Beyond Blue

Beyond Blue

Depression: 5 Steps to Prevent Relapse

Mindfulness and Psychotherapy blogger Elisha Goldstein wrote an important post about ways we can try to prevent a relapse. To get to his blog post, click here. I’ve excerpted the five steps below.

1) Relapse Signatures – Take a moment right now or make a plan to write down some of your relapse signatures just to increase awareness when they’re happening.

2) Breathing Space – When you notice one of these signatures occurring it is going to be important to ground yourself to the present moment so you can increase you chance of making a choice in that moment. Here is where you introduce mindfulness and bring your attention to the breath to anchor yourself to the present moment. Then take a moment to sense into the body to check-in with how you are feeling physically and emotionally.


3) Thoughts are not facts – It is important to remind yourself that thoughts are not facts. We know this because the same event can happen (e.g., a friend walking by us without saying hello) and our interpretation would be different depending on our mood. Therefore, it’s important to remind ourselves that thoughts are not facts, they are mental events in the mind that are temporary and mood dependent. What is a fact is that negative thoughts are circling and however we are feeling physically and emotionally.

4) Take Action – Now that we are grounded to the present moment and have come down from the mental rumination, we want to take action with 2 things that can support us in this moment. That is either an action that brings us pleasure or an action that brings us a sense of mastery or accomplishment. Here you want to make a list with two columns. Column 1 will include actions in your life that you consider to be pleasurable (e.g., having tea with a friend, taking a walk, giving yourself a manicure/pedicure). Column 2 will include those things that give you a sense of accomplishment (e.g., paying the bills, getting exercise, going to the post office). These lists may overlap in some areas, but have the list down so you have access to it and don’t have to think as much when you notice this relapse occurring.


5) A letter of encouragement – Sometimes when relapse is happening, the thought “what’s the point” comes on really fast. When you’re feeling well, write yourself an empathic letter spelling out the importance of engaging in this process. Be kind to yourself in this letter see if you can think of the words that would be supportive and helpful for you to here when in the midst of a slide into relapse.

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  • Christine

    Thanks for re-posting this! I’ve always been really bad at recognizing when I’m relapsing and before I knew it I’d be in a full-blown depression. After my last depression it occurred to me to write a list of signals, or relapse signatures, which for me are things like getting annoyed easily, feeling rejected by people, etc. I now mentally go over that list each evening. If I am having negative thoughts, I make sure to go over what you have in step 3 (Thoughts are not facts) and replace the negative thoughts with something positive.
    Preventing a relapse can take some work, sometimes A LOT of work, but it is definitely worth preventing a depressive episode from occurring.

  • Elisha Goldstein, Ph.D.

    Thanks for posting this Therese. I’ll add that it’s often helpful to get guidance with some of these practices in person or via audio CD or MP3. For individual guidance, you may want to google a Mindfulness-Based Cognitive Therapy (MBCT) program in your area. There may not be one, but if there is, it is worth exploring.
    In addition to working with this with people in my private practice, I lead these programs in West Los Angeles and Santa Monica. I have also created some audio CDs which Therese discusses in her blog “4 Steps to Mindfulness”
    Just even getting started with a little bit a day is worth congratulating yourself for.
    Thank you Therese!

  • huile

    Many factors can lead to a relapse or flare-up to one or both of our no-fault illnesses. A flare-up of psychiatric symptoms can leave us more vulnerable to relapsing on drugs or alcohol. Drinking and drugging can lead to a flare-up of our psychiatric illness. Alcohol and drugs can also change the effects of psychiatric medications with unpredictable results.

  • bethw

    prayer,faith,and a plan help me stay clean and sober one day at a time.

  • Carelee

    I don’t want to be depressed. i try these things but I’m to depressed and tired to forcus on what I need to do for me. I’m not really sure there is me. My family pulles me in fourteen different direction and want so much I just get deeper and deeprer. It almost like i’m to depressed to work my way out of it. I read spirtural books all the time. But, God doesn’t seem to bve istening or I’ve just asked to much to offen. I ‘m so glad I have this blog.

  • David

    A great source that has helped me with depression is the book Overcoming Depression; Finding Hope Again by Dr. Neil Anderson and Hal Baumchen.
    Go to the link above for more info.
    You have my prayers.
    God Bless

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