Relapse prevention (RP) is a cognitive-behavioral approach to

relapse In internal medicine, relapse or recidivism is a recurrence of a past (typically medical) condition. For example, multiple sclerosis and malaria often exhibit peaks of activity and sometimes very long periods of dormancy, followed by relapse or ...

with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behavior, sexual offending,

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...

, and depression.Witkiewitz, K. & Marlatt, G.A. (2004). Relapse Prevention for Alcohol and Drug Problems. American Psychologist, 59, 4, 224-235. It is an important component in the treatment process for

alcohol use disorder Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomin ...

, or

alcohol dependence Alcohol dependence is a previous (DSM-IV and ICD-10) psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol (also chemically known as ethanol). In 2013, it was reclassified as alcohol use disorder ...

Underlying assumptions

Relapse is seen as both an outcome and a transgression in the process of behavior change. An initial setback or lapse may translate into either a return to the previous problematic behavior, known as relapse, or the individual turning again towards positive change, called prolapse. A relapse often occurs in the following stages: emotional relapse, mental relapse, and finally, physical relapse. Each stage is characterized by feelings, thoughts, and actions that ultimately lead to the individual's returning to their old behavior. Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. In particular, high

self-efficacy In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura. Self-efficacy affects every area of human end ...

, negative outcome expectancies, potent availability of

coping skills Coping refers to conscious strategies used to reduce unpleasant emotions. Coping strategies can be cognitions or behaviours and can be individual or social. Theories of coping Hundreds of coping strategies have been proposed in an attempt to ...

following treatment, positive affect, and functional

social support Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be emotional (e.g., nurturance), ...

are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor of relapse.

Efficacy and effectiveness

Carroll ''et al''. conducted a review of 24 other trials and concluded that RP was more effective than no treatment and was equally effective as other active treatments such as

supportive psychotherapy Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques. The aim of supportive psychotherap ...

and

interpersonal therapy Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limite ...

in improving substance use outcomes. Irvin and colleagues also conducted a

meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting m ...

of RP techniques in the treatment of alcohol, tobacco, cocaine, and polysubstance use, and upon reviewing 26 studies, concluded that RP was successful in reducing substance use and improving psychosocial adjustment. RP seemed to be most effective for individuals with alcohol problems, suggesting that certain characteristics of alcohol use are amenable to the RP. Miller et al. (1996) found the GORSKI/CENAPS relapse warning signs to be a good predictor of the occurrence of relapse on the AWARE scale (r = .42, p < .001).

Prevention approaches

General prevention theories

Some theorists, including

Katie Witkiewitz Katie Witkiewitz is an American psychologist, Distinguished Professor of Psychology at the University of New Mexico in Albuquerque, New Mexico, and Director of the Center on Alcoholism, Substance Abuse, & Addictions, and the Addictive Behaviors ...

and

G. Alan Marlatt Gordon Alan Marlatt (November 26, 1941 – March 14, 2011) was a leading American-Canadian clinical psychologist in the field of addictive behaviors from the 1980s through the 2000s. He conducted pioneering research in harm reduction, brief inter ...

, borrowing ideas from

systems theory Systems theory is the interdisciplinary study of systems, i.e. cohesive groups of interrelated, interdependent components that can be natural or human-made. Every system has causal boundaries, is influenced by its context, defined by its structu ...

, conceptualize relapse as a multidimensional,

complex system A complex system is a system composed of many components which may interact with each other. Examples of complex systems are Earth's global climate, organisms, the human brain, infrastructure such as power grid, transportation or communication sy ...

. Such a

nonlinear In mathematics and science, a nonlinear system is a system in which the change of the output is not proportional to the change of the input. Nonlinear problems are of interest to engineers, biologists, physicists, mathematicians, and many oth ...

dynamical system In mathematics, a dynamical system is a system in which a function describes the time dependence of a point in an ambient space. Examples include the mathematical models that describe the swinging of a clock pendulum, the flow of water i ...

is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organization, feedback loops, timing/context effects, and the interplay between tonic and phasic processes. Rami Jumnoodoo and Dr. Patrick Coyne, in London UK, have been working with

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

users and carers over the past ten years to transfer RP theory into the field of adult mental health. The uniqueness of the model is the sustainment of change by developing service users and carers as 'experts' - following RP as an educational process and graduating as Relapse Prevention Practitioners. The work has won many national awards, been presented at many conferences, and has resulted in many publications. Terence Gorski MA has developed the CENAPS (Center for Applied Science) model for relapse prevention including Relapse Prevention Counseling (Gorski, Counseling For Relapse Prevention, 1983) and a system for certification of Relapse Prevention Specialists (CRPS).

Depression

For the prevention of relapse in

Major Depressive Disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Intro ...

, several approaches and intervention programs have been proposed. Mindfulness-based Cognitive Therapy is commonly used and was found to be effective in preventing relapse especially in patients with more pronounced residual symptoms. Another approach often used in patients who wish to taper down antidepressant medication is Preventive Cognitive Therapy, an 8-weeks lasting psychological intervention program delivered in individual or group sessions that focuses on changing dysfunctional attitudes, enhancing memories of positive experiences and helping patients to develop personal relapse prevention strategies. Preventive Cognitive Therapy has been found to be equally effective in preventing a return of depressive symptoms as

antidepressant Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common Side effect, side-effects of antidepressants include Xerostomia, dry mouth, weig ...

medication use alone in the long-term treatment of

. In combination with pharmaceuticals, it was found to be even more effective than antidepressant use alone.

References