On the previous article we discussed the downward spiral of anxiety. Today we'll see about one tool to avoid letting that spiral get out of hand. That tool is a relapse prevention plan.
Anxiety tends to come and go. Sometimes we have very little issues with it, and can go months or even years feeling stable. Then, for whatever reason, it rears it's ugly head: the anxiety and it's physical manifestations comes back.
Thinking about this wave can already be useful. Maybe you notice that you always have more problems during the dark months, for example, or during family holidays? These are important clues in getting to the root cause of your anxiety.
A relapse prevention plan can be written after a treatment trajectory, or when you are having little to no problems from the anxiety. It should be written soon after recovering from a worse period. When writing the plan during the start of "the good times" you ensure that it's logical, and that you still remember what helped you to start feeling better.
Of course, a plan can be as complex as you want. In it's most simple for a relapse prevention plan has three sections: Situations and risks that can cause you to relapse, how you can recognize a relapse, and helpful thoughts to recover. We will now look at each section.
1. Situations and risks that can cause a relapse
This is your first section. It's simply a list of things that cause you anxiety.
For someone with health anxiety (general fear of falling ill, may or may not be focused of a specific illness) the list could have things like
- news about illnesses, problems in healthcare or relating to sickness
- someone in the family or at work getting ill
- minor physical health complaints such as colds, headache, tiredness, rash
- news about epidemics or pandemics anywhere in the world
- doctor's visits where no clear reason is found for what I'm feeling
- watching medical drama series like House, E.R., Gray's Anatomy (tip: don't.)
- hearing about a person of my age or younger passing away.
For someone with somatic symptom disorder (excessive worries about a specific, existing symptom) the list could be something like
- changes in the experiences symptoms (stronger, appearing more often)
- news about illnesses, problems in healthcare or relating to sickness
- news or shows where my symptom is linked to a very serious condition
- new physical sensations I haven't had before
- deaths or sicknesses in the family.
Try to find the real, more general reasons behind day-to-day occurrences. It's more helpful to write "sickness in the family" than "that one time when uncle George coughed the whole evening, even though it was caused by a cat hair in his mouth".
Note that this is not a list of things you should avoid. It's a list of things that under specific circumstances can cause you to experience severe anxiety for a longer period of time.
2. How to recognize a relapse
In this section you detail how you recognize that you are slipping back to the anxious circle.
Try to be specific. for example, instead of writing that you feel stressed, write how do you know it's stress. Perhaps you get stomach aches, even though you haven't eaten anything out of the ordinary? Swollen stomach, fast heartbeat, trouble falling asleep, thinking about sickness, hair loss, dry skin from constantly washing your hands, often considering calling in sick, withdrawing from social encounters, avoiding leaving the house...
The point of this section is to remind you that what you're feeling is caused by your anxiety. Nothing else. You don't need to call an ambulance. When you then re-read section one, it should give you a feeling of "Ohhh I see, it's this thing again! I see I've indeed been seeing more X, and now I'm experiencing Y. "
3. How to recover
This is the most important, and sometimes most difficult, section. So you know what caused your anxiety, and you know it's indeed anxiety. Well great, but your heart is still beating million miles an hour, you're hyperventilating and you cannot sleep. So what now?
You can start by admitting that you are more prone to anxiety, and that it causes you physical symptoms. This sounds silly, but it's important: it shows that what you experience is anxiety, not a serious illness.
If you have done CBT, cognitive behavioral therapy, you have made a list of helpful thoughts. Thoughts that make you experience your anxiety in a new light. This is where you write those thoughts. For example, if my worst fear happened and I got sick with X, I would be treated and people would be there to support me. I can rely on people around me.
If you have done exposure therapy, write here all the things you have faces and survived. Remind yourself that you've been here before, and you came out stronger. I have been to hospitals, and while they smell bad (antiseptics), they otherwise have no impact on me.
If you do ACT, acceptance and commitment therapy, remind yourself that this is who you are. Despite the anxiety, you can still do (list all your favorite things here). Focus on what you still have and can do.
Save the plan and come back to it from time to time
You can tell about the plan to your friends or family. They can remind you of it when you're feeling bad, and perhaps you yourself have forgotten about it already.
Remember that a plan is just a plan. It's a tool. You still need to do the work - and you can always ask for help doing it. You're not alone.
I hope this post can help you the next time you're feeling down in the dumps!
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