Gain Maintenance Plan: Practitioner Guide

A relapse prevention or ‘gain maintenance’ plan (GMP) is a structured tool to help clients anticipate, recognise, and effectively manage potential setbacks in their recovery/maintenance of intervention gains. In this activity, setbacks are conceptualised as predictable and manageable processes, rather than catastrophic events. A GMP can be used to convert relapse concerns into concrete, actionable strategies to manage challenging periods.

CLINICAL EVIDENCE BASE

The effectiveness of GMPs is supported by multiple lines of evidence:

  • Relapse prevention plans are an effective intervention for substance use disorders, with positive effects on functioning and abstinence (Irvin et al., 1999).
  • Relapse prevention can reduce recurrence of depression (Vittengl et al., 2007).
  • Relapse prevention planning has been associated with maintenance of treatment gains for anxiety disorders (Craske et al., 2014).

WORKSHEET USES

When to Use

  • Substance use disorders to identify triggers, craving management, and adaptive coping strategies.
  • In depression to recognise and respond to early warning signs of mood deterioration.
  • Bipolar disorder and monitoring for prodromal symptoms with early intervention.
  • Anxiety disorder and managing high stress periods.
  • Psychosis and identifying early warning signs to compliment stepped-care responses.

EMOTIPAL WORKSHEET STRUCTURE

Task - 6 columns

Understanding or Defining the Problem

High Risk Situations

Coping Strategies

Support Network

Maintenance Strategies

Emergency Plan

The issue or challenge at the centre of the GMP should be clearly defined and operationalised here

Record antecedents and/or risk factors for relapse or deterioration in functioning / peformance here. Ensure these situations are clearly described in sufficient detail for them to be easily recognised and distinguished from other circumstances.

List appropriate coping strategies here

Detail specific people to be used as part of the GMP, including their roles, how they will be engaged/involved with this plan, and under what circumstances their support will be utilised.

List overarching strategies to maintain, consolidate or build on previous gains. Specific when, where, and how often they will be used.

Detail a clear, simple plan to deal with emergency situations, including specific details on how to contact key people and relevant services. You should clearly document what circumstances would warrant this plan to be actioned.

TROUBLESHOOTING

Common Challenges and Solutions

Non-Specific Risk Situations

  • Insufficient detailing of high risk situations can be countered by using functional analysis to identify specific antecedents, utilising past relapse as information sources.

Slow Warning Sign Recognition

  • Use a hierarchical system for warning signs (mild, moderate, severe), use support network to assist in warning sign recognition

Limited Coping Strategy Plan

  • Review treatment/intervention to identify non- or under-utilised strategies, and consider further skills development if required.

Hesitancy to Activate Crisis Plan

  • Focus on advantages of early intervention and have clear crisis plan activation rules that are shared with appropriate support people.

Minimising Relapse Risk

  • Frame relapse prevention as positive health maintenance and active engagement with GMP as competency building over time.

References

Note: While this guide references various studies, practitioners should verify current research as the field continues to evolve. The core principles remain well-established in the literature and clinical practice.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.

Irvin, J. E., Bowers, C. A., Dunn, M. E., & Wang, M. C. (1999). Efficacy of relapse prevention: A meta-analytic review. Journal of Consulting and Clinical Psychology, 67(4), 563-570.

Vittengl, J. R., Clark, L. A., Dunn, T. W., & Jarrett, R. B. (2007). Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects. Journal of Consulting and Clinical Psychology, 75(3), 475-488.

Template Information Block

The Gain Maintenance Plan is a structured approach to help you maintain the progress you've made and effectively manage potential setbacks. This worksheet guides you through identifying specific high-risk situations that might challenge your progress, developing personalized coping strategies for these situations, and creating a support network to assist when needed.

By documenting maintenance strategies to continue your progress and establishing a clear emergency plan for difficult moments, you're preparing proactively rather than reactively. This approach helps normalise setbacks as a natural part of change while providing concrete tools to address them effectively. Your practitioner will help you develop this comprehensive plan based on your specific needs, ensuring you have practical strategies to sustain your improvements over time and prevent minor lapses from becoming major relapses.

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