M.A. / The present investigation aims to provide a profile of the social factors, which may have an influence on the relapse of alcoholics. The following questions are to be answered in the study: (a) Which social risk factors play a role in the relapse of alcoholics? (b) Are these factors related to the alcoholic’s immediate environment or wider societal factors? (c) What role does the alcoholic’s anonymous service or lack thereof play? The five relapsed alcoholic patients who went for outpatient for several times, at SANCA in Johannesburg and the five family members comprise the research sample. To each of these clients the researcher administered an interview schedule in order to obtain information pertaining to the relapse. The majority of clients are unemployed because they were retrenched from their work due to their relapse rates. Most clients have one or more family members who are alcoholic. Most clients are apparently socially isolated from their families. Most clients fail to complete the defined treatment programmes at SANCA in Johannesburg due to the distance they have to travel from Alexandra to Johannesburg. From the findings pertaining to the staff in the investigation it is revealed that Social Workers are the professionals most involved in rendering out-patient treatment to alcoholics. In conclusion it is proposed that administrators of out-patient alcoholism clinics expend more energy in structuring comprehensive programmes of intervention for clients. It is also recommended that there be more Social Workers in Alexandra dealing with the problems of alcoholics. There must be an Alcoholics Anonymous and a treatment centre in Alexandra so that the relapse rate of alcoholics must go down. / Dr. W. Roestenburg

Thesis submitted in fulfilment for the requirements of Masters Degree in Psychology, University of Zululand, 2002 / The present investigation is a descriptive experimental study with two conditions (experimental and control conditions). The main aim was to develop, implement and evaluate a program directed at educating health professionals and families to accept and manage people presenting with mental health problems. The second aim was to teach mental health promotion strategies. To this end, a questionnaire was administered to a group of health professionals and relatives. Results suggest that the participants' training programme significantly improved attitudes and increased knowledge and understanding about mental illness.

Behavioral Modification and Relapse Rates in Opioid-Dependent Pregnant Women Managed with Subutex by Tammy Minor MSN, Walden University, 2009 BSN, Marshall University, 1986 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University March 2016 Opioid dependency affects not only the individual who is dependent on opioids but negatively impactsalso the family unit, the community, and society as a whole. Opioid use in the prenatal period can have devastating effects on both the mother and the fetus. The purpose of this paper is to perform a secondary analysis of the effectiveness of behavioral modification in reducing relapse rates and improving compliance of treatment regimen in opioid- dependent pregnant women who were being managed in a FamilyCare Health Center in West Virginia. The transtheoretical model was used as a framework to determine participants' behavioral readiness to change. The Stetler model was used to evaluate outcomes and goal achievement. The sample consisted of 43 pregnant opioid-dependent women who had participated in the Subutex-assisted program at 3 Family Care Health Centers in West Virginia. Descriptive statistics and regressive analysis were used to analyze relapse data at weeks 2, 6, and 10. A secondary analysis was conducted to determine if behavioral modification contributed to a reduction in relapse rates and improved compliance with the treatment regimen using ANOVA and MANOVA. The results of ANOVA and MANOVA tests showed that behavioral modification has a potential to influence a reduction in relapse rates in the target population. The information obtained from this analysis can be used to influence social change by assisting healthcare providers in revising or modifying existing programs; this information can also and inform the help to design of future programs that effectively meet the needs of this target population .

Strategies that provide access to alternative non-drug rewards are among the most effective at reducing substance use in individuals with substance use disorders, but relapse often occurs when alternative rewards are removed. Relapse induced by the loss of alternative rewards is called resurgence, and represents a challenge to otherwise effective strategies for reducing drug use. An animal model has been useful for studying resurgence, but the extant model has two limitations. First, humans usually refer to the negative consequences of drug use as the reason they stop taking drugs, but the extant model uses drug unavailability to reduce drug seeking. Second, individuals with substance use disorders display behaviors that can be summarized as uncontrolled drug seeking, but the extant model does not simulate uncontrolled drug seeking. Chapter 2 addressed the first concern by studying resurgence of previously-punished cocaine seeking. Chapter 3 addressed the second concern by using procedures shown to simulate uncontrolled drug seeking in rats to study resurgence of previously-punished cocaine seeking. Chapter 2 showed that resurgence of cocaine seeking can occur following suppression by punishment, and Chapter 3 showed that resurgence may be unaffected following procedures shown to increase relapse in other models. The models developed herein should contribute to future research into resurgence by better simulating the conditions under which individuals with substance use disorders experience relapse.

Behavioral and cognitive-behavioral psychotherapies utilizing exposure are considered the gold standard in anxiety disorder treatments. Despite their success, relapse remains problematic, especially over long-term follow up periods. Basic researchers traditionally conceptualize the mechanism of exposure as Pavlovian extinction, but this may overlook the important role of operant processes in the treatment and relapse of anxiety. Resurgence, in which a previously extinguished behavior returns following the extinction of another behavior that has replaced it, is a promising model of operant relapse. Nonhuman research on resurgence has shown that, while higher rates of alternative reinforcement result in faster and more comprehensive extinction of target behavior, they also result in greater resurgence. This somewhat paradoxical finding could have important implications for clinicians treating anxiety, as higher rates of alternative reinforcement may have the unintended side effect of producing greater relapse of avoidance if access to positive reinforcement later becomes unavailable. The current study took a translational approach to investigating the effects of rich and lean rates of alternative reinforcement on extinction and magnitude of resurgence in typically developing humans using a computerized task. Three groups (Rich, n = 18; Lean, n = 18; Control, n = 10) underwent acquisition of a target response. Target responding was then placed on extinction while varying rates of reinforcement for an alternative behavior were delivered. Resurgence was assessed under extinction conditions for all groups. Results indicated that the rich rate of alternative reinforcement facilitated extinction while the lean rate ultimately had a detrimental effect on extinction. Within groups, Rich and Lean experienced significant resurgence, while Control did not. Effect sizes were large. Between groups, Rich resurged more than Lean and Control. Effect sizes were again large. There was no significant difference in resurgence between Lean and Control. Implications for the treatment of anxiety disorders and future research directions are discussed.

Thesis (M.S.)--Boston University

The present study was designed to test the efficacy of a bibliotherapy-relapse prevention (BT-RP) program for panic attacks in which the active BT-RP condition was compared to a waiting-list control condition. Prior to the administration of the six-month BT-RP program, all participants completed an initial BT intervention (Febbraro, 1997) based on the book Coping with Panic (Clum, 1990). The BT-RP program was designed to: (a) review major components of the initial intervention; (b) increase practice of panic coping skills and therapeutic self-exposure; (c) enhance social support for panic recovery; (d) teach cognitive restructuring skills related to relapse prevention; (e) provide a protocol to follow in the event of a setback; and (f) reduce overall levels of stress. Brief monthly phone contacts were included in the BT-RP condition. Thirty-six participants, 17 in the BT-RP condition and 19 in the WL control condition, completed the study. A 2 (Treatment condition: BT-RP versus WL control) X 2 (Time: Pre-BT-RP assessment versus Post-BT-RP assessment) mixed-model research design was used to analyze the results. Results indicted significant reductions from pre- to post-treatment in the BT-RP condition for panic cognitions, anticipatory anxiety, agoraphobic avoidance, and depression, but not in the WL condition. When statistically controlling for initial levels of these variables via analyses of covariance (ANCOVAs), significant post-treatment differences in the expected direction emerged for these four dependent measure and for state anxiety. In addition, the BT-RP group reported significantly fewer panic attacks during the six-month course of the treatment trial than the WL control group on a measure of retrospective recall of full-blown panic attacks. There was also a statistically significant proportional between-group difference in terms of clinically significant improvement for full-blown panic attacks and agoraphobic avoidance in favor of the BT-RP group. However, no significant between-group differences emerged for the maintenance of initial treatment gains for panic frequency, panic symptoms, panic cognitions, anticipatory anxiety, or agoraphobic avoidance. Results of the present study are discussed in the framework of benefits of the present BT-RP program, limitations of the findings, recommendations for future research in this area, and implications for BT treatments in general. / Ph. D.

Obesity and relapse after dieting pose a significant threat to an increasing number of adults in this country. Resistance to treatment and high relapse rates make this problem frustrating for patients and practitioners. There is limited research on relapse causation; research on social and life circumstance factors is uncommon. Given the limitations of existing research, the purpose of this study was to investigate the natural course of obesity relapse. A purposive sample of eight obese women, ages 31-57, was selected. All of the women relapsed at least one or more times throughout their lives. A qualitative study design was used to examine and integrate their attributions for relapse. The qualitative paradigm was selected because it allowed for an inclusive study of relapse without confining the investigation to a predetermined set of responses. Information was gathered on contributory factors: physical, social and psychological, but not limited to these areas. These factors were reported in a case study format. Verbatim quotes were used to provide descriptive information and insight into individual cases. Cases were analyzed for main attributions; key words and phrases were used to develop categories. Common themes were derived from these categories and examined across the cases. Conventional wisdom about the factors, which contribute to obesity relapse, was challenged by this research study. Excess calories and decreased physical activity were not the only conditions that were contributory to the respondents' relapses. Diverse social and psychological issues often combined with physical factors to dominate the respondents' attributions. The relapse attribution themes commonly represented in the case studies included: the impact of food restriction, the impact of having personal choice taken away, negative emotions, physiological factors, lifestyle demands and the return to familiar food habits. Based on this study, it is recommended that obesity practitioners consider assessment and treatment modalities that are holistic. A paradigm shift away from traditional approaches may be a necessary step in providing more effective treatment. Additional research, which focuses on life circumstances and obesity relapse, is needed. / Ph. D.

Depression has been cited as the most prevalent of the Axis I disorders affecting upward of 16% of American adults in their lifetimes (Kessler et al., 2005). The literature on effective treatments for depression is substantial, however the follow-up literature that speaks to what happens after treatment ends is much smaller. This thesis describes two studies. The first is an overview of reviews of post-treatment outcomes for adults treated for major depressive disorder (MDD). The second is a narrative systematic review of studies of long-term (at least 12 months) post-treatment outcomes after the completion of treatment for major depressive disorder (MDD). These studies synthesize the available evidence concerning post-treatment outcomes and discuss the limitations of these data. Relapse is a significant issue for many people who respond to treatment with upwards of 50% of people relapsing within a year of the end of treatment, depending on the type of treatment. Some treatments have significant relapse prevention effects, including continued medication treatment, acute and continuation phase CBT, and variations of CBT designed specifically for addressing residual symptoms after acute treatment or specifically aimed at relapse prevention. Given that the risk of relapse after treatment is significant, it should be discussed during acute treatment, as should approaches to reducing the risk of relapse. Recommendations for future research are discussed. Within the overview of reviews, there was considerable consistency across reviews which aided in the formulation of practical recommendations for clinicians and for patients. Examples include provision of education about the probability of relapse and planning for relapse prevention during acute phase treatment. Engaging in continuation and maintenance treatments that are aimed at reducing relapse, and whenever possible, continuing treatment until patients are considered to be in recovery, and not just for a certain period of time, or until the point of remission of symptoms are also recommended to reduce rates of relapse.

Depression has been cited as the most prevalent of the Axis I disorders affecting upward of 16% of American adults in their lifetimes (Kessler et al., 2005). The literature on effective treatments for depression is substantial, however the follow-up literature that speaks to what happens after treatment ends is much smaller. This thesis describes two studies. The first is an overview of reviews of post-treatment outcomes for adults treated for major depressive disorder (MDD). The second is a narrative systematic review of studies of long-term (at least 12 months) post-treatment outcomes after the completion of treatment for major depressive disorder (MDD). These studies synthesize the available evidence concerning post-treatment outcomes and discuss the limitations of these data. Relapse is a significant issue for many people who respond to treatment with upwards of 50% of people relapsing within a year of the end of treatment, depending on the type of treatment. Some treatments have significant relapse prevention effects, including continued medication treatment, acute and continuation phase CBT, and variations of CBT designed specifically for addressing residual symptoms after acute treatment or specifically aimed at relapse prevention. Given that the risk of relapse after treatment is significant, it should be discussed during acute treatment, as should approaches to reducing the risk of relapse. Recommendations for future research are discussed. Within the overview of reviews, there was considerable consistency across reviews which aided in the formulation of practical recommendations for clinicians and for patients. Examples include provision of education about the probability of relapse and planning for relapse prevention during acute phase treatment. Engaging in continuation and maintenance treatments that are aimed at reducing relapse, and whenever possible, continuing treatment until patients are considered to be in recovery, and not just for a certain period of time, or until the point of remission of symptoms are also recommended to reduce rates of relapse.