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Relapse on anxiety, depression or another mental illness?

Posted Jul 23 2012 5:52pm

Can you relapse on anxiety, depression or another mental illness?

Relapse is a concept that has been borrowed from substance abuse treatment. It is easy to think in terms of an alcoholic drinking again as a relapse, but do people with a mental illness relapse? What would a relapse for anxiety or depression look like and what can we do to prevent a mental health relapse?

We are starting to view mental health and wellness as a continuum so people can move from well to less well to unwell and back again. In that respect a mental health relapse seems to make sense. 

A lot of people experience a mental illness at least once on their lifetime. Estimate run from 25% in any one year to 50% at some point in a life time. For an Anxiety Disorder the estimates run from 10% to 20% and may even be higher than that when we consider the increase in PTSD.

In a previous post we talked about Bob and Ellen who were treated for anxiety disorders, social phobia and specific phobia using systematic desensitization sometimes called exposure therapy. This is a proven effective treatment for specific phobia. As we last saw Bob and Ellen, after getting better they had both relapsed and were having symptoms of anxiety again. This is not surprising.

From one third to two thirds of everyone treated for anxiety disorders relapses, despite the fact that we know why this happens and how to prevent it.

1. Anxiety is fear based. It shrinks when approached. We tend to avoid scary thing but the more you avoid them the harder they become to face the next time. Once people complete treatment they tend to stop thinking about the thing they feared. Over time they gains they made fade away. Substance abuse treatment tries to avoid this problem by encouraging people to continue with self-help groups to maintain the growth that has happened. Self-help groups for emotional issues are much harder to find.

2. Treatment for fear in the office does not equal less fear out in the backyard.  A recovery skill needs to be practiced in many settings so that it is usable any time or place. Fear is worse in new novel situations. Learning, to be useful, needs to “generalize” into many settings. People who are in treatment for an anxiety disorder need to practice their skills in as many situations as possible.

3. Many people use medication to reduce or manage symptoms. As soon as the symptoms are reduced they discontinue the medication. Discontinuing medication too soon is likely to result in relapse.

4. If there is an actual injury fear is more likely to return. Getting treated for irrational fear is likely to stick but if you were in an accident you have good reason to be afraid of the same think happening again. You should expect to use extra caution in dangerous situations if you have been injured in the past. Anxiety is meant to keep you safe. The goal is to manage the anxiety not to completely eliminate it.  

5. If nothing else happens fear tends to return with time. Treatment for anxiety needs occasional “boosters” to prevent its return.

6.  Other emotional issues increase the risk of a return of anxiety. An untreated Depression greatly increases the risk of a relapse of anxiety, so does substance abuse. If you have multiple problems, anxiety and depression or anxiety and substance abuse you need to be working on all the issues at the same time. Leave on issue untreated and the risk of relapse for the others increases.

 Continue to work on your recovery to prevent a relapse on anxiety, depression or another mental illness.

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