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The path to social anxiety recovery is not a linear process, and people will commonly experience short, temporary obstacles, and sometimes longer term setbacks. These are known as lapses and relapses.
Lapse
Relapse
A temporary and short return to experiencing physical symptoms and thoughts triggered by social anxiety, followed by engagement in safety behaviours and avoidant behaviours. A lapse is usually a one-time thing but if not addressed it can extend into a relapse.
A complete return to unhelpful thinking styles, safety/avoidant behaviours, and physical symptoms when in social anxiety-provoking situations. People who experience relapses usually follow the same pattern of behaviours they did prior to seeking treatment.
When are lapses more likely to occur?
An individual is likely to experience a lapse when:
Experience new and sudden stressors (e.g. starting a new job, relationship break ups, financial burdens, illnesses, death of a loved one etc).
They try confronting a situation that is too high on the stepladder than they are prepared for
They start to avoid situations that trigger social anxiety
They start to focus too much on anxiety symptoms again
They start utilizing safety behaviours again
How to cope when you experience a lapse
When you experience a lapse, try writing down reasons why you could be feeling anxiety once again. Furthermore, it is important that you continually identify unhelpful thinking styles and brainstorm more realistic alternatives to challenge your anxious thoughts. Lastly, start following the Exposure Step Ladder again without relying on avoidant and safety behaviours
How to prevent relapses: creating a Relapse Prevention Plan
By creating your personal Relapse Prevention Plan, you can prepare for potential lapses ahead of time in order to prevent them from developing into a relapse.
Step 1: List common precursors to social anxiety when in a triggering situation
Step 2: List situations that would typically produce an anxiety response
Step 3: Schedule self-care activities into your every-day life. Also, list everything you have achieved so far along your journey of recovery
Step 4: List actions you can take following a lapse or relapse
They think I’m hopeless. I’m boring. They think I’m stupid
Behaviours
Escaping to the bathroom regularly to avoid people, intense focus on phone to avoid conversation, avoiding eye contact with others, staying in an inconspicuous spot (edge of the room)
Identify future situations that could trigger social anxiety
In the classroom, in workplace meetings, at a birthday party, at a family gathering, eating lunch in a food court etc
Things I have achieved
I have been able to answer my phone within 10 seconds and greet the caller in a friendly manner, I have been able to start a conversation with the store clerk, I have been able to reply to emails in a timely manner without performing excessive checking behaviours etc
Self-care activities I can complete
30 mins of exercise every day (7:00-7:30 am), my daily skincare regimen (9:00-9:30 pm), 30 mins of an activity I enjoy (e.g., painting) (10:00-10:30 pm), making my own healthy meals instead of ordering fast food etc (6:00-8:00pm).
What to do if a lapse or relapse occurs
Focus on my breathing and practice relaxation techniques
Assess my thinking styles and identify more realistic thoughts
If having a conversation, focus on what the other person is saying instead of my own symptoms and thoughts
Start my stepladder again
Seek professional help
Appendix
References
Anxiety Canada. (2021). What is CBT: How to Prevent a Relapse. Anxiety Canada. https://www.anxietycanada.com/sites/default/files/RelapsePrevention.pdf
Menon, J., & Kandasamy, A. (2018). Relapse prevention. Indian Journal of Psychiatry, 60(Suppl 4), S473–S478. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_36_18
This Way Up Clinic. (2021). Social Anxiety Lesson 6: Relapse Prevention. This Way Up Clinic.
Turning Point. (2021). Lapse and relapse. Turning Point. https://www.turningpoint.org.au/treatment/about-addiction/treating-addiction/lapse-and-relapse
