Intensive Individual Therapy
Most people think of therapy in the traditional sense: once a week for 45 minutes. However, interest in and support for brief, intensive, and concentrated doses of therapy to treat anxiety disorders has grown in recent years. For example, in their 2017 review and meta-analysis of brief, intensive, and concentrated (BIC) cognitive behavioral treatments (CBT) for anxiety disorders in children and adolescents, Ost and Ollendick found that brief intensive treatments were just as effective as CBT. In other words, treatment effect from a shorter, intensive, and concentrated dose of treatment (e.g., Ost’s 3-hr one-session treatment) can be as effective as a traditional therapy hour delivered over several weeks (e.g., 11-18 weeks of standard CBT).
How can this be?
First, it is important to understand the anxiety loop. When anxiety is triggered, we act to avoid the distress. When we avoid, we feel better, but it’s a short-term relief. The anxiety is triggered again, and we act to avoid again, only to find that we are anxious about the next time the trigger will loop around again. Eventually, anxiety grows stronger, as does our avoidance. For example, a person with social anxiety may turn down an invitation to join others for a snack in the break room. They may even go further in their avoidance the next day by getting to work early to avoid running into their workmates in case they are approached again. They may stay late at work to make sure they can leave after everyone else has left to avoid running into them, and so on.
With intensive doses of therapy, we can activate the feared association and “unlearn” the avoidance pattern by practicing a new approach pattern instead, creating a new association. Processing the new learning (e.g., “I can survive this”) and consolidating the new experience is maximized when there are more opportunities to create new pairings. With more pairings, we have deeper learning, leading to deeper fear extinction. So, it makes sense that if we had three hours, we would be able to create more pairings than if we had 45 minutes.
Intensive doses of treatment also make sense for conditions that have a long acclimation period before reaching a therapeutic dose of exposure. For example, a child with selective mutism may take 55 minutes before they can be verbal to their parent in front of the therapist. If we only had an hour, that only leaves 5 minutes of active exposure to the feared situation (i.e., talking to mom in front of the therapist). If we had three hours, then that would give us two additional hours to continue exposure to the feared situation, as well as the opportunity to provide successive exposures (i.e., talk to mom in front of therapist, talk to therapist using mom as verbal intermediary, talk to therapist directly in front of mom, talk to therapist with mom faded out). With six hours of therapy, we can extend exposure to multiple contexts, such as going outside of the clinic (e.g., the library, the park, the craft store, etc.), creating multiple new associations and deepening the fear extinction even more so.
A Shift to Intensive Treatments
Overall, we are seeing a paradigm shift in the way treatment for anxiety disorders is delivered. At ATSA, we see first hand how effective intensive treatment is, and there are times when intensive treatment is recommended over the traditional therapy hour in order to reach the therapeutic window more effectively and timely. Intensive treatments are not meant to be long term; they are meant to be a large dose of concentrated treatment delivered over less time (e.g., six hours in one day versus six hours over six weeks).
Who chooses intensive treatments?
- People who come to ATSA travel from a range of distances, from neighboring towns and states to internationally. They come for concentrated doses of treatment for several days, then travel back with their new learning, ready to apply new patterns at home.
- If symptoms are severe and extended time is needed to reach a therapeutic dose of exposure, intensive treatments are recommended (regardless if the individual is local or from out of town).
- Individuals may prefer intensive doses to reach symptom alleviation faster.
- Individuals with busy schedules may find it hard to keep attending therapy once a week and therefore may prefer intensive doses of treatment spaced further apart (e.g., 6-hr dose every 6-8 weeks).
- Call 630-230-6505 for more information.