Relapse Prevention
One key aspect to treating institutional syndrome is the prevention of a return to the IOD. Oftentimes when survivors return to their IOD, they have relapsed into old behaviors, setting back their recovery. Relapse Prevention is the process of taking steps and doing activities to prevent oneself from falling back into negatively affecting behavior patterns. It includes any strategies and techniques that turn potential relapses into adaptive coping experiences. It is a common part of trauma therapy for its importance in recovery maintenance; its inclusion as a principle of Institution Therapy is not as a method of re-invention, but as an introduction to and/or further emphasis on relapse prevention skills.
Relapses are often triggered by negative emotions and stress. As such, widening one’s window of tolerance can help reduce relapse being triggered. This includes identifying triggered reactions that survivors may have developed in their IOD (such as an activated freeze response at the beeping of a vitals machine, an activated fight response at a security officer acting aggressively towards them, etc.), processing the emotions and memories behind them, and practicing self-care after coming in contact with them.
Urge surfing is a helpful dialectical-behavioral strategy that can assist in reducing relapses. During urge surfing, participants imagine their urge as a wave and ride through it (Linehan 2014, p. 404-405). Rather than blocking the emotions or lingering in them, urge surfing allows survivors to pass these negative experiences by. It is a key treatment technique in preventing a return to old behaviors.
Another helpful Relapse Prevention strategy is the creation of urge cards, or flash cards that list the consequences of indulging in an urge, as well as alternative coping mechanisms. Survivors may write the name of their urge on the top of their cars (i.e. self-harm, substance use, trauma reenactment, etc.). They should list at least five immediate, short-term consequences and five long-term consequences of participating in their relapse behavior. Then, on the back, they should list ten adaptive coping responses. Example responses include taking a walk, listening to music, talking to a trusted companion, and more. The urge cards described in this paper were discovered at The New Orleans Institute at River Oaks Hospital in Louisiana, where urge cards are implemented in their trauma recovery programs.
The final Relapse Prevention strategy listed in this paper is challenging negative core beliefs. A cognitive-behavioral concept, core beliefs are the internal beliefs that inform one’s worldview and influence their thoughts and behavior (Osmo et al., 2018). Survivors of institutional trauma often have their negative core beliefs manipulated and affirmed by their IOD, making it more difficult to unlearn them. Some core beliefs that may lead to relapse include ‘I deserve bad things to happen to me’ or ‘This world is intolerable without using my relapse behaviors to cope.’ It’s important that survivors understand their own core values while working on creating adaptive coping responses so they can properly address the fundamental fears and concerns they may have about abstaining.
Relapse Prevention is an on-going process that is further addressed by other forms of therapy. It is easier with the support of counselors, support groups (such as twelve-step programs), and loved ones.
Disclaimer
The Five R’s of Institution Therapy serve as overarching umbrella categories under which different skills and techniques may fall. Example techniques are provided in each principle section, but this paper is not a complete list of all possible treatment methods that fall under Institution Therapy. Any skills taught in trauma therapy will be helpful in Institution Therapy and can be freely applied with the administer’s discretion.