Therapy is one of the best ways to confront anxiety. But, if you’ve never been to therapy, there are likely many questions.
One of the most common questions asked is, “How often should you expect to see your therapist?” Typically, it’s best to see your therapist 1 time per week. If your anxiety is at a higher level, your therapist may recommend 2 times per week. As your anxiety decreases and your goals are met, it makes sense to stop or move to less frequent sessions.
How long is anxiety therapy?
Each session is typically 45 – 60 minutes in length. The length of treatment varies on the intensity of your anxiety and how consistent you come to therapy.
Typically, therapy for anxiety can range anywhere from 5 to 25 sessions.
Is anxiety curable?
A certain level of anxiety is inevitable. It’s part of being human. In fact, we don’t want to get rid of anxiety entirely as it keeps us safe from threats.
But, what about unhelpful, destructive anxiety? Can that be cured?
Asking if anxiety can be cured is the same as asking if poor fitness can be cured.
To stay fit, we must work at it continuously. At times we may be less fit than others. Life events happen like a vacation or a major life transition, which causes us to veer off from our workout routine and become less fit.
The same is true for anxiety. By developing habits and routines, we can keep anxiety in check.
Anxiety is also like fitness in the sense that it exists on a spectrum. It’s not that you’re fit or not fit. Fitness exists to varying degrees. Anxiety should be viewed in the same way.
Instead of asking if we can cure anxiety or not, a more realistic question is, is it possible to reduce anxiety back to a level where it serves me well.
And the answer is yes.
What to expect at your first session
The goal of the first session is assessment. Your therapist will be interested in assessing your current levels of anxiety and clarifying what you’d like to gain from therapy.
Just as important, it’s a chance for you to get a taste of your therapist’s style and to assess if it might be a good fit or not.
Typically, therapists have clients fill out an intake form before session. You can expect to be asked basic contact information, date of birth, and your medical and mental health treatment history. You’ll also be asked to write about your current challenges and details about your personal history.
At the beginning of your first session, you can expect your therapist to review a few important things:
- Confidentiality and the therapist’s limits to maintaining confidentiality
- Your therapist’s background
- Office policies and fees
After you agree to treatment, your therapist will typically ask you to talk about your reason for coming.
What to expect during your treatment
During the course of your therapy, you can expect your therapist to ask questions about your emotions, thoughts, and behaviors during session. You can also expect your therapist to provide you education (which we call psychoeducation) on how the brain works and typical patterns in emotions, thoughts, and behaviors.
You can also expect your therapist to suggest home activities outside of therapy.
What type of therapy exists for anxiety?
Cognitive Behavioral Therapy (CBT)
CBT is a style a therapy that is common and effective at treating anxiety. It’s a talk therapy, meaning a clinician and client meet for sessions typically around 45 to 60 minutes in length and talk with one another.
CBT is based on the understanding that thoughts, behaviors, and emotions all influence one another.
Dialectic Behavioral Therapy DBT
DBT is also a type of CBT and works with thoughts, behaviors, and emotions, but with added skills and approaches.
Mindfulness is a big component of DBT. You can think of mindfulness as the ability to watch and observe ourselves. A skill we all have, but something we all need to improve on. As we increase our ability to be more aware, we are less susceptible to being reactionary to our environment, emotions, and thoughts. By becoming more of an observer, we gain more control.
Another key component is acceptance of self. Which is also contradictory. How do we accept ourselves, while also maintaining the desire to change ourselves? DBT aims to address this conflict.
DBT, just like CBT is collaborative between the therapist and client.
Acceptance Commitment Therapy ACT
ACT is also a type of CBT and like DBT has a mindfulness component to it. ACT’s main goal is to help clients identify values and figure out ways to align behaviors with those values.
ACT also works under the assumption that a large part of our anxiety is created by trying to reduce our anxiety. ACT is about learning to accept intense emotions. Not to necessarily be complacent, but to give up the struggle of trying to avoid and escape anxiety.
ACT also works under the assumption that clients aren’t broken and therefore something to be fixed.
Exposure Response Prevention (ERP)
ERP is about exposing ourselves to the very things that cause us anxiety.
The premise of ERP is that it challenges the avoidance strategy. Avoidance is a common, maladaptive coping strategy used by people dealing with anxiety.
Logically avoidance makes sense: “This certain situation causes me anxiety, so I will avoid it.” What happens, however, is anxiety becomes increasingly higher the more the person avoids. Avoidance also tends to spread into other areas. In short, avoidance works in the short-term, but it usually causes us more trouble in the long-term.
ERP’s goal is to break this cycle.
ERP is commonly understood as a technique used to habituate our brains to triggers. However, I think a better way to understand it is that it teaches clients that they can in fact lean into the anxiety and face it.
How to choose the right therapist?
Even though a therapist may have all the right training, if you don’t feel like it’s a good match, therapy won’t work. And a therapist who you feel you click with, may not have the right training to effectively and efficiently treat you.
Finding the right therapist is about finding a balance between their training and the feeling you have about them during sessions.
I encourage people to shop around. You can spend one or two sessions with one therapist and try a different one to get a feeling for their different styles.
Getting recommendations from friends, family, or other professionals is a great place to start.
There are a number of online directories, but I find them to be a little overwhelming as most therapist have a large number of “specialties” listed, making the filter tool almost useless. But, if gender, location, and fees are more important, online directories might be a good place to start.
Podcasts, YouTube and searching for articles are also a great way to find therapists. This is a great way to find true experts and specialists. It’s also a great way to get a taste of their style without having to pay.
You can learn more about finding an online therapist here: Is Online Therapy Effective? The Pros and Cons.
When to seek help for anxiety?
A general rule of thumb is that when symptoms start to impair a person’s day-to-day functioning, this is a clear sign that intervention from a professional is needed.
At the same time, the earlier someone gets help the better the outcome. The longer someone waits, the more time it will take to get anxiety back down to a functioning level.
If your questioning whether or not you need therapy, this is probably reason enough to reach out to someone.