Coping with Thinking Errors: Relapse Prevention Planning for PTSD and Substance Abuse

Trauma symptoms (PTSD) and substance problems often go hand in hand for many people and constitute a dual diagnosis or co-occurring treatment and recovery need. Symptoms of PTSD and of Substance Disorders occur in thoughts, feelings, nightmares, physiological symptoms, behaviors and sensory perceptions. People in recovery from Substance Disorders and co-occurring trauma can have an increase in PTSD symptoms at various stages of addiction recovery. 

The stress of withdrawal and detox, for example, can increase trauma symptoms as can prolonged abstinence, particularly if substances were used to self-medicate chronic PTSD. Consequently, untreated trauma can be a significant factor in relapse back to substance use.

Coordinated treatment for both issues is critical for those who have both a Substance Disorder and PTSD. Both should be considered primary treatment needs because of the intricate link between the two. Relapse is more apt to occur in both if one condition is put aside while the other is addressed.

A good relapse prevention plan for any condition will integrate every level of functioning and give a thorough ‘troubleshooting’ assessment and plan for potential problems. A substance relapse prevention plan should include a detailed consideration of trauma issues for those who have both conditions.


Identifying and coping with triggers for both conditions are important in successful recovery efforts and are basic in both substance and trauma relapse prevention.  A thorough relapse prevention plan should address as many triggers as possible in various modalities including:

·        Thoughts

·        Feelings

·        Situations

·        People

·        Places

·        Objects

·        Sensory Experiences

The Value of Self-Talk In Controlling Triggers

There are many ways to prepare oneself to actively prevent relapse in both disorders. One of the chief components of a good relapse prevention plan is to increase self-awareness and monitor one’s internal experience. Learning to monitor one’s thoughts, for example,  is a basic element of relapse prevention for both substance use and trauma reactions.   Monitoring one’s thoughts or one’s “self-talk” helps identify problematic encounters with situations, people, places and objects. It also helps identify how one is triggered to have certain physiological responses such as agitation, fear and cravings.  Consistent practice in listening to one’s self-talk throughout the day and in different circumstances will help identify the thinking errors (cognitive distortions) and beliefs that trigger unsafe feelings, distressful memories, self-sabotaging behaviors and cravings.  Once these thinking errors are identified, coping strategies can be developed to stop the dysfunctional thinking process, challenge the underlying beliefs, self-soothe and prevent any negative associated behaviors. Familiarity with thinking errors or cognitively distorted and self-sabotaging thoughts help one to more effectively monitor self-talk.

Thinking Errors or Cognitive Distortions

Below are some of the basic thinking errors that can be involved in both trauma reactions and substance use and the process of relapsing:

·        Catastrophic thinking—jumping to extreme and negative conclusions when something goes wrong an projecting into the negative future to create fantasies, thoughts and images of dire consequences

·        Internalization of blame—personalizing problems and negative intentions and behaviors of others and considering one’s self to be the cause of these

·        Black and white thinking—seeing people, circumstances, things, events and situations as all good or all bad and being unable to view these as a combination of good and bad, pro’s and con’s

·        Overgeneralization—thinking in terms of always and never by focusing on a negative outcome and believing that all similar situations will also be negative

·        Pessimism—seeing only the negative even when there are positive factors present as well

·        Emotional Reasoning—acting as if feelings are indicators of reality even when feelings are subjective

·        Victim Thinking—believing self to be a victim of others and circumstances

·        Attempts to Control—assuming an inappropriate and overly responsible stance for people and circumstances while dismissing their accountability or competence

·        Image Maintenance—attempting to portray oneself as something one is not in order to maintain a certain social image

·        Power Focus—attempting to manipulate others, to have power over their behaviors and decisions to feel better about one’s self and prevent loss, rejection or abandonment

·        Denial—believing there are no issues or problems that need to be addressed

·        Splitting—compartmentalizing situations, interactions and issues so that one’s experience is disjointed

·        Justifying—explaining the need for a negative feeling, behavior or situation in order to continue it or avoid solutions

·        Rationalizing—using the intellect to find a desirable meaning in situations and interactions that have negative consequences

·        Intellectualization—using thinking rather than an integration of thinking and feeling

Coping and Alternatives to Thinking Errors

Below are tips for counteracting cognitive distortions, soothing one’s self and resuming a healthy approach to dual recovery:

·        Catastrophic Thinking—focusing on the here and now and re-assessing ‘what is’ as opposed to ‘what could be’

·        Black and White Thinking—considering pros and cons, positives and negatives/refraining from ‘snap decisions’ when feeling frightened, hurt, rejected or abandoned

·        Overgeneralization—thinking in terms of a specific incident, interaction, person, etc. and withholding judgment about others until able to reassess those

·        Pessimism—looking for positives however small and focusing on gratitudes rather than obsessing about negatives

·        Emotional Reasoning—asking for feedback and “reality checks” from others not emotionally involved in the situation

·        Victim Thinking—accepting responsibility for choices, setting boundaries to keep self safe

·        Attempts to control—letting go of relationships with irresponsible and unavailable people, setting good boundaries on own behaviors

·        Image Maintenance—disclosing real feelings to trusted and safe people/allowing one’s self to be vulnerable with safe people

·        Power Focus—focusing on self, own choices and responsibilities/asserting self in respectful ways

·        Denial—asking others for feedback/remembering ‘where you came from’

·        Splitting—avoiding gossip, speaking directly, asserting self during conflict in safe ways

·        Justifying—accepting difficult issues as having solutions, addressing issues directly

·        Rationalizing—setting one’s standards to protect safety, serenity/eliminating relationships and situations that compromise one’s standards

·        Intellectualizing—practicing identification of feelings, asserting feelings in safe and respectful ways to others who accept them

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