Perspectives of health practitioners and adults who regained weight on predictors of relapse in weight loss maintenance behaviors: a concept mapping study PMC

31 Mar Perspectives of health practitioners and adults who regained weight on predictors of relapse in weight loss maintenance behaviors: a concept mapping study PMC

For instance, twelve-month relapse rates following alcohol or tobacco cessation attempts generally range from 80-95% [1,4] and evidence suggests comparable relapse trajectories across various classes of substance use [1,5,6]. Preventing relapse or minimizing its extent is therefore a prerequisite for any attempt to facilitate successful, long-term changes in addictive behaviors. These covert antecedents include lifestyle factors, such as overall stress level, one’s temperament and personality, as well as cognitive factors.

In addition, the influence of the social or physical environment is often felt in combination with individual factors (e.g. not being able to cope with the social pressure at a party), which might make environmental factors more distal and therefore harder to recall. This remoteness of environmental factors is also reflected in the so-called fundamental attribution error, which is defined as ‘the https://ecosoberhouse.com/ tendency for attributors to underestimate the impact of situational factors and to overestimate the role of dispositional factors in controlling behavior’ (Ross, 1977). Participants’ greater focus on individual factors could furthermore be stimulated by the current stigma surrounding overweight and obese individuals and the notion that they are to blame for their weight (Puhl & Heuer, 2010).

Models of nonabstinence psychosocial treatment for SUD

Interpersonal relationships and support systems are highly influenced by intrapersonal processes such as emotion, coping, and expectancies18. Encouragement and understanding from friends, family, or support groups can help individuals overcome the negative emotional aftermath of the AVE. The mechanisms of mindfulness include being non-judgemental, acceptance, habituation and extinction, relaxation and cognitive change35. These variables are essential in developing distress tolerance and reducing impulsivity, which are important variables in relapse process. One helpful cognitive strategy in the initial phase of CBT includes using the Advantage/disadvantage technique with the patient29.

• Relapse prevention (RP) is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours4.
• Oxford English Dictionary defines motivation as “the conscious or unconscious stimulus for action towards a desired goal provided by psychological or social factors; that which gives purpose or direction to behaviour.
• Further, there are reasons to presume a problem will re-emerge on returning to the old environment that elicited and maintained the problem behaviour; for instance, forgetting the skills, techniques, and information taught during therapy; and decreased motivation5.
• First, clinicians can help clients identify and apply effective behavioral and cognitive strategies in high-risk situations to avoid the initial lapse altogether.

As indicated in Figure ​Figure2,2, distal risks may influence relapse either directly or indirectly (via phasic processes). For instance, the return to substance use can have reciprocal effects on the same cognitive or affective factors (motivation, mood, self-efficacy) that contributed to the lapse. Lapses may also evoke physiological (e.g., alleviation of withdrawal) and/or cognitive (e.g., the AVE) responses that in turn determine whether use escalates or desists. The dynamic abstinence violation effect model further emphasizes the importance of nonlinear relationships and timing/sequencing of events. For instance, in a high-risk context, a slight and momentary drop in self-efficacy could have a disproportionate impact on other relapse antecedents (negative affect, expectancies) [8]. Furthermore, the strength of proximal influences on relapse may vary based on distal risk factors, with these relationships becoming increasingly nonlinear as distal risk increases [31].

Theoretical and empirical rationale for nonabstinence treatment

This literature – most of which has been conducted in the U.S. – suggests a strong link between abstinence goals and treatment entry. For example, in one study testing the predictive validity of a measure of treatment readiness among non-treatment-seeking people who use drugs, the authors found that the only item in their measure that significantly predicted future treatment entry was motivation to quit using (Neff & Zule, 2002). The study was especially notable because most other treatment readiness measures have been validated on treatment-seeking samples (see Freyer et al., 2004). This finding supplements the numerous studies that identify lack of readiness for abstinence as the top reason for non-engagement in SUD treatment, even among those who recognize a need for treatment (e.g., Chen, Strain, Crum, & Mojtabai, 2013; SAMHSA, 2019a). If a lapse occurs, it may be experienced as a “violation” of self-imposed abstinence, which gave rise to the term, AVE.

In the last several years increasing emphasis has been placed on “dual process” models of addiction, which hypothesize that distinct (but related) cognitive networks, each reflective of specific neural pathways, act to influence substance use behavior. According to these models, the relative balance between controlled (explicit) and automatic (implicit) cognitive networks is influential in guiding drug-related decision making [54,55]. Dual process accounts of addictive behaviors [56,57] are likely to be useful for generating hypotheses about dynamic relapse processes and explaining variance in relapse, including episodes of sudden divergence from abstinence to relapse. Implicit cognitive processes are also being examined as an intervention target, with some potentially promising results [62]. A basic assumption is that relapse events are immediately preceded by a high-risk situation, broadly defined as any context that confers vulnerability for engaging in the target behavior. Examples of high-risk contexts include emotional or cognitive states (e.g., negative affect, diminished self-efficacy), environmental contingencies (e.g., conditioned drug cues), or physiological states (e.g., acute withdrawal).

The role of attributions in abstinence, lapse, and relapse following substance abuse treatment

Because the volume and scope of this work precludes an exhaustive review, the following section summarizes a select body of findings reflective of the literature and relevant to RP theory. The studies reviewed focus primarily on alcohol and tobacco cessation, however, it should be noted that RP principles have been applied to an increasing range of addictive behaviors [10,11]. The dynamic model of relapse assumes that relapse can take the form of sudden and unexpected returns to the target behavior.