Category: Blog

When you’re new to therapy, one of the most common questions people ask is, “How often should I go?” The frequency and duration of therapy sessions can significantly impact the effectiveness of treatment for general concerns like stress management, navigating life changes, and relationship issues as well as for more specific mental health disorders, including Depression, Anxiety Disorders, and Obsessive-Compulsive Disorder (OCD). 

How Often Should You See A Therapist For Anxiety

Once you’re in therapy and have made progress towards your goals, the question might come up of “How long should I stay in therapy?” For most people, the answer to this is one of personal preference.  If therapy continues to be helpful and supportive for you once your treatment goals are met, you may want to continue ongoing therapy and consider it one of your self-care or wellness activities. At Dallas CBT, we generally think of therapy as something that you may want to pause and then un-pause numerous times across your life.  There may be times when you really need the extra support, and other times when you’re coasting along fine without therapy.  

To look further into the question of how often to attend therapy and how long to attend therapy, let’s look at the research on optimal therapy schedules for achieving the best outcomes.

General Recommendations Across Disorders

While the specific frequency and number of sessions can vary depending on the disorder and individual needs, some general recommendations can be made:

1. Initial Frequency: For most mental health concerns, starting with weekly sessions is generally recommended. This frequency allows for the establishment of a strong therapeutic relationship, consistent progress, and the reinforcement of therapeutic techniques.

2. Duration: Many evidence-based therapies for anxiety, OCD, and depression suggest a course of at least 12 to 20 sessions. This duration can provide a solid foundation for symptom management and skill development.
3. Maintenance: After the initial course of therapy, some individuals may benefit from less frequent “maintenance” sessions (e.g., bi-weekly or monthly) to reinforce skills and prevent relapse.
4. Personalization: It’s essential to tailor the therapy schedule to the individual’s specific needs, symptoms, life demands, and response to treatment. Open communication with your therapist about your progress and any adjustments needed is crucial.

Anxiety Disorders

For individuals dealing with anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder, the research suggests that weekly therapy sessions are often the most effective. Cognitive Behavioral Therapy (CBT), a widely used and evidence-based approach, typically recommends weekly sessions over the course of 12 to 20 weeks. 

A study published in the Journal of Consulting and Clinical Psychology found that weekly sessions of CBT significantly reduced symptoms of anxiety in patients. The study highlighted that consistency and regularity in therapy sessions allowed for steady progress and the reinforcement of coping strategies learned during therapy.

Obsessive-Compulsive Disorder (OCD)

When it comes to OCD, the treatment typically involves Exposure and Response Prevention (ERP), a specific form of CBT. Research indicates that intensive ERP, which may involve multiple sessions per week when possible, can be particularly effective. According to the OCD experts at Dallas CBT’s experience, 20 sessions seems to be the right dosage of ERP for substantial improvement in OCD symptoms.  Those 20 sessions can be done on a weekly basis or condensed into multiple sessions across a shorter number of weeks, and the effects appear to be the same.  In support, a review in the Journal of Anxiety Disorders found that intensive treatment schedules (e.g., twice or three times weekly) over a shorter period (4 to 8 weeks) could lead to substantial symptom reduction.

One should consider their life and schedule demands when deciding about the timing of therapy sessions. For those who cannot commit to such an intensive schedule, weekly sessions would be the better choice and are equally beneficial. The key is to maintain regular exposure to anxiety-provoking stimuli and consistent practice of response prevention techniques.

Depression

For individuals with depression, the frequency and duration of therapy can vary based on the severity of symptoms. Studies have shown that for mild to moderate depression, weekly sessions of CBT for about 12 to 16 weeks can lead to significant improvements. 

In cases of severe depression, more frequent sessions may be required initially to stabilize symptoms, potentially transitioning to weekly or bi-weekly sessions as symptoms improve. A meta-analysis published in PLOS Medicine indicated that regular, ongoing therapy sessions contribute to sustained symptom relief and reduce the likelihood of relapse.

 Schedule Your Appointment with our Dallas Therapists

Deciding how often to attend therapy and for how long can be a decision that depends on various factors, including the type and severity of symptoms, individual needs, and response to treatment. Research consistently supports the effectiveness of regular, weekly therapy sessions over a specified period for achieving the best outcomes in treating anxiety, OCD, and depression. However, personalized treatment plans are essential, and working closely with a therapist can help determine the most effective schedule for you.

If you’re considering therapy, don’t hesitate to discuss these recommendations with your Dallas therapist to develop a plan that best suits your needs. The commitment to regular sessions can make a significant difference in your journey toward improved mental health.

 

For OCD Awareness Month, we asked the OCD experts at Dallas CBT for a round up of their favorite OCD resources.  These are suggestions they make to their clients to help support and supplement their therapy work:

1. OCD Stories Podcast
2. Freedom from OCD, a book by Jonathan Grayson
3. @obsessivelyeverafter on Instagram
4. The podcast “Your Anxiety Toolkit – It’s a Beautiful Day to Do Hard Things”
5. Anxiety Happens: 52 Ways to Find Peace of Mind– a book on daily practices for anxiety by ACT experts
6. Our own Dallas CBT OCD Support Group!
7. The International OCD Foundation website for educational information.

*The Minze Minute is a one-minute (or so) speed read summarizing the literature on a given mental health topic

Boredom is a topic that has come up quite a bit with my clients, so I am always looking for some good research. Many of my kid clients relate to The Most Boring Video Ever which cites a study in which participants left alone in a room absent of other stimulation preferred shocking themselves to boredom (Wilson et al., 2014). While I still appreciate the video for the discussion that ensues when I watch it with kids, it actually takes the study out of context. The study is actually a series of 11 experiments all examining the enjoyment of “just thinking,” in which they conclude that electric shock or another mundane task is preferable to being alone with one’s thoughts. Boredom isn’t really studied as a concept. Plus, there is some backlash about the conclusions drawn. Fox et al., 2014 went back to the original data (can you say dedication?) to throw a wrench in the conclusions drawn. For one, the people who shocked themselves during the study actually reported finding the experience of “just thinking” to be just fine, maybe even “somewhat pleasant.” The majority reported choosing to shock themselves simply out of curiosity. These pesky little details were overlooked by the Harvard publication that publicized it and seem to really cast doubt on the conclusions drawn. (There really was one outlier of a guy who shocked himself 190 times, though.)

Boredom is by definition aversive. When we are bored, we feel restless, discontent, and wearied with mental fatigue…and we want an escape! (Elpidorou, 2014). More specifically, boredom has been defined by Eastwood et al., 2012  as “the aversive experience of wanting, but being unable, to engage in satisfying activity.” They go on to conceptualize it as a disruption in attention. We are unable to focus our attention and engage either with an internal or external information; that is, we cannot engage with our thoughts or feelings and we cannot engage with our environment. Plus, then we get hung up on the fact that we can’t engage. Oh, and we blame it all on the environment…even though in a bad mood we could be bored in the most exciting of environments. “Mom! There’s nothing to do; I’m bored!” (In your best whiny voice)

“There is nothing new under the sun!” (Ecclesiastes 1:9)

Boredom research goes back to the 1950s and philosophical discussions of boredom even further back in time. So we can’t blame it all on smartphones. I’ve said it before and I’ll say it again, boredom is a good thing. First there’s the default neural network and its connection to creativity (for more information, I’ll refer you to a good TEDx talk or a past issue of The MinzeMinute). On top of that, boredom is informative. If attended to, our boredom can give us insight as to our goals, interests, expectations, and even our wellbeing. Plus (and arguably most importantly), boredom spurs us on toward action, toward making changes that align more closely with our ultimate goals. It has even been argued that boredom allows for monitoring and regulating our behavior (Elpidorou, 2014).

Clinically, we need to distinguish the state of boredom (good) and boredom proneness (maybe/probably not good). Boredom proneness is trait-like. It is the tendency to experience boredom in a wide variety of settings and measured in research by the Boredom Proneness Scale (BPS; Farmer & Sundberg, 1986). Boredom proneness is linked with a litany of negative outcomes including (but not limited to) depression, anxiety, anger, aggression, low enjoyment of thinking (I’m thinking that the 190 shocks guy might be prone to boredom…maybe that’s just me), poor social engagement, less job satisfaction, mistakes in task completion, difficulty finding meaning and purpose, and addictive behaviors (for a list of citations on these, see the Elpidorou, 2014 article). Yikes!

Essentially, for those prone to boredom, the functional value of boredom is obscured by its indiscrimination and frequency. Whether or not these correlates are cause or consequence of boredom proneness is not clear. Maybe someday someone will do some research on that. Nonetheless, if boredom is conceptualized (as it is by Eastman and colleagues) as an attentional issue, boredom proneness may reflect some dysregulation in the dopaminergic system (think ADHD of which intolerance for boredom is a de facto symptom…this also may be why this comes up so often in my office). Clinically, the old standards –  mindfulness, behavioral activation, cognitive restructuring, values clarification, etc. – viewed in light of boredom reduction make conceptual sense. A quick search suggests there is a lot of self-help for boredom that mostly resembles behavioral activation, but little related to clinical interventions.

-Laura Minze, PhD