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The Fear of Relapse: 5 Cognitive Tools

I use a couple of cognitive reminders today when I'm panicking about relapsing into depression and anxiety.

A Beyond Blue reader recently wrote to me about her overwhelming fear of relapse. She said, "I'm struggling now with it, obsessing over it, and I'm so, so scared. Do I want to crawl into the hole? I fear that. But I can't. I can't."

First of all, thank you for being honest. Because so many of us know exactly how you feel. I'm there a lot of the time myself. Less than I was the two years following my hospitalizations, but there too much of the time.

Doctor Smith would continually remind me during those first fragile years after my big breakdown that a slight setback in my recovery didn't mean that I was plunging into a full-fledged depressive episode again, and that it wouldn't take another 18 months to recover, like it did after my breakdown. These hiccups are normal, she reminded me. Recovery is never static, predictable, or symmetrical. On the contrary, it's often messy, unpredictable, and annoyingly erratic.

I use a couple of cognitive reminders today when I'm panicking about relapsing.

1. My past doesn't dictate my future.

They are totally separate. Just because I have been through an excruciating depression in my past doesn't mean I will return to the same painful place every time my thoughts go south. Think of it this way: your brain is constantly forming. It's part plastic. Which means, what was isn't necessarily what is or what will be.

2. All things pass.

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NOTHING is forever ... which is a shame on the good days, but a lovely thing on the bad days. Moreover, this too shall pass. Everything does. Even the ice-cream truck in the summer. One minute it's there, and then, bam! Gone to the next neighborhood. So much for the Klondike bars.

3. I will be okay.

Even if I do get sucked up right back into the Black Hole, I will survive it. I have before. I can rely on the reserves of strength and wisdom that got me out of there before (that is, in addition to some medication, in my case).

4. Have a plan.

Sometimes it helps to jot down some specific steps to take if you've just cried yourself through two boxes of Kleenex. A friend of mine knows it's time to see her shrink when she doesn't get out of bed for three days. My kids don't really leave me that option, so my requirements are different: by the third day of crying incessantly I make an appointment to see Dr. Smith.

5. Be prepared.

You might not ever have a relapse. I hope you don't. But if you suffer from chronic, and especially treatment-resistant depression, you can count on a few in your future. So be ready for the hurricane. For example, I always like to have at least two weeks worth of blogs uploaded in the blogging software that I can use in the event of a relapse. Some weeks I'm simply more productive than others, so I try to be like a communist country and even things out a little bit ... taking the energy from the good weeks, and using them for the "my brain is a big fart" cycles.

Therese J. Borchard writes the daily blog Beyond Blue. Her memoir “Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes” is just out, followed by a handsome book of therapy notes called "The Pocket Therapist" in April 2010. Subscribe to Beyond Blue or visit her at



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