Evidence-Based Strategies For Relapse Prevention In Depression

Introduction

The best predictor of future behaviour is past behaviour.

Paul Meehl

This saying holds true in most aspects of life. It also holds true in depression.

In fact, research indicates that the best predictor of future depression is past depression (Rudolph et al., 2009). People who have experienced prior depression may be particularly vulnerable to future depressive episodes because they are cognitively and behaviourally reactive to negative events. This means that when something bad happens, these individuals might think or behave in a way that increases risk of falling into depression.

To give an example, a person with a history of depression may be more likely to ruminate (i.e., repetitively think about a negative event) or have stronger negative thoughts (see: thinking errors) when something bad happens. A few examples of these thoughts might be “I’m worthless”, “I’m such a failure”, and/or “Nobody likes me”.

These thoughts may also lead to behaviours that further exacerbate low mood, such as cutting back on activities that give them enjoyment or meaning, and/or distancing themselves from social circles. All these working parts increase risk of falling back into another depressive episode.

It is therefore crucial to have a toolbox of evidence-based strategies in place to support yourself to reduce the chances of a depressive relapse. Below, I list a few strategies that one can use to increase your resilience against depression.

Strategies for Relapse Prevention

1. Recognizing your triggers. Perhaps the most important piece of relapse prevention is an awareness of what is likely to put you in a depressive spiral in the first place. For some, it may be certain situations or anniversaries; for others, it may be specific people or places. It can be very helpful to note down these risk factors that may lead to depression and have a plan in place on how you are going to handle them. For example, one of past patients recognized that a specific day was particularly traumatizing for them. To combat this, they made plans to spend time with friends and engage in something they really enjoy on that day to keep themself busy.

2. Maintaining positive reinforcement. One of the effective treatments of depression is behavioural activation. This is an evidence-based therapy that ensures that we have activities in our day that give us enjoyment and mastery. The positive reinforcement we get from doing things we enjoy and make us feel competent is important to keeping depression at bay. Therefore, it is encouraged that you think about some things in life that give you enjoyment and mastery (it’s different for everybody!) and make you sure you have a few scheduled throughout the week. If life is a bit busy, then choose activities that are small but give you a good bang for your buck (e.g., getting your favorite latte!).    

3. Managing negative thoughts. It’s normal for our brain to generate negative thoughts from time to time. What’s important, however, is to ensure that these thoughts don’t lead to a depressive spiral. When it comes to thoughts, we can either challenge and change the thought itself, or change our relationship with the thought. Thought records and mindfulness practices are evidence-based strategies for this, respectively.

4. Leaning on social supports. A strong social network is instrumental in supporting you through tough times. Therefore, it’s important to take stock of people in your life who you might be able to lean on if things get difficult.  

5. Taking stock of your values. According to logotherapy, discovering what gives our life meaning is incredibly important in inspiring hope and purpose. Figuring out what is important in your own life can be helpful in taking concrete steps in ensuring that your actions are consistent with your goals and values. For example, if helping others is an important value, then ensuring that parts of our life incorporate this value in some shape or form.  

6. Continued supportive counselling. Therapy and counselling are not only for when you are in the pits of depression and anxiety. Even people who are generally doing well on a day to day can benefit from continued check-ins or counselling sessions with mental health professionals. These check-ins can be a great way to ensure that you are maintaining the great work that you have already done and discuss strategies to continue moving towards your goals.

7. Nourishing the body. Our mental health is closely tied with our physical health. Therefore, it’s important to ensure that we are nourishing our physical health (e.g., sleep, diet, physical activity). It’s important to pick a routine that feels good for you, and that you can stay consistent with! If you’re interested in strategies to nourish the body an reduce vulnerability, see this post here!

What if I end up having another depressive episode anyways?

As Jean-Luc Picard once said: “It is possible to commit no mistakes and still lose. That is not a weakness. That is life”.

Sometimes even with our best efforts, we can fall into a depression relapse. During these moments, it is important to have self-compassion and recall the skills that were helpful in the previous episode. Remind of yourself of the resilience that you showed in the past and use that to support your current challenges.

Of course, make sure to connect with your healthcare provider and listen to their recommendations.

Let us know in the comments if there is a specific strategy you like to use to maintain your mood!

Best wishes,

P

Featured Photo Credits: Photo by Count Chris on Unsplash