When Therapy Fails: What’s Different About OCD, Panic Disorder, and Agoraphobia
“I like my therapist a lot, but I’m not making progress with my anxiety. Why?”
“They tell me to go to the place that makes me anxious for exposure therapy and just let the feelings be there, but they don’t give me any more direction than that. I’m still having panic attacks that wake me up every night.”
“His confessing every bad thought and asking for reassurance got a little better at first, but then it just started getting worse and worse.”
“My therapist and I really connected and talked about a lot of good things, but my OCD wasn’t getting better.”
“I’ve tried every medication you can think of, but I keep having panic attacks. The only one that works is Xanax, but I can barely function when I take it.”
“It’s gotten to the point where I don’t leave my house unless I absolutely have to.”
These are the voices of people who are struggling with severe anxiety that isn’t responding to talk therapy or behavior therapy that isn’t quite tailored to the individual’s needs.
There is a difference between someone who has experienced a few panic attacks and someone who gets stuck in a constant fear of the next panic attack, which is Panic Disorder. Likewise, there is a difference between someone who has above-normal anxiety about life events and someone whose life completely revolves around anxiety about a few particular topics, which is often OCD. And there is certainly a difference between someone who has anxiety but decides to “do it anyway” and someone who feels like their only recourse is to stay home and miss things they care about, which is Agoraphobia.
I’ve seen someone’s struggle with panic attacks disappear instantly with insight into their story or reprocessing of a trauma they’ve experienced. I’ve seen someone’s struggle with anxiety go away rapidly with mindfulness exercises that encourage “making room” for feelings instead of fighting them. Many people manage their schedule, routine, relationships, expectations, and finances better, and their anxiety decreases significantly. I love working with those clients to find success managing anxiety, but OCD, Panic Disorder, and Agoraphobia don’t work this way.
If you are stuck in one of these anxiety disorders, you must truly lean in to your anxiety in a powerful way to change your perspective enough for it to let up. Management techniques, leaning back and trying to defend against anxiety, have failed repeatedly. Now the anxiety is so daunting that something big is going to have to happen for you to change your relationship with it. The problem is this can make your therapist, myself included, anxious. When you are honest with your therapist about how repeated panic attacks, obsessional fears, and years of struggle with anxiety have made you feel so hopeless that you don’t know if you can go on, the last thing they want to do is ask you to experience more of that anxiety on purpose. They want to help you construct a better system of organization, relaxation, and medications that will help you lower the anxiety. This, unfortunately, will leave you stuck if your battle with anxiety has been significant and prolonged.
So, what does it look like to lean in to start the process of recovery? And why would we do this?
**All stories are always fictionalized to protect clients’ identities.**
Jen’s life has become totally consumed with panic attacks and fear of panic attacks. Even if they aren’t happening that often at times, she’s always afraid they will. Therapists and psychiatrists haven’t been able to help her find any relief from the attacks that wake her up at night. What she has to do to get better is move towards the conscious and unconscious fears related to her panic attacks. Consciously, she is always thinking to herself, “I’ll be ok as long as I manage these symptoms and keep them from getting out of hand.” The more she tries to manage them, however, the more they increase… or at least don’t decrease. Unconsciously, her body viscerally responds to places and situations where she has had panic symptoms before. This also happens in places where it would be catastrophic for her to have a panic attack - where the stakes are high. She has to do something drastic to alter those conscious beliefs and unconscious conditioning, and it’s going to require quite a bit of motivation, understanding, coaching, empathy, and encouragement for her to actually try it and stick with it. I won’t describe the procedure in great detail here for brevity, but she has to try to increase her panic symptoms on purpose (sounds crazy, right?) in order to learn that constantly trying to manage the panic symptoms is the very thing that’s increasing them. Effort works really well outside of the skin, but effort backfires internally. This is the largest conscious shift she must make. Then she must go after her unconscious conditioning and go past the “invisible walls” that her body is telling her not to cross: Driving on certain roads, having certain types of conversations, not getting enough sleep, going certain places, allowing certain thoughts and sensations, etc. It can also help to identify traumas that have created unconscious conditioning, but that insight is no substitute for the work that must be done to re-condition the body. After Jen does this repeatedly for a while, she starts to learn a few really important lessons that will aid her full recovery. Her fear of spiraling out of control when she tries to increase her symptoms rather than trying to manage them doesn’t actually happen. Actually, the panic attacks lessen significantly. She can handle a lot more than she thought. She moves past that constant sense of dread and instead feels secure and resilient.
There is a very similar process for OCD, agoraphobia, and other anxiety disorders as well.
If you take nothing else from reading this, here is what I want you to know. When you are really stuck in an anxiety disorder, the key to true relief and recovery is to find your comfort level and continually go two steps past it. Not five steps, but two. Rarely does anyone defeat this type of anxiety in an intense moment of bravery. But so many people stall out at “white knuckling” past their anxiety and then grow weary and give up because nobody is lovingly pushing them hard enough to have emotionally transformative experiences that help them change their relationship with anxiety in a way that finally allows it to fade.
This is more than “just do it.” This is do it over and over with support, with understanding of the processes of change, connecting your struggles to your story, with a clear vision of what recovery looks like, and with a growing sense of hope and strength. We engage this journey to break anxiety’s grip on your life, find peace, and be who you want to be for yourself and those you love.
About Tyler Slay
Tyler Slay is a Licensed Professional Counselor in Madison, Mississippi working at The Center for Hope and Healing at Broadmoor. Tyler Specializes in OCD, Anxiety Disorders, Trauma, Stress, and Christian Counseling.
