Relapse Prevention

Description of the Strategy

Behavior therapists and clinical researchers have long recognized relapse prevention as an essential area of focus in the treatment of clinical problems. Relapse prevention strategies are defined as treatment procedures that aim to protect patients from the realistic threat that their clinical problems will recur or return to pretreatment levels. Behavior therapists historically have used the term relapse prevention vis-à-vis treatment of substance use problems, although this term also applies to a wide range of clinical problems, such as eating disorders, anxiety, depression, disruptive behavior, and sexual offending with some terminological modifications. For example, interventions for anxiety disorders include relapse prevention strategies that are designed to prevent what is frequently called renewal, reinstatement, or return of fear. Also, procedures described as addressing the generalization or maintenance of outcomes across [Page 986]time and settings relate to relapse prevention in important ways.

Behavioral interventions have been developed to treat children with a broad range of clinical problems, and many of these interventions commonly are delivered effectively in outpatient therapy settings. Despite the success of such interventions, however, risk of relapse may remain high when a child's experience with the natural environment does not change in meaningful ways throughout the course of treatment. For example, parents may learn and successfully role-play behavior management strategies for disruptive behavior in the clinic setting, but if parents fail to use such strategies reliably at home, it is unlikely that any shortterm improvements in the child's disruptive behavior will be maintained over time. For a more traditional example, consider a substance-abusing adolescent who is temporarily placed in a restrictive environment, “successfully” treated, and then returned to an environment that might include permissive caretakers and regular contact with peers who use and encourage use of substances. Unless efforts are made to facilitate changes within the peer network, and unless parents learn strategies that enable them to exercise greater control over the adolescent's behavior, risk of relapse for this adolescent is likely to be high.

Behavior therapists use a variety of clinical techniques that can reduce risk of relapse. Techniques discussed here include functional assessment, identification of risk factors, psychoeducation, skills training, and behavioral rehearsal. Functional assessment helps clinicians identify the wide range of contextual cues or antecedents (e.g., situations, events, people) that are associated with the targeted behavior, as well as reinforcing or punishing consequences that typically follow such behavior. Identifying the antecedents and consequences for targeted behavior across multiple settings and contexts prepares clinicians to guide changes in the way the child relates to and experiences the natural environment. With such changes in effect, the natural environment is more likely to sustain improvements in behavior that occur as a function of treatment.

The identification of risk factors can occur in the context of functional assessment and entails the identification of factors that are associated with risk for returning to pretreatment behavior patterns. Factors are identified in collaboration with the child and family and may include risk factors that are present in the external environment (e.g., socializing with unsafe people) and/or correlates at the level of the individual (e.g., increased heart rate, muscle tension). Coping skills are developed to promote functional and safe ways of responding when these factors are recognized in the natural environment.

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