Here’s an abbreviated version of my Relapse Prevention Plan and my Distress Tolerance Crisis and Safety Plan that I created while living at Rogers Memorial Hospital. Feel free to use these examples as building blocks for your own recovery plans!
Note: When I scale things, it is on a 1-7 scale. Feel free to contact me for a detailed list of what each number entails, or with any other questions.
Relapse Prevention Plan: Serenity Kaspar
Green Zone: Recovery
Recovery is finding joy in the little things. It’s the morning sun on my face because I got out of bed this morning. It means trying things on my own first. It’s healthy relationships and kept boundaries. It’s facing the good and the bad with the courage of a lion. It’s recovering.
What I’ll be doing:
- Little to no Self Harm/ Suicidal Ideation (at or less than 3, no plan or intent
- Hanging out with friends 3x or more per week
- Keeping my framily close and unhealthy people away (boundaries that I set)
- Eating a good, sufficient amount (three meals a day & following meal plan)
- Sleeping 7-9 hours each night
- Being confident: smiling, laughing.
- Getting ready in the morning.
- Sticking to my set schedule and keeping busy
- Taking my meds 9pm-11pm every night.
- Exercising daily
- Going to therapy
- Meeting expectations/ doing chores/ helping out as needed/ completing tasks
- Showering 4x/wk
- Brushing my teeth daily
- Taking time to myself
- Might be having some social anxiety but still seeing friends and going out
- 15 minutes of respiratory control x2 a day
- Reading books or listening to podcasts/music
What I’ll need:
- Support from my support system
- My accomplishments to be acknowledged
- To be expressing my feelings daily and truthfully, no exaggeration
- Reminders from friends to be in touch with my feelings and expressing them
- To advocate for myself and let my needs be known
- A good night sleep/ sleep schedule
- Be mindful
- Not rushing my therapy/ recovery
- Talking to friends about my mental health frequently (at least once a week)
- Be able to watch Netflix in moderation
- Doing thought challenging with anxiety
Yellow Zone: Between Recovery and Relapse
Remember how happy and stable you were. You couldn’t WAIT to go back home and be with your friends! Do this for your pets!
What I will be doing:
- SH/SI will be a 4 or above, with no plan or intent
- Temptation to miss meds, but can resist on my own
- Talking about my problems too often or not at all
- Not completing all my daily tasks/ chores/ expectations
- Taking naps when they are not needed
- Isolating (x1/day or more)
- Not following a morning routine/ sleeping in late
- Not keeping up with hygiene (missing showers/ not brushing teeth/ not changing)
- Thinking about calling into work sick for multiple shifts in a row (but not doing it)
- Not asking for help
- Ruminating often (x5/day or more)
- Not hanging out with friends as often (once or twice a week only)
- Making excuses to not exercise (not exercising in some way every day)
Plan for getting back to Green Zone:
- Call *therapist’s name* to let him/her know what’s going on: (***) ***-****
- Talk to a member of the support team who has the time and energy
- Take things one step at a time
- Keep fighting
Red Zone: Full Relapse
You aren’t giving up. You’ve got a 100% survival rate so far. Be the butterfly in the butterfly effect. Your future husband is out there, waiting for you. Stick to it. Go get help NOW.
What I will be doing:
- Thinking of suicide/ SH on a daily basis (or close to daily), with intent or plan
- Buying razors
- Overusing my pills/ not taking as prescribed/ not taking them at all
- Not following meal plan (restricting or avoiding)
- Hoarding and not taking my medication
- Needing to be driven places due to safety concerns
- Spending all of my free time on my phone
- Refusing to do chores/ meet expectations
- Not following any part of my schedule
- Won’t be brushing my teeth
- Calling into work sick
- Refusing to go to therapy
- Isolating or sleeping in my room (at least once daily, 2 hours at a time)
- Self-harming
- Reassurance seeking
- Not changing clothes
- Decrease showering
- Avoiding/ ignoring texts from friends OR not reaching out
- Negative self-talk
- Negative attention seeking actions
- Watching excessive Netflix/ playing Xbox
What I NEED to do:
- Tell someone in my support system and *therapist name* ASAP
- Force myself to be around people
- Stay out of my room until bedtime
- Increase my treatment frequency
- Distract myself when I start to ruminate
- NO SKIPPING MEDS!!
- Call 911 or go to ER
DOs and DON’Ts: For Support System
- DO ask me how I’m feeling throughout the day
- DO try to distract me when I tell you that I am ruminating (but don’t force it)
- DO ask me how you can support me, don’t assume
- DO validate my feelings
- DO ask me how I am doing mentally (x1/wk)
- DO ask me if I have been working out (x1/wk)
- DO ask if I am feeling overwhelmed (at appropriate times)
- DO encourage me to ask for help if it seems like I am having trouble asking it
- DO ask if I have done my laundry (x1/wk)
- DO ask about my depression (x1/wk)
- DO ask about my anxiety (x1/wk)
- DO ask about my PTSD/ nightmares (x1/wk)
- DO remind me you love me and are proud of me
- DO remind me it is ok not to have a traditional family/ life/ education
- DO NOT go overboard asking about my feelings
- DO NOT tell me “You understand”
- DO NOT pressure me to do anything, instead, remind me of the skills I can use
- DO NOT “Tell my treatment team on me”
- DO NOT only talk to me about recovery/ mental illness
- DO NOT minimize my emotions
Triggers: Tricky Situations
- Food having rules put on it can trigger my ED. Instead, I will work to radically accept the rule and keep the incident separate from my exposures and all the work I’ve done thus far with my ED.
- Someone speaking in line with the stigma surrounding mental illness can trigger hostility in me. Instead, I will be assertive and educate the person on why their thinking fed the stigma.
- Minimizing my emotions, telling me my emotion is too extreme or telling me to “get over it” (or the like) can trigger depressive behaviors or me closing off. Instead, I will work through emotion regulation and assertively ask for the person to not say that in the future.
- Rushing me in my recovery can trigger unhealthy coping within me. Instead, I will get out a list of healthy coping skills and try them.
- Having difficulty backing up in a car or going over a bridge can trigger my driving anxiety. Instead, I will practice respiratory control and mindfully observe my anxiety rise and fall without acting on the anxiety.
- Pressing me to share something can trigger me to close off and isolate. Instead, I will be assertive and say NO. Understand my NO means NO.
- Not taking my PTSD into account when picking a TV show or movie can trigger my PTSD and give me flashbacks or anxiety/ panic attacks. Instead, I will check myself and the video in question to decide if something may have triggers, and respond appropriately.
- Jokes and inappropriate usage of mental health terms can trigger me to close off/ become angry or hostile. Instead, I will assertively call attention to the error in speech and ask that it not be used in the future.
Coping Skills: For Assistance From Support
- Use my Relapse Prevention Plan, Distress Tolerance Crisis and Safety Plan
- Help me cope by Distracting me if I’m ruminating
- See all skills used in Yellow Zone
- Thought Challenge any Negative Automatic Thoughts (NATs)
- Use PROs & CONs when a ___ vs.___ situation arises
- Listen to me and empathize instead of sympathize (see TED talk video)
- Aid me in using 5-4-3-2-1 if I need grounding
- Practice Repertory Control with me if panicky
- Encourage me to be assertive (DEAR MAN, assertiveness formula) if I’m having difficulty with a relationship (also use A2R)
- Bring me my Self-Soothe Kit
- Practice Gratitude with me
- Work on Emotion Regulation to work through emotions that are difficult to work through or handle. Especially with extreme emotions.
- Brainstorm alternative Boundaries if I’m in a unhealthy relationship.
- Accumulate Positive Emotions by doing pleasant activities with me whenever.
Distress Tolerance Crisis and Safety Plan:
My Reasons for Managing Crisis Effectively and/or Staying Safe:
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My Strengths and Resources:
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EMERGENCY: 1-800-273-8255 |
Warning Signs:
Bipolar Warning Signs:
Going into manic:
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Going into depressive:
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See also: Red and Yellow Zones of Relapse Prevention Plan, and keep reading.
Feelings: Examples of what I might be feeling before or during crisis:
Depressed, discouraged, powerless, miserable, dejected, burdened, doubtful, lost, incapable, incapacitated, hopeless, trapped, alone, distrustful, stressed, tense, comparing/ competing, lifeless, uncaring, fearful, cowardly, timid, guarded, tormented, agonized, withdrawn, sullen, fragile, recoiling, frustrated, hostile, tired.
Thoughts: Examples of what I might be thinking before or during crisis:
All-or-nothing (black-and-white) thinking, jumping to conclusions, overgeneralization, mind reading, fortune telling/ predicting, mental filter, magnification/ catastrophizing, emotional reasoning, shoulds/ musts/ oughts, labeling, personalization, probability overestimation (of threat), negative self talk, pessimistic thoughts, getting a bad case of the “fuck it”s, questioning my coping abilities, etc.
Behaviors: Examples of what I might be doing before or during crisis:
Might become more passive/ aggressive/ passive aggressive, reckless or risky behaviors, intent/ plan/ ruminating on Self-Harm/ Suicidal Ideation, not eating, breaking boundaries and not following my RPP (see the Red and Yellow Zones)
Sensations: Examples of what I might be sensing before or during crisis:
Tightness in chest, “brain is crosseyed”, numbness or tingling of limbs, dizziness, weakness, nausea, overtired, little to no energy, feeling cold, racing heart, rapid breathing, “heart attack” sensation, dry mouth, dilated eyes, muscle spasms, shaking, difficulty swallowing, choking sensations, inability to concentrate, claustrophobia, etc.
Environment: What my environment is, or what is happening in my environment that can feed into my experience before/ during a crisis:
Movies with violence in them, theater performances with violence, any sort of abuse happening or being portrayed, locations linked with past trauma (various, encourage me to be assertive on what the locations are when applicable), in public places frequented by abusers, etc.
Key Triggers:
See Triggers: Tricky Situations for examples of Key Triggers.
See also Environment (above) for the starts of Key Triggers.
Burn the Bridges:
Cutting Urges: remove the sharp items, hard plastic or glass from my person spaces. This INCLUDES razor from bathroom.
Set restrictions and departure/ arrival times on driving if SI is present.
Take my meds in front of someone or have them store them somewhere.
Naps/ Isolating: I will “lock” myself out of my room, forcing myself to stay present.
“Unplugging” all my electronics (phone off, no xbox, no laptop) if using in excess.
Self-Care Skills to Use:
Shower or a bath (hot or cold based on the situation), drinking tea, holding a frozen orange, engaging in Behavioral Activations (BAs), cuddling with a blanket/ stuffed animal (NO ISOLATING!!!), dancing, yoga, going on a walk, spa things, meditate, watch a movie or a FEW episodes of a TV show, coloring, wordsearches, solitaire, card games, journal, burn incense, use essential oils, rip up newspaper, hit pillow, massage hands w/ lotion, listen to music, reality checklist, engage in spiritual activities, change into baggy pants and sports bra, visit Faeryland, go to arboretum, pinterest, color/ engage in an art activity, stretching, play with hair, work on therapy HW/ skills, spending time with Hamilton, cuddling Bun, cleaning pet’s cage, pick something from my “pleasant events” lists or my “build mastery” list, etc.
Distress Tolerance Skills:
ACCEPTS, self-soothe, urge surfing, bridge burning, IMPROVE, pros & cons, grounding myself (ex: 5-4-3-2-1), radical acceptance, ABC PLEASE, mood momentum, opposite to emotion, boundaries, FAST/ GIVE/ DEARMAN, self-care breaks, attend to self, attend to relationships, peer support, professional support, validation, turn to journal or DBT book for more coping skills.
My Personal Support System:
List of friends and their numbers (***) ***-****
My Professional Support System:
Therapist (***) ***-****
Psychiatrist (***) ***-****
Crisis (***) ***-****
EMERGENCY: 1-800-273-8255
911
My Medications and Dosages
Nightly (9pm-11pm):
Medicine 1: 12mg
Medicine 2: 900mg
Medicine 3: 600mg
Medicine 4: 10mg
PRNs (as needed):
Medicine 1: 25-50mg as needed for anxiety
Inhaler: 2 puffs as needed for shortness of breath
My Hospital of Choice:
Hospital Name – Emergency Room
My Commitment:
| I commit to practicing my plan proactively and during times of crisis. I further commit to be safe and call 911 or go to the hospital BEFORE acting on suicidal urges.
Name: Date: **/**/**** |
Ungluing Stigma 