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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
Relapse prevention (RP) is a cognitive–behavioral treatment (CBT) intervention designed to prevent or cope with relapse for clients who are committed to changing their addictive behavior, either by pursuing abstinence or moderation as a treatment goal. In terms of the "Stages of Change" model of behavior change, RP is often described as a maintenance stage approach once the client's initial commitment to change has been established. RP has two main goals:
The first goal of RP is to identify the client's high-risk situations or potential triggers for relapse. Assessment methods are used to pinpoint high-risk situations such as negative emotional states, social pressure, or interpersonal conflict. RP intervention strategies include both cognitive and behavioral coping skills that are matched to the client's profile of potential triggers. Cognitive intervention strategies include assessment and modification of unrealistic outcome expectancies for the initial effects of engaging in the addictive behavior (to counter the demand for immediate gratification), strengthening the client's confidence or self-efficacy in their ability to successfully cope with high-risk situations, developing cognitive imagery designed to help the client identify and manage craving and urges (e.g., "urge surfing"), and practicing mindfulness of thoughts and feelings that may be related to risk of relapse. Behavior intervention strategies include avoidance or escape from trigger situations, including exposure to environmental cues that may trigger craving or cue reactivity related to urges to use. For social pressure situations, clients are taught effective communication skills to resist the pressure, rather than relying on will power alone (strengthening "skillpower"). Behavioral interventions such as exercise, relaxation and establishing a balanced lifestyle are also offered as stress-reduction techniques, particularly for clients who are at risk for relapse related to a desire for self-medication to cope with negative affect. The second goal of RP is to help clients who are experiencing setbacks or relapse episodes during treatment. The therapist works with the client to restructure the guilt and shame that often arise following lapses (coping with the "Abstinence Violation Effect") so as to reframe the lapse as a mistake or error in the recovery process, an event that can be learned from in the process of recovery. Relapse management is designed to keep the client working on change, rather than giving up or dropping out when setbacks occur. The therapist style in RP is based on a client-centered approach, with acceptance of the client based on a compassionate relationship (vs. a confrontational or judgmental approach). The therapist's role is that of an understanding and helpful ally or guide to work with the client in the pursuit of his or her own treatment goals. In RP, the typical client is someone who is committed to either abstinence or a harm-reduction goal of moderation. Often this client is faced with co-occurring mental health and addictive behavior problems (e.g., a woman who has alcohol problems because she drinks as an attempt to cope with severe episodes of depression). Many clients come to RP after they have completed an initial treatment program (e.g., residential or intensive outpatient therapy). The therapist provides an integrative approach to working with dual disorder clients. Other clients come to RP because other treatment approaches (e.g., 12-Step groups) are not working for them and they prefer a more individualized treatment approach. |
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