A reader recently wrote to me about her overwhelming fear of relapse. She said, “I’m struggling now with it, obsessing over it, and I’m so, so scared. Do I want to crawl into the hole? I fear that. But I can’t. I can’t.”
First of all, thank you for being honest. Because so many of us know exactly how you feel. I’m there a lot of the time myself. Less than I was the two years following my hospitalizations, but there too much of the time.
Doctor Smith would continually remind me during those first fragile years after my big breakdown that a slight setback in my recovery didn’t mean that I was plunging into a full-fledged depressive episode again, and that it wouldn’t take another 18 months to recover, like it did after my breakdown. These hiccups are normal, she reminded me. Recovery is never static, predictable, or symmetrical. On the contrary, it’s often messy, unpredictable, and annoyingly erratic.
I use a couple of cognitive reminders today when I’m panicking about relapsing.
1. My past doesn’t dictate my future.
They are totally separate. Just because I have been through an excruciating depression in my past doesn’t mean I will return to the same painful place every time my thoughts go south. Think of it this way: your brain is constantly forming. It’s part plastic. Which means, what was isn’t necessarily what is or what will be.
2. All things pass.
NOTHING is forever … which is a shame on the good days, but a lovely thing on the bad days. Moreover, this too shall pass. Everything does. Even the ice-cream truck in the summer. One minute it’s there, and then, bam! Gone to the next neighborhood. So much for the Klondike bars.
3. I will be okay.
Even if I do get sucked up right back into the Black Hole, I will survive it. I have before. I can rely on the reserves of strength and wisdom that got me out of there before (that is, in addition to some medication, in my case).
4. Have a plan.
Sometimes it helps to jot down some specific steps to take if you’ve just cried yourself through two boxes of Kleenex. A friend of mine knows it’s time to see her shrink when she doesn’t get out of bed for three days. My kids don’t really leave me that option, so my requirements are different: by the third day of crying incessantly I make an appointment to see Dr. Smith.
5. Be prepared.
You might not ever have a relapse. I hope you don’t. But if you suffer from chronic, and especially treatment-resistant depression, you can count on a few in your future. So be ready for the hurricane. For example, I always like to have at least two weeks worth of blogs uploaded in the blogging software that I can use in the event of a relapse. Some weeks I’m simply more productive than others, so I try to be like a communist country and even things out a little bit … taking the energy from the good weeks, and using them for the “my brain is a big fart” cycles.
What about you? How do you keep yourself from worrying about a relapse? Do you prepare yourself for one?
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Collection Development Blog » Psychology Headlines from PSYCHNEWS (11/6/2009)
8 Comments to
“The Fear of Relapse: 5 Cognitive Tools”
To prevent or catch relapse before it gets too bad, I use my personal Wellness Action Recovery Plan (WRAP) by Mary Ellen Copeland. It’s an amazing tool both for the darkening times and for the times that just seem off-balance.
Thanks for this article; I can relate a lot. I’ve often had this fear too since my hospitalization. During a few slips I was close to panic. My therapist said this is very normal though. Thankfully, this fear has gradually lessened; I think acceptance and a wider support network has helped.
I was doing well for quite sometime; I even tapered off 2 of my medications(with my doc’s OK). The depression hit back again, I didn’t have a plan. My therapist threatened to call the cops to get me put in a safe place. My Psych doc said he wouldn’t put me in, but I had to get back on my meds- the side effects are terrible! I have a WRAP book; but they tried to have me fill it out while I was still foggy from the meds- I could think straight! Once I get to feeling better I do have to find a way to keep me from hitting rock bottom again. Due to my dual-diagnosis( Addiction and mental illness) it gets harder to separate- did I really fall if I only took too much Rx medication- I didn’t drink!
Mary Ellen Copeland’s book, Winning Against Relapse, has really helped me. It’s filled with great stories, examples, helpful hints, and has helped me find the confidence I need to advocate for myself.
Mary Ellen is the author of the Wellness Recovery Action Plan (WRAP). You can get Winning Against Relapse at
http://mentalhealthrecovery.com
Before being diagnosed as bipolar I was vulnerable to crisis, even though I didn’t know it. After finding a wonderful doctor, one of the most important things we did together was to identify the signs of a possible crisis so now when I notice one of them, I call my shrink to see him as soon as possible. I also recommed Donald Winnicott’s article on the fear of the breakdown. He provides an explanation for the fear and also calls attention to the fact that people who have experienced a breakdown learn to avoid new ones.
So far I have been able to stop my slide down by adjusting my meds;I am blessed. Lately, I can talk with dear friends about how frightened I get when I have a few bad days. I guess it is like someone with any disease that is in remission; they freak when old symptoms come back.I know afterwards that most folks not suffering with severe depression have learned to ride these dips out until they pass. It is consoling to me that my fears are shared by others and I am not “just not grown up”.
This is an important subject – thank you for writing about it.
I wonder thought about the past not be a predictor of the future, where depression is concerned. My doctor told me otherwise, and he is a prominent psychiatrist who was head of the teaching staff at a major institution.
What he told me is that once a person has had a severe major depressive episode, she/he is actually more prone to them in the future. We were talking about this in the context of understanding the disease as being a life-long condition, as opposed to an isolated incident, and as such, one that required vigilance and strategies for coping through life.
Has anyone heard the same thing? It was scary to hear at first, but it also gave me a stronger sense of myself in a way. Because it dispelled ideas I’d had about ‘escaping’ depression, and rather, seeing it as part of my makeup, and therefore, being more in control.
I have had the experience of multiple episodes, years apart. When I was in a psych day program, we did a lot of work with CBT for monitoring ourselves and developing strategies. I got a lot out of that, even after years of very productive talk therapy. Along with meds.
THANK YOU from the bottom of my heart for this little article. I’m 28 and have gone trough 4 episodes of depression varying in severity. I’m currently on medication that does not seem to work as well as the medication I was on before which I cannot take right now because I’m trying to get pregnant. The past few days have been difficult because every time I feel the anxiety mounting and I feel the usual symptoms of gloominess and despair, I feel like at any moment I could have the rug ripped from under me and fall again. To be able to relate to what other people are going through and not feeling so alien really helps. I find the cognitive tricks very useful and will try putting them to good use. To all of you out there who have been touched by anxiety or depression, my heart goes out to you. You are not alone:)
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Last reviewed: By John M. Grohol, Psy.D. on 3 Nov 2009
