Barbara O. Rothbaum, Ph.D., has been working with people who have PTSD, or PTSD, since 1986, not long after the condition became an official diagnosis in 1980. As executive director of Emory Healthcare Veterans The Trauma and Anxiety Recovery Program and Program at Emory University School of Medicine has seen it all: nervous, sweaty panic cannot breathe and almost faints that occur when waves bathe someone's waist and they are sure they will be sucked under; The horror of abuse or imminent trauma that appears with the click of a key in the lock. It is never pretty and often does not end well. "Weekly therapy is like starting a scab," she says. “In the week between sessions, the scab heals a little, but you know that you have to go back and experience the pain of starting it again. Who wants to do that?
Nobody. That is why most PTSD treatment programs have a high dropout rate. Hell, that's why many of those who suffer some kind of anxiety, be it a serious fear of flying or an obsessive compulsive disorder (OCD) that prevents them from using public restrooms, doesn't go to therapy at all. "Many people with anxiety avoid therapy because avoidance is part of the problem," says Rothbaum. It is also the reason why she and a handful of other practitioners are becoming radical, shortening the course of therapy for conditions such as PTSD, OCD, panic attacks and certain phobias, sometimes three weeks, another three hours.
They are practicing a new, more intense version of exposure therapy. Instead of scheduling weekly one-hour sessions to work on this, a therapist could spend three hours a day for three weeks gradually increasing a patient's exposure to their worst fear. A boy with a debilitating germ aversion could eat from a shared tub of popcorn without a hand sanitizer in sight. Later that week, you might be asked to put your hands on the floor of a public restroom without washing them later. This approach is short. It's intense Adopters say it's like HIIT for your emotions, and science is discovering that it does the job.
Inner anxiety training camp
It may be a novelty for many therapists and anxious people, but condensed courses of anxiety treatment have been around since the 1970s, the creation of Swedish researcher Lars-Göran Öst. As a young psychologist, he noted that his phobic patients did not need the 10 to 12 sessions that were typical at that time; he was eliminating his phobias in just four or five. It was not a superpower he only had; Other therapists could get these results if they were willing to review their treatment.
"Most patients arrive for 50 minutes and progress a little, but when they return the following week, they do not start their second session where they finished the first, their anxiety has increased," says Öst, now professor. emeritus at the University of Stockholm. By using intense exposure therapy (training a patient with fear of elevators to an elevator, for example, or letting a spider crawl on someone with arachnophobia) he could refute his patients' beliefs about what catastrophic thing would happen if they came in direct contact with whatever they feared, usually in two or three hours, but often in just one hour.
To demonstrate its effectiveness, Öst conducted a randomized controlled trial that compared his method with standard cognitive behavioral therapy (CBT) and found that his approach not only worked as well, but that 90 percent of his patients who were receiving intense exposure therapy They improved a lot or completely recovered after just one session. That is the kind of time frame that even the most committed people can work with.
Professionals looking for a better way to help their patients have launched programs based on this research. For example, Rothbaum therapy for veterans with PTSD requires only two weeks of intense work. The short-term commitment has helped reduce the dropout rate to about 10 percent of its usual 25 to 50, she says. Thomas H. Ollendick, Ph.D., director of the Virginia Tech Children's Studies Center, successfully treats children with OCD in four days and those with specific phobias (such as fear of dogs or heights) in a single session three hours
No one calls HIIT for easy anxiety
In theory, any professional trained in CBT should be able to work intensively with people who have anxiety disorders. Actually, inertia and programming get in the way. "Although there is no evidence that a 50-minute therapy session each week is the best way to do psychotherapy, it is the standard," says Ollendick. "We are not sure how this standard evolved." Programming two or three hours in a row over the course of a few weeks is difficult for most professionals, although doctors say patients prefer it overwhelmingly.
And the work itself is hard. Most therapists do not practice exposure therapy because it is difficult logistically (how can you treat fear of elevators if you are in a building without an elevator?), Because it makes you feel uncomfortable (exposure therapy it's a challenge, for both the patient and the doctor, says Ollendick), or simply because they are used to the standard approach. "Many therapists will talk to you about things that are not related to your anxiety, and although that may feel good, it is probably not helping the symptoms you are dealing with," says Rothbaum. Then there is the money. Many insurance companies do not cover these intensive outpatient treatments, which can cost more than $ 2,500 per week, even if that would mean less hours of therapy than the traditional model.
Still, there is hope. At the forefront of intense exposure therapy are professors and researchers, who teach their methods to their students and publish studies on the effectiveness of this HIIT-style approach, two important steps necessary for it to really spread. However, all experts in rapid results say that CBT administered in the traditional weekly format can be very useful for anxiety. "In the end, we know that learning to feel less anxious about your anxiety is key," says clinical psychologist Jonathan Abramowitz, Ph.D., of Chapel Hill, North Carolina, no matter how he gets there. "But it is important to keep in mind that it is not necessary to take a lifetime on a therapist's couch to get that lesson."
Warp Speed Anxiety Training: Is it right for you?
If you meet all these criteria, you could be a good candidate for a condensed intensive therapy program.
You have OCD, panic disorder or a specific phobia. However, there is still no research to show that these short and intense treatments work for generalized anxiety disorder.
You are motivated to face your anxiety. This approach works by gradually increasing exposure to what you fear most, so you must commit to experiencing what really scares you. "You have to be all in," says Abramowitz. "Otherwise, you will spend a lot of time making yourself miserable and, in the long run, it won't help you."
You are not psychotic and you are able to avoid alcohol and drugs. This type of therapy is difficult and can bring many bad memories, says Rothbaum. "We want to make sure that patients feel safe when they are doing this job, not on the verge of collapse. And we don't want you to immerse yourself in old coping habits and use substances to cushion the anguish that will undoubtedly arise."