Anxiety Institute Intensive Outpatient Program (IOP): Parent’s 13 Most Frequently Asked Questions

How long is the Intensive Outpatient Program (IOP) program? Eight weeks seems like a very long time. Does anyone finish quicker?

The recommended minimal course of treatment for the IOP is 30 days with an average treatment duration of 40 days, as indicated by clinical efficacy results. Clients who complete the program show a 2-3X improvement in symptom reduction compared to shorter treatment duration (see the Clinical Outcomes Report). Clients who have had previous exposure and response prevention therapy (ERP) may possibly complete treatment in less than 30 days; however, that is not typical nor recommended.

How will we know if the IOP treatment is working? What should our expectations be? Which factors does Anxiety Institute consider in determining whether IOP treatment need continue?

Following a comprehensive assessment, IOP treatment begins with the development of a client-specific treatment plan created by the primary clinician and client. The IOP also includes the input from parents and other collateral providers, including therapists, psychiatrists, and school-based counselors. The treatment plan outlines the specific goals and objectives of the client’s treatment and is reviewed each week to assess progress toward goals. As goals and objectives of treatment are achieved, length of treatment and plans for transition out of IOP treatment are determined.

My child doesn’t like group activities. Do they have to attend the Group and Wellness portions of the day?

The Intensive Outpatient Program is designed as a 4-hour day, which includes individual therapy, individual exposure coaching, group wellness activities, and peer group therapy. Many clients, particularly those with social anxiety issues, may be initially reluctant to engage in group activities; however, all four hours of the program are integral to the efficacy of the treatment and optimal treatment outcomes are contingent upon full participation in each component of care. Anxiety Institute understands that it may take time to reach a level of comfort with group participation, and have thus thoughtfully designed protocols to assist clients who may be initially reluctant to engage in group activities.

Why is it important to incorporate academic exposures into treatment? When is the right time to do that?

Many of our Anxiety Institute clients present with academic avoidance or inconsistent school attendance. Others may attend school but are unable to fully engage due to anxiety or obsessive-compulsive disorder (OCD) issues which prevent their full participation. At Anxiety Institute, we are committed to helping our clients fully engage in life and live according to their goals and values. For adolescents and young adults, this typically includes academic engagement and plans for higher education.

Anxiety Institute introduces the basics of exposure work within the first days of treatment. This often takes the form of primary social exposures or phobia exposures, depending on your child’s particular needs. Once we have established a strong therapeutic alliance, typically within the first 2-3 weeks of treatment, we begin designing more complex exposures, including intensive academic exposures and off-site challenges.

How can we build our child’s self-confidence? They seem fragile and unsure; how do we help them feel stronger?

Adolescents and young adults who struggle with anxiety disorders often doubt their ability to manage fear, uncertainty, and discomfort. We often suggest that parents utilize techniques from positive psychology to promote increased self-efficacy, internal motivation, and a growth mindset. These techniques include helping your child identify their strengths and values to increase confidence and support the belief that abilities are not innate, but rather can be improved through effort, learning, and persistence.

How do we manage social media and phone use? How do we best enforce appropriate screen time limits?

According to the Pew Research Center, 46% of teens say they use the internet “almost constantly.” When considering how to approach boundaries for your child’s screen time, you will need to consider:

• The age and maturity of your child, including self-regulation skills, intellectual development, and their comprehension of risk. Younger children will need limited access to online materials, frequent monitoring, and conversations surrounding how they are engaging social media.
• The function of screen time in your child’s day/lifestyle. Ask yourself, is your child meeting their responsibilities (academic, self-care, family, social, physical, etc.)? While too much screen time can interfere with your child’s engagement in important daily activities and responsibilities, it can also be a place of connection, fun and healthy information. Allow your child to experience age-appropriate agency for portions of their free time.
• How is your child responding to screen time? For example, can your child set/follow limits and shift gears between screen vs. no screen time? If you notice your child struggling with separation, continue to be clear about limits and expectations. What types of interactions is your child having online, positive or negative? If your child is experiencing negative online interactions, intervene and offer support.
• Think about how you model screentime. If you are trying to instill the value of time away from screens, can you set aside times in your day and week where the family spends time together uninterrupted by phones and screens?

How much of a “schedule” should we impose on our anxious child? What would we include?

Creating and maintaining a daily schedule may be a useful tool for supporting your anxious child. Routines and schedules can help regulate anxiety by setting explicit expectations for the day and limiting unstructured time that might be otherwise spent ruminating. Research has shown that structure is important for healthy adolescent and young adult functioning, including consistent sleep, eating, and exercise habits. Additionally, family routines have been found to promote healthy social skills and increase resilience during times of stress. If setting a daily schedule is new to you and your child, try selecting one or two activities that will be accomplished each day; perhaps a daily shower, a nightly walk, and/or a family meal. Consider adding in additional activities each week.

We feel like we accommodate our child too much at times and not enough at other times. What do we do?

Parents are hard-wired to protect their children, so learning how to respond to a child with high levels of anxiety can be a confusing process. Consider the following when determining how to respond to your child’s anxiety:

• If you feel that you are accommodating your child’s anxiety-driven behavior too much, ask yourself: is my response helping my child learn that they can cope with their anxiety? Is my response helping my child develop the confidence to navigate life’s challenges? If the answer is ‘No,’ you may want to reconsider your response and reframe your guidance.
• If you worry that you are not accommodating enough, ask yourself: Am I responding to my own distress or the distress of my child? Am I “mixing” objectives, such as reducing accommodations by adding additional demands? For example, having a child face their fear of going outdoors by adding the chore of racking the leaves. If the answer is ‘Yes,’ you may want to clarify your own reactions and simplify your requests of your child.
• Ultimately, we want to support our anxious child by demonstrating we understand they are fearful AND that we are confident that they can manage their distress. We communicate this by compassionately validating and reflecting on what they are communicating, while simultaneously supporting them to engage with their fears one step at a time. Gradually, they will learn to cope with their distress.

What is your stance on medicine? I do/don’t want my child on medicine.

While cognitive behavioral therapy (CBT) and exposure and response prevention therapy (ERP) are the gold-standard for treating anxiety disorders and obsessive-compulsive disorder (OCD), medication may also play an important role in the treatment process. Consultation with a psychopharmacology professional (psychiatrist or psychiatric nurse practitioner) is necessary before making any decisions about medication. Decisions about medication are often based on how significantly the anxiety disorder/OCD is affecting your child’s daily life. Antidepressants with anti-anxiety properties are often the first-line medications used in the treatment of anxiety disorders. Anxiolytics may be used for a brief duration, but only if needed while an antidepressant is being initiated and titrated up. Many Anxiety Institute clients have benefitted from a combination of CBT/ERP and medication management.

When is residential treatment more optimal than IOP treatment and vice versa?

IOP is a wonderful option for clients who need more intense therapeutic support than weekly individual therapy and who can remain in their current home environment/community. While attending IOP, clients can stay engaged, or re-engage in activities, responsibilities, and social connections. IOP allows the client an opportunity to participate in intensive therapy while implementing changes in real time in their home and community. The entire family system can grow simultaneously and family members can learn new ways to respond and manage client symptoms.

Clients who are unable to remain in their home environment may benefit from residential treatment, especially if alternative levels of care, such as outpatient treatment or an intensive outpatient program, have been ineffective. Residential treatment can provide a safe place for those that need a new environment, whether because the current environment interferes with the client’s ability to engage in therapy, or the home environment is not conducive to client change.

After completing IOP treatment, what does recovery look like for my child?

In anticipation of completing the Intensive Outpatient Treatment, your child’s individual therapist will work with you and your child to create a comprehensive post-IOP transition plan. This transition plan will be designed to support the goals that your child has made in IOP treatment and continue to scaffold their progress moving forward. Transition plans may include ongoing individual therapy, ongoing exposure sessions, weekly support groups, continued family support, academic tutoring services, and/or continued medication management appointments. Recovery is never linear, and your therapist will help you and your child anticipate difficulties and develop strategies for overcoming setbacks in the transition back to academic, social, and family life.

If my child needs treatment again in the future, does this mean the previous treatment was not successful?

No, not at all. Self-awareness, emotional growth, and skill-building are all life-long processes that require refining coping strategies and developing techniques to match the current challenges. While a return to full Intensive Outpatient Treatment is unlikely, many of our most successful clients return for 2-3 week “booster” sessions in preparation for upcoming transitions or major life events, such as preparing to launch for college. If you are unsure whether your child might benefit from a return to treatment, our admissions and clinical teams are always happy to consult with you to discuss treatment options.

My child is manipulative and verbally abusive toward us. Are they appropriate for IOP treatment?

Anxiety Institute specializes in treating anxiety, obsessive-compulsive disorder, and related disorders. As such, individuals struggling with disruptive behavior disorders; oppositional defiant disorder; intermittent explosive disorder; and/or conduct disorders are better served by other programs. We are happy to provide consultation and referral to an educational consultant who specializes in these clinical and educational options.