Relapse Prevention

The road to recovery is long and hard. No one travels it gracefully.  There are many slips, trips, and lapses.  Those who eventually do recover learn to pick themselves up when they fall, brush off the dust, and keep going.  By doing so, they keep temporary lapses from turning into full-blown relapses. Here are things to do when relapse threatens.

Nourish yourself physically, emotionally, and spiritually. Accept that everyone has needs, legitimate needs, and you don't need to be ashamed of yours. Learn how to meet your needs in healthy, responsible ways.  If you make yourself feel needy, you will tend to look for comfort in diet books or the refrigerator.  Especially make sure that everyday that you spend time with friends.  In person is the best, but phone calls and emails are better than nothing.

A Healthy Lifestyle Insulates Against Major Relapses Try and get at least 8 hours of sleep every night, exercise (but don't overdo it), nurture supportive relationships, no alcohol, no drugs, no cutting, no smoking, no other form of self abuse.  Wear your seat belt in the car etc.

Also every day spend time doing things you are good at, things you can take pride in, things the demonstrate your competency and abilities. Allow yourself to enjoy your accomplishments and refuse to listen to the inner nagging voice that insists you could do better if only you tried harder.

Schedule something to look forward to every day, something that is fun and enjoyable. Watch comedy videos and laugh out loud at outrageous jokes.  Play something-a board game, a computer game, a musical instrument, tapes, or CD's.  Go outside and enjoy the birds, trees, flowers, and fresh air.  If you live in the middle of a big city, go to the park.  Make something with your own hands.  Figure out how to give yourself a fun break from the daily routine, and then do it.

Keep tabs on your feelings. Several times during the day, especially in the first stages of recovery, take time out and ask yourself how you feel.  If you notice rising stress, anger, anxiety, fear, sadness-even strong joy-be alert to the possibility that you may try and dull these strong emotions by turning to, or away from, food.  Find a better way of dealing with your feelings such as talking them over with a trusted friend.

Do something meaningful every day, something that gives you a sense of having made the world a better place, if only in a small way.  If you do this consistently, you will build a sense of your dignity, value and ability to make a difference in your world.

The 12-step folks have a useful formula. When they feel on the verge of falling into old behaviors, they say HALT! Then they ask, "Am I too Hungry, too Angry, too Lonely, or too Tired?" All of those statements are strong triggers.  Additionally triggers for people with eating disorders seem to be Boredom and Unstructured time.  If you find yourself stressed by any of these feelings, figure out a healthier and more effective way of dealing them rather than binge eating or starving.

If you feel yourself slipping back into old unhealthy habits, call your therapist and schedule an appointment.  Returning to counseling in no way means that you have failed.  It means that it's only time to reevaluate and fine tune your recovery plan.

MORE RELAPSE PREVENTION STRATEGIES

Withdrawal is avoidable but not permanent.  First, you have physical withdrawal: feeling bloated, lack of hunger signals, the incredible binge, weight gain, and 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 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 meal plan, it can be dangerous for your health...rather like alcohol withdrawal.  Secondly, mentally you will feel depressed, anxious, angry, etc.  All those emotions you were hiding or numbing come back and furious.  Not to mention your measure of self-worth is pretty low when you start recovery.  It is important that you have support behind you or it can feel absolutely hopeless.  However, it passes.  It's NOT permanent.

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 the obvious things like scales etc. and things like family, financial problems, weather, etc.  After you made a list imprint it on your brain.  A list won't help unless that information is in your mental stores.

Build a recovery peer group. An online peer recovery support group. For some, it may take a real time group to keep you accountable.  OA is a great organization that is 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't afford it, go!  Skimping on recovery is 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, Al Anon and Nar Anon can be excellent resources even if their addictions 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 actual winners.

Write down an emergency phone list and keep it with you at all times.  On the top of the list should be your therapist, your internist (or pediatrician, cardiologist, GP, etc.), your dietitian, and your psychiatrist.  If you are involved in a 12-step, your sponsor should be up there, too.  Fill the rest of the list with people who are supportive of your recovery until you get at least 10 names and numbers.  This should include peers and friends instead of partners or family.  There are too many emotional strings attached to family.  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 hotlines for the Good Samaritan (for suicidality) and EDA, AA, ANAD, Alanon etc.

Make a list of affirmations about yourself.  Many of us (almost all of us) believe that we are 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 basic as necessary.  You don't even have to believe them for now.  For example:  I am human, and I have the 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.

Develop a mantra that works for you. I have always said " I am worth it" when I was struggling. A sponsor in AA said "I love me".  Other people have used "I can do this, I'll do it for me, " and "Easy does it."

Know your symptoms.  What I mean by that is 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." or "lots of people exercise for hours at a time" or "ya know...I got this enough under control to go on a diet again" or "I really should keep laxatives around for when I'm constipated", etc.  This also includes "I really don't think I need my meds; I feel fine right now" or "my meds are 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.