Relapse Prevention: A Stitch in Time

So, you’ve recovered from an episode of depression, psychosis, or mania, and you’re hoping never to be unwell again.

The good news is that spending some time and thought on relapse prevention planning can make that a reality. It’s possible to set up a personalised plan to help you notice your early warning signs that an episode may be on its way, and any actions you want to take after noticing these signs.

It is important not to live in a constant state of vigilance, wondering if one night of poor sleep means you’re about to have a relapse. All that stress can bring down your quality of life and may even trigger a relapse. But, burying your head in the sand and hoping for the best is equally unlikely to help you stay well.

If you have had a significant episode of depression, mania, or psychosis, it can be helpful to set up a relapse prevention plan. You could also commit to attending mental health checkup appointments at set intervals – every three months generally seems manageable and productive. This checkup could be with a mental health nurse, psychologist, psychiatrist, or a GP with a special interest in mental health.

There is a framework for relapse prevention planning that some psychologists have training in. It is a process with three stages:

Stage 1

You meet with your psychologist for around an hour to identify your early warning signs and work out a personalised plan of actions you can take to stay well and also actions to take if you notice early warning signs. Taking action at the first signs of relapse can prevent a relapse or at least greatly reduce the length and severity of an episode.

The psychologist uses a card sorting activity to help you identify your early warning signs. This involves sorting cards with statements such as “needing less sleep” or “feeling confused” into piles according to the stage at which they happen for you.

This activity is helpful for identifying early warning signs you hadn’t noticed before. Most people have noticed some of their early warning signs, such as wanting to go back to bed during the day as an early sign of depression. There are likely to be other signs that you’ve never noticed, such as talking less or withdrawing from friends and family.

It is very helpful if you can bring someone who knows you well to this appointment, as they may have noticed some early warning signs that you are unaware of. They can also provide ideas for how you can help yourself, and what support they are prepared to offer.

Stage 2

The psychologist types up a personalised relapse prevention plan for you to keep. This plan includes the early warning signs you’ve identified, plus the actions you plan to take if you notice these signs. The plan also includes contact details for any health professionals you see for your mental health, plus crisis numbers. 

If you have a history of an episode affecting your judgement and refusing to seek support, you may choose to specify that you give permission for a trusted friend or family member to contact treatment services on your behalf. This is reassuring for your loved ones, who often worry about upsetting you or damaging their relationship with you if they “put a foot wrong” when you are becoming unwell.

Stage 3

You review the plan with your psychologist and make sure it covers everything you need it to cover. You then receive a printed copy and an electronic (PDF) version for your records. 

You can contact your psychologist to review and change the plan whenever you need to in future.

Download a sample relapse prevention plan PDF: SAMPLE Relapse Prevention Plan

If you’re looking for a psychologist who is trained in this style of relapse planning, feel free to contact us at Wheelers Hill Psychology.