I spoke Tuesday at The Team Challenge about PAWS Post Acute Withdrawal Syndrome. It was a powerful subject as we recognized that permanent change takes time...more time than it takes to lose weight. The emotional and psychological work of recovery of any destructive behavior takes time. I challenged our clients to do the very important work of self-care and rewards to change the way they think about their relationship with food and also to prevent relapse in the future.
Relapse...a scary word in all of recovery.
Relapse is a process, it's not an event. In order to understand relapse prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. There are three stages of relapse.
1. Emotional relapse
2. Mental relapse
3. Physical relapse
Emotional Relapse
In emotional relapse, you're not thinking about overeating. But your emotions and behaviors are setting you up for a possible relapse in the future.
The signs of emotional relapse are:
* Anxiety
* Intolerance
* Anger
* Defensiveness
* Mood swings
* Isolation
* Not asking for help
* Poor sleep habits
The signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it's easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.
Relapse prevention at this stage means recognizing that you're in emotional relapse and changing your behavior. Recognize that you're isolating and remind yourself to ask for help. Recognize that you're anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.
If you don't change your behavior at this stage and you live too long in the stage of emotional relapse you'll become exhausted, and when you're exhausted you will want to escape, which will move you into mental relapse.
Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you overeat. You use food or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don't take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.
For example, if you don't take care of yourself and eat poorly or have poor sleep habits, you'll feel exhausted and want to escape. If you don't let go of your resentments and fears through some form of relaxation, they will build to the point where you'll feel uncomfortable in your own skin. If you don't ask for help, you'll feel isolated. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.
Mental Relapse
In mental relapse there's a war going on in your mind. Part of you wants to overeat and go back to old habits, but part of you doesn't. In the early phase of mental relapse you're just idly thinking about it. But in the later phase you're definitely thinking about using...your drug of choice.
The signs of mental relapse are:
* Thinking about people, places, and things you "used" with
* Glamorizing your past life style
* Fantasizing about using
* Thinking about relapsing
* Planning your relapse around other people's schedules
It gets harder to make the right choices as the pull of addiction gets stronger.
It's important to use tools at this time to stop the mental relapse. Play the tape through. When you think about overeating, the fantasy is that you'll be able to control your self and get back on track this time. You'll just eat poorly one day, one week. But play the tape through. One bad day usually leads to another. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, over eating doesn't seem so appealing. Remind yourself of the negative consequences you've already suffered, and the potential consequences that lie around the corner if you relapse again.
Call a friend, a support, or someone on the same journey. Share with them what you're going through. The magic of sharing is that the minute you start to talk about what you're thinking and feeling, your urges begin to disappear. They don't seem quite as big and you don't feel as alone.
Distract yourself. When you think about eating, do something to occupy yourself. Call a friend. Get up and go for a walk. If you just sit there with your urge and don't do anything, you're giving your mental relapse room to grow.
Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you're in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you're supposed to do, it'll quickly be gone.
Do your recovery one day at a time. Don't think about whether you can stay "on program" forever. That's a paralyzing thought. It's overwhelming even for people who've been healthy and at goal weight for a long time.
One day at a time, means you should match your goals to your emotional strength. When you feel strong and you're motivated to eat healthy, then tell yourself that you won't eat poorly for the next week or the next month. But when you're struggling and having lots of urges, tell yourself that you'll eat well today or for the next 30 minutes. Do your recovery in bite-sized chunks and don't sabotage yourself by thinking too far ahead.
Make relaxation part of your recovery. Relaxation is an important part of relapse prevention, because when you're tense you tend to do what’s familiar and wrong, instead of what's new and right. When you're tense you tend to repeat the same mistakes you made before. When you're relaxed you are more open to change.
Physical Relapse
Once you start thinking about relapse, if you don't use some of the techniques mentioned above, it doesn't take long to go from there to physical relapse.
It's hard to stop the process of relapse at that point. That's not where you should focus your efforts in recovery. That's achieving abstinence through brute force. But it is not recovery. If you recognize the early warning signs of relapse, and understand the symptoms of post-acute withdrawal, you'll be able to catch yourself before it's too late.
Beliefs=Thoughts=Feelings=Actions...it always come down to this! Work the program and you will keep your weight off for life!
Always encouraging you,
Letha
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