Barbara O. Rothbaum, Ph.D., has been working with people who have post-traumatic stress disorder, or PTSD, since 1986, not long after the condition became an official diagnosis back in 1980. As executive director of the Emory Healthcare Veterans Program and the Trauma and Anxiety Recovery Program at the Emory University School of Medicine, she has seen it all—the jumpy, sweaty, can’t-breathe panic and near fainting that happen when the surf washes over someone’s waist and they’re sure they’ll be sucked under; the horror of impending abuse or trauma that flashes up with the click of a key in the lock. It’s never pretty and often doesn’t end well. “Weekly therapy is like ripping off a scab,” she says. “In the week between sessions, the scab heals a little—but you know you have to go back and experience the pain of ripping it off again. Who wants to do that?”
Nobody. It’s why most PTSD treatment programs have a high dropout rate. Hell, it’s why a lot of those suffering from any kind of anxiety—whether it’s a serious fear of flying or an obsessive-compulsive disorder (OCD) that keeps you from using public restrooms—don’t go to therapy at all. “Many people with anxiety avoid therapy because avoidance is part of the problem,” Rothbaum says. It’s also why she and a handful of other practitioners are getting radical, shortening the course of therapy for conditions like PTSD, OCD, panic attacks, and certain phobias—sometimes to three weeks, other times three hours.
They’re practicing a new, more intense version of exposure therapy. Rather than scheduling weekly hour-long sessions to work on this, a therapist might spend three hours every day for three weeks incrementally increasing a patient’s exposure to their worst fear. A guy with a debilitating aversion to germs might eat from a shared tub of popcorn with no hand sanitizer in sight. Later that week, he might be asked to put his hands on the floor of a public bathroom without washing them afterward. This approach is short. It’s intense. Adopters say it’s like HIIT for your emotions, and science is finding that it gets the job done.
Inside Anxiety Boot Camp
It may be news to many therapists and anxious people, but condensed courses of treatment for anxiety have been around since the ’70s, the brainchild of Swedish researcher Lars-Göran Öst. As a young psychologist, he noticed that his phobic patients didn’t need the 10 to 12 sessions that were typical at the time; he was eliminating their phobias in just four or five. It wasn’t a superpower that he alone had; other therapists could get these results if they were willing to revise their treatment.
“Most patients come in for 50 minutes and make some progress, but when they come back the following week, they don’t start their second session where they ended the first—their anxiety has ratcheted back up,” says Öst, now a professor emeritus at Stockholm University. By using intense exposure therapy—coaching a patient with a fear of elevators into an elevator, for example, or letting a spider crawl all over someone with arachnophobia—he was able to disprove his patients’ beliefs about what catastrophic thing would happen if they came in direct contact with whatever it was they feared—usually in two to three hours, but often in as little as an hour.
To prove its effectiveness, Öst conducted a randomized controlled trial comparing his method to standard cognitive behavioral therapy (CBT) and found that not only did his approach work as well, but 90 percent of his patients who were undergoing intense exposure therapy were either much improved or completely recovered after just one session. That’s the kind of time frame even the most overcommitted people can work with.