Accessing Therapy Beyond Crisis Situations

“When we are no longer able to change a situation,

we are challenged to change ourselves.”

~Viktor E. Frankl

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

There’s a misconception that therapy should be complete once you start “feeling better.” It’s important to recognize your progress, but there shouldn’t be a deadline to feel your best. Mental health is complex, and oftentimes, your progress doesn’t follow a linear fashion. One week, you might feel stable and secure, and then the next week, you might feel like you fell a few steps back. Don’t worry, these ups and downs are perfectly normal. But what if you’ve been “feeling better” for months, or even years? Or, what if you’ve never had a mental health crisis? Therapy can still be a valuable resource! No matter your background or previous experiences, you are deserving of this kind of care. 

Here are 3 reasons for considering therapy beyond the context of a crisis:

#1: The Brain Doesn’t Function Properly While Under Distress

Chronic stress can make your body feel like it is in a never-ending fight-or-flight state. This is because of how chronic stress delays two important parts of the brain: the prefrontal cortex and the neurotransmitter GABA. The prefrontal cortex is responsible for processes such as cognitive planning and self-regulation, while GABA produces a calming effect meant to counteract stress. Because of these delays, traumas or other ongoing adversities can impair daily functioning. For example, those who experience such stressors have significant declines in working memory, a component of short-term memory that allows you to actively process information. As we age, our working memory skills decrease naturally, but chronic stress accelerates this process (Gandy et al., 2024). COVID-19 has contributed to global increases in chronic stress, which has subsequently produced similar accelerated aging effects in adolescents (Gotlib et al., 2022). Our bodies are not equipped to handle such extreme amounts of stress in small amounts of time, which can increase the risk of cognitive and health-related deficits.

Therapy can help us navigate these stressors by providing coping strategies. However, deficits in working memory impair the learning of these strategies, and delays in the prefrontal cortex and the firing of GABA impair the proper use of these strategies. This is not to say that therapy wouldn’t be helpful to someone actively experiencing a crisis. Rather, you don’t need a crisis to justify therapy. In fact, you might be more receptive to these strategies if they are learned before a crisis emerges.

#2: Therapy Can Be a Protective Measure Against Future Mental Health Crises

It’s never too early to consider therapy. We may not be able to predict when we will encounter another crisis, but we can take action to better prepare ourselves for one. This doesn’t mean that you need to be in therapy for the rest of your life. But attending therapy even when you feel stable can help you maintain that stability over time. One way that therapy operates as a maintenance tool is by teaching skills such as mindfulness, which can help reduce symptoms of anxiety and depression (Eilert et al., 2021). Your therapist can work with you to develop mindfulness strategies that fit best for you. These can include daily affirmations, breathing exercises, or meditations. Additionally, compared to brief forms of therapy (~6 months), long-term therapy, which we often prefer at Thrive SLO (~3 years), is slightly more effective in reducing depressive symptoms and improving daily functioning (Knekt et al., 2016). For some individuals, short-term therapy may not be enough time to implement maintenance strategies and measure their effects, especially for those who are only focused on overcoming a chronic stressor. There isn’t necessarily an ideal length of therapy; it depends on the goals that you set with your therapist. You might have multiple short-term goals (e.g., wanting to be social at an upcoming party) or one overarching goal (e.g., adjusting to daily life after an unexpected loss). Each step you take towards reaching these goals can have a strong positive impact on your well-being, and the lessons you learn can be applied to new goals or concerns.

#3: Long-term Therapy Gives You More Time to Build an Alliance With Your Therapist

Another valuable aspect of therapy is that you have someone to talk to who knows you well. Someone who is unbiased, who recognizes your potential, and who encourages your personal growth. In one meta-analysis that reviewed over 30,000 therapy clients, the relationships those clients had with their therapists were consistently associated with positive outcomes such as symptom reduction (Flückiger et al., 2018). Your therapist can be a consistent form of support. Even having one such person in your life can make a difference. 

As with many other kinds of relationships, though, it can take some time for you and your therapist to form a close bond. You may be hesitant to be vulnerable to a new person in your life, while your therapist has to adapt to your level of comfort with certain topics or situations. If you’re experiencing a crisis, then your typical responses to these topics may be exaggerated or distorted. You could be more on edge, less willing to disclose personal information, or you could be more likely to think irrationally. As a result, there could be misinterpretations between the two of you that can threaten the therapeutic alliance. By spending more time with your therapist, they will have more opportunities to learn about who you are outside the context of a crisis situation. Remember that crises are temporary, and the skills you develop with your therapist can help protect you not just against the crisis you’re currently facing, but also against many other future challenges. There is no concern too small for therapy.

Have more questions or feel like you need supportive therapy? Schedule a session with one of our therapists today! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post!

References

Eilert, N., Wogan, R., Adegoke, A., Earley, C., Duffy, D., Enrique, A., Palacios, J., Timulak, L., & Richards, D. (2023). The relationship between posttherapeutic cognitive behavior therapy skills usage and follow-up outcomes of internet-delivered cognitive behavior therapy. Journal of Clinical Psychology, 79(1), 55-67. https://doi.org/10.1002/jclp.23403

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340. https://doi.org/10.1037/pst0000172

Gandy, H. M., Holis, F., Hernandez, C. M., & McQuail, J. (2024). Aging or chronic stress impairs working memory and modules GABA and glutamate gene expression in prelimbic cortex. Frontiers in Aging Neuroscience, 15. https://doi.org/10.3389/fnagi.2023.1306496

Gotlib, I. H., Miller, J. G., Borchers, L. R., Coury, S. M., Costello, L. A., Garcia, J. M., & Ho, T. C. (2023). Effects of the COVID-19 pandemic on mental health and brain maturation in adolescents: Implications for analyzing longitudinal data. Biological Psychiatry Global Open Science, 3(4), 912-918. https://doi.org/10.1016/j.bpsgos.2022.11.002

Knekt, P., Virtala, E., Härkänen, T., Vaarama, M., Lehtonen, J., & Lindfors, O. (2016). The outcome of short- and long-term psychotherapy 10 years after start of treatment. Psychological Medicine, 46(6), 1175-1188. https://doi.org/10.1017/S0033291715002718