What to Expect at Anxiety Solutions

This is a chance for you and your therapist to get to know each other. The therapist will learn all about you, the problems that brought you to therapy, and your history.  At the end of your first session, they will leave some time to give you some feedback about your diagnosis and what your treatment will look like. They will answer your questions as well.

Your therapist will teach you some basic concepts that set the foundation for how to make an anxiety problem better.  You can check out our blog for a small taste of how we explain anxiety concepts to our clients.

You will learn about:

• the brain science behind anxiety and OCD and how it is changed through the cognitive-behavioral treatment method of Exposure Therapy.
• The 3 parts of an anxiety problem: thoughts, emotions, and behaviors.
• The different strategies for approaching each of these 3 parts.
• The skill of how to cut off the worry process and redirect attention back to what you are actually doing in the present moment.  This is a critical but difficult “mental behavior” to learn, and we typically spend a lot of time in therapy working on this skill.

Changing what you do in response to anxiety is what really leads to anxiety getting better in the long run. Based on the foundational concepts in the psychoeducation step, your therapist will review all of the behavior changes they see as being critical to your recovery and go over how to implement them.  This typically means eliminating behaviors designed to help avoid or resist anxiety in the short-term (because that’s what keeps anxiety going in the long term) and returning to normal activities even in spite of anxiety.

This is the part that takes up the bulk of your therapy sessions.  Your therapist will decide which of these parts to prioritize and then they will go through them with you over the course of several sessions each. Once you have learned and practiced the basic skills and exercises, your therapist will continue to update and repeat these as needed. Clients typically notice improvements gradually, starting when they begin consistently making the behavior changes and practicing these skills and exercises on their own outside of sessions.  To learn more about the type of therapy we use, check out the Our Approach page.

• Skill Training and Practice: You will learn key skills that help with anxiety and go through various exercises to practice these skills in session with your therapist. Typically, the most important skill is to purposely leave worry questions unanswered while redirecting attention onto the present moment.  Mindfulness meditation is another key skill that can be very helpful and your therapist may teach you specific mindfulness exercises for anxiety and how to use them most effectively.
• Exposure Exercises: The core of Exposure Therapy is to practice confronting (rather than avoiding) the anxiety triggers to gradually train your brain through experience that they are not dangerous. What this looks like depends on the content of your fears. Sometimes it means confronting something physically like purposely inducing panic sensations for panic disorder or touching feared surfaces in contamination OCD. But it can also mean confronting anxiety-provoking thoughts, for which we often use a technique called “imaginal exposure”. This involves having us make a recording of the anxiety-provoking thoughts and then having you listen to it repeatedly without doing typical avoidance behaviors in order to train your brain that those thoughts are not dangerous. This causes the thoughts to lose their emotional impact. Exposure exercises often change as you progress through therapy and we figure out different nuances of your anxiety triggers, and as we move up to more and more difficult exercises in your “exposure hierarchy”.
• Homework: Between sessions, you will practice the skills and implement the behavior changes that you work on during sessions. You will also practice the exposure exercises.  Homework is actually the most important part of therapy: change does not actually happen during therapy sessions themselves, it really happens when you take what you learned in your therapy sessions and use it.

Making big changes is hard and improvement is rarely a straight line upwards; it is more typically a gradual “2 steps forward, 1 step back” kind of process. The therapist is there to compassionately support you through this, keep you accountable and on target, and help troubleshoot barriers to success so that you ultimately reach your goals.

Towards the end of therapy when we have taught you everything you need and things are improving, there is at some point less and less need for full 50 minute sessions every week and we typically start to titrate down the length and frequency of sessions. Most clients at some point start doing less frequent half sessions (25 minutes) for a little while until they have met their goals and maintained that success for a little while.

Cognitive-behavioral therapy is not meant to be a never-ending, lifelong process: the idea is that at some point (usually a relatively short period of time), we have given you everything you need: goals have been met, suffering has been minimized, and you no longer need us! The skills you learned in therapy become new, healthy habits that will serve you for the rest of your life.

The overall length of therapy does vary a lot for each specific person, but on average, a full course of treatment usually takes about 10 to 20 sessions. We sometimes have clients go even faster than that for those who are really willing to push themselves and use all the strategies quickly. We also sometimes have clients who need longer-term help.  But most clients fall in that 10 to 20 session range. For a more detailed explanation of what determines the length of therapy, check out our Frequently Asked Questions page.