How long does Exposure Therapy take?
While it can be difficult to give an exact estimate of how long therapy will take for you because it varies a lot from person to person, we can give you an average range and tell you what the length of therapy depends on:
An average course of treatment with Exposure Therapy is usually in the range of 10-20 sessions. If you are coming in once per week, which is typical, this means within a few weeks or a few months. 10-20 sessions is the typical range for a full course of treatment, though most people start to see some improvements gradually once they start implementing the strategies we give them during sessions on their own between sessions.
Note also that while most clients fall in that 10-20 session range, we certainly have clients who have quicker treatments in as few as 5 sessions, and we sometimes also have clients who need longer-term help beyond 20 sessions, and sometimes well beyond 20 sessions. Everyone’s needs are different.
While the length of therapy can depend partially on symptom severity, what it mostly depends on is how fast you prefer to move through the process. Getting over an anxiety problem requires you to do things that are uncomfortable for you, and Exposure Therapy is all about changing habits and facing your fears. It requires going through anxiety in the short term for anxiety to get better in the long run. It’s not necessarily MORE anxiety in the short-term, it’s just that you’re confronting it more directly. But people vary in how quickly or gradually they want to do this. Some clients say “Screw it, I don’t care what it takes, let’s just do it all and get it over with quickly”. That tends to result in a faster treatment and fewer sessions needed. Others need to take things more slowly and gradually; they start with easier versions of exposure exercises and gradually work their way up. That works great too, it just takes a bit longer depending on how slow or fast you want to go.
To learn more about how long therapy might take for your specific issue, we recommend contacting us for a free phone consultation with one of our therapists.
I am not afraid of something simple and physically concrete like dogs, can Exposure Therapy still work for me?
Yes, absolutely.
Although we use that fear as an example on this page about Exposure Therapy, very few clients that we see are coming in for such a simple phobia. Typically, if you are not sure of specific situations and triggers for your anxiety, the trigger is really just uncertainty of any kind. It could be uncertainty about your future, whether you will be able to keep a job or relationship, why you are having certain thoughts, why you feel anxious, or really anything. Even though uncertainty is not a physical thing we can put in front of you to do exposure therapy with like a dog, the idea of exposure works exactly the same way. We simply need to get you exposed to feeling uncertain without doing anything to resolve it. In other words, it’s exposure to particular thoughts about uncertainty rather than a physical object.
Remember that short-term avoidance of anxiety leads to long-term maintenance of anxiety. The way this works with uncertainty is that when we feel uncertain about something, the way our brains tell us to “run away” from it is to analyze it so that we can feel reassured, resolved, and certain about it. This leads to excessive worry, rumination, and overanalysis because you are trying to get a for-certain answer to something that cannot be answered for certain.
The solution is to learn the skill of cutting off the process of mentally analyzing worry questions and instead moving on with your day while purposely leaving these questions unresolved, unanswered, and uncertain. If you do this, you will be exposed to uncertainty and will get used to it the same way someone with a dog phobia would get used to dogs. Believe it or not, you can eventually reach the point where uncertainty is no longer a trigger for anxiety for you.
Basically, instead of exposing yourself to a physical object like a dog, you would be exposing yourself to thoughts about uncertainty, but without the avoidance you usually do via mentally analyzing. This would give your brain a chance to re-learn that such thoughts are not actually dangerous and do not require any action, which is how the exposure works and the anxiety gets better (see below to learn why this hasn’t happened for you already).
That is the very quick, short explanation of this, obviously we will go into much more detail about it when we meet with you. We can also tell you more about how this works during a free phone consultation, or you can read this blog post all about this topic: Why You Worry: Obsessing, Overthinking, and Overanalyzing Explained Part 1 and Why You Worry Part 2: How to Stop the Worry Cycle.
But the short answer to this common question is that yes, exposure will still work for fears like this and it is actually more common for folks to be coming to us for help for something like this than for a more concrete, simple phobia. We know what to do with it.
I don’t even know what triggers my anxiety, it seems like it just happens all the time! How can we do exposure if we don’t know what the trigger is?
Anxiety triggers can often be difficult to identify, which is why it can seem like the anxiety comes out of nowhere. But there is always a trigger. Anxiety does not just happen randomly even though it may seem that way sometimes.
We will use our extensive experience with anxiety clients to help you identify subtle triggers, which we will then use for exposure exercises.
I get exposed to the things I’m afraid of all the time. It hasn’t worked so far. Why would Exposure Therapy work for me?
This is a good question that we get all the time. You are correct, you’ve already had lots of exposure to the things that make you anxious, otherwise you probably wouldn’t be seeking help. However, the problem is that when you get exposed, there is something you are doing to avoid the trigger or the anxiety itself. And any avoidance prevents exposure from working.
Avoidance behaviors can be subtle and you may not even realize what you are doing to avoid the anxiety. It may even seem like you are not avoiding at all. But there is no such thing as an anxiety problem without some form of avoidance. Even doing anything to partially avoid or resist the anxiety or the anxiety triggers can prevent exposure from working.
Most people are not aware of how they are avoiding, which is where we can help. We will help you recognize and eliminate avoidance behaviors you may not be aware of that are maintaining your anxiety. Then your exposure will work and your anxiety will decrease.
Therapy has not worked for me before, why would this be different?
Firstly, don’t worry, the vast majority of our clients are coming to us having had other attempts at therapy fail for them before. We are often a last resort for people. Most of our clients have been to what is typically referred to as “talk therapy”, where the therapist listens to the client and perhaps offers interpretations of what the client is feeling or the origins of their issues, but does not offer any concrete advice about what they should do about it.
Most of our clients who have been through this type of therapy will say that while their therapist may have been very nice, it did not ultimately do much for their anxiety. While talk therapy has its place for some issues, it is often not enough for anxiety. Our clients will also often say that if their therapist did give them specific advice, it was typically to do some relaxation exercises, which also usually were not effective.
Even worse than these attempts at these therapies not being effective is the fact that they often leave clients feeling that they must have a more serious, untreatable issue that cannot get better or that they themselves were not doing the therapy right somehow. If you have been through a similar experience, rest assured that the issue was likely not with you but with the fact that you weren’t receiving the kind of specialized help you need.
Exposure Therapy is different because the therapist takes a much more active role. We will give you very clear, straightforward advice on exactly what to do to fix your anxiety issue and reach your goals. In Exposure Therapy, the therapist is more like a coach: we will show you what to do, model it for you, practice it with you, offer encouragement, and do our best to hold you accountable. There is a place for talking through things of course; it is not purely a set of techniques we perform with you, but it is much more goal-directed and action-oriented than what most therapists do. Because it is so different, we typically get results even when a client has not found success with other therapies before.
What if I have too much anxiety to be exposed to my “triggers”? What if I can’t handle it?
At every point in counseling, YOU will decide what you are willing to do and what you are not willing to do. We will not (nor could we) force you to do anything that you do not want to do.
And even though facing your anxiety may be scary, we will help you every step of the way. We will show you exactly what to do when you feel anxious, and we will be WITH you for your exposure exercises whenever possible.
We are your partner in the treatment, and we want you to get better. Most people find out through doing this type of therapy that they can handle more than they thought, which can be empowering.
What if the thing I’m afraid of actually IS dangerous? How do we expose to that?
We will NEVER ask you to do anything that we think is dangerous. We will also NEVER ask you to do anything that we would not do ourselves.
In accordance with this, we will, whenever possible, demonstrate doing the exposures ourselves before you do them.
Instead of doing anything dangerous, we will design an exposure to the perceived RISK of something dangerous happening rather than actually exposing to anything dangerous. We design exposures like this all the time. They are safe and very effective.