With Short, Intense Sessions, Some Patients Finish Therapy in Just Weeks

Recidivism will be high just like in CBT.

The latest fad. I suppose at least it costs less.

I find this interesting, considering what I have read in the past and heard from mental health professionals. Most of the time, it is recommended that someone continually practices using their "tools" and over time, your mindset changes. This seems like a good kick start, but I'm not one-hundred percent sure this is the best way to deal with long term trauma, maybe caused by a parental divorce or abuse. Perhaps, coupled with follow-up therapy through the months, this system will help people with mental health issues recover more quickly.

Relief is “quicker”, and the effects quickly disappear. Much research has documented the lack of enduring effects of time limited psychotherapeutic interventions, yet these treatments proliferate. Everyone wants a quick fix, but none really exist for these complex, multifaceted problems.

Makes sense. When I’ve been in therapy in the past I found that, for me, more than two months is too much, and didn’t add any benefit. When I would tell the therapist that I just needed a short 2-3 month treatment they seemed annoyed. I would find one who understood. Of course some people’s personal issues will need much longer treatments. But, for a lot of New Yorker’s everyday anxieties, ocd or stress related mental angst a short and intense program will do the trick. I see this becoming a “thing”.

Ahh... we certainly live in the culture of the quick fix. The question not addressed in the article, of course, is: How long do the effects of this particular treatment last? Are outcome measures taken six months after the end of treatment? At the one-year mark? Two years? In my experience, quick fixes yield an illusory, quick "cure" and make for a revolving door to treatment. Symptoms almost invariably recur. No matter how much we wish for the magic-wand cure, we can't put a bandage on a deep wound and expect it to heal well.

In Zen, this is called Sesshin.

Thank you for this article. I am a LCSW in Portland and where I work we are consistently striving to provide quality brief therapy for teens up young adults. We have had some great success with DBT groups and ACT groups which run 6-8 weeks and have been working ADHD and Depression and anxiety pathways as well. We also have a TEEN IOP which has been successful. I do think it can be done and, particularly for teens, I think it can be great to do a short burst of work in certain cases.

But...but...but How on *earth* is that therapist going to afford that new Mercedes and braces for their Devil's Spawn without the carrot and stick approach so many use to keep their patients on the hook for years and years and years? This was NOT what these people were told would happen when they were in school! I know people who have been suckered into once a week sessions for more than a decade. Their main problem has long since been relegated into the background, with their problem now being their addiction to their therapist. They need a new therapist to get them away from their current therapist. Not to say therapy is not helpful in some cases. But once it becomes a real business, some therapists can't help but work at increasing their income at the expense of their patients. The sessions become a micro-cult, with the therapist as cult leader.

Anxiety disorders are lifelong illnesses, and they take work each and every day, both in and out of therapy, to get through. I find it hard to believe only a few weeks of therapy truly helps people through their lifetime if they struggle with severe OCD.

Aaron Beck, one of the founders of CBT, prescribes 6 to 20 visits. Its in several of his books. This was decades ago. Think of it as new if you wish. There are numerous "new" therapies that have a new name, and new empirical studies that support they are effective, but human haven't changed that much in a few decades. An autism training (also straight behavior mod) is something "new". Nothing new about it.

It's wonderful there is a more efficacious form of therapy for children dealing with OCD and vets dealing with PTSD. Some have posted this therapy has always been available to the public. How these providers identified? My anxiety problem seems small in comparison, but I have developed a phobia over driving that has become absolute. It started when I had undiagnosed cataracts concurrent with Graves eye disease. Although I complained to my primary care office about vision problems even with new glasses, a doctor would look into my eyes and say, "I don't see anything," and that was that. I was young for advanced cataracts, in my early fifties. I referred myself to an ophthalmologist, was diagnosed with both conditions, then referred myself to an endocrinologist, and eventually successfully treated. However, for many months I tried to drive (had to go to work) with weird vision, resulting in more than a few near misses. The end was when my wind shield wiper stopped working on a rainy night in the middle of traffic, hard to overcome with even good vision. Somehow I made it to the side of the road without causing a multiple car pile up. Now I ride with my husband to work, even though it means getting to work much earlier than I need to, having him take me anywhere I want to go, shopping, etc.. However, when I sit in a driver's seat of a car, panic ensures. Has this intensive short term therapy been used on people with specific phobias?

Thought provoking article. I applaud any information in the mainstream news about Exposure and Response Prevention for OCD. For many people, it is the only hope, but sadly, it is poorly reimbursed.

This article focuses just on young people. If it indeed works long-term, that might be because the neurosis of long-standing anxiety has not set in. The message is the same whether it is intensive therapy or weekly therapy: face your fear. What's the difference whether you hear that once a week or several? A person needs to be healthy enough to do it. The article is claiming that fears are being conquered, but are they? The youth are in a temporary, safe environment similar to drug and alcohol rehab. Actual recovery cannot be measured within a short span while the euphoric phase is still present. Also, I think the rate of recovery would be determined differently if they were to study people with chronic anxiety and panic disorder. The panic is what prevents people from facing their fear factor, not an unwillingness to do it. Anxiety wouldn't be the huge problem it is if it were that easy to recover.

Let's see: Intensive Outpatient treatment, commonly known as IOP, that has been around for more than a decade has proven about as effective as not intensive (weekly) treatment. The dropout rate is lower (duh, it's only several weeks), and some people prefer it. How is it a news? Or have I missed something? P.S. The standard for intensity of psychological treatments used to be 2-4 sessions a week. Weekly therapy is the result of an uneasy compromise between psychologists and insurance co. I'm unaware that anyone has proven that a weekly format is superior to, say, 2x a week.

So basically, this is just describing Intensive Outpatient Programs, which have been around for ages and ages. Some are more general, but you can find IOPs for just about everything from addiction to personality disorders. They're very useful and covered by insurance.

The decision making of insurance and medicare is so upside down. Requiring the patient to undergo slow, traditional therapy and fail at that and then the insurance will pay for this new treatment. I have faced this in mental health where until recently to be eligible for medicare paid treatment using the Transcranial Magnetic Stimulation device, the patient had to have a failed course of ECT first. TMS is not invasive, there is no prep time, no recovery time. Ect requires an anesthesiologist and psychiatrist present and the patient has to have the preparation of taking nothing by mouth for hours prior to the treatment and had to have assistance in going to the treatment site and returning home. With TMS, one can get treatment on one's lunch hour. Why is insurance so willing to pay more and make the patient suffer more when the newer treatments can be easier on the patient and cheaper in the long run?

Excellent article and comments. My son had OCD so severe he could not even eat and intensive CBT in the form of exposure and response prevention (ERP) therapy at a residential treatment center for OCD literally saved his life. He was there for nine weeks. That was over ten years ago and my son continues to function very well with mild OCD. As an advocate for OCD awareness and proper treatment for over ten years, what continues to amaze me is how many supposedly qualified therapists do not know of the proper treatment for OCD. We need to work on educating families, and therapists, as to the frontline evidence-based treatment for the disorder - ERP therapy.

Awesome. Shared to a very good private FB group that is partially monitored by an OCD awareness/ education non profit group for OCD and Intrusive thoughts.

The fact that short-term concentrated therapy works well for some people some of the time does not mean that different approaches (e.g., longer-term therapy) are inferior or to be avoided. One size does not fit all. Many factors (genes, temperament, developmental experiences, etc.) come into play to generate OCD, panic and all the other "official" mental health diagnoses. (For example, a person with panic disorder arising from a traumatic car accident differs greatly from someone who has panic disorder because of chronic childhood sexual abuse.) There are many very different pathways to the same symptom. Therefore, different people need different kinds of help to overcome their problems of living. A key passage in this article: "Patients also need to be motivated and ready and willing to move quickly into exposure work, noted Boston University’s Dr. Pincus." People accomplish remarkable changes when they have a lot to gain by trying out something new (but anxiety-provoking) or a lot to lose by not trying. This variiable, motivation to change, is often not measured in therapy outcome studies but, in my experience as a psychotherapist, it is of crucial importance.

Be very wary about accepting the results of psychotherapy outcome studies which often are neither representative of real-world clinical conditions nor clinical populations and tend to be tests of efficacy rather than effectiveness. Claims for clinical progress often prove to be less than robust and to have very limited shelf lives.

When I began graduate school mid-1960s I was seeking a career in psychotherapy, which I soon observed could go on for many years without meaningful improvement in the patients (some in institutions, some not). I found it depressing that I might treat patients for years without a “cure”, so I switched my focus to psychological research. Then the emphasis in treating mental illness swung toward using drugs, which often suppressed negative symptoms but affected patients’ thinking and emotions—and still didn’t offer cures. Only long after I had graduated did behavioral therapy (now “cognitive behavioral therapy,” CBT) gain acceptance. I am not an authority on CBT, but I think it offers a promising alternative to drugs or years of expensive psychotherapy. However, expecting to see meaningful changes in human psychology and behavior after a couple of days or a couple of weeks of CBT seems almost as extreme as requiring long-term psychotherapy. I don't mean to say such short-term change is impossible, but I think extreme claims for any treatment warrant close scrutiny. Carrying out group CBT enables formation of a support group, which often helps achieve behavioral change in individuals. Group treatment should also be less expensive than one-on-one sessions. From the article it is not clear which CBT protocols and timetables are most appropriate for which individuals, so those considering CBT for themselves or others should seek the advice of a mental health professional.

It’s good to see these kind of approaches gaining recognition. It’s also worth noting the effects are not limited to CBT and the disorders the article described. Decades of research, validated internationally, show that between one-third and one-half of patients choose to be seen for only a single session of therapy, and on follow-up these patients show benefits similar to those patients experience in longer therapies. These results hold for a wide range of patients with a wide range of presenting problems. Of course, many patients need longer therapy. But there is a paucity of research on who needs intensive short-term treatment, who needs brief weekly sessions, who needs long-term or intermittent treatment. When my colleagues Moshe Talmon and Michael Hoyt first presented these results at an APA conference in the 1990s, we were pilloried for “short-changing” patients - despite the fact that we left it up to the patients to decide whether they wanted more therapy. It’s heartening to see the climate has changed.

It is so great that treatment providers are focusing on what works. It also helps to describe what is working more accurately. While not having the full protocols, this describes Cognitive Behavior Therapy blended with Gradual Exposure Therapy. Perhaps the most significant part is that you are describing the jump start to anxiety reduction which is that there is a supportive person there during the early parts of the gradual exposure to help the person self-regulate their internal responses of anxiety – or maybe notice their competencies instead of their difficulties. Also, this describes an action-oriented therapy that is not just sitting – which mimics the freeze associated with intense anxiety – helps our bodies to become allies in the process of becoming more functional. There is much to love about these programs!

So many adolescents suffer without any treatment, let alone the expensive, intensive treatment described here. What can we do for them?

As a psychologist, I applaud these efforts. Now, if only we can develop CPT codes and have insurance companies honor them with reasonable compensation. Although I have never had the opportunity to do therapy quite this intense, I often spend much more time than I get reimbursed for - because it is more effective. Sadly, the trend in reimbursement seems to be to abbreviate therapy sessions, with claims that 45 minutes is as good as an hour. While many patients are resilient enough to improve, even under such adverse therapy allowances, no regard is given to the prolonged suffering that comes for having to wait longer for improvement. And there are those who, while waiting, conclude that therapy is of no value. Let's go with what helps the patient. With the proper focus, we might actually find that we save money in the meantime.

CBT works and it works quickly. CBT is best practice and highly effective not only for OCD and PSD but for eating disorders and addiction. The problem, especially in places like New York, is that the practitioners do not accept insurance because the reimbursements are way too low for them to afford to. Thus, the most effective treatments for these disorders, at least in this town, are reserved for the wealthy.

The great thing about this is that change is recognized, we are no longer stuck in a freudian treatment world. Change is slower to come to other areas impacting our lives developed around the same time...like the internal combustion engine and men's suits for example, both have been stuck in a rut, people are focused on improving them, not changing them entirely.