Setbacks, relapses, and resilience

How often have we observed an individual who is well on his/her way towards the path of recovery who then experiences an unforeseen relapse in response to new challenges? When a setback occurs, the individual moves into the negative syndrome mode and the psychotic mode may be exacerbated. Consequently, the various systems ( cognitive, effective, and motivational) become de-energized. This situation may transpire when the individual is about to move to a less restricted residence when they are confronted with a series of problematic tasks to be attended to or has one or more unpleasant experiences with other people.

Definitions

A setback is represented by an exacerbation of the individuals’ symptoms and partial regression from the adaptive mode to the maladaptive mode. In setbacks, there is a partial reactivation of the negative mode but major elements of the adaptive mode are still energized.

A relapse is defined as a total regression to the maladaptive mode. Along with a complete re-activation of the regressive models is a corresponding deactivation of the adaptive mode.

Resilience means the ability to bounce back after a setback. Resilience is represented by either flexibility so that the adaptive mode is maintained despite challenging or traumatic events or the return to the adaptive mode after a brief setback or even a relapse.

Flexibility: Switching to another path when a particular path is blocked or is more difficult than it is worth.

The mode, when activated, is represented as the total experience of the individual including the cognitive, affective, motivational, and physiological systems.

Vulnerability to relapse: The individual has a set of dysfunctional, cognitive schemas, which when activated by stress, tend to activate the other systems in the mode and thus deactivate the adaptive mode.

The particular stressor impinges on a congruent belief and thus sets in motion the reactivation of the mode. For example, an individual with schizophrenia has the belief “ If a person shows dislike for me, it means that I am generally unlikable and cannot have any friends.” Consequently, perceived rejection by another person fits into this belief which becomes activated and leads to the activation of the other systems.

Strategies for Addressing Setbacks and relapse in CTR

Since the regression involves the deactivation of the adaptive and the reactivation of the negative, one should try to reverse this process by use of various strategies that aim to prevent relapse and support recovery. These can generally include:

-Self-coping Statements

-Reasoning out of dichotomous thinking, etc.

-Reactivation of objectives

-Activating positive beliefs

Even though a relapse occurs, it does not have to be the occasion for pessimism. There are a number of adaptive outcomes that can stem directly from experiencing a relapse: It is possible to learn from relapses, you can de-catastrophize and realize that this one event was not the end of the road, you can choose to actively rise above the setback or relapse, etc. In these cases, the clinician can go through the chain analysis to determine the vulnerability and its solution in order to actively learn from the setback with the individual. Additionally, an individual sails through the recovery process without an opportunity to practice the cognitive and behavioral skills that can only be learned through the process of relapse and resilience.

Note: Although there is an opportunity for new learning, the relapsing individual often has learned a number of coping strategies in treatment or has coping strategies that served him/her prior to the onset of the illness. Thus, even before relapse occurs these strategies can be activated through discussion or preferably through role play, Particularly, if there was an interpersonal element in the regression.

Specific Behavioral and Cognitive Techniques

The behavioral strategy depends on the utilization of action as a way of restoring the individuals’ equilibrium. The rationale for these strategies is that by their proper application, the individual has an increase in the positive dimensions of their personalities such as competence, self-confidence, control and the ability to have a social connection with other and a reduction in the negative aspects such as insecurity, low self-esteem, and dysfunctional attitudes.

Among the behavioral techniques are the following:

1. Social support: turning to others for empathy and understanding

2.Distancing: moving away from the “hot area” –where the negative emotions being stirred up, to a safer “cooler” area

3. Addressing interpersonal problems directly with the other person

4. Making a conscious effort to control aggressive behavior

Among the cognitive strategies which have to do with a direct reformulation of the individual’s attitudes are the following:

1. Formulation of positive attitudes regarding self-control: “This shows that I am a strong person.”

2.Correction of misinterpretations and other cognitive distortions: looking for alternative explanations, etc.

3.Emphasis on emotional reasoning: “ Just because I feel something does not make it real.”

4. Logical problem-solving

In conclusion, setbacks, and relapses can serve as learning experiences, can help to sharpen previously learned strategies, and can provide an opportunity to evoke the positive aspects of the personality.

-ATB