My last post left us in the Action Stage (Stage 5) where we had finally made our change.  But no matter what you’re trying to do, if the change you’re making is challenging, you will have slip ups.  That’s precisely why Stage 6, Relapse, is actually considered a stage of change, because it’s such a natural part of  the long term process of change.  Although it’s listed as the final stage in the Transtheoretical Model, the model is actually a circle, where Relapse flows directly back into Stage 1.  This circular shape is in recognition of the continual cycle of falling off and then getting back up on the change horse, so to speak. Change will always have its ups and downs and backs and forths. Today’s post is about how to cope with relapse in order to minimize its detrimental effect on your long term goals.  In other words, how not to give up after a setback!

In most cases, it’s not the relapse behavior itself that is so costly, but the negative effect of the relapse on your self esteem and confidence.  After a backslide into old behavior, it’s natural to feel disappointed, frustrated, and like you’re a failure.  But it’s these exact feelings that actually perpetuate the relapse behavior, research indicates.  People get so down on themselves, they give up, labeling themselves as too weak or too lazy, or some other character flaw that is permanent.  This negativity actually fuels the relapse behavior, as you get into an “Oh, **** it” mindset and punish yourself with harsh self criticism.  This continued self criticism further sinks you down into the dark hole of relapse.  

The biggest factor in how well people overcome a relapse incident or episode is how quickly they can get back on track.  The longer the old behavior continues, the harder it is to get out from under its grip.  An important factor is your perception of your relapse and what you attribute it to.  If you declare it happened because you are a no-good loser who will never be able to be successful, it will be harder to get back on track.  If, however, you attribute it to a bad choice, a stressful event without the proper coping tools available, or a slip due to a temporary situation you can keep the problem to a fixable solution rather than a character flaw that dooms you.

When and if you do have a relapse, try to distance yourself from it as if you were a scientist investigating a problem.  Create reasonable hypotheses regarding what happened by looking at the evidence, such as what triggered the behavior, what coping was needed, and what could have prevented the behavior from happening.  As best you can, develop a rational explanation to counter your emotional self sabotage. Begin to problem solve and plan for the future. Understanding what happened is about creating forgiveness so that you can let go and move on, not about making an excuse so that you can keep going in your relapse.  Think of relapse as a good time to evaluate your self care.  We tend to be most vulnerable to slipping back into old habits when we are stressed, tired, lonely, depressed, or too busy to be thinking about our values and our choices.  Sometimes it helps to think about emotional relapse as separate from the actual relapse behavior.  When we stop caring about ourselves, we emotionally give up and slip into circumstances that make us more likely to engage in the behavior we have been careful to avoid.  In AA there is a saying, you take your first drink before it ever crosses your lips.  Warning signs might be isolation, avoidance, rationalizing, and romanticising how life used to be.

And this is how we get back to the beginning, by reaffirming our need and desire for a change, reassessing our motivation and our skills.  Try to use your relapse as good energy to recommit yourself rather than a drain on your energy in self punishment.  While relapse is never pleasant or desired, by incorporating it as a part of the change process, you can take the powerful sting out of it that may lead you to give up.  If it’s planned for and an expected part of the process, it makes it easier to move past it.  Letting go of shame is critical to moving into a recommitment.  This is why it’s often important to tell someone about your setback, airing it out in a way that tends to take the secrecy and darkness out of the incident.  It also allows you to gather support and guidance in getting back on track.

After a relapse incident, it’s often a good idea to write a letter to yourself about what happened.  It helps to clarify how you are feeling and to let go of the negativity.  It’s also a great reminder of what it feels like to be in the situation.  There is nothing better than reading your own words to remind yourself about the pain of relapse as a tool to keep it from happening again!  For example, now that I am older, I motivate myself to keep moving by remembering how hard it is to get back into shape!   It’s often the thought of what it takes to start over that can keep us from having the need for it.  So think of your Relapse Stage as an opportunity for learning.  Like most things psychological, the more you can name it, the better you can tame it!

RELAPSE (stage 6) – reengaging in old behavior pattern. Task: Learning from relapse what will help deter or minimize a relapse the next time.

So congratulations! We did it! In my last post we took Action and made our change after time spent avoiding, deliberating, and preparing. And now we are in Stage 5, the Maintenance Stage. Sounds so easy, doesn’t it? Just maintain, keep the status quo, as if the work is done. But unfortunately, as we all know from past attempts at change, it ain’t all that easy. The Maintenance Stage is hardly a passive “just keep it up” phase. It actually involves a lot of work and a continued hypervigilance to avoiding the dreaded relapse. So in this post, we’ll take a look at some strategies to keeping on keeping on.

Maintainers must learn to successfully navigate temptation.  It helps to remind yourself of the progress you’ve made and acknowledge the time that’s gone by as a way of keeping the momentum.  Mark milestones, such as days of the new pattern – the first week, the first month, etc.  Reminding yourself of the work already put in helps to avoid the temptation to break the chain.  It’s also important to remind yourself of the importance of the change, as this may tend to fade over time.  Keeping tangible reminders of the meaning and significance of your change can be good motivation.  Sometimes just having a bracelet with a word on it, posting a list of why you are changing on your desk, or having a meaningful photo in your line of site can be a good pick me up at a low point.   

Maintainers need to be adaptable. You must be able to reformulate the rules of living and acquire new skills as needed to deal with unexpected challenges as they present themselves.  For example, a vacation or a change in routine can throw you a curveball.  In order to maintain a change, it requires planning ahead, anticipating where you will most likely face challenges, and then coming up with workable strategies to adapt to them. You might need to pack some of your own food, some coping tools (such as a book, a knitting project, or other distractions), or do some research about resources that will be available in your new environment.  For example, you may want to find a place you can go to get exercise or attend an AA meeting on a trip. Whatever the need is, to maintain your change, how can you take care of you in your new situation? 

Maintaining requires a lot of patience with yourself, as it takes time to let go of old habits and replace them with new ones.  It can be discouraging when you’ve stuck to a plan for so long to  be so easily pulled into desires that you thought you had put behind you.  There are some definite warning signs to look out for in order to Maintain.  Beware of the word “just.”  It usually represents some sort of way you are trying to fool yourself.  “I can have just one cigarette,” or “I can skip my medication just for a few days,” are some examples of how our own mind can play tricks on us!  Just really?  And also beware of romanticizing your old behavior.  “Remember when I drank tequila?  I was so funny!”  Or “I was able to get so much more done when I went to bed at 2 am.”  You tend to remember a distorted image and forget what led you to need to make the change in the first place.  It wasn’t worth the cost, whatever the habit was, as you had decided to make a change.  Remind yourself about the flip side of the coin and why you had decided the old way didn’t work.  

And finally, Maintaining requires assertiveness skills.  There will be countless people who will pressure you to go back to your old habit.  “Oh, you don’t like my cooking?” or “Come on join us, what’s the harm.”  It can be hard to say no and risk feeling like you are rejecting someone or refusing a kind gesture.  But Maintenance involves a commitment to yourself.  It involves internalizing permission to put what you determine is healthiest for you above what someone else may want.  Maintainers have to navigate how to set boundaries that are flexible enough to get along in the world, but firm enough to keep true to their goals.  See what I mean?  Maintaining is indeed a lot of work, but the good news is, you get a big reward.  Not only do you get the change you desired, but you get the confidence and pride that comes along with being successful at it!

Maintenance (Stage 5) – having reached a goal now taking steps to maintain it Primary Task:  Developing necessary skills to keep the change and avoid relapse

So, after all the thinking, considering, avoiding, and then making plans in the process of change, the time comes when you are ready to take Action.  Stage 4 of the Transtheoretical Model is all about that first plunge into actual behavior change and beginning the journey to accomplish your goals.  But as many people find in Stage 4, finally taking the leap may come with some surprises, and this week’s post is about how to help you begin your actual change with the highest chance of continued success.  

Often the build up to change is so filled with anxiety that finally doing something may actually bring a bit of relief.  For so long you may have avoided a change, constantly living with the fear it would be too difficult to maintain and/or that you wouldn’t be able to do it at all.  Often people find that when they do make the change, it feels pretty good.  For example, many people who want to quit smoking or drinking feel tremendous anxiety about what a nicotine or alcohol free life will be like.  They imagine all sorts of scenarios involving attempts in the past that had gone awry.  The anticipation of how bad it will be is itself really uncomfortable.  So by the time they actually have their first taste of smoke free or alcohol free living it feels better to actually face it than to worry about it.

One strategy that may be useful is to pick a start date.  Quite often people moving into the Action Stage are too nervous to commit. Fearing failure, they try to ease into it, by saying things like, “tomorrow I’m going to try to go the whole day without a cigarette.”  Human nature being what it is, we leave ourselves too much wiggle room for the ambivalence we have been fending off to sneak back in.  After a few days of “trying” but not fully committing, we unfortunately prove to ourselves that we can’t do it.  So picking a start date is a very important psychological step to cementing our commitment and calling in all the coping when we reach that milestone.  A start date provides the structure to your plan and signals that the beginning of your new way of being has completely begun. 

Once you take the action toward your goal, reward yourself and congratulate yourself.  Reinforcement and support are extremely important in maintaining the confidence and motivation required in a change.  Use the people who you had identified as support people and let them know what is helpful. The Action Stage typically involves making some kind of public commitment to your change.  People may notice you doing things differently or you may have to announce it.  Declining an offer of a drink,  dessert, or a cigarette can feel uncomfortable at first.  You may find yourself awkwardly explaining or even in the role of needing to make an excuse for suddenly being different than other people, especially in your social circle.  It’s important not to feel you have to justify yourself or make others feel better.  Each of us are entitled to make our own choices and your change is not a comment on other people’s habits.  

Depending on the goals you set in the Contemplation Stage and the plans you made in the Preparation Stage, the Action Stage can be either a series of small steps or one big life change.  It may feel strange or even empty to be living without a habit or way of life that you have done for so long.  And while the initial success may be exciting, it may take time to see the long term desired results.  It is natural to have a period of grieving and a transition time to adjust to a new normal.  Identifying effective ways of coping with stress are crucial during this action phase. Of course the better prepared you were with your plan, the easier it tends to be, but you will inevitably encounter circumstances you had not prepared for.  Don’t be afraid to continue to ask for help and to problem solve and tweek your plan as needed.  Sometimes we need a little extra help to break through a barrier or to face an unexpected road block.  

Repetition is one way to help in the early stage of Action.  Doing the same thing each day tends to help make any change a new habit more quickly.  Reviewing your list of motivations each morning and your successes each evening is a good way to keep in touch with your goals and what you may need to help support yourself.  

Often the fear of failure keeps us from wanting to tell people we are making a change.  But by not telling anyone, you rob yourself of their support. And you will need it.  Because at some point during the Action Stage, the realization will  kick in that not only do you have to do this new change today, but you may in fact have to keep doing it every day.  And this, my friend will tend to bring a bit of shock and fatigue and even regret.  But have no fear, my dear change agents in action, this will be a perfect sign that you are moving into the next stage…Maintenance. A sure indicator you are creating success!

Action: Taking steps toward change but hasn’t stabilized in the process 

Primary Task:  Help implement change strategies and learn to eliminate potential relapse