Relapse Prevention with DREAM: Determination Resilience Exceptions Awareness Motivation

Hey there, everybody, and welcome to this presentation on relapse prevention for addiction and mood disorders. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to start out by defining relapse. What is it? Then we'll explore the mnemonic dream, which stands for determination, resilience, exceptions, awareness of vulnerabilities, and motivation. And we'll finish up by talking about how to develop an effective relapse prevention plan. Relapse indicates that the old behaviors have returned either because the new behaviors weren't doing what they needed to do, the person was struggling too much with distress and wasn't able to tolerate it for some reason, or because the person fell back into mindless autopilot. And we see this a lot in people in recovery. They work really hard and they start feeling better, and they're like, huh, I'm recovered. And then they quit doing the new behaviors, and they fall back into old habits, including not getting enough sleep, eating like crap, pessimism, burning the candle at both ends, lots of stress, et cetera. And all that stuff can start adding up and leading to a relapse. But they were the old habits that the person had been engaging in during their symptomatic period of time. Or they could have relapsed because the old behaviors were just flat, more rewarding. And it's true, a lot of times, behaviors that we use to numb or escape from pain provide rapid relief and feel really rewarding in the moment. But in the long term, they divert us or make us move further away from the things that are important in our rich and meaningful life. Recovery involves understanding what triggers each person's relapse. So it's really important not to say everybody is triggered by this. And in recovery circles, one of the mnemonics that we use is halt, hungry, angry, lonely, and tired. We. Well, that's true. Being malnourished, angry, lonely, and tired can be triggers for people. But there are a whole bunch of other triggers out there that we need to consider. I encourage people in recovery to dare to dream. Imagine what life will be like if you are in recovery or when you are in recovery. Daring to dream means recognizing that recovery is going to take effort and it's going to take a consistent visualization of a rich and meaningful life and choosing behaviors that are going to move you toward that rich and meaningful life. And that starts out with determination. A person who is getting ready to enter recovery needs determination because it's hard and it is not a cakewalk. Resilience or the Ability to bounce back, because even in recovery, life is going to throw you lemons sometimes. And it's important to be able to be resilient, even if you get knocked off course for a minute, to be able to get centered again. Exceptions. The ability to find exceptions to distress is really important to balance out, to become more mindful of all of the things in your life, not just the things that are going crappy. Awareness of vulnerabilities is really important because a lot of times we focus on one or two things that might trigger distress. But we need to be aware that we might be able to handle those triggers a lot better if we weren't already run down, if we weren't already vulnerable. Think about getting sick. If you are generally healthy, you can probably fight off the flu virus pretty well. Or if you do get sick, you're more resilient, you bounce back more quickly. But if you are vulnerable, if you are worn down, if you're eating poorly, if you've got underlying conditions, then if you get the flu, it could be a much bigger deal. So being aware of our vulnerabilities and preventing them as much as possible is a big step to preventing relapse, because it means that we are more fortified and able to deal with life on life's terms. And finally, M stands for motivation. Any change we make, any behavior we do, requires motivation. You have to be motivated to get out of bed in the morning. So we'll want to look at what motivates that person for each behavior. Things that motivate me may not motivate my husband or my best friend. Let's start with determination. I already said recovery ain't easy, and that may be the understatement of the year. I recognize this. People need a high level of tenacity to get through the rough points. And recovery, unfortunately, is also not a linear process. A person may go through a rough point, and then they're like, oh, wow, I've developed this new skill. Or let's take addiction recovery, for example. That first 30 days is really rough because their brain is getting out of the fog. Their body is starting to recover from the inflammation and the damage that was done as a result of the ingestion of the substances. So that first 30 days is really tough. And getting through that takes a lot of determination and tenacity. Things get easier after that until they hit another rough point. And when I work with people, you know, that first 30 days, we're not processing trauma. We are not actually doing a whole lot of really intense work. During that first 30 days is their time to get set, stabilized and fortified. So they have the ability, they have the resilience to cope with the difficult things when they happen. And in recovery there are going to be fits and spurts of encountering things that are distressful. But in life the same thing is true. You may be kind of coasting for a while and then all of a sudden a series of bad things happens. And unfortunately it does seem to happen in a series, but that can really be distressful at that point. So people need the tenacity and the determination to embrace that and say, even though these things are going crappy right now, I can stay in recovery and experience these things. And we talk a lot about living in the and in acceptance and commitment therapy. So you might want to check out that video. But let's stick with determination for right now. When experiencing distress, people often behave impulsively. And I've made the analogy before of a bee. If you have a bee land on your arm and whether you're allergic or not, a lot of people get stressed out. They're like, ah, I don't really want this bee on my arm. It could sting me, it could hurt me, bad things could happen. So our impulse is to try to swat it away or run away from it. That's our impulse. However, when we do that, a lot of times it makes the bee scared or angry and it ends up stinging us anyway. So exactly what we didn't want to happen, we, we cause to happen. When we experience distress. It's important to be able to forego the immediate impulse in order to achieve longer term goals, to think and go, okay, this bee is on my arm. Not really loving this right now. So we mindfully and non judgmentally observe the situation and we say, all right, what are my options here? I could swat it. Yeah, that's probably going to have bad consequences. Or I could wait for it to get bored because it will. Or whatever bees do that cause them to fly away. And that's what we want to do when we have urges. We want to be able to observe them nonjudgmentally, notice that they're there, and say, okay, what are my options here? And choose the option that is going to most effectively help us move toward our rich and meaningful life. R stands for resilience. I've already mentioned that a couple of times here because all of these things are integrated in order to be resilient, we also have to be determined we're not going to bounce back if we don't have some level of determination and motivation and all that other stuff. These things are not mutually exclusive. Resilience is the ability to bounce back. So think about a deflated ball. You know how. Well, if you were in elementary school, I know we used to have a whole rack of basketballs or dodgeballs that were available to us and some of them were more inflated than others. Think about the deflated ones. If you bounced them, how effectively did they bounce back? They may give a little half hearted plop, but they did not. The ones that were fully inflated when you bounced them, they often bounced twice as high and then came back down. That's what we're talking about with resilience. Keeping ourselves inflated or fortified enough that we can have the most impact when we experience distress. It's like, all right, you can push against me for a minute, but then I'm going to come back strong. A trampoline with rusted springs is another example. You can you bounce on that. You know you're gonna have springs break here and there and you may not be able to bounce as high. That's not the best analogy. Plants. Now, y' all know I'm a gardener. So this is another analogy of resilience. In the summer when it is really, really hot, the plants in the afternoon will often wilt because they are starting to become a little bit dehydrated. They wilt in the heat. And when you provide them water, then they're able to plump up their cells again and they bounce back. They go from being all, you know, wilted and kind of slumping over to being happy again or whatever you want to call it. People also show resilience. Think about people who are resilient after sickness or surgery. There are some people who have surgery and then they just kind of languish and. And there are other people who have surgery and the doctor says it'll be six weeks before you can return to normal functioning. And a month later, the doctor's like, wow, you bounced back faster than I thought you're cleared to go. So depending on what they started with and how well they take care of themselves during the distress controls, how quickly they're able to be resilient. A person can experience a stressful situation and return to what is normal for them. That's why I have normal in quotes, because everybody's baseline is different. But return to what is normal for them in a reasonable amount of time. That's what we're talking about with resilience, whether that's emotionally. If somebody has a panic attack they experience a stressful situation, they have a panic attack. And yes, that's exhausting. I'm with you on that one. And they are able to recover from that in a reasonable amount of time. What is reasonable depends on the person. Ideally, if somebody has a panic attack on Tuesday, we don't want to see them still languishing on Thursday. You know, we really want to see them feeling better the next morning, for example. But important for each person to define what that looks like. Part of resilience is hardiness. And hardiness, as I've talked about before, is composed of the three commitment, control, and challenge. And this was proposed back in the late 1970s by Kobasa. It's a really phenomenally interesting philosophy that actually underscores a lot of the future techniques like dialectical behavior therapy and acceptance and commitment therapy and even positive psychology. If you look back now, they may not specifically say this comes from hardiness work of Kobasa, but you can look at the hardiness work of Kobasa and look at the principles of these cognitive behavioral interventions and mindfulness interventions that go, hey, there's a lot of parallels here. I digress. Commitment, control and challenge. Commitment is motivation to enhance and use your energy purposefully for all of the aspects of your rich and meaningful life. Recognizing, yes, I am committed to my job, love my job, I am going to give it energy. But I am also committed to my children, to my husband, to my animals, to my garden. I could go on, and it's important for me to recognize where I'm spending my energy, because sometimes some things are going to go well and other things aren't going to be going so well. But recognizing all of those things and my commitment to all of those things helps me see the big picture. When one thing or even two things start to go kind of south, I can also recognize that, yes, that's happening and these other things are still going well. Control, recognizing what you can and cannot control in each situation. For example, you know, I said, I'm committed to my gardening. We have really awful soil in my garden. Actually, it's clay. It's not even soil. And growing in that medium takes a lot of preparation, takes a lot of effort, takes a little bit more water because it, when it dries out, it gets rock hard. And if I'm not devoting enough energy to it, my garden will languish. And then that makes me sad. And there have been some times when I've had to devote energy to other places and like my own health or my kids health or something like that. And I have. I've had to borrow energy from my gardening time to use over there, and that's fine. You know, sometimes you got to move widgets around. However, that meant that my garden did not do that well that year, and that was disappointing. However, I stepped back and I go, okay, well, that was a colossal failure this year. And it was important, or however it was important that I redirect my energy to these other things that are important in my life and do what I could to impact those things. So control is recognizing what I can and cannot affect, how much control is rewarding. And some people say, give it all to me. But think about that. If you are in control of everything all the time, oh, my gosh, how exhausting would that be? How much responsibility would that be? So a certain amount of control is rewarding, but having total control all the time can actually add stress to our lives, because then we start shoulding ourselves, and we start feeling guilty and overly responsible. It's important when we look at control, we also look at other people's parts in it. I said, last year, my garden kind of languished a little bit because my daughter and I were both having health problems at the same time. And it was important for me to recognize my daughter needed my energy. She needed my support at that point in time. But she also had a role to play in. In the situation, in taking care of herself and following the doctor's orders and those sorts of things. I could not control her health condition. I could support her, I could advocate for her, but I could not control everything. It's really important to recognize and allow people to take responsibility for their part. It's not your job to be responsible for everybody's part. Think about how having too much or too little control can be unmotivating or add extra distress. Now, if you have too little control, then it feels like nothing you do matters. And that can be overwhelming and exasperating, too. And a lot of people that I've talked to lately are really experiencing that particular end of the spectrum. They feel completely powerless over most things. And yes, there are some things that you are powerless over, but what do you have power over? For example, in addiction recovery, we talk about being powerless over the substance of abuse. Okay, you're powerless over that. You do have the power to choose whether you put yourself right in the path of it. You have the power to choose whether you walk into a bar. If you are struggling with alcoholism now, you know, you can't change how that alcohol impacts your body once you ingest it. But you can choose not to put yourself in that situation. Recognizing which aspects you can control depression, you can't necessarily choose when you're going to have a depressive episode. However, you can choose to have strategies in place to mitigate or minimize the distress it causes. So maybe it's not as intense or you've got supports that can help you get through it so you don't get angry and start feeling guilty and all those other secondary emotions that just cause you to lose even more energy and feel even more helpless and hopeless. So we'll get to that. And finally, challenge viewing distress, viewing unpleasant events as obstacles. You know, we talk about running obstacle courses. Obstacle courses are things that you figure out how to get or obstacles you face, figure out how to get over them, under them, around them, whatever. It's a challenge, it's a puzzle to solve. A barrier is something that is put there and it's, you're not meant to go over it, around it, under it, anything like that. So viewing challenges as obstacles instead of barriers can be motivating in some ways because that brings out your inner scientist, your inner curious person that says, all right now how can we solve this problem? Instead of saying big old barrier, I give up. Why is it rewarding when something is challenging? We know that most people find challenges more rewarding than things that are too easy. So why are things that are really easy not very rewarding? And why are things that are rewarding or challenging more rewarding? And ultimately the answer often lies in our self pride. When we do something that is too easy, we're like anybody could have done it. We minimize it, we move on. When we accomplish something that's challenging, we look back and we go, I did that. Awesome. For me. In order to be resilient dreamers, we need to have certain characteristics and resilience. Remember I said we've got to be fortified. That starts with making sure our body factory is in tip top condition. So engaging in healthy habits, sleep, hydration, nutrition, movement, slow breathing, you know, all of those things that I've talked about in so many other videos, affectively or emotionally and cognitively, what do resilient people do? Well, they are often approaching things from a place of empowerment. Instead of seeing challenges as barriers, instead of seeing things as overwhelming, they explore them as puzzles or things to be conquered. And they have a sense of personal power, they have a sense of what we call efficacy that they can accomplish this. So in recovery, the sense of empowerment that you can achieve recovery, you can achieve and maintain a rich and meaningful life and deal with the pain and distress that occasionally comes with it. People who are resilient, who are empowered in their recovery, can see that. And they don't have this false belief that everything's going to be great and I'm never going to have to stress again. They feel empowered to handle whatever life throws at them. Mindfulness is another characteristic. They are aware of what their physical needs are, what their emotional needs are, what their environmental needs are, and they use their energy wisely in order to best meet those needs and move toward their definition of a rich and meaningful life. Meaning is another characteristic of people who are resilient. They look for meaning in things, even when bad things happen. They look back and go, okay, what can I get out of that? And there's a story in one of my books on resilience that talks about finding the pony. And the short version is this child was taken to a farm and he was put in a room that was filled with hay and horse crap. And they told him, you know, you've got to shovel this out. And the child surprisingly, didn't argue. And his parents were just astonished because he had been being very oppositional. And child didn't argue when he went in and he started shoveling and digging and shoveling and digging. And eventually they went back and they checked on him and he was still shoveling and digging. And they said, what is motivating you to do this? And the kid looks at him and says, very matter of factly, well, with all this poop that's in here, there has got to be a pony in here somewhere. So he was looking for the pony. Instead of seeing it as a punishment or useless activity, he thought, okay, there must be a purpose to this. Maybe there's going to be a reward at the end. So let me find that pony. And theoretically they took him somewhere where there was a pony after that. But find the pony. Look for the meaning in things that happen. What can you learn about it to prevent it the next time? What can you learn about yourself from the experience you know, your courage, your strength, your endurance, any of those things? What can you learn about yourself? What can you learn about your significant others from this experience? What meaning can you find that can enrich and guide your actions and your beliefs in the future? Accurate cognitions is another characteristic of resilient people. They tend to use fact based reasoning, and I've talked about this before, as FCP facts in the current context, at the present time, what are the facts of the situation Instead of going with, you know, I'm anxious, therefore this is. This is going to be a bad day. What are the facts that support that feeling? Do I have any actual concrete knowledge about something bad that's going to happen? What do I have control over of the facts? What do I have control over that I might be able to mitigate? And p what is the probability? If I take control where I can and address the things that I know are going to happen? What is the probability that there is going to be a significantly negative outcome? Accurate cognitions also involve looking for exceptions instead of saying this always happens or this never happens, addressing those what they call in cognitive behavioral therapy, cognitive distortions. What are the exceptions? When has this happened before? Very few things always or never happen. A balanced mood and perception is also important for resilient people. It doesn't mean always being happy because that's not realistic or even natural. It means embracing the good with the bad, having positive times that balance out your negative times, having optimism that can help balance out pessimism. It's not saying ignore one and celebrate the positive. It's saying have a balanced perception of what's going on. Think about relationships, any relationship you're in, whether it's with yourself or with your kids or with your friends or whomever. Having a balanced perception, it's likely, or I should say it's highly unlikely that any of those people is perfect. So a balanced perception would say, these are all the great things about this person, or these are all the great things about me. And there are these other few things over here that are, you know, could be worked on. It doesn't have to be a 50, 50 balance. It just has to be an objective, reasonable look at things. And if you look at the yin and Yang diagram, you will see that there is yin within the Yang side and Yang within the yin side. It's important to know that there's always going to be an element of both in everything. Distress tolerance skills and thoughts are also essential for people who are resilient. Distress tolerance skills help people sit with negative feelings, sit with emotional and physical pain, recognizing that it's uncomfortable, but it will not destroy them, recognizing that they have the ability to tolerate it until all of the adrenaline kind of goes away and they can get in their wise mind and make an informed, purposeful decision. And finally, stress inoculation with visualization. There's really no nice way to put this or easy way to put that, but basically what it means is when you're getting ready to start the day, Visualize yourself going through the day and visualize it going well. That helps prevent distress because you're already seeing the things that you're going to do. You're envisioning them going well. Even if you're going to do something stressful, you're envisioning how you're going to handle it. So you're priming your brain for empowerment before you do something stressful, visualizing it in order to see yourself successfully moving through it. If you're going to have a difficult discussion with somebody, or you're going into a stressful meeting, or you're getting ready to take a test, envisioning yourself doing it well, it actually helps the brain go to form memories, form schema, form beliefs about that situation that it can use in order to guide you, which makes it less likely to trigger your amygdala or your stress response without significant provocation. Additionally, curiosity, flexibility, and persistence are three other characteristics of resilient people. They are going through life and, you know, things happen. Life throws you a curveball and they get curious. They wake up in the morning and they're experiencing depression, or they wake up in the morning and they're in the middle of a panic attack, or they start having cravings for their addictive behavior instead of getting angry about it. Resilient people get curious and they say, why now? Where's this coming from? Let me explore. They are flexible in their approach. They're not rigid because they recognize that life changes constantly. And based on the current time and the current context, the response to whatever's going on may need to be a little bit different. How I respond to my children when they are acting up at Home Depot may be slightly different than how I respond to my children when they're acting up at home. You know, at Home Depot, I can't really put them in effective timeout. I could take them to the car or something, but oftentimes I respond differently there. How we respond to our depression or our anxiety when we're at home may be different than how we respond to having anxiety right before we go out on stage to give a speech. So we need to be flexible in our response, even if it's to the same emotion or to the same situation based on the context. And they're persistent, they're flexible in their approach. But if what they try doesn't seem to be cutting it, then they back up, they get curious again, and go, okay, why didn't that work? What might work better and let me try it again. You know, like the little Engine that could. They just keep trying until they find the right solution. Scientists do this all the time. That's why they go through multiple trials of things. They're like, well, I think this will work. Oh, okay, didn't work how I expected. Let me try something different. They don't get, they don't take it personally, they don't get angry, they may get frustrated because they're like, okay, I don't know what the other options are right now. But that's when they back up, they talk to colleagues, they do more research, they continue to get curious because they're determined, they're persistent in their pursuit of a solution and problem solving skills. In order to be resilient, we have to be able to figure out how to deal with that curveball when it starts heading towards us. And that requires the curiosity, flexibility, persistence, mindfulness, et cetera. People who are resilient dreamers feel safe in their environment. They don't worry about where they're going to sleep tonight. They don't fear being having their boundaries invaded by others. In their environment they feel safe. So they have the ability to relax at times. I mean, when they're at work, they're working hard at work, but they don't have this secondary issue having to be hypervigilant because they want to make sure that something bad doesn't happen while they're at work. And that's triply exhausting. They are able to focus on work when they feel safe and they're not having to divert energy to being on guard. And relationally, people who are resilient tend to have more social support. They recognize that it takes a village, they have higher self esteem, they unhook from a lot of those shoulds and negative self talk. And they recognize that they are doing their very best at this point in time with the tools they have and appreciate and love themselves for who they are not based on a tally of successes or failures. People who are resilient are authentic with themselves and others. And this kind of goes back to mindfulness. But being mindful means being aware, communicating it, responding to it is authenticity. But your social support people cannot meet your needs if you are not being authentic. If you're not telling them what your needs are, then they can't possibly hope to even try to be supportive of you. Resilient people are also compassionate with themselves and others, recognizing that nobody has an A day all the time and everybody is going to make mistakes occasionally. Yes, I know those are extreme words, but I feel pretty confident using those extreme words in this situation. And finally, resilient people identify as survivors, not victims. They recognize that what may have happened in the past happened and it was unfortunate. And yes, at that point in time, they may have been a victim, whether it was a crime or a natural disaster or whatever. However, as survivors, they are resilient. They are able to move forward from that situation and it's not going to hold them down, it's not going to continue, continue to keep hurting them. Exceptions, and I talked about this and you know, dreamers, we have determination, resilience, exceptions. Nothing is done all of the time. Exceptions are what people are doing when they are not engaging in the target behavior. If I'm working with somebody who is struggling with binge eating, for example, or struggling with their weight and emotional eating, I may ask, what are you doing when you're not eating? And we want to do more of that. If that means walking the dog, if that means chewing gum, if that means talking on the telephone, doing crochet, what is it that you're doing when you're not eating? When people enhance or increase the exceptions, they, they're often doing things to enhance recovery. If I'm doing these things that are contrary to my target behavior, then those are things that are likely going to be pro health, pro recovery. Walking is good, engaging in hobbies is good, playing with the dog is good. Those are all positive activities that help me nurture other aspects of my life that are important and keep me from engaging in a behavior that I don't want to be engaging in. To identify exceptions, ask questions like, before this problem started, what was different? How did you deal with distress before this problem started? So people who are smokers, for example, before you started smoking, what was different? Now, a lot of people have been smoking since they could legally smoke, so they may not have a lot of answers to that question. But how did you deal with distress? Or how do you deal with distress when you're not smoking and look for exceptions. Look for tools that they use besides smoking to deal with the stress and build on those. That's called a strength based approach in the past six months when you were not engaging in the target behavior. So in this case, when you were not smoking, what was different? How did you deal with distress over the past six months? Because the way somebody coped when they were 15 is probably far different than how they will cope when they are 35. So we do want to look at, you know, the past six months and how have you coped? The same thing can be said for depression for example, before this depressive episode started, what was different? How were you dealing with the stress? What were you doing in the past six months when you were not depressed? What was different? And again build off those things. What things were you doing that were helping you stay happier and healthier and prevent a relapse? Not all mood relapses, for example, depressive episodes can be entirely prevented. You know, you can be doing everything in your power and then life just showers a whole pile dump load of crap on you and you know, then you start experiencing depression. That is a normal reaction to, to an abnormal situation. So when that happens, recognizing, okay, you know, there was nothing I could have done to completely prevent this distress. How can I cope with it in the best possible way to become resilient and bounce back? Awareness of vulnerabilities, triggers and relapse warning signs is also really important. Vulnerabilities are things that make you more likely to react with extreme distress when you experience them. I gave the example of getting sick earlier. If you have pre existing conditions and you haven't been sleeping and your nutrition is in the crapper, you're more vulnerable to getting sick than somebody who had been taking really good care of themselves. The same thing is true for our emotions and our behaviors. And if we are taking good care of our body factory, then when we experience distress, the stress reaction that's caused by the HPA axis or our stress response system will likely not have as intense or enduring of an effect. If we weren't already stressed out and primed, then we're probably not going to blow the lid off the pressure cooker. If we were relatively fortified, then we are more likely to be able to deal with what comes our way. We may experience distress, but it won't be the straw that broke the camel's back, so to speak. It's also important to remember that triggers can be positive or negative and prompt a feeling, thought, memory or behavior. You can bunnies, for example. I love bunnies. And when I see them, that's a trigger that triggers a smile on me every single time. So triggers can be positive and we want to incorporate positive triggers in our environment. When I come into the office, I turn on the little tart warmer that's plugged into the wall because I have my favorite tarts in there. And it, the smell makes me feel happy, it makes me feel relaxed. So I'm adding those positive triggers to my environment and I'm eliminating or mitigating as much as possible distressful triggers, things that make me angry or Unhappy relapse warning signs are the way people act when relapse is imminent. And a lot of times our social support see those before we notice them, unless we are really spot on with practicing our mindfulness, which is one of the reasons support systems are so good. Because they may say, hey, you know, you seem to be getting run down or you seem to be burning the candle at both ends. You want to talk about that? Or you know, how are you feeling? They may bring it to our attention. Describe your addicted versus sober self or your sick versus healthy self. How are you different when you are symptomatic versus when you're not symptomatic? When the behaviors of your sick self start to emerge, it's a warning sign that current strategies are not working, current skills and strategies are not being used in lieu of old behaviors. So if some of my relapse warning signs, for example, are irritability and insomnia, if I start staying up to all hours of the night playing on, you know, video games or something, and I start becoming more irritable with people, you know, that's an indication that a relapse is imminent. If I start losing motivation and having a, you know, forget about it attitude about work, you know, that's an indication that a relapse may be incoming pretty quickly unless I change my course and examine what I need to do to shore up my my resilience. Physical vulnerabilities, triggers and relapse warning signs. Sleep, lack of sufficient quality, sleep, insomnia or sleeping too much can all indicate a problem. Sleep hygiene is important. Nutrition, especially gravitating toward high caffeine, high sugar, high fat foods, often indicates self medication and also often deprives your body of the antioxidants and nutrients it needs in order to keep your body factory running effectively. So paying attention to your nutrition, an app can be really helpful. Keeping a food diary. Medication, being aware of the side effects of medication. For example, I know that I am super sensitive to stimulants. If I take a decongestant, I feel like I'm going to crawl out of my skin and I need to know that ahead of time because that makes me more vulnerable to anxiety. If I'm feeling. If my heart's kind of going faster than normal anyway because I've taken a decongestant, then I already feel amped up a little bit and I tend to be more likely to be irritable with other people around me when I'm in that state. It's important to be aware of so I can take appropriate actions. Pain management when we experience distress, our fight or flight system, our HPA axis, kicks off cortisol and a bunch of other stuff is dumped. Inflammation tends to go up and serotonin and endorphins tend to go down, both of which contribute to us feeling more pain. What might not be super painful to us. We feel it more when we are under extreme stress or chronic stress because of the alteration in our neurochemicals hormones. Estrogen, testosterone and thyroid hormone. Imbalances can be caused by sleep disruption, for example, can be caused by excessive stress and can cause symptoms. They can cause cravings, they can cause mood symptoms. So it's important to be attuned to your hormone levels to go in for your annual physical to make sure that your hormones are balanced and you're not suffering from hypothyroid or hyperthyroid or something. Order to keep your body factory running optimally. Affective and cognitive. Your mood can be a vulnerability. If you wake up in the morning and you just get up on the wrong side of the bed, that is a vulnerability potentially for having a more extreme reaction to anything that goes wrong during the day. Recognizing that, figuring out, okay, how am I going to deal with this since I'm starting 20 yards back? Emotional lability, having moods that are very fluid, so to speak, you can go from being happy to being angry like that. That is a symptom for a lot of people of chronic stress, and it's something that we need to make sure we address. Distress tolerance can be. Or intolerance can be a vulnerability. If we don't have the skills to tolerate discomfort when it happens, that can be a vulnerability. So when we feel distress, it can trigger a relapse. Our perceptions and attitude when they become negative can be a vulnerability because it causes us to have a negative outlook on a lot of things. We pay more attention to the threats, so it sets us up for distress, which can set us up for a relapse. When you have negative perceptions and attitudes, mindfulness, gratitude, and embracing the dialectics can all be helpful. Problems with concentration and attention can also be a vulnerability because when we have difficulty concentrating, we may get frustrated easier. We, we may forget things, and then people get mad at us because we didn't follow through. So there's a lot of things that happen when concentration and attention are disrupted. What can you do? Write things down, Ask for assistance when needed. Same thing with problem solving. Environmental vulnerabilities. Remember that a lot of our memories are tied to our senses. What we see, what we hear what we smell. So making sure that our environment is as relaxing, comfortable and safe feeling as possible is really important. And stability in that environment is also important. If we're worried about whether we're going to have a roof over our head tonight, that's going to be a vulnerability. It's going to make it harder to deal with anything else life throws at us because we're having difficulty getting our basic needs met. And finally, relational vulnerabilities, triggers and relapse warning signs social support and Engagement A lot of people, when they're heading down that relapse road, either start hanging out with people that support their unhealthy thinking and rationalization in recovery. We say they hang out with people who will co sign on their crap or they withdraw. They don't want to be around people at all. So if you notice that, that can be a vulnerability because you don't have other people to help you shoulder the weight of the world. It can also be a relapse warning sign. What do you do? Where can you find the social support that is not overwhelming? Communication styles when people tend to. When people communicate tersely or ineffectively, it can be a vulnerability. If you don't effectively communicate what your needs are, it's hard for people to respond and meet those needs. So you may start feeling resentful if you're not effectively communicating. It can also be a relapse warning sign. If you start communicating aggressively, or on the other hand, passively just saying whatever, I don't care, that can be a warning sign that you are feeling either threatened or just completely burned out and overwhelmed. And self esteem can also be a vulnerability if your self esteem starts to take a take a nose dive for whatever reason. A lot of times that makes people feel anxious and depressed and fearful of abandonment and maybe fearful that they're not lovable, which are all very distressful thoughts that can trigger anxiety, depression, anger, addiction, all kinds of stuff. When you notice your self esteem is hitting rough ground, it's important to have strategies for addressing that. And that's far beyond the scope of this particular presentation. People do what's most rewarding, so help them enhance the drawbacks to the target behavior. What are the drawbacks to smoking? Help them enhance the benefits to the new behavior. What are the benefits to being whatever you're going to do to be smoke free? What are the benefits to your new coping strategies and help them minimize the benefits to the target behavior? You know, yeah, smoking may have helped you relax really quickly, but let's minimize Those benefits? What else can you do to help you quickly re regulate your autonomic nervous system and address the drawbacks to the new behavior? What are they afraid of? What are these new coping strategies? Not doing that the old behavior did and how can we maybe manage that? Motivation differs for each behavior. Sleep, sobriety, nutrition. Our motivation to engage in each one of those behaviors is going to be a little different. Motivation also differs for different aspects of a behavior. For example, in nutrition, my motivation for staying hydrated may be a lot higher than my motivation for giving up caffeine or eating fruits and vegetables to get my antioxidants. We need to recognize that and get very granular as we're enhancing motivation. Motivation has five different components. Physical how is it going to reduce my pain? Help me have more energy? Improve my health? Affective how's it going to make me happier? Cognitive how is it going to help me think clearer? How does it make sense that what I'm doing is going to be helpful? How is it logical? Environmental in what ways can I adjust my environment to support this new decision? What triggers can I put in my environment to remind me to do it? And social who can be there to support me and encourage me? Motivation is changeable. And I've got other videos on the YouTube channel that talk about the stages of readiness for change. But basically pre contemplation, people don't believe they've got a problem. Contemplation. They recognize they've got a problem, but they're not asking for help yet. Preparation. They're starting to figure out what they might be able to do to make a change. And then action obviously is self explanatory. Once people have achieved their goal, then they need to maintain their goals. And I have relapse down here because relapse often happens, but it's not a prerequisite. You don't have to relapse. Some people may refer to slips, and sometimes this means you start backsliding a little bit, but you catch yourself before you go into a full blown relapse. As such, motivation is not linear. Mindfulness will help people identify when their motivation is waning, when they're falling back into an earlier stage of readiness for change. So they can say, okay, I'm starting to get unmotivated. What do I need to do in order to turn up that motivation volume? Relapse prevention plans incorporate mindfulness, minimize vulnerabilities, and contain an emergency response plan. If you suddenly get into crisis, what do you do? What are three to five things that you can do to keep yourself safe to prevent a full blown relapse. Set goals that are specific. Such as I want to stop smoking versus I want to get healthy. Well, what does get healthy look like? Stop smoking is a very specific behavior. Go to bed by 10:00pm versus I want to improve my sleep. Well, there's a lot of things you can do to improve your sleep. So what's one thing that you're going to do? It needs to be measurable. Something that can be said either true or false. Yes you did it or no you didn't. Like, did you stop smoking? Did you go to bed at 10? Yes or no. Or the frequency, like the number of cigarettes you smoked in a day or the number of crying spells or temper tantrums that you had during the day, you want to see those start to decrease. Or the duration, like the duration of your sleep, the duration of your distress, or the duration of your cravings for sleep, you know, eight hours or more, you know that's what you're shooting for. Are you increasing even gradually the how long you're sleeping, are you reducing even gradually the duration of your distress? When you have a depressive episode, is it going instead of being one whole week long, is it now six days or even five days? Or intensity, is it one minimal? So you have the symptoms, you know they're there, but they're not at all disruptive. Two mild, somewhat disruptive, but you're still going on with your daily life. 3 moderate, very disruptive but not totally overwhelming or 4 severe, overwhelming, debilitating, can't go through normal life Right now we want to reduce intensity so you can choose frequency, intensity, duration or just a yes or no for the goal. Goals also need to be achievable. You need to pick stuff that you actually have the skills and tools to accomplish. Make sure you can do it. It's something you can do. Time limited and I encourage people to set micro goals. Each goal should be accomplishable in one hour or one day. That way you can slowly build up your micro goals. People in recovery have determination, resilience and understanding of the exceptions. That is what are they doing differently when they're not symptomatic, they're aware of their vulnerabilities, triggers and relapse warning signs. And they have a motivation to live a recovery lifestyle. And yes, that's a really vague goal. Each person is going to have to define what that looks like for them, what their rich and meaningful life looks like that they're motivated to put the effort in relapse prevention planning, minimizes vulnerabilities, incorporates mindfulness, and contains an emergency response plan.