Relapse prevention model

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Relapse is a breakdown or setback in a person's attempt to change or modify target behaviour. The relapse prevention model was developed to treat addictive behaviours, such as alcoholism and smoking (Marlatt and Gordon, 1985). The model proposes that relapse may result from an individual's inability to cope with situations that pose a risk of return to the previous behaviour. For example, a former smoker finds himself or herself in a social situation with lots of smokers and is tempted to smoke. Thus, helping the individual to acquire strategies to cope with high-risk situations will both reduce the risk of an initial lapse and prevent any lapse from escalating into a total relapse. Simkin and Gross (1994) assessed coping responses to high-risk situations for exercise relapse (e.g. negative mood, boredom, lack of time) in 29 healthy women who had adopted exercise without formal intervention. The participants' activity levels were measured weekly for 14 weeks. The study found that 66% of participants experienced a lapse (defined as not exercising for one week) and 41% experienced a relapse (defined as not exercising for three or more consecutive weeks) over the 14 monitored weeks. Participants who experienced a relapse reported significantly fewer behavioural and cognitive strategies to cope with high-risk situations, compared to participants who did not relapse. These findings suggest that acquiring effective strategies to cope with high-risk situations may prevent relapse.

Relapse prevention training (Simkin and Gross, 1994) involves teaching individuals that a lapse from exercising (e.g. missing an exercise session) need not lead to a relapse (e.g. missing a week without exercising) and a lapse can be prevented from escalating into a complete relapse (e.g. return to a sedentary lifestyle).The individual is encouraged to identify situations that are likely to cause a lapse. Potential high-risk situations relevant to exercise can include bad weather, an increase in work commitments, change in routine, injury or illness. Individuals are encouraged to develop a plan to cope with these high-risk situations. For example, increased work commitments could be overcome by rescheduling an activity session or engaging in a shorter bout of activity. Such coping is believed to prevent escalation of a lapse into a relapse.

Studies have used relapse prevention strategies to improve exercise adherence in the general population (King and Fredrickson, 1984; Belisle, et al., 1987;

Table 8.3. Description of how each component of the TTM is addressed during exercise consultation

Exercise Consultation Strategy

Decisional balance table

Exploring activity options and setting goals

Decisional balance table

Decisional balance table Decisional balance table

Component of TTM

Decisional balance Self-efficacy

Experiential

Processes

Consciousness raising

Dramatic relief

Environmental reevaluation

Self-reevaluation

Social liberation

Behavioural

Processes

Counterconditioning

Helping relationships

Reinforcement management Self-liberation

Stimulus control

Review current physical activity status and assess values related to physical activity Exploring suitable activity options

Description of Strategy

Perceived pros and cons of being active Providing realistic opportunities for success and achievement

Providing information about the benefits of physical activity and discuss the current physical activity recommendations Discussing the risks of inactivity Emphasise the social and environmental benefits of physical activity Review current physical activity status and assess values related to physical activity Raise awareness of potential opportunities to be active and discuss how acceptable and available they are to the individual

Discussion of how to substitute inactivity for more active options (e.g. taking the stairs instead of the lift) Seeking out friends, family and work colleagues who can provide support Rewarding successful attempts at being active Making commitments for activity (e.g. goal setting) Control of situations that may have a negative impact on activity and develop ways to prevent relapse in these situations

Exploring suitable activity options

Seeking social support

Relapse prevention strategies Goal setting

Relapse prevention

King, et al., 1988). Belisle, et al. (1987) reported that relapse prevention training increased attendance at a ten-week exercise programme and improved maintenance of exercise for 12 weeks following programme completion (Belisle, et al., 1987). Another study evaluated the effect of relapse prevention techniques to maintain physical activity for six months after completion of a six-month home-based exercise programme (King, et al., 1988). Fifty-one subjects were randomised either to receive strategies for improving exercise adherence, including daily self-monitoring of activity and relapse prevention, or to a comparison group who underwent weekly self-monitoring of activity. The intervention group engaged in significantly more exercise sessions over the six-month period, relative to the comparison group. Therefore, daily self-monitoring of activity levels and relapse prevention training is associated with exercise adherence.

Overall, these behaviour change models have been used to understand exercise behaviour change in non-clinical and, to a lesser extent, in clinical populations. These theories have identified factors influencing physical activity participation: exercise self-efficacy, perceived pros and cons, use of cognitive and behavioural processes and ability to cope with high-risk situations. In addition, evidence suggests that interventions based on these models are effective in increasing and maintaining physical activity.

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