Why Can Therapy Make Anxiety Feel Worse?

Therapy invites you to face thoughts, feelings, and situations you may have been avoiding. Avoidance is a core feature of anxiety and while it can provide short-term relief, it tends to maintain anxiety in the long-term.

When therapy gently reduces avoidance, anxiety can rise temporarily.

Exposure Therapy and Increased Anxiety

Approaches like Cognitive Behavioural Therapy (CBT) often include exposure techniques. This means gradually facing feared situations in a controlled and supported way.

For example:

• Someone with social anxiety might practise initiating conversations
• Someone with panic disorder might intentionally trigger mild physical sensations

This process can feel uncomfortable at first. But over time, repeated exposure helps your brain learn that the situation isn’t actually dangerous, reducing anxiety in the longer term.

Diane Kohl, a consultant counselling psychologist at HelloSelf says, ‘Avoidance can seem to help, because as we avoid the feared situation anxiety reduces, providing instant relief. However, it also means that we do not have the opportunity to learn that we can, in fact, manage the feared situation, which is the only thing that helps us reach our goals in the longer term.’

How Long Does This Phase Last?

There’s no fixed timeline, but early increases in anxiety often:

• Occur in the first few sessions
• Fluctuate rather than stay constantly high
• Begin to settle as your confidence and coping skills build

If anxiety is part of therapeutic progress, it should feel:

• Temporary
• Understandable in context
• Supported by your therapist

Tracking your progress can be really helpful in establishing whether increased anxiety from therapy is just a productive phase or a sign that you need a different approach. The HelloSelf app makes it easy to log key moments in your journey and Companion supports you to reflect on working out your best next step.

Productive Discomfort vs. Warning Signs

It’s important to distinguish between helpful discomfort and something that may not be working.

Productive discomfort might feel like:

• Challenging but manageable
• Linked to specific therapeutic goals
• Accompanied by a sense of learning or progress

Potential warning signs include:

• Feeling overwhelmed without support
• Anxiety that keeps escalating without relief
• Feeling unsafe, pressured, or misunderstood

Therapy should stretch you but you should always feel supported in the process.

Diane Kohl says, ‘Reducing avoidance can, of course, feel daunting. However, your therapist will be with you every step of the way. They will also give you the skills and tools to manage anxiety more effectively.’

The Role of the Therapeutic Relationship

A key part of managing increased anxiety is feeling supported. A good therapist will:

• Explain why anxiety may increase
• Set a manageable pace
• Check in regularly about how you’re coping

If you understand why something feels difficult, it’s often easier to stay on track.

The Bottom Line

Yes, therapy can sometimes make anxiety feel worse at the beginning. But when done well, this is often a sign that meaningful work is happening.

The goal isn’t to avoid discomfort entirely, it’s to move through it in a way that leads to lasting change.

If you’re unsure whether what you’re experiencing is part of progress, speaking openly with your therapist is the most important next step.

Any questions, get in touch at hello@helloself.com