and one can be a friend. If you don't have three people that you would consider social supports. But it's important to have options. If you have an addiction or you were surrounding yourself with people who are just really unhealthy, consider changing your phone number and if possible, destroy contact information for people who might trigger a relapse. Some people are going to be willing to get with the ball game and respect your move toward health and happiness. Great. The people who refuse to respect that are the ones you need to consider. Do I really want to maintain contact? And where do I need to set those boundaries and find at least one pro social activity to do each week? And I emphasize the social part because we're talking about interpersonal relapse. Where you're around other people. You don't have to be spending a lot of time talking to them. You can go volunteer to clean up a trail at a state park or something. But just being around others and doing something positive increases oxytocin for some people. Going to church or synagogue for others, just going to the gym. Being around other human beings can be very helpful in emotional relapse. People's emotions and behaviors become negative and unpleasant. This is true in addiction or mental health issues, or overconfident and driven to maintain euphoria. And like I said earlier, this is more common in addiction than anything else. Encouraging people to be aware of their vulnerabilities for emotional relapse. All right, I can be, you know, doing fine. Something happens that causes me to feel anxious or angry or depressed, and I can roll with that. I can be resilient to that. But what vulnerabilities exist in me physically, interpersonally, emotionally, mentally, environmentally, or spiritually that would actually knock me on my butt if that same thing happened. I'm just. I'm already depleted. I can't do it. And it triggers that emotional relapse. Remember, with pain, for example, pain is in many cases triggered and can trigger the stress response. Increases in pain are associated with dysregulation of the HPA axis and stress. When we feel stressed, we have tension. When we have tension it tends to throw things out of whack and can cause increased pain. It also in impacts. Stress also impacts the levels of inflammatory cytokines and other biological processes that can make pain worse. So recognizing that and recognizing how when you're depressed for example, or you're anxious, how does that impact if you're recovering from pain, how does that impact your pain? When you are depressed or anxious, how does that make you more likely to start feeling helpless and hopeless and distressed and then know what your triggers are for emotional relapse. And this is probably the easiest one for people to fill out. What are your triggers for depression? Anxiety, hopelessness, anger. Physically, if something happens like you are an avid fitness person and you break your leg so you know you can't work out for three months while your leg heals, that could be a trigger for feeling hopeless and helpless when you are over tired. And I know that's a big one for me if I don't get enough sleep I am much more vulnerable to making mountains out of proverbial molehills and being more. Sensitive. So if I'm exhausted already and then I don't get a good night's sleep or something happens, I can feel overwhelmed. Really easy. Interpersonal and intrapersonal triggers for emotional relapse Triggers for distress what triggers your distress? And again go back to the vulnerabilities. My I, I have a relative who has some in laws that are extremely stressful. Now this is not mine. My, my mother in law is about the next thing to aane. But I, I do have a relative who has some in laws that, that are extremely critical and extremely stressful. And they know that pretty much every time they interact with their in laws they are going to have a flare of their fibromyalgia. It's almost a one to one correlation and it also is affected by how long if they spend a meal with their in laws it may be a day or two before they get their energy back and they can get their pain under control. If they have to spend the weekend with them they may be in bed for a, for a month with pain and it's, it's such an intensely direct correlation. But recognizing that and then making a decision how do I handle this in, in a way that makes sense for myself as well as my family. Addressing emotions help people develop emotional intelligence, identify the emotion, explore why they're feeling that way, and take steps to fix the problem. Now, the first thing people have to do before they identify the emotion a lot of times is to down regulate, use those distress tolerance skills so then they can more effectively observe and describe what's going on. People can become stuck in an emotion, nurturing it or blowing it out of proportion. Have you ever had a situation where you were already irritable and something else happened and it just made you more irritable and you just kept getting more and more irritable and you started seeing the whole world as. Or everybody as just a stressor. It's like, I can't take anymore. Y' all just go away. Compounding it with other emotions like anger and guilt. We talked about this in acceptance and commitment therapy. If you're feeling depressed and then you start feeling guilty about being depressed and you get angry that you're woke up and you were depressed, that drained even more energy, that turns the stress response on even more, which is going to be more likely to lead to a backwards cascade. Personalizing things and trying to escape from feelings. Feelings are like your body's smoke alarm. And if you try to escape from it, it's not going to do any good. It's your. Those feelings are trying to tell you something. Sometimes those feelings are saying, all right, this sucks. We're not in a lot of danger right now. But just letting you know that this sucks, okay? Other times it's saying this sucks and is dangerous, so you need to fight or flee. But trying to escape from it, just trying to ignore it and avoid it and make it go away, that doesn't address the underlying issue. You've still got the little control guy in your brain going, I'm trying to get you to pay attention to something. Remember, the emotions are like cues. You feel how you feel in the moment. So unhook. I feel. I notice. I feel angry. All right, so I feel angry. What's that about? What's triggering my anger? You know, I'm unhooking from it and I'm trying to figure out what's causing this to happen, what's triggering my anger right now and what can I do to address the problem? Evaluate the situation based on fitcat the facts in this context at this time, and then choose to change or improve the next moment in order to prevent emotional relapse. Practice mindfulness. We can. We're. We're programmed to focus more on the negative than on the positive because we want to be more aware of the vipers than the bunny rabbits to to survive. So it's important to practice mindfulness so we can see the big picture and not just what's going crappy. Increase positive experiences both in real life and using guided imagery Going to your mental happy place Keep a gratitude journal. Avoid personalizing things 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. To evaluate the situation and figure out if there's a threat. It doesn't mean there's a threat. Kind of like a smoke alarm doesn't always mean the house is on fire and the smell of poop doesn't always mean that the dog went in the house. Dwelling on, nurturing or avoiding or hiding from negative emotions doesn't make anything better. I I tell my clients, don't marry it. Don't say to Having to hold from this day forward to death do us part no, those feelings are transient states that are designed to motivate you to do something and then move on. And remember that you can choose to feel and fix or relapse and repeat. Encourage people to list 10 things that they chose to get anxious or angry about over the last week. Why did they get upset? What was their mind telling them needed to be fixed? What vulnerabilities did they have that made it more difficult to deal with that situation? Did holding on to the upsetness do any good? What could they do differently next time to either change or fix the situation, which is improving the next moment? Change how they feel about the situation instead of feeling that it's the end of the world, feeling that it's unpleasant but manageable. And Linehan calls this walking the middle path or letting it go. Sometimes it is what it is and there's nothing I can do to change it, so I'm not going to continue to throw my energy at it. In cognitive relapse, there's a war going on in your mind. Part of you wants to stay positive, but part of you is struggling to tolerate the distress. Signs of mental relapse are focusing only on the negative or mainly having a pessimistic, helpless, blaming or hopeless attitude. Just giving your giving your power away. Difficulty, problem solving, difficulty concentrating and using those cognitive distortions, the extreme language like jump and jumping to conclusions, or personalizing. If you had an addiction, signs of relapse may also include thinking about people, places and things you used with you start having these intrusive thoughts, glamorizing or romanticizing your past. Use lying, justifying and Minimizing the impact of that substance or just adopting a screw it attitude, you know, whatever. I'm going to do what I want, when I want, because I want to like everything else. Help people identify what makes them more vulnerable to having those negative attitudes or to reacting in a pessimistic way. And what are their triggers for cognitive relapse. A lot of us have difficulty thinking clearly when we're in pain or we're exhausted when we are in a bad mood. Our brain is actually kind of wired to think pessimistically. So if you are already distressed in some way, then it may make it harder to adopt that cognitive restructuring and adopt that healthy thinking style. In terms of addressing cognitive relapse, what types of things trigger the negative thoughts for the person? This can be things and the media, people, places, events, sights, sounds and smells. Just thinking very holistically about what may trigger them to have negative thoughts. And what thoughts do they have that make them feel. So this is kind of another way of addressing it. What thoughts do they have that make them feel angry or irritated, guilty, envious, scared, anxious, worried or stressed? One chart that I have people use is this one to help them identify their unpleasant thoughts. A lot of our unpleasant thoughts can be traced back to four basic fears. Loss of control or the unknown. And whenever something's unknown with, then we don't have control, so they kind of go together. Failure, isolation and rejection or death. So when you think about things that cause you to feel angry, irritated or resentful, what do they have to do with being out of control? Failure, fearing that you're going to be rejected, or death if somebody does something that could threaten your life. Yeah, you're probably going to be a little bit poed. Encouraging people to evaluate these things so they can understand what is my body telling me when this happens and how accurate is it? If I get angry about something because I fear that it's going to lead people to reject me, okay, that's a feeling and that's a valid feeling. But let's look at the facts. Facts in this context at this time is this. Whatever happened, is this. Does this make me more likely to be rejected by people? Or is that just a feeling? Do I have facts to support it? Preventing cognitive relapse. Keep it simple, silly. Try to change. Don't try to change too many things at once or it's probably all going to go to crap. Often some of the simplest things can have the greatest impact, like getting enough sleep or spending 10 minutes with looking outside and enjoying the day. Regularly practice fitkat Mindfulness Prevent and address vulnerabilities that can make you focus on the negative and trigger the stress response. And remember, good, orderly direction is a shortcut for saying this is your plan for getting to your rich and meaningful life. Your life is a road map with the destination being hopefully recovery and happiness. Before you act, think whether whatever you're getting ready to do keeps you on the right road or is an unplanned detour. And maintain head, heart and gut honesty. My heart can lie to me, My head can lie to me, but rarely do all three of them lie to me. So if they're not in alignment, if your spidey senses say it's okay, your heart says it's okay and your head says it's okay, you're probably in the in a good place and environmental relapse. This is when you start reintegrating things that trigger your problem. If you are recovering from alcoholism, keeping alcohol in the house or hanging out at bars probably a problem. If you are recovering from depression, spending two hours each night on Twitter doom scrolling probably not helpful. Encourage people not only to review their vulnerabilities but also to review their strengths. What is life like when they are happy? What's different from when they're unhappy? Okay, so let's look at what changes. You're happy one moment, then something changes and then you're unhappy. What happened? What changed and what is the same? What things do you have that actually make your life feel rich and meaningful? And what in those areas of your life physically, interpersonally, emotionally, cognitively, environmentally, spiritually? What is the same that helps you feel happy? What people, things and experiences are important in your rich and meaningful life? And how many of them are going okay? How many are crap? And how can you best use your energy to nurture the things that are going okay and address the things that aren't going so good? List three healthy ways that you cope with stress Having people look because they've been surviving until now. So what are three healthy ways to They've dealt with stress in the past that work for them and what are their positive qualities and strengths? Review prior relapses what was happening before the relapse? Again? Pain, psychosis, mood, addiction it doesn't matter what was happening before the relapse. In what ways were you vulnerable to relapse at that point in time? What were you doing or what was going on that made you already more vulnerable? You're already stressed. What actually triggered the relapse? What was that straw that broke the camel's back Relapses occur when old behaviors are more rewarding or stronger than new ones. So what became more rewarding than your recovery program? And this is important as we watch people you know start slipping down that slope to relapse, their old behaviors are becoming more rewarding and these new behaviors that may not be quite as fun or pleasurable are less rewarding. So we want to help people recognize what was pulling them back towards that relapse. Before your relapse, what changes occurred in your physical functioning, interpersonal and intra personal self relationships, your emotions and your emotional control, the your cognitions, the way you are thinking about things and your ability to solve problems. Your environment and your sense of connection, meaning and purpose. Once you've reviewed that relapse, think about what you've learned. What can you take away from that to prevent the next relapse? What weaknesses do you see in your plan or in what you were doing that may have caused you to start slipping down that relapse slide? Include time in the morning and at night to use mindfulness skills to get grounded. Identify and prevent or mitigate vulnerabilities each day. Each day you're going to wake up, you may have slept well one day, not the next. You may, you know, don't skip breakfast, all those things eliminate unnecessary stressors that are going to make you more vulnerable. Avoid alone idle time if your mind tends to wander to dark places. Incorporate positive experiences each day. Set realistic daily goals and remember to give yourself credit for your accomplishments. Relapse triggers can be emotional, mental, physical, social, or even spiritual. For each trigger the person identifies, describe at least one way to deal with it. Practice mindfulness each day to become more aware of personal daily vulnerabilities for relapse and for each general category of vulnerabilities and relapses. Identify three things or relapse triggers. Identify three things that can be done to continue on the journey towards happiness. Are there any questions? Foreign. Everybody have an absolutely wonderful day and I will see you next week where we're actually I'm doing a brand new video on the importance of hydration for mental health. Remember your neurotransmitters com communicate through synapses in a fluid environment so when we're dehydrated you can see how that might throw a wrench in the in the works. Have a great day.