Relapse Prevention Planning for Mental Health
In Australia, anxiety disorders, affective disorders, and substance use disorders are the most commonly diagnosed mental health conditions (Australian Bureau of Statistics, 2023). Many people struggle with symptoms such as panic attacks, social isolation, worry and rumination, depressive or manic mood episodes, and substance misuse. For some, these conditions can also follow chronic, relapsing patterns that threaten long-term stability and quality of life. Fortunately, evidence-based psychological treatment strategies, such as relapse prevention planning, can help interrupt these cycles and support wellbeing.
Relapse prevention planning is where responses are planned out ahead of time to reduce the impact, frequency, intensity, or duration of periods of mental illness. While relapse prevention planning originated in addiction recovery (Marlatt & Gordon, 1985), it is a valuable strategy for managing a range of mental health conditions, as well as supporting general wellbeing to reduce or prevent symptoms in everyday life. This article introduces relapse prevention planning and its benefits, outlines how it can be done, and provides suggestions of starting points to build upon. It will also explain how a psychologist can assist with identifying early warning signs, developing coping skills, and supporting greater management of independent functioning.
As with all articles on this website, this information does not constitute personalised advice or replace individual guidance from your own mental health professional. Instead, information is for educational purposes to increase awareness of psychological strategies available to help improve management of mental illness and long-term mental health. This article features AI-generated images created with Grok by xAI for illustrative purposes.
Approach & Benefits of Relapse Prevention Planning
Relapse prevention planning is an applied psychological strategy often included as part of the recovery process or during a period of wellness. It takes information from self-monitoring data, early warning signs, and personal mental health history, then plans out clear actions ahead of time that are likely to be beneficial for future scenarios. This planning equips you with the knowledge and insight of how and why problems may have developed in the past; then, translates it into guiding preparation to reduce the likelihood or severity of the same problems from happening again. The resulting plan can increase a person’s responsiveness and ability to cope with specific challenges and everyday stress, as well as provide some level of control over a process which often feels totally out of control at the time.
Relapse prevention can be compared with the ‘check engine’ light in a car, where the light provides an early warning alerting the driver to take action before things get worse. The owners manual then guides the responses that will most likely prevent potential disaster from occurring. Humans have built many examples of early warning and response systems into the environments we interact with over time. Smoke alarms, blood glucose monitors, and even historically the canary in the coal mine. These are all examples of systems relied upon to detect change and cue pre-determined actions to navigate situations more safely and successfully. This is because our human senses are not great at noticing slow, quiet shifts over time and when things do go wrong, the ‘fight-or-flight’ activation of the nervous system can dramatically interfere with the ability to think logically and clearly. For example, you do not want to be trying to learn how to properly use a fire extinguisher in the exact moment you really need it to work. It is far better to get that lesson, and give it a practise run, ahead of time.
When creating relapse prevention plans, organising responses to common early warning signs is beneficial, but the predictive ability and utility of the plan can be improved by focusing on personal early warning signs, evaluated against baseline scores, if they are known (Birchwood et al., 2000; Lobban et al., 2011). As discussed in a previous self-monitoring and early warning signs article, information like this can be particularly beneficial for different conditions, including depression, Bipolar Disorder, addiction, psychosis, or Eating Disorders (Jørgensen, 1998; Birchwood et al., 2000; Morriss, 2004; Lam & Wong, 2005; Marlatt & Donovan, 2005; Morriss et al., 2007; Goossens et al., 2010; Lobban et al., 2011; DiClemente & Crisafulli, 2022; Chen et al., 2025; Pennesi et al., 2025). This is because different conditions have unique features that could be early warning signs, but are not realised without education or assessment. Working with a psychologist can typically help with learning to identify changes, including in thoughts or thinking patterns which were not recognised previously.
Finally, relapse prevention planning emphasises a non-linear recovery process is normal, and realistically, will likely include some bumps along the way. So rather than adding unhelpful emotions to the situation or seeing temporary set-backs as ‘all-or-nothing’ failures, relapse prevention planning encourages seeing them as opportunities for learning how to make successful changes in the long-term, which is essential to practise (DiClemente & Crisafulli, 2022).
Developing a Relapse Prevention Plan
Relapse prevention plans are made up of several components which each contribute to the overall approach. They do not all have to follow the same structure, however, typically function best when divided into clearly defined sections and tailored to fit individual needs. For instance, a plan developed for someone diagnosed with Major Depressive Disorder will likely feature different recommendations compared to if it was for problems with Generalised Anxiety Disorder or addiction. While components of the plan could be completed independently, most benefit from additional guidance or discussion with a mental health professional, like a clinical psychologist. The main sections of a plan are discussed below.
1) Establish a Foundation & Motivation
I often find one of the most critical things to start with in planning out a relapse prevention plan is clarifying your reasons for it. Asking yourself, “why is this important to me and why now?”. I typically encourage people to take the time to reflect on this question and determine where they are at and what their reasons are internally, rather than “because my doctor told me I had to”. Setting up the plan from this personal perspective encourages more responsibility and ownership, which improves chances of successful use and integration into your life. This section can also include intentionally gathering other health information to better understand what to be mindful of and future desired directions.
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Determine two to three personal goals spread over a manageable timeline and, critically, why these are important to you.
My reason for this plan is…
I’m starting this now because…
In 1-month, 6-months, and 1-months time I want to be…
This is important to me because…
Achieving these goals will feel…
An important lesson from overcoming challenges in the past to remember is…
Specify your day-to-day strategies or a self-care routine that will be sustainable to support your goals and wellbeing. Include consideration of domains and habits from key areas of functioning including:
sleep
nutrition
exercise and physical activity
physical health
family life
work and life long learning
socialisation
community, spirituality, or religion
nature and outdoors
alcohol/substance use
Clearly list out any current medication details:
medication dosage, prescriber, when scripts need to be renewed or expire, and PRN medication details, if relevant
remedial dosing strategies (what to do if there is a missed/delayed dose)
interactions you need to be aware of, including other medications, supplements, substances, or foods (these are commonly unknown)
reasons for commencing or discontinuing a medication and when your next regular medication review is, as this can help improve medication management and reduce polypharmacy
2) Build Insight & Awareness
Once your foundational goals and motivation have been defined as a starting point, relapse prevention planning shifts towards building greater insight, symptom recognition, and contextual awareness. This is developed through learning what could be signalling changes in your wellbeing, how and where these symptoms can emerge, and other factors that either need to be avoided, minimised, or managed.
The process of building insight and awareness starts with knowing what is ‘normal’ for you, then identifying the signs and symptoms to pay extra attention to, and finally, listing the factors that are activating, ‘triggering’, or high-risk so that they can be planned for in the next section.
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Start with identifying what your metrics are across the key domains of functioning most relevant to you. This can be done with averages or ranges being applied to each domain. Ideally, this can be taken from past self-monitoring data if available, or by beginning structured tracking now. This information can then be used as an anchor for your baseline to get an idea of what is normal for you.
Examples of domains to include are:
Daily average mood on a scale of 1-10, or peak stress ratings out of 100 over time
Typical sleep duration in hours, quality ratings, and stability or changes in sleep behavioural patterns
Frequency, duration, and type of physical activity or exercise
Social engagement levels or frequency of in-person contact
Frequency and quantity of caffeine, nicotine, or other stimulant use
Weekly number of hours spent working or studying
Acute or chronic pain levels, type, or presentation
Frequency, quantity, and behavioural patters of alcohol or other substance use
Establishing a baseline allows you to recognise contextualised changes away from personal norms which can suggest when things are starting to get off track so that corrections can be made or early intervention actions taken.
It also allows for comparison to the routine documented in the previous step and evidence-based recommendations to tailor structured interventions to your needs, where large changes or differences outside of your typical range could suggest more scaffolding, earlier, or more intensive options would be beneficial.
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Early warning signs include a range of specific cognitive, emotional, behavioural, and physical indicators that often occur before deterioration or relapse. Building awareness of these usually starts with learning more about general mental health and any relevant diagnosis from formally qualified and evidence-based sources.
These early warning signs can be grouped into two categories. The first is ‘common’ early warning signs which are the widely recognised range of indicators that many people with a particular mental health condition may tend to experience, and are often described in resources or clinical literature. The second is ‘personal’ early warning signs which are the unique changes that historically preceded deterioration or relapse for that individual, even if not shared by other people with the same diagnosis. As previously discussed, these can be particularly important, as they can more reliably detect changes compared to common signs alone. In some contexts, this is referred to as the relapse signature (Morris, 2004; Lobban et al., 2011; Eisner et al., 2018), to better communicate the individualised relevance of these signs.
Examples of early warning signs can include:
Low mood persisting for 3 days in a row or inability to feel enjoyment
Persistent insomnia or sleep durations outside your usual range (i.e., <5 or >9 hours)
Reduced activity or withdrawal from your usual routines, hobbies, or interests
Frequent arguments or urges to end relationships and cut people off
Excessive time working or unrealistically high demand expectations being put on yourself
Increased self-critical thoughts or anxious rumination replaying situations in your mind
Excessive time worrying or catastrophising about worst-case future scenarios
Increased frequency, risky, or harmful use of alcohol or other substances
Restlessness, increased physical tension, changes in appetite, or gut issues
Increased comments from others on your behaviour or showing concern
Reckless or engaging in high-risk behaviours, such as gambling, over-spending, dangerous driving, or unprotected sex
Emergence of suicidal thoughts or urges to harm self or others
The benefit in learning to recognise these signs is being able to intervene before problems escalate further. For example, it is easier to manage starting to feel run down versus the physical exhaustion of chronic fatigue. Some people may already have a good idea of the situations that could lead to these kinds of problems, which is where identifying them to be able to avoid, minimise, or manage these factors can come into the plan.
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Mental health difficulties frequently emerge in response to specific activating events, or ‘triggers’, that uniquely affect the individual. Identifying these can require an examination of what external and internal factors were problematic in the past or could be in the future. Activating events are typically factors which are out of the individual’s control and more intense than feeling uncomfortable. They are often related to what could seem like a disproportionate response, intense urge, or immediate reaction.
Some common trigger categories include:
interpersonal conflict or ongoing unresolved arguments
real or perceived judgement, rejection, criticism, or abandonment
boundary violations or social pressure
uncomfortable or intense emotional states (e.g., stress, anger, loneliness, anxiety, shame, jealousy)
anniversary dates, cues, sensory reminders, or times of year associated with loss, past mood episodes, trauma, or grief
intrusive thoughts, memories, inner critic, or unhelpful thoughts and thinking patterns (e.g., all-or-nothing, catastrophising, personalisation)
acute unmet biological needs or signals like physical illness, breathlessness, heart palpitations, acute/chronic pain, sleep, or hunger
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Early warning signs and activating events do not occur in isolation. The environmental context around them and timing of what else was happening also matters, as these factors can moderate the effect and contribute additional unrealised burden. The result can be an increased vulnerability to destabilisation or relapse as a person’s normal ability to cope adaptively beyond that moment is temporarily overwhelmed. For example, receiving critical feedback from a boss when you have just found out a loved one is seriously ill, or attending an event with an open bar if you are currently struggling with alcohol use, are likely to elicit a stronger reactions than if the activating event occurred on a day without these additional vulnerability factors.
Honest and open reflection can be essential to recognise the high-risk scenarios, upcoming events, or unhelpful environments that are likely to be detrimental.
Some high-risk scenarios or environments often include:
periods of major life changes or stress (e.g., transitioning roles, job loss and financial stress, death of a loved one, health concerns, divorce)
overstimulating, crowded, loud, or chaotic sensory environments (e.g., shopping centres, classrooms, public transport, sporting events)
excessive media exposure or social contexts where unhelpful behaviours are pressured, reinforced, or idolised
being in situations or places that preceded problems or relapse (e.g., unsafe workplaces, bars/clubs, trauma locations, weight class sports)
being alone or extended isolation from family, social supports, or monitoring
commencing, changing, or discontinuing a medication
The personal relevance of these contextual factors frequently plays a determining role in the outcome observed. This is why individualised approaches accounting for these influences needs to be taken. As more information or new factors are uncovered, these are then also integrated into the plan as part of a continual learning process (DiClemente & Crisafulli, 2022).
Other factors which often go unrecognised without structured self-monitoring or objective examination are the shifting internal processes related to unhelpful thoughts or thinking patterns. These often create and add significant stress, however, due to the intrinsic influence they have, this can be masked. By the end of this section, aim to have a clear list of the different activating events and high-risk scenarios as these guide the next part.
3) Plan Responses & Practise Coping Skills
With the foundation of the plan in place and after sharpening your insight what to look out for when a problem may be starting to develop, the next stage is combining this information with action planning. This is arguably the primary component of the plan, where proactive identification and development of the skills or strategies that are the most likely to help correct downward trajectories or restore stability after deviation from your personal baseline are focused on.
The goal is planning out and linking actionable responses to the early warning signs, activating events, and/or high-risk scenarios identified in previous steps. This could be with general strategies or formal coping skills mapped out in tables or using ‘If-Then’ statements, where if this happens, then I do this. Including more than one response option is encouraged and even if the responses only function slowing down the rate of deterioration this can still provide a valuable window of time to access professional support.
An example for somebody with a Bipolar Disorder diagnosis could be:
If I identify unusually elevated mood for 3 days and notice that my mind is constantly racing;
Then I will stay in a low-stimulus environment, double-check I have been taking the correct medications, practise deep breathing and muscle relaxation twice a day, eliminate stimulants from my diet, prioritise good sleep hygiene and routine, reduce any stressors, avoid making unsupported big decisions or purchases, and if needed, let my support network know I might need help getting to my doctor before this progresses into a manic episode.
Essentially, coping skills tell you what to do, but planned responses tell you when to do it. Including further details of where and how to do the coping skills can also make plans more realistic and actionable. More examples of planned responses are provided here.
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If I notice I’ve been exhausted for more than 3 days in a row (e.g., yawning constantly, excessively tired by mid-afternoon, or using more than two coffees or stimulants to get through the day);
Then I will focus on engaging with a consistent, high-quality sleep hygiene program, aiming for 7–9 hours of sleep per night by avoiding screens at least 30 minutes before sleep, cutting off caffeine after mid-morning, and going to bed and getting up at the same times each day.If I am under high stress where my resting heart rate is elevated or my mind is racing for more than an hour;
Then I will have a cold shower, go for a 30 minute walk outside, practise a my progressive muscle relaxation exercise, avoid alcohol or substance use, and practise journaling 15-30 minutes a day.If I am feeling frustration, anger, or intense emotion tension (e.g., irritably snapping at people, tense shoulders, clenched jaw);
Then I will engage in 30-60 minutes of non-violent, non-aggressive exercise like swimming or yoga to provide a healthy outlet as soon as possible, and hold off saying anything for a minimum of 24-hours or until I’ve slept on it.If I notice I’m not finding work rewarding or fulfilling where I don’t care about mentally showing up or getting fired;
Then I will schedule an extra 60-90 minutes of regular ‘down-time’ for self-care engaging with my hobbies while I identify ways of connecting to my values outside of work.If my responsibilities start to feel overwhelming where there are >3-4 urgent tasks piling up or I feel mentally overloaded for a whole day;
Then I will practice taking regular 10-15 minute breaks throughout the day for deep breathing, then ask to share the load with other people, or engage in some structured problem-solving to see what tasks can be cut back or reprioritised.If my lower back pain persists beyond 5 days or interferes with my ability to play with the kids;
Then I will rebook in with my physio rather than procrastinating it because I’m afraid of judgement or blaming myself because I stopped doing my rehab exercises for a bit.If I have high stress >7/10 for two or more days in a row;
Then I will message or call my friends to organise a catch-up, plan a day off or mini-getaway to look forward to, and communicate how I’ve been feeling in-person to prevent becoming overwhelmed or isolated.In the context of addictions:
If I start using again, even once;
Then I will practise thinking of this as a temporary slip or lapse rather than evidence I can’t do this or that I am weak (Brown, 2003), I will fully recommit to sobriety and learning from this mistake by actively removing any triggers or ability to use again, contact my formal supports, and conducting a Chain Analysis to identify what I can do to prevent it happening again and repair the consequences if possible.
Seeing a psychologist can be useful for learning and practising a wide range of different practical, evidence-based coping skills, some of which many people may have never had opportunities to develop. Broadly defined, coping skills are the tools, techniques, approaches, and internal/external resources used to manage, reduce, tolerate, or avoid demands that are appraised as taxing or exceeding the capacity of the person (Folkman & Lazarus, 1988; 1990).
Although they provide similar protective functions as ‘defence mechanisms’, like denial or repression, coping skills instead represent conscious, adaptive processes which are distinctly different. They are typically divided into ‘problem-focused’ or ‘emotion-focused’, where the aim is to address the stressor directly or regulate the emotional response to it (Folkman & Lazarus, 1988; 1990). This is also why it is important to develop a range of coping skills, as one may be appropriate in one situation or environment, but not others (Folkman & Moskowitz, 2004).
For example, a hammer is great for putting nails into a piece of wood, but not as useful for painting it. If you think of coping skills as psychological tools, the idea works similarly, where one single tool or coping skill is not expected to be able to do everything. The investment of time adding tools to your psychological toolkit also reduces vulnerability to mental illness in the first place, as they can improve abilities to manage stress before it turns into distress.
To take the analogy a step further, after getting a new tool (learning a new coping skill) a key part is developing the experience needed to effectively use it. In psychology, this process is referred to as psychological skills training, where techniques and expertise are developed through systematic, consistent practise.
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Cognitive skills including learning to recognise and challenge unhelpful thinking, reframing thoughts, and cognitive restructuring
Behavioural activation and activity management to support lifestyle change, task initiation, positive habit formation, or graded exposure
Strategies for emotional regulation, processing, expression, and self-soothing
Somatic grounding techniques and methods for managing sensory profile needs
Structured problem-solving, decision-making, time management, and task prioritisation
Support networking, communication skills for assertiveness, boundary setting, and conflict resolution
Acceptance, psychological flexibility, and values-based action to increase meaning and fulfillment
Mindfulness, non-reactivity, and responding with equanimity
4) Engage Support Networks
Taking the time to establish regular contact and engagement with your informal and formal support networks can provide one of the core pillars of positive mental health. These social networks can be vital sources of the mutual benefits of a sense of companionship, community, acceptance, understanding, belonging, and self-regard, among many other factors. A relapse prevention plan can highlight areas for manageable changes to cultivate and strengthen supportive relationships with family, friends, community, land, and culture.
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Family members I feel comfortable talking to are…
Friends that I’ve checked I can rely on for support include…
The colleagues at work I can talk to if I feel overloaded are…
Some local community groups I can connect with to stay active include…
If I want interactions to feel more connected to home I can…
Some local places I like to go to where I can spend time at to relax or clear my head could be…
In-person connections that are important to me are…
Digital connections I value for support are…
If some professional support would be helpful I can always book in with…
If everyone else is asleep, I can always chat with these 24/7 support lines…
Along with identifying options for key personal and professional supports, working with a psychologist can be useful for developing:
skills to form new friendships as an adult or young person and maintain them over the lifespan
methods for managing family commitments while balancing social time with personal time to avoid social fatigue or neurodivergent burnout
options for participating in rewarding community events or volunteering
effective communication strategies, including assertively asking for what you want or need, setting and maintaining boundaries, and resolving conflicts
pathways for ending self-sabotaging relationship behaviours or destructive and interfering relationships
5) Final Considerations
The final parts of the plan might include any other additional information that you might deem as relevant or useful to have. This could include requesting and keeping supportive messages from friends or family, inspirational or meaningful photos as reminders, or artistic representations of your goals or values.
An example of the first page of a relapse prevention plan outlining structured goals, everyday strategies, and recognition of potential challenges for somebody experiencing low mood can be seen here.
Summing Up
Engaging in relapse prevention planning is a proactive step towards symptom reduction, and at the same time, maintenance of long-term mental health and functioning. Taking action with structured relapse prevention planning to guide clear actions for possible future interventions based on personal early warning signs can make it easier to respond more effectively to challenges when they arise. This article has provided information on the approach and benefits of relapse prevention planning, with suggestions for identifying early warning signs, triggers, and high-risk scenarios. It has also outlined how to plan and prepare responses and coping skills while building up supportive social networks.
Remember, the majority of challenges in mental health do not just show up overnight and many people benefit from seeking out therapy for stress, relationship issues, or adjustment difficulties before they become overwhelming. Learning how to use the psychological coping skills referenced here and recognising when to seek help can allow problems to be addressed before they become impairing.
When peoples’ regular coping skills are overwhelmed, this is often what brings people to see psychologists for the first time. If you or someone you know is struggling, it could be important to consider reaching out for professional support. Talking to a psychologist or therapist can be a great first step and to help you learn additional coping strategies to prevent stress from turning into distress. Whether you are located in Brisbane or interested in accessing telehealth therapy sessions online, Kelly Brooks Psychology offers professional, comprehensive, and evidence-based support. If you feel like you could benefit from expanding your psychological toolkit, I invite you to get in contact today to book an appointment.
References
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