Process / Ending
Follow-up and relapse prevention
How therapy prepares for life after regular sessions end, including recognising early warning signs, maintaining changes and arranging review appointments.
Overview
Near the end of a course of therapy, or after acute symptoms have eased, attention often turns to what happens after regular sessions finish. Relapse prevention and follow-up are ways of consolidating what has been learned, planning for future setbacks, and agreeing how a person can seek support again if difficulties return.
How relapse prevention is approached
The term relapse prevention originated in cognitive behavioural work on addictive behaviours by G. Alan Marlatt and colleagues, who distinguished a temporary slip (a lapse) from a full return to an old pattern (a relapse) and focused on identifying high-risk situations and coping responses.
In depression treatment, relapse prevention can take the form of reviewing helpful strategies at the end of therapy or taking part in a dedicated programme such as mindfulness-based cognitive therapy (MBCT), which was designed for people who have experienced recurrent episodes of depression.
Follow-up and booster appointments
Some services and practitioners offer one or more follow-up or review appointments several weeks or months after regular sessions end, or space the final sessions further apart (for example, fortnightly or monthly). These meetings allow the person to try managing without weekly therapy while knowing a review date is in place.
A constructed example
Constructed for learning. Not a real case.
In the penultimate session of a course of therapy, a client and practitioner write down a brief summary for the client to keep: the early signs that their mood is dipping, three things that helped during the therapy, and who the client would speak to if those signs lasted more than a fortnight. They also book a single review appointment for eight weeks’ time.
UK and US
In England and Wales, NICE guideline NG222 on depression in adults includes specific recommendations on preventing relapse for people at higher risk of returning depression, including discussing continued psychological or pharmacological options and offering group MBCT or CBT with a relapse-prevention component in defined circumstances.
In the US, maintenance and booster sessions are described in clinical practice guidelines and treatment manuals, though insurance coverage for spaced follow-up appointments varies by plan.
Limits and open questions
A return of distress after therapy ends does not mean that therapy failed or that the person did something wrong; many difficulties fluctuate with life events, health and social circumstances. A 2016 individual patient data meta-analysis of nine randomised trials (1,258 adults) found that MBCT was associated with a lower risk of depressive relapse over 60 weeks than comparison conditions, while noting differences across comparison groups and incomplete adverse-event reporting in some earlier trials.
Sources and inspection notes
NICE. Depression in adults: treatment and management (NG222).
Supports: Recommendations on relapse prevention for adults at higher risk of relapse in England and Wales, including psychological interventions with an explicit relapse-prevention component and group MBCT.
Supports: Individual participant data meta-analysis of nine trials (1,258 adults) examining depressive relapse over 60 weeks, comparison groups and limitations.
Supports: Overview of Marlatt's cognitive-behavioural relapse prevention model, including the distinction between a lapse and a relapse and identification of high-risk situations.