Could Therapy For Your Anxiety Make It Worse?
Many people with anxiety consider psychotherapy for it at some point. One worry they may have is that working on their issues with a counselor will backfire and leave their nerves even worse than before. They're not happy with their current lifestyle or mental health, but at least it's familiar. Their lives may even be comfortable and manageable, in a stagnant, limited way. What if working on their anxiety causes it to flare up and sets off a downward spiral, and they lose what little they already have? Nervousness feels awful. It's totally understandable that if someone thinks they have it more or less under control, that they wouldn't want to risk undoing all that.
Below I'll share my thoughts on this worry, and how likely therapy is to make things much worse. Some of the ideas also apply to working on your anxiety yourself using self-help material.
The quick answer: Most of the time therapy might cause some acceptable short-term stress. In rare cases, if someone is already struggling with a ton of anxiety, they should be reasonably careful that therapy doesn't push them too far. Here's more detail.
What do you mean exactly by making your anxiety "worse"?
There are three ways therapy might make someone's anxiety "worse". The first two tend to be manageable. The third is the true fear:
Therapy can deliberately make you feel moments of nervousness or distress, with the goal of helping you feel calmer in the long run
This can include:
- Facing your fears and getting used to them, in a systematic, gradual way. That could involve confronting scary situations in real life, like talking to people at a party or driving on the highway. It also includes exercises you'd do with a therapist, like role-playing a job interview, or deliberately making yourself out of breath so you can learn to tolerate the sensation without it triggering panic. Exposing yourself to your fears can obviously cause your anxiety to go up while you're doing it. You can also feel more nervous day to day as you anticipate those moments, e.g., thinking all week about a nerve-racking role play you'll be doing with your counselor on Friday afternoon.
- Talking about anxiety-provoking topics in your sessions, like how you're worried about your finances, or that you're nervous about a tough conversation you need to have with a friend.
- If you have any, dealing with traumatic memories - Doing this can bring up a range of distressing emotions, but anxiety is certainly in the mix.
- Generally giving more thought to your problems, when your usual approach is to do your best not to think about them.
These things all technically make your anxiety worse, in the sense that while you're in therapy you're feeling a greater amount of anxiety than if you were out of treatment and in your comfort zone. However:
- It's an increase of anxiety you're willingly signing up for, on your own terms. You're strategically feeling worse now so you can be better off in the future.
- A lot of the extra nervousness you'll feel is predictable and under your control. It's uncomfortable to do exposure exercises, but you plan them ahead of time. It's not a random, uncontrollable stressor like getting laid off out of nowhere. If therapy as a whole is feeling too tough, you can slow things down, regroup and try a different approach, or even take some time off and come back to it later.
- Many of the anxiety-inducing things you'll do are bite-sized, one-off events. Your stomach may be in knots before and during an exposure, but once it's done, it's done. Doing a series of exposures over a few months may cause you to be more nervous several days each week, but there's still an overall feeling that it will all be finished one day.
- A good therapist will do things to make the work as comfortable and manageable as possible. They won't be able to prevent you from feeling all anxiety, but they can do things like teach you techniques to cope with your distressing emotions, and to start with easier tasks and ramp up the difficulty at a reasonable pace. Of course, the therapist themselves can be a source of comfort and support.
- All the extra nervousness you feel is shot through with a sense that you're doing it for a good reason. There are lots of little moments of success and celebration. The pain doesn't feel pointless.
Overall, they may not love every second of it, but most people are okay with this kind of increased anxiety therapy may bring on.
Other aspects of the therapy process may make you upset and anxious
Therapy can be a very positive experience, but it doesn't always go that way. Negative things can happen while you're in counseling that directly make you anxious. Some people also have a tendency to morph their other unpleasant emotions into feelings of anxiety. So an experience that initially causes disappointment or confusion will add to their stress levels. Here are some examples:
- The cost of therapy is a financial strain
- It's a hassle to make it to your appointments
- Your therapist does something irritating, like being disorganized and rescheduling too many sessions at the last second
- Your counselor has you do exposure exercises, but plans them poorly, and you end up doing something that's too much, too soon, and having a bad experience
- Your therapist blunders and says something insensitive or tone deaf
- Your therapist gives you genuinely misguided advice, like telling you to stay in a toxic friendship
- Your therapist misdiagnoses you and provides inappropriate treatment
- Your insecurities cause you to worry about your relationship with your therapist, e.g., that they may not like you and want to get rid of you, because they took too long to reply to one of your emails
- You feel discouraged because you don't feel like you're making enough progress, or that it's coming too slowly
- If you have a belief system that people in therapy are "weak" and "crazy", just knowing you're seeing a counselor may get to you
- Fearing that you might be beyond hope, if you try one counselor or therapy method and it doesn't pan out
All these things can bump up your anxiety levels. There are things you can do to resolve or take the sting out of them:
- If you have an overly-stressful exposure experience, you can learn from what went wrong, re-work your plan, and try again with something easier.
- For inconveniences and hassles you may be able to tell yourself it's all for the greater good, e.g., "It makes my day more hectic rushing to my appointment after work, but it's worth it."
- For worries about what your therapist thinks of you, you can bring it up with them and hopefully work through it (e.g., discussing an insecurity that they're bored with you because you sometimes don't know what to say in sessions).
- If you're feeling down about your lack of progress, you could examine any counterproductive thinking patterns that may be contributing to those feelings, e.g., believing you're a lost cause unless you make amazing improvements each week. You can also talk to your counselor, and see if it's worth trying a different approach.
- If your therapist makes a true mistake, you can either discuss it and give them a chance to make amends, or cut your losses and find someone better to work with.
Though even if you eventually address some of these situations, they still add to your stress meter, at least temporarily. The real question is...
What if therapy tips your anxiety levels over the edge, and leaves you way more anxious going forward?
There's not a formal clinical term for it, but I mean when your stress and worries pile up to the point that you "snap" or "have a breakdown". Everything feels like too much, and it peaks in a moment where your anxiety shoots through the roof. You might have a big panic attack and go to the hospital. You may spend the next two days pacing around your apartment worrying non-stop, while barely eating or sleeping.
Even once that crisis moment passes, you don't go back to how you were. Your baseline anxiety level stays up in the weeks and months that follow. You're more frayed and jittery throughout each day. If you get panic attacks, they're more frequent and/or intense. You're scared to do more activities than ever before. You're afraid of your own anxiety, and sensitive to any sign it may be rising. It feels like you have to put all your energy into basic functioning; forget about optional self-improvement. You may know on some level you can recover, but it'll be a while. It seems like your progress has taken twenty steps back.
It's horrible when your nerves get this bad. If you've been through a period like this once, it's incredibly understandable that you wouldn't want it to happen again. So is getting therapy for your anxiety likely to make it much worse in this way?
Anxiety flare ups or breakdowns usually happen when someone is under a ton of stress, often combined with a lack of coping skills. As I covered above, therapy and working on your anxiety can be stressful, though much of that is in a way that feels manageable and under your control. If you're not feeling very pressured and overwhelmed otherwise, it's highly unlikely counseling will be enough to tilt you into a crisis.
Now if you already have waaaay too much on your plate, it's possible therapy could put you over the edge. It's not that counseling is stressful in some special way. It's more that if you're near your limit, any kind of new challenge may be your breaking point. It could happen to be therapy. It could also be your car needing sudden repairs, or your cat starting to pee on your sheets once a week.
Of course, therapy doesn't automatically have to be a source of extra stress, especially if you know you're already stretched thin. If anything, it can be a great way to bring your all-around stress levels down:
- You can learn relaxation and coping skills
- You can use your therapist as a supportive, understanding ear
- You can learn to take the air out of your thoughts and beliefs that put unnecessary pressure on you
- You and your counselor can problem solve the practical concerns that are stressing you out
More importantly, if you know your stress levels are close to maximum, you can choose to put off the more-difficult types of therapeutic work until you're feeling more stable. If you're not up for it right now, you don't have to face your biggest fears, discuss difficult topics, or wade into your most upsetting memories.
A few more thoughts
Unless you make a radical lifestyle change, you can always go back to your pre-therapy comfort zone
Your comfort zone may not be that fulfilling, but it is stable. If you're in therapy and it seems like your anxiety is rising too much, you can always stop and live your old life for a while until you're feeling more motivated.
Even if your anxiety does spiral out of control, you can rein it in
I explained that counseling is unlikely to trigger an anxious breakdown, not unless you're already close to that point, and then do therapy in a stress-provoking, careless way. But even in the worst-case scenario, if you do have a mental health crisis, it's something you can recover from. It's not a quick or easy process, but people do it all the time.
Ask yourself whether the risk is worth it
There's a small chance therapy could leave you in worse shape than when you started. There's also a decent chance it will make you feel better. Studies show that many people who do counseling for their anxiety make improvements.
If you do nothing you're pretty much guaranteed to keep feeling the same way. You may not feel terrible every second of every day, but you know your life isn't where you want it to be. Would you be willing to risk giving that up for a shot at something better? ...And I realize the answer always isn't an instant 'yes'. Maybe you'll weigh the pros and cons and realize you're okay with the status quo for a while longer. But how much longer? After five years of more of the same, will you be more open to laying it all on the line?