There are different levels of specialty anxiety treatment. The most common is standard outpatient therapy. This consists of meeting with a therapist one to two times a week typically for around three or more months. Sessions are usually spaced out towards the latter part of treatment and “booster sessions” may continue intermittently for a number of months afterwards. The advantage of this form of treatment is that it fits in relatively well with someone’s current lifestyle. In other words, it does not necessarily cause a major life upheaval (at least in a negative way). The disadvantage of this type of treatment is that it may not be sufficient for particularly severe anxiety and obsessive-compulsive disorders and some people have a very difficult time following through with “homework” assignments between sessions.
Next there is Intensive Outpatient Programs (IOP) which consists of structured treatment four or five days per week, two and a half to five hours each day (with daily homework assignments in addition) for several weeks to several months. The advantage of this type of treatment is that not only will therapists be available almost daily to help guide you through rigorous exposure activities, but there are typically a number of clients being treated simultaneously and they benefit from each other’s support. It makes use of the well-documented fact that exposure therapy works best when it is conducted with high frequency and for longer amounts of time. There are also a number of IOP programs throughout the country, giving clients greater choice than inpatient destinations. The disadvantages are that often insurance does not want to pay for this expensive treatment, one typically needs to be away from their jobs and families for an extended period of time, costly hotel and meal arrangements must be made (insurance will definitely not cover this), and some anxiety issues revolve around one’s home or family and that removing them from that situation can sometimes be an escape rather a way to face their fears.
The inpatient (or residential) anxiety treatment option involves moving into a specialized facility for one to three or more months. Meals and housing are included in this around the clock treatment. Because you are living in the program 24/7 the range and intensity of exposures that can be generated may be higher than what other programs can generate. For example, if you are a compulsive washer, you can be monitored for various washing rituals, length of showers, etc. For extreme anxiety disorders this is often the treatment of choice. For children or adolescents living at home, sometimes living away from family (who they may have inadvertently trained through the years to accommodate their anxiety) is a necessary step for them to improve. The disadvantages of inpatient treatment is that it is prohibitively expensive for most of us to pay for if insurance will not pay, some people are reluctant to enter an inpatient psychiatric facility due to stigma concerns, and like IOP, for some people moving away from home and family may feel to them like an escape (which is antithetical to confronting their fear). Also, there are only a few well known inpatient treatment programs that specialize in anxiety disorders in the country so you will likely need to travel to get there (a challenge for someone terrified to fly or drive long distances and it can be a challenge, at times, to “get a bed” due to the popularity of these programs.
Wait lists for inpatient, IOP, and outpatient, for that matter, are often the norm so if you are thinking that you might be interested in any level of specialized anxiety treatment, I recommend that you contact the program or the treatment provider, discuss whether their program is a good fit for you, and if so get on the waiting list just in case. If you decide not to attend then nothing is lost.
There are other levels of treatment that are less-often offered. Single-session (but a very long one) treatment for phobias, three day anxiety intensive groups, week-long daily panic disorder treatment, and other groups of varying formats. Often these programs are designed to provide therapeutic tools and skills and to move people along in their treatment with the understanding that they will continue to work on their anxiety on their own upon completion of the brief program.
No single treatment is right for everyone so consider your options and talk to treatment providers to see which is right for you. The best source of information regarding anxiety treatment programs and providers is the Anxiety Disorders Association of America (www.adaa.org) or feel free to go to my website (www.216.194.169.74/~anxiet14) and click on Resources for links to this and other helpful websites.
Eric Goodman, Ph.D.