Relapse Prevention Strategies
(The following was written by Eleanor Garrett. Thanks Eleanor!)
Here are some key elements to relapse prevention, and recovering from a slip. They are based on what I’ve learned while in treatment that worked for me and still works for me today.
1. Withdrawal is unavoidable but not permanent. First, you have physical withdrawal: feeling bloated, lack of hunger signals, the incredible binge, weight gain, possible edema, electrolyte imbalances, nausea, constipation, dizzy spells, and insomnia. It’s part and parcel. Everyone goes through this! If your problem is COE, there will be extreme hunger, insomnia, fatigue and nausea. Think of it like detoxing off of drugs or alcohol. You have to be very careful during the first few weeks of recovery because if you don’t work carefully with your mealplan, it can be dangerous to your health…rather like alcohol withdrawal. Secondly, mentally you will feel depressed, anxious, angry, etc. All those emotions you were hiding/numbing come back fast and furious. Not to mention that your measure of self-worth is pretty damn low when you start your recovery. It is so important that you have support behind you or it can seem absolutely hopeless. However, just like withdrawal from drugs, it passes. It’s NOT permanent!!!
2. Know your triggers. Make a list of your triggers… ALL of them. What I mean by that are internal triggers like shame, boredom, anger, fear, etc., external triggers including obvious things like scales, etc., and factors like family, financial problems, weather, unwanted sexual attention, etc. After you’ve made a list, imprint it on your brain. A list won’t help unless that information is in your mental stores.
3. Build a recovery peer group. For me, an online recovery peer group is support enough. But I don’t know what I’d do without it. For other people, it may take a real time group to keep you accountable. OA is a great organization that’s free, ABA/EDA are great organizations, ANAD is too, and there may be other groups in your area. Some of them cost money. If you can afford it, go! Skimping on recovery is a part of the general rule of relapsing as listed above. Keep in mind that if you are in a relationship where the other person (parent, child, sibling, friend, partner, etc.) is addicted, Alanon and Naranon can be excellent resources even if their addiction is not limited to substances. One other important point: make sure there are plenty of people in your group who are in recovery! There’s a 12-step phrase “stick with the winners.” Make sure your “winners” are actually winners!
4. Write down an emergency phone list and keep it with you at all times. On the top of this list should be your therapist, your internist (or pediatrician, cardiologist, GP, etc.), your dietician, and your pdoc. If you are involved in a 12-step, your sponsor should be up there, too. Fill in the rest of the list with people who are supportive of your recovery till you get at least 10 names and numbers. This should include peers and friends instead of partners and/or family. There are too many emotional strings attached to family and romance. They should never be the first resort when you are teetering on the edge of relapse. Other numbers (beyond the 10) you might consider including are the hotlines for the Good Samaritans (for suicidality) and EDA, AA, ANAD, Alanon, etc.
5. Make a list of affirmations about yourself. Many of us (almost all of us) believe that we’re the scum of the earth half the time. This is especially true in relapse mode. So… make a list of at least 10 affirmations and keep it with you at all times. Post it on your bathroom mirror and your car visor as well. Don’t try to come up with extensive, elaborate affirmations. They should be as basic as necessary. You don’t even have to believe them for now. For example: I am a human, and I have a right to be cared for; I am loved; I care about myself; I deserve good mental and physical health; I deny myself when I deny my problems; etc.
6. Develop a mantra that works for you. For me I always said “I am worth it” when I was struggling. My sponsor in AA said “I love me.” Other people I know used “I can do this,” “I’ll do it for me,” and “easy does it.”
7. Make a “God” box. This seems stupid, but I’m serious here. Make a sack or a box or something. This is your “God” box. Every time something gets overwhelming or hard, write it on a slip of paper and drop it in your “God” box. Then, try to practice radical acceptance instead of ruminating on the said problem.
8. Know your symptoms. What I mean by this is that you should be able to recognize a slip coming. This is different from triggers. This is being able to recognize those thoughts that come along and say “ya know… I don’t really need to eat my snack tonight,” “lots of people exercise for hours at a time,” “ya know… I’ve got this under control enough to go on a diet again,” or “I really should keep laxatives around for when I’m constipated,” etc. This also includes “I don’t really think I need my meds; I feel fine right now” or “my meds are so expensive; I think I’ll stop taking them.” Be aware of behaviors, too. For example, progressively being later and later to work or school, buying magazines about people losing weight, letting your sleep habits fall by the wayside, etc. Lastly, be overly aware of things like flashbacks, nightmares, etc. Knowing your symptoms is as important as knowing your triggers.
9. Recognize loss of symptom control. This may seem obvious, but what I mean by this is recognizing depression, anxiety, ED/SI/CD thoughts, maladaptive behaviors. Basically if you know your symptoms, don’t go into denial as soon as they start to rear their heads. Be consciously aware of symptoms creeping up.
10. Keep a journal. I cannot stress the importance of this. If you put your thoughts out on paper, you will begin to notice patterns. If it’s on paper, you can’t deny it. Kinda like a business contract is made legal when it’s on paper, if you write down those emotions, the thoughts, your fears, etc. you can’t deny that they’re there. And since they’re in concrete form you can share them with your sponsor, T, dietician, etc. So… I highly encourage keeping a journal for accountability.
11. Do recovery assignments. I didn’t really hit recovery until I started doing regular recovery assignments in treatment. This could be updating lists of triggers, going over your affirmations, writing about your feelings, writing about past abuse, goodbye letters to your ED, SI, CD, etc. This has been one of my saving graces in recovery.
12. Attend regular therapy appointments and keep in regular contact with your sponsor. As much as we hate to admit it, we cannot work recovery on our own. WE CANNOT WORK RECOVERY ON OUR OWN!!! We need help, and that is one of the hardest things to accept and ask for. So… get into therapy. If you can’t afford therapy, go to a 12-step group and get sponsor. This is so extremely important if you’re in relapse mode or just in recovery.
13. Develop healthy coping skills. Make a list of 10 things that are healthy coping skills. These can be things like hot showers, knitting, writing, drawing, crochet, taking a walk, napping (as long as it’s healthy napping), baking, etc. Here’s the important point: use them when you’re struggling!
14. Practice radical acceptance. Life is hardly perfect. We are hardly perfect. Yet we tend to expect it to be, and when something goes wrong we crash and burn. It’s not our fault, but we assume it is. We assume that we must either punish ourselves or numb the pain somehow. The best phrase I ever learned was “it is what it is!” Punishing ourselves and numbing the pain will not make a situation go away. All you are doing is avoiding the truth. So… practice radical acceptance and turn to your healthy coping skills.
15. Pray. I’m not getting religious on you! That said, we tend to discount that there is always something more powerful than each of us. Whether it’s science, nature, the sheer number of people who are already in recovery, God, HaShem, Goddess, Allah, the spirit of someone deceased whom you were close to (grandmother, grandfather, brother, partner, etc.), there is a greater Something than you and me individually. So… I challenge you to get up in the morning and pray “Help me get through this day without ED, SI, CD, etc.” Then at night when you’re about to go to bed pray ‘thank you for getting me through this day without ED, SI, CD, etc.”