You Should Know Within Six Weeks Whether Anxiety Treatment Is Working
Updated: 6 days ago
By Sarah El Nabulsi, M.Sc., M.A., M.A. | DHA Licensed Clinical Psychologist, Dubai
A man in his forties told me he had been working on his anxiety for eight years. He meant it. He had read the books, tried three therapists, downloaded the apps, learned to breathe from the diaphragm. When I asked him how he knew whether any of it had helped, he thought about it for a while and said that some months felt better than others.
That is the sentence I hear most often in a first session, in one form or another. Not "nothing works." Something closer to: I have been trying for years and I cannot tell you whether I am better.
Eight years of effort, and no way to answer the only question that matters. This is what I want to write about, because the honest problem in anxiety treatment is rarely that the methods are weak. The methods have decent evidence behind them. The problem is that most people cannot tell whether the thing they are doing is working, which is the same gap I wrote about in why structure beats more information, so they carry on doing it long after it has stopped, or they stop something that was working before it had time to show.
What the evidence actually promises
Let me be precise about what cognitive behavioural therapy does, because both the enthusiasts and the sceptics tend to overstate their case. In a meta-analysis of placebo-controlled trials across the adult anxiety disorders, CBT produced moderate reductions in symptoms (Carpenter et al., 2018). Moderate. Not transformation, not a cure, and not nothing either. A real effect of a real size.
I say this to clients in the first session and it usually lands as a relief rather than a disappointment. Anyone who has been unwell for years has already been promised transformation, by somebody, probably for money. What they have not been offered is a number they can check.
The part that actually moves things
Here is the shift that changed how I work. Reviews of measurement-based care in mental health treatment find that outcomes improve when symptoms are measured routinely and the results are fed back into the treatment as it goes, rather than assessed at the end (Lewis et al., 2019). The intervention there is not a new technique. It is the act of looking.
So from the first session I use the GAD-7 and the PHQ-9, two short questionnaires that take about a minute each, and I repeat them every two to four sessions. The scores are not for my file. We look at them together.
This is the paragraph I would ask a reader to take away. Anxiety treatment does not need to be faster. It needs to be legible. If you are six weeks into a course of therapy and neither you nor your therapist can say whether your score has moved, the problem is not that you need more time or more effort. It is that nobody is measuring, and without measurement the difference between treatment that is working slowly and treatment that is not working at all is invisible.
Six weeks is roughly where I set the first honest checkpoint. Not because six weeks is a promise of recovery, but because it is long enough for a method to show something and short enough that a wrong approach has not eaten a year. Sometimes the number has moved and we carry on. Sometimes it has not, and the conversation changes: the formulation was wrong, or the practice is not happening between sessions, or something else is going on that therapy alone will not reach. That conversation is only possible because there is a number to have it about.
Format matters less than people expect here. When internet-delivered CBT and face-to-face CBT were compared directly for anxiety disorders, the two produced equivalent results (Esfandiari et al., 2021). So online or in person can follow your schedule rather than your hopes, which for professionals in Dubai usually settles the question.
The part clients resist, and why I keep asking
Behind most requests for "just techniques" is a hope that we can do this without going near the thing that frightens you. I understand the hope. I am going to disappoint it a little.
Within CBT, the procedures with the strongest evidence behind them involve approaching what you have been avoiding, in a graded way, on purpose. The current understanding of why this works is not that you wear the fear out. It is that you build a second, competing memory, a new learning that sits alongside the old one and gets stronger each time it is confirmed (Craske et al., 2014). That model changed how exposure is designed. It is why I care more about whether you were surprised by what happened than about whether your anxiety came down during the exercise.
In practice this is far less dramatic than people imagine. Nobody is pushed. A man who has not driven on Sheikh Zayed Road for two years does not start on Sheikh Zayed Road. But I will keep steering towards the avoided thing rather than around it, because the avoidance is what maintains the anxiety, the same mechanism I describe in how exposure and response prevention works in OCD, and the sense of progress you get from managing your symptoms while still avoiding your life tends to be temporary.
What holds after you stop
The question people ask at the end is whether it comes back. A meta-analysis of relapse after CBT for anxiety-related disorders found that relapse occurred in a minority of patients, at an overall rate of 14 per cent (Levy et al., 2021).
That is one of the more useful things I can tell someone who is deciding whether to start. The work is not a subscription to feeling well. It is closer to learning to swim: awkward, effortful, and then yours, provided you go in the water occasionally.
Where meditation sits, and where it does not
I teach Transcendental Meditation and I am careful about what I claim for it, because I would rather be trusted than impressive.
The most rigorous trial I can point to randomised health care workers under real occupational stress to TM or usual care for three months. On its primary outcome, acute psychological distress, the difference between the groups was not statistically significant. On the secondary outcomes it was: emotional exhaustion, insomnia and anxiety all improved more in the meditation group (Joshi et al., 2022). A meta-analysis of trials measuring trait anxiety found reductions compared with control conditions, largest in the people whose anxiety was highest to begin with (Orme-Johnson & Barnes, 2014).
Read those two findings together and you get something specific rather than something promotional. Meditation is a daily regulation practice with real effects on the background load a person carries. It is not a treatment for a diagnosed anxiety disorder, and when someone arrives with panic that is running their week, I do not start there. I start with the therapy that has the evidence for the presenting problem, and meditation earns its place alongside it when the person has the capacity to practise daily.
The question worth asking instead
Most people come in asking how long this will take. It is the wrong question, and it is unanswerable in a first session by anyone honest, because the answer depends on things neither of us knows yet.
The better question is: how quickly will I know whether this is working. That one has an answer. It is a few weeks, if someone is measuring, and never, if nobody is.
The man who had been working on it for eight years was not lacking discipline. He had plenty. What he had never had was a scoreboard, and once there was one, the conversation stopped being about whether he was the kind of person who gets better and started being about which specific thing we would change next.
References
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety, 35(6), 502–514. https://doi.org/10.1002/da.22728
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006
Esfandiari, N., Mazaheri, M. A., Akbari-Zardkhaneh, S., Sadeghi-Firoozabadi, V., & Cheraghi, M. (2021). Internet-delivered versus face-to-face cognitive behavior therapy for anxiety disorders: Systematic review and meta-analysis. International Journal of Preventive Medicine, 12, 153. https://doi.org/10.4103/ijpvm.ijpvm_208_21
Joshi, S. P., Wong, A. I., Brucker, A., Ardito, T. A., Chow, S. C., Vaishnavi, S., & Lee, P. J. (2022). Efficacy of Transcendental Meditation to reduce stress among health care workers: A randomized clinical trial. JAMA Network Open, 5(9), e2231917. https://doi.org/10.1001/jamanetworkopen.2022.31917
Levy, H. C., O'Bryan, E. M., & Tolin, D. F. (2021). A meta-analysis of relapse rates in cognitive-behavioral therapy for anxiety disorders. Journal of Anxiety Disorders, 81, 102407. https://doi.org/10.1016/j.janxdis.2021.102407
Lewis, C. C., Boyd, M., Puspitasari, A., Navarro, E., Howard, J., Kassab, H., Hoffman, M., Scott, K., Lyon, A., Douglas, S., Simon, G., & Kroenke, K. (2019). Implementing measurement-based care in behavioral health: A review. JAMA Psychiatry, 76(3), 324–335. https://doi.org/10.1001/jamapsychiatry.2018.3329
Orme-Johnson, D. W., & Barnes, V. A. (2014). Effects of the Transcendental Meditation technique on trait anxiety: A meta-analysis of randomized controlled trials. Journal of Alternative and Complementary Medicine, 20(5), 330–341. https://doi.org/10.1089/acm.2013.0204
About the Author
Sarah El Nabulsi, M.Sc., M.A., M.A. is a DHA Licensed Clinical Psychologist and Clinical Director in Dubai, and Director of the National Office of Transcendental Meditation in the U.A.E. With over 15 years of experience supporting adults and couples across the UAE through anxiety, stress, burnout, and relationship challenges, she writes for Gulf News and Psychreg, appears regularly on MBC, Sky News Arabia, Dubai TV, and BBC Arabic, and is the creator of the online courses Anxiety 101 (Level 1) and Master Yourself (Level 2).
Frequently Asked Questions
I have had anxiety for fifteen years. Is it too late for therapy to work?
No, and length of history is a weaker predictor of outcome than most people assume. What fifteen years usually means is fifteen years of avoidance, which is a habit rather than a personality, and habits respond to the same methods whether they are two years old or twenty. The practical difference with a long history is not that treatment fails; it is that there is more scaffolding built around the anxiety to dismantle, so the early weeks can feel slower. I would also say this honestly: a long history often comes with a strong belief that you are simply an anxious person. That belief tends to do more damage than the symptoms, and it is usually the first thing the scores contradict.
How much does anxiety therapy in Dubai cost, and how many sessions will I need?
The current fees are published, and reception will confirm the figure before you book, so nobody is surprised at the end of a first session. On sessions, I will not give you a number in advance, because anyone who does is guessing. What I will commit to is a checkpoint: we measure at the start and every two to four sessions, and by around week six we look at whether your score has moved and decide together what happens next. Courses of CBT for anxiety are usually counted in weeks rather than years. If you are not seeing change by that checkpoint, the answer is a change of approach, not more of the same.
Do I have to do exposure work? The idea of it frightens me.
You are never pushed into anything, and you decide the pace, but I will keep steering us towards what you have been avoiding rather than around it. The reason is mechanical. Avoidance is what keeps anxiety in place, so a treatment that carefully protects your avoidance can reduce your distress in the short term and leave the structure of the problem intact. Modern exposure work is also less brutal than the reputation suggests: it is graded, planned with you, and aimed at surprising you rather than exhausting you. Most clients tell me the anticipation was substantially worse than the exercise, which is itself useful information about how anxiety works.
Does online therapy work as well as sitting in the room?
For anxiety disorders, the direct comparisons are reassuring: when internet-delivered CBT was compared with face-to-face CBT in the same trials, the results were equivalent. In practice I find the choice depends less on effectiveness than on logistics and privacy. Clients who travel, who work long hospital or trading hours, or who would not attend at all if it meant crossing Dubai at 6pm, do better online for the simple reason that they actually attend. Some people concentrate better in a room away from their own home, and a few types of work, particularly where a partner is involved, are easier in person. It is a practical decision, not a compromise on quality.
Talking to someone
If you have been working on your anxiety for years without knowing whether it is improving, that is worth an hour of proper assessment rather than another method. Structured, measured support tends to make the difference visible sooner than people expect.
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