Free Managing Your Depression by Susan J. Noonan

been shown to decrease the chance of relapse. Mindfulness-based cognitive behavioral therapy has also been shown to reduce the risk of relapse and recurrence in some patients. In addition to CBT and other psychotherapy, you can take some preventive steps to manage your own symptoms and in this way improve the quality of your life.
    Relapse Prevention is an effective daily approach to help you minimize the chance of a relapse occurring and to help you stay well. Relapse Prevention means that you identify and respondpromptly to changes in your Warning Signs, Triggers, or Symptoms of mood disorder. With this strategy, you can intervene when an important change in your emotional health may be happening. Early identification and intervention helps to prevent your episode from worsening.
    A Relapse Prevention Strategy includes five main steps that you and your treatment team will act on:
1. Identify your specific Warning Signs, Symptoms, and Triggers (see pages 74 –76).
2. Pay attention to changes that are Warning Signs for you.
3. Prepare an intervention Action Plan for Relapse Prevention in advance for use when you notice a change in your Symptoms or Warning Signs. The Action Plan includes steps you will take to manage, cope, and distract from the intensity of the episode. It also includes the people you will ask to help you (health care providers, family, and friends). See page 78 .
4. Follow your Action Plan when you first notice a change in your emotional health. An Action Plan enables you to intervene early when necessary and modify or improve the course of the episode.
5. Relapse Prevention also means that you follow some basic preventive steps every day. These will help you maintain emotional stability and to decrease your vulnerability to fluctuations, although they may not eliminate these changes completely.
    Preventive steps include:
• Maintain good Sleep Hygiene (see pages 8 –9).
• Eat three meals per day with balanced nutrition.
• Exercise regularly.
• Keep up with self-care.
• Maintain regular social supports and contacts.
• Avoid isolation.
• Include positive, pleasurable experiences in your life ( pages 102 –3).
• Keep a structure and routine to your day. Schedule your time ( page 24 ).
• Use your coping skills, the actions you take to lessen the effect of stressors ( pages 105 –10).
• Remain on your medications as prescribed.
• Do not use alcohol or drugs.
• Continue to work with your psychotherapist.
• Continue to work on any exercises your therapist gives you.
    Relapse Prevention for bipolar disorder is very similar. In addition to the recommendations outlined above, a few additional tips are especially helpful to follow:
• Keep your life routine, balanced, and structured.
• Simplify your life as much as possible.
• Avoid overstimulation.
• Pace yourself, breaking large tasks down into several smaller ones.
• Find sources of replenishment and take periodic breaks in the day.
• Decrease chaotic or stimulating input at the end of the day (try relaxing, meditation, writing in your journal, taking a bath).
• Avoid impulsive actions. Wait at least two days before making any major decision or purchase, and ask two trusted friends for their feedback.
• Try social rhythm therapy, which has been formally evaluated as an intervention for bipolar disorder. It can help you keep routine and structure in your day.
    Triggers
    Triggers are events or circumstances that may cause you distress and lead to an increase in your depression symptoms. It is important to understand that certain circumstances have the potential to set off an episode of depression for you. Triggers can be different for each person, so to be aware of them in your everyday life, you have to first identify them for yourself.
    Triggers may include such things as …
• external events, good or bad
• a sudden change in your life, such as a loss (of a loved one, job, home, etc.)
• change in a relationship, or