Relapse management

Moving forwards

It will take time to break the vicious cycle of fear, but these evidence based techniques will help you to do just that.

Once you have worked up the hierarchy and your anxiety level feels more manageable, it is time to think about next steps. Going back to the targets and goals you set at the start of this programme is a great way to do that. It may be you still want to work towards some of these, or you may feel you have now achieved these, which is great. This next section helps you to think about keeping your CBT skills fresh for the future and what to do if you feel anxious again.

Everyday mood changes and anxiety

It is normal for our mood to change day to day. Often more than once a day, depending on what happens to us! We all have times when we feel anxious for a few hours or even a few days at a time. Some situations it is entirely appropriate to feel fear in response to. We also have worries, a level of worry and fear in our lives is normal! and keeps us safe. Remember the adrenalin response is there for our safety. We need it to kick in when it should do. What do you do when you have a day like this? Try not to let any anxiety affect what you do. That’s when that vicious cycle can take hold again. It is part of everyday life to feel this way from time to time. You may even have a panic attack again in the future, remember anyone can have a panic attack. The key thing is to not let it affect what you do as a result. Be kind to yourself. Don’t put yourself under too much pressure that your mood has always got to be positive and you won’t feel anxious – you will have days where you feel down or where your anxiety is there. This is OK, we all do!

The important thing is to remember it is just a normal part of life. Try not to let it form a cycle again and affect what you do and how you feel about how far you have come.

What is a lapse?

Sometimes, you can lapse back into old ways for a few days. For example, you may avoid things or fall into using old safety behaviours. A lapse does not mean that you have relapsed. Spotting it means you can act to break the cycle before it takes hold. Recognise a lapse for what it is. Try not to worry that it is a sign that you have gone back to square one. It isn’t! If you spot this happening, it’s a sign to put your skills into action again.

What is a relapse?

A relapse is when you start to feel the way you did before over a longer period of time. Your physical symptoms of fear may return for several days in a row and be out of proportion to the situation. If this should happen, you have the CBT skills to put back into action again. That should mean that the problem doesn’t get as bad or last as long. Completing this guide can help you to spot early warning signs before that vicious cycle has a chance to take hold again. You can also refer yourself again for more support, should you need it.

“Ferg: I kept working up the hierarchy even after my support sessions had finished, just to prove to myself I could manage the things at the top I hadn’t got to yet. I am so pleased I did. I have done nicer things than exposure and habituation, but I have never done anything that has helped me so much!

My early warning signs

Make a note of the things that you noticed first with your panic disorder and any agoraphobia. How did it affect you physically? What where you doing or not doing because of this? How did it affect your thoughts? Think about any safety behaviours you may have used that could be an early sign if you start using them again. Sometimes others around us noticed these things before we do. Ask those close to you what they noticed first. These are things to look out for as early warning signs in the future. Remember though, that you may have some of these symptoms as part of a normal mood pattern. If they are affecting how you are feeling and what you are doing more days than not, it is time to act.

Both Ferg and Alison suggest reflecting on how you feel now your panic and agoraphobia has improved. This is useful in staying well. Write can yourself a letter about how far you have come, how you are feeling and how you made that happen. Then, pop it into an envelope and address it to yourself. Or ask a trusted friend to post it to you then. Put a reminder on your calendar or on your phone. This can remind you to open it and enjoy reading it again in 3, 6 and 9 months from today’s date. Once opened, reflect on how you are feeling. Also reflect on the impact that making the changes you have put into place has had on your life since. Then re-seal it and put it somewhere safe you will remember for next time! You should take out your letter and read this again if you notice any early warning signs. This will motivate you to put your CBT skills back into action. This will help prevent your early warning signs from getting worse. Remember, you have helped yourself before. You can do it again if you need to!

“Alison: I found it useful to write a letter to myself. It enabled me to see how our life had improved and how far I had come. I knew I would be able to put my skills back into practice if I experienced any early warning signs.”

My monthly mood check

Keeping check on my mood

How has my anxiety and panic been this month?

Have I had any of my early warning signs?

Am I avoiding things because of how I am feeling, having negative thoughts that are affecting what I am doing, or have I been doing things to feel better that only work in the short term?

YES

For how many days?

NO

Reflect on the progress you have made since your last review and take a moment to think about what you would like to do in the next month to keep moving forwards

YES

If yes: Do I need to put my CBT skills back into action? If so what am I going to do and when am I going to do it? Use the questions from the first aid kit to keep your exposure and habituation skills fresh

NO

Use the first aid kit questions to keep your skills fresh

Think of your exposure and habituation skills as a first aid kit for your mood. They are always there if you need them. You just need to remember how to use them and to keep your skills fresh.

What do I remember are the key points of the exposure and habituation approach that I learnt? What are the 4 conditions and how do you know you have met them?

Take a few moments to read through your intervention booklet again. Even if you are feeling well, this is a great way to make sure you know what you need to do if you need the skill again in the future. Do I feel confident enough to be able to use the techniques again if I needed to?

Put this page somewhere you will remember it and mark a review day on your calender once a month