# The Gap Between: Gap Numbers

> One Gap Number per page: the study, its sample, its key finding, and its DOI. Every value is copied from the published page. Education only, not medical advice.

JSON version: https://www.asendar.com/gap/facts.json

## Does ketamine help treatment-resistant depression?

- Gap Number: 73 adults with treatment-resistant depression in a two-site randomized controlled trial
- Finding: Early research says yes, with a catch. In people whose depression has not responded to other treatments, a single ketamine infusion can lift symptoms within a day, far faster than a usual antidepressant. But the relief often fades within a few weeks, so it works best as the start of a plan, not a one-time fix.
- Study: Murrough, J. W., Iosifescu, D. V., Chang, L. C., Al Jurdi, R. K., Green, C. E., Perez, A. M., Iqbal, S., Pillemer, S., Foulkes, A., Shah, A., Charney, D. S., and Mathew, S. J. (2013). Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial. American Journal of Psychiatry.
- DOI: 10.1176/appi.ajp.2013.13030392 (https://doi.org/10.1176/appi.ajp.2013.13030392)
- Page: https://www.asendar.com/gap/q/does-ketamine-help-treatment-resistant-depression

## Does psilocybin therapy help with depression?

- Gap Number: 24 adults with major depression who completed two supervised psilocybin sessions paired with supportive therapy
- Finding: Early research says yes, with real promise and real limits. Small trials of psilocybin-assisted therapy found large drops in depression, lasting up to a year for some people. A larger, more rigorous trial found a smaller benefit that was less clearly lasting. It is still investigational, studied only in supervised settings.
- Study: Davis, A. K., Barrett, F. S., May, D. G., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., Finan, P. H., and Griffiths, R. R. (2021). Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry.
- DOI: 10.1001/jamapsychiatry.2020.3285 (https://doi.org/10.1001/jamapsychiatry.2020.3285)
- Page: https://www.asendar.com/gap/q/does-psilocybin-therapy-help-with-depression

## Do mental health apps help between therapy sessions?

- Gap Number: 66 randomized controlled trials of app-supported smartphone interventions
- Finding: Often, a little. A 2019 meta-analysis of 66 trials found mental health apps beat no app for depression, anxiety, and stress, with small effects. They helped most when a real person was involved and reminders kept people coming back. Useful support between sessions, not a replacement for care.
- Study: Linardon, J., Cuijpers, P., Carlbring, P., Messer, M., and Fuller-Tyszkiewicz, M. (2019). The efficacy of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials. World Psychiatry.
- DOI: 10.1002/wps.20673 (https://doi.org/10.1002/wps.20673)
- Page: https://www.asendar.com/gap/q/do-mental-health-apps-help-between-therapy-sessions

## How can a clinic tell if treatment is working?

- Gap Number: A review of 51 articles on measurement-based care, not a single trial of patients. It gathers the evidence on what kind of symptom tracking changes outcomes and what kind does not, drawing on published studies and a focus group of experts.
- Finding: By measuring, the right way. A 2017 review in Psychiatric Services found that clinics can tell whether treatment is working when they collect a brief validated symptom score often, on time, and review it with the patient during the visit. One-time screening and scores that arrive late do not help.
- Study: Fortney, J. C., Unützer, J., Wrenn, G., et al. (2017). A Tipping Point for Measurement-Based Care. Psychiatric Services.
- DOI: 10.1176/appi.ps.201500439 (https://doi.org/10.1176/appi.ps.201500439)
- Page: https://www.asendar.com/gap/q/how-can-a-clinic-tell-if-treatment-is-working

## Why do patients miss mental health appointments?

- Gap Number: A systematic review and meta-analysis of 35 studies reporting on 40 datasets from general (nonspecialist) outpatient mental health clinics, searched through July 2024. Pooled estimates drew on 2,668 patients for first visits, 4,377 for second visits, and 3,634 for later visits.
- Finding: Missed visits are common, and they grow over time. A 2026 review of 35 studies found that about a third of patients missed their first outpatient mental health appointment, and the share kept climbing at later visits. Forgetting, money, distance, illness severity, and a weak bond with the clinician were all linked to missed visits.
- Study: Kuppili, P. P., Singhai, K., Divyanish, D., Krishnamoorthy, Y., & Menon, V. (2026). Factors Associated With Nonattendance at Nonspecialist Outpatient Mental Health Clinics: Systematic Review and Meta-Analysis. Psychiatric Services.
- DOI: 10.1176/appi.ps.20250094 (https://doi.org/10.1176/appi.ps.20250094)
- Page: https://www.asendar.com/gap/q/why-do-patients-miss-mental-health-appointments

## Why do so few clinics track mental health outcomes?

- Gap Number: A narrative review of the research on measurement-based care rather than a single study of patients. It gathers the evidence on how often the practice is used, what blocks it, and what helps a clinic adopt it.
- Finding: Not because clinics do not care. A 2019 JAMA Psychiatry review found that fewer than 20% of behavioral health practitioners regularly track outcomes with a validated measure. The reasons sit at every level: patient worries, practitioner doubt, thin time and budget, and competing rules. The barriers are known, and so are the fixes.
- Study: Lewis, C. C., Boyd, M., Puspitasari, A., et al. (2019). Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA Psychiatry.
- DOI: 10.1001/jamapsychiatry.2018.3329 (https://doi.org/10.1001/jamapsychiatry.2018.3329)
- Page: https://www.asendar.com/gap/q/why-do-so-few-clinics-track-mental-health-outcomes

## Does it help to talk through mixed feelings before therapy?

- Gap Number: 76 adults with a principal diagnosis of generalized anxiety disorder, recruited in the Toronto area and randomly assigned to two groups before both groups received individual CBT.
- Finding: It may help. In a 2009 trial of 76 adults with generalized anxiety, people who spent four sessions exploring their mixed feelings about change before starting CBT did more of their between-session practice and had more treatment responders. The gains were clearest when worry was severe, and the authors called the trial preliminary.
- Study: Westra, H. A., Arkowitz, H., & Dozois, D. J. A. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial. Journal of Anxiety Disorders.
- DOI: 10.1016/j.janxdis.2009.07.014 (https://doi.org/10.1016/j.janxdis.2009.07.014)
- Page: https://www.asendar.com/gap/q/does-it-help-to-talk-through-mixed-feelings-before-therapy

## How accurate is the PHQ-9 for measuring depression?

- Gap Number: About 6,000 primary care and obstetrics-gynecology patients across 15 clinics completed the PHQ-9, and 580 of them also had a separate interview with a mental health professional that served as the yardstick.
- Finding: It is accurate enough to trust for a short questionnaire. In the study that validated it, a PHQ-9 score of 10 or higher flagged major depression correctly about 88% of the time, whether or not a person actually had it. Scores of 5, 10, 15, and 20 mark mild, moderate, moderately severe, and severe depression.
- Study: Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine.
- DOI: 10.1046/j.1525-1497.2001.016009606.x (https://doi.org/10.1046/j.1525-1497.2001.016009606.x)
- Page: https://www.asendar.com/gap/q/how-accurate-is-the-phq-9-for-measuring-depression

## Does collaborative care work across different clinics and conditions?

- Gap Number: 57 randomized controlled trials, reported in 78 articles and yielding 161 analyses. 40 trials studied depression, 4 studied bipolar disorder, 3 studied anxiety disorders, and 10 covered multiple or other conditions, across primary care, specialty care, and behavioral health settings.
- Finding: Yes. A 2012 review of 57 randomized trials found collaborative care models improved mental health outcomes across primary care, specialty, and behavioral health settings, and across depression, anxiety, and bipolar disorder. The gains were small but consistent, and total health care costs did not rise.
- Study: Woltmann, E., Grogan-Kaylor, A., Perron, B., et al. (2012). Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions Across Primary, Specialty, and Behavioral Health Care Settings. American Journal of Psychiatry.
- DOI: 10.1176/appi.ajp.2012.11111616 (https://doi.org/10.1176/appi.ajp.2012.11111616)
- Page: https://www.asendar.com/gap/q/does-collaborative-care-work-across-different-clinics-and-conditions

## Does keeping family in the loop help older adults after a hospital or rehab stay?

- Gap Number: A systematic review and meta-analysis of randomized controlled trials. Of 10,715 abstracts screened, 15 trials met the criteria and 11 gave enough detail to pool readmission rates. Older adults with family or other informal caregivers, discharged from a hospital or skilled nursing facility to the community.
- Finding: Yes. A 2017 meta-analysis found that when family caregivers were built into discharge planning from a hospital or skilled nursing facility, older adults had 25 percent fewer readmissions at 90 days and 24 percent fewer at 180 days. Millions of families already coordinate care, often with little support.
- Study: Rodakowski, J., Rocco, P. B., Ortiz, M., Folb, B., Schulz, R., Morton, S. C., Leathers, S. C., Hu, L., and James, A. E. (2017). Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis. Journal of the American Geriatrics Society.
- DOI: 10.1111/jgs.14873 (https://doi.org/10.1111/jgs.14873)
- Page: https://www.asendar.com/gap/q/does-keeping-family-in-the-loop-help-older-adults-after-a-hospital-or-rehab-stay

## Does online CBT work better with human support?

- Gap Number: 42 eligible randomized trials published up to January 2019. 39 of them shared patient-level data on 9,751 adults with depression, and data from 8,107 people were analyzed together, across 12 countries in Europe, North America, and China. An individual patient data network meta-analysis.
- Finding: Yes, on average, at least at first. A 2021 analysis of patient-level data from 39 trials and 9,751 people found online CBT for depression worked better when a coach or therapist checked in, mostly for moderate to severe depression. With mild symptoms the difference was small, and by six to twelve months it had faded.
- Study: Karyotaki, E., Efthimiou, O., Miguel, C., Maas genannt Bermpohl, F., Furukawa, T. A., Cuijpers, P., and the Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration (2021). Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis. JAMA Psychiatry.
- DOI: 10.1001/jamapsychiatry.2020.4364 (https://doi.org/10.1001/jamapsychiatry.2020.4364)
- Page: https://www.asendar.com/gap/q/does-online-cbt-work-better-with-human-support

## What makes a collaborative care program actually work?

- Gap Number: 37 randomized controlled trials of collaborative care for depression in primary care, covering 12,355 patients. A cumulative meta-analysis that also reviewed longer-term outcomes and tested which program features tracked with larger effects.
- Finding: A 2006 review of 37 trials and 12,355 patients found collaborative care beat usual care for depression. What drove the effect was not more therapy sessions. It was patients staying with treatment, and case managers who had real professional training and regular supervision. The structure does the work.
- Study: Gilbody, S., Bower, P., Fletcher, J., et al. (2006). Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes. Archives of Internal Medicine.
- DOI: 10.1001/archinte.166.21.2314 (https://doi.org/10.1001/archinte.166.21.2314)
- Page: https://www.asendar.com/gap/q/what-makes-a-collaborative-care-program-actually-work

## Does collaborative care help older adults with depression?

- Gap Number: 1,801 primary care patients aged 60 or older with depression, across 18 clinics in 8 health care organizations in 5 US states. A randomized controlled trial comparing the IMPACT collaborative care program with usual care.
- Finding: Yes. In the IMPACT trial, 1,801 primary care patients aged 60 and older were randomized to collaborative care or usual care. At one year, 45 percent of the collaborative care group had cut their depression symptoms in half, against 19 percent in usual care. One large trial, run faithfully.
- Study: Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Hunkeler, E., Harpole, L., and the IMPACT Investigators (2002). Collaborative Care Management of Late-Life Depression in the Primary Care Setting. JAMA.
- DOI: 10.1001/jama.288.22.2836 (https://doi.org/10.1001/jama.288.22.2836)
- Page: https://www.asendar.com/gap/q/does-collaborative-care-help-older-adults-with-depression

## Does collaborative care help patients with depression and a chronic illness?

- Gap Number: 214 patients who had depression together with poorly controlled diabetes, coronary heart disease, or both, across 14 primary care clinics in an integrated health system in Washington State. A single-blind randomized controlled trial.
- Finding: Yes. In a randomized trial of 214 patients who had depression alongside diabetes or heart disease, a nurse-led team that worked on the mind and the body together improved depression and the physical markers more than usual care at one year. It was one small trial in one health system, so read it as promising, not settled.
- Study: Katon, W. J., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., Peterson, D., Rutter, C. M., McGregor, M., & McCulloch, D. (2010). Collaborative Care for Patients with Depression and Chronic Illnesses. New England Journal of Medicine.
- DOI: 10.1056/nejmoa1003955 (https://doi.org/10.1056/nejmoa1003955)
- Page: https://www.asendar.com/gap/q/does-collaborative-care-help-patients-with-depression-and-a-chronic-illness

## Why do patients drop out of therapy after a few sessions?

- Gap Number: 669 studies representing 83,834 adult psychotherapy clients, across many diagnoses, treatment settings, provider types, and ways of defining dropout.
- Finding: About 1 in 5 adults leave therapy early. A 2012 meta-analysis of 669 studies and 83,834 clients put the average dropout rate at 19.7%. It was higher for younger clients, for people with personality or eating disorder diagnoses, and for those seen by trainee clinicians, and it did not depend on the type of therapy.
- Study: Swift, J. K., & Greenberg, R. P. (2012). Premature Discontinuation in Adult Psychotherapy: A Meta-Analysis. Journal of Consulting and Clinical Psychology.
- DOI: 10.1037/a0028226 (https://doi.org/10.1037/a0028226)
- Page: https://www.asendar.com/gap/q/why-do-patients-drop-out-of-therapy-after-a-few-sessions

## Why do people answer mental health surveys to look better than they feel?

- Gap Number: 3,502 soldiers from one US Army infantry brigade returning from Iraq in 2008 took the routine, named screen. 1,712 of them also answered the same questions on an anonymous survey.
- Finding: Many people shade their answers on mental health surveys so they look more okay than they feel. In one Army study, soldiers reported depression, PTSD, and suicidal thoughts 2 to 4 times more often on an anonymous survey than on their official, named screen. People tend to share more when they feel no one is judging them.
- Study: Warner, C. H., and colleagues (2011). Importance of Anonymity to Encourage Honest Reporting in Mental Health Screening After Combat Deployment. Archives of General Psychiatry.
- DOI: 10.1001/archgenpsychiatry.2011.112 (https://doi.org/10.1001/archgenpsychiatry.2011.112)
- Page: https://www.asendar.com/gap/q/why-do-people-answer-mental-health-surveys-to-look-better-than-they-feel

## Do text message reminders reduce missed appointments?

- Gap Number: 18 reports in all, 8 randomized controlled trials and 10 controlled observational studies of text message reminders for health care appointments, across primary care and hospital outpatient clinics.
- Finding: Yes. A 2012 review of eight randomized trials found that text message reminders made patients clearly more likely to attend their appointments, a pooled effect of 1.48. The gain held across clinic types and whether the reminder went out one, two, or three days ahead. One small message, sent into the gap before the visit.
- Study: Guy, R., Hocking, J., Wand, H., Stott, S., Ali, H., & Kaldor, J. (2012). How Effective Are Short Message Service Reminders at Increasing Clinic Attendance? A Meta-Analysis and Systematic Review. Health Services Research.
- DOI: 10.1111/j.1475-6773.2011.01342.x (https://doi.org/10.1111/j.1475-6773.2011.01342.x)
- Page: https://www.asendar.com/gap/q/do-text-message-reminders-reduce-missed-appointments

## Do care manager phone calls between visits help patients with depression?

- Gap Number: 600 patients starting depression treatment in 7 group-model primary care clinics in Seattle, randomized to usual care, usual care plus telephone care management, or care management plus an 8-session telephone therapy program.
- Finding: Yes. In a 600-patient randomized trial, adding telephone care management to usual primary care raised the share of patients who rated their depression much improved, from 55% to 66%, and satisfaction from 29% to 47%. Pairing those calls with brief phone therapy helped more, reaching 80% much improved.
- Study: Simon, G. E., Ludman, E. J., Tutty, S., Operskalski, B., & Von Korff, M. (2004). Telephone Psychotherapy and Telephone Care Management for Primary Care Patients Starting Antidepressant Treatment: A Randomized Controlled Trial. JAMA.
- DOI: 10.1001/jama.292.8.935 (https://doi.org/10.1001/jama.292.8.935)
- Page: https://www.asendar.com/gap/q/do-care-manager-phone-calls-between-visits-help-patients-with-depression

## Does giving therapists progress feedback improve patient outcomes?

- Gap Number: 24 studies of the two most-studied routine outcome monitoring systems, the Partners for Change Outcome Management System and the Outcome Questionnaire System, in adult psychotherapy.
- Finding: Often, yes. A 2018 meta-analysis of 24 studies found that measuring a client's progress and feeding it back to the therapist during care beat treatment as usual in about two thirds of them. The gains were largest for clients heading for a poor outcome. Effects ranged from small to moderate.
- Study: Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and Delivering Progress Feedback: A Meta-Analysis of Routine Outcome Monitoring. Psychotherapy.
- DOI: 10.1037/pst0000167 (https://doi.org/10.1037/pst0000167)
- Page: https://www.asendar.com/gap/q/does-giving-therapists-progress-feedback-improve-patient-outcomes

## Does measurement-based care improve depression treatment?

- Gap Number: 120 outpatients with moderate to severe major depression at a single center in Beijing, randomized to measurement-based care (61) or standard care (59) for 24 weeks.
- Finding: In one strong trial, yes. When regular rating-scale scores and a guideline drove each treatment decision, 73.8% of outpatients with moderate to severe depression reached remission in 24 weeks, compared with 28.8% under standard care. They also got there about nine weeks sooner. It is one trial, so treat it as a strong signal.
- Study: Guo, T., Xiang, Y.-T., Xiao, L., Hu, C.-Q., Chiu, H. F. K., Ungvari, G. S., Correll, C. U., Lai, K. Y. C., Feng, L., Geng, Y., Feng, Y., & Wang, G. (2015). Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters. American Journal of Psychiatry.
- DOI: 10.1176/appi.ajp.2015.14050652 (https://doi.org/10.1176/appi.ajp.2015.14050652)
- Page: https://www.asendar.com/gap/q/does-measurement-based-care-improve-depression-treatment

## Does collaborative care work for depression over the long term?

- Gap Number: 79 randomized controlled trials (90 comparisons) with 24,308 participants, comparing collaborative care with usual care for depression or anxiety.
- Finding: Yes, through long-term follow-up, but not indefinitely. A Cochrane review of 79 randomized trials and 24,308 people found collaborative care improved depression more than usual care at short, medium, and long-term follow-up. In the very long term the benefit was no longer clear, so a clinic needs a plan for what comes after the program.
- Study: Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews.
- DOI: 10.1002/14651858.CD006525.pub2 (https://doi.org/10.1002/14651858.CD006525.pub2)
- Page: https://www.asendar.com/gap/q/does-collaborative-care-work-for-depression-over-the-long-term

## Does crying actually make you feel better?

- Gap Number: 106 adults, followed for four weeks, who logged 315 crying episodes in the moment on their phones. Mood was checked right after each cry and again at 15, 30, and 60 minutes, and at the end of the day.
- Finding: Not always. A 2026 study that tracked real crying episodes found crying does not reliably lift your mood on its own. What matters is why you cried. Tears from feeling overwhelmed often left people feeling worse for a while, while tears from moving moments eased some distress instead.
- Study: Stieger, S., Graf, H., & Biebl, S. (2026). Effects of Crying on Affect: An Event-based Experience Sampling Study of Adult Emotional Crying. Collabra: Psychology.
- DOI: 10.1525/collabra.157541 (https://doi.org/10.1525/collabra.157541)
- Page: https://www.asendar.com/gap/q/does-crying-actually-make-you-feel-better

## Is it normal to feel adrift between therapy sessions?

- Gap Number: 211 adults, 161 women and 50 men, on a waiting list for pain management at a regional NHS hospital in the south east of England. Standard wellbeing measures were taken at the start of the wait, then again at three months and six months.
- Finding: Yes. Feeling adrift or low between therapy sessions is common. Research on people waiting for care found that distress like anxiety and low mood tends to stay high across a long wait rather than fade on its own. The gap is an active stretch, and it is easier with support and a small plan.
- Study: Tidmarsh, L. V., Harrison, R., Wilkinson, H., Harrington, M., Ravindran, D., Norwood, S., & Finlay, K. A. (2026). The persistence of psychological distress while waiting for pain management. British Journal of Pain.
- DOI: 10.1177/20494637251377761 (https://doi.org/10.1177/20494637251377761)
- Page: https://www.asendar.com/gap/q/is-it-normal-to-feel-adrift-between-therapy-sessions

## Do eyeshades and headphones change a plant medicine session?

- Gap Number: Ten adults in a psilocybin study for smoking cessation, each doing sessions with different music. This page describes the study's design and direction, not exact effect sizes, because the source could not be opened directly to confirm those numbers this run.
- Finding: Eyeshades and headphones are standard in plant medicine therapy. Eyeshades turn your gaze inward, and headphones carry a guiding music program. Direct evidence that the setup itself changes a session is thin. In one small randomized study, even swapping the music genre inside that setup produced no clear, reliable difference.
- Study: Strickland, J. C., Garcia-Romeu, A., & Johnson, M. W. (2021). Set and Setting: A Randomized Study of Different Musical Genres in Supporting Psychedelic Therapy. ACS Pharmacology & Translational Science.
- DOI: 10.1021/acsptsci.0c00187 (https://doi.org/10.1021/acsptsci.0c00187)
- Page: https://www.asendar.com/gap/q/do-eyeshades-and-headphones-change-a-plant-medicine-session

## Does talking about change actually build your motivation?

- Gap Number: Twenty studies of motivational interviewing for mental health problems, in people with mood, anxiety, psychotic, and eating conditions and mixes of these. This page describes the review's design and direction, not exact pooled numbers, because the source could not be opened to confirm them this run.
- Finding: Not the way you might think. When researchers pooled 20 studies of motivational interviewing for mental health, the approach did not raise people's motivation more than other methods did. What it did improve was engagement, staying involved in the work. Talking about change seems to help you show up, not just want it.
- Study: Romano, M., & Peters, L. (2015). Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: A review and meta-analysis. Clinical Psychology Review.
- DOI: 10.1016/j.cpr.2015.02.008 (https://doi.org/10.1016/j.cpr.2015.02.008)
- Page: https://www.asendar.com/gap/q/does-talking-about-change-actually-build-your-motivation

## Why do old memories come up during a session?

- Gap Number: Healthy adult volunteers in a laboratory fear-conditioning experiment, measured with the eyeblink startle response. This was a study of a simple learned fear in the lab, not of the personal memories that surface in a therapy or plant medicine session.
- Finding: Old memories often surface during a session because a session reactivates them, and a reactivated memory can become open to change rather than just replay. A 2012 fear-memory study found that retrieval alone does not update a memory. It is the surprise of a new experience during retrieval that opens the door.
- Study: Sevenster, D., Beckers, T., & Kindt, M. (2012). Retrieval per se is not sufficient to trigger reconsolidation of human fear memory. Neurobiology of Learning and Memory.
- DOI: 10.1016/j.nlm.2012.01.009 (https://doi.org/10.1016/j.nlm.2012.01.009)
- Page: https://www.asendar.com/gap/q/why-do-old-memories-come-up-during-a-session

## How do I cope with waiting for my next therapy appointment?

- Gap Number: None. This is a conceptual paper that names and describes a pattern. It did not count people or test coping methods.
- Finding: Waiting for your next appointment can bring real distress, even when you know help is coming. A 2026 conceptual paper named this pattern waiting anxiety. It describes racing thoughts, a tense body, and feelings that are hard to settle during a certain, positive wait. Naming it is the first step to easing it.
- Study: Husain, W., and Jahrami, H. (2026). Waiting Anxiety: A Phenomenological Account of Anticipatory Anxiety During Rationally Certain and Pleasant Outcome Waiting. Psychiatry International.
- DOI: 10.3390/psychiatryint7020068 (https://doi.org/10.3390/psychiatryint7020068)
- Page: https://www.asendar.com/gap/q/how-do-i-cope-with-waiting-for-my-next-therapy-appointment

## Does time feel different during a plant medicine session?

- Gap Number: Twelve healthy adult volunteers, each tested under both placebo and psilocybin in a double-blind laboratory design. This was a small study of timing tasks, not a study of a therapy session.
- Finding: Yes, many people feel time stretch, blur, or loosen during a plant medicine session, and a small controlled study backs that up. When people were given psilocybin, their sense of longer stretches of time, over roughly two to three seconds, drifted off, while very short intervals stayed accurate.
- Study: Wittmann, M., Carter, O., Hasler, F., Cahn, B. R., Grimberg, U., Spring, P., Hell, D., Flohr, H., & Vollenweider, F. X. (2007). Effects of psilocybin on time perception and temporal control of behaviour in humans. Journal of Psychopharmacology.
- DOI: 10.1177/0269881106065859 (https://doi.org/10.1177/0269881106065859)
- Page: https://www.asendar.com/gap/q/does-time-feel-different-during-a-plant-medicine-session

## Can a positive mindset before a session improve it?

- Gap Number: Adults receiving cognitive behavioral therapy for generalized anxiety disorder in a clinical trial, with their outcome expectation measured over and over across treatment. This page describes the study's design and direction, not an exact participant count, because the source could not be opened to confirm that number this run.
- Finding: A hopeful mindset does appear to help, but it is not a switch you flip alone. In therapy for anxiety, people's belief that treatment would work tended to rise over the course of care, and it rose most alongside early relief and a steady therapist. Hope matters, and it also grows.
- Study: Vîslă, A., Constantino, M. J., & Flückiger, C. (2021). Predictors of change in patient treatment outcome expectation during cognitive-behavioral psychotherapy for generalized anxiety disorder. Psychotherapy.
- DOI: 10.1037/pst0000371 (https://doi.org/10.1037/pst0000371)
- Page: https://www.asendar.com/gap/q/can-a-positive-mindset-before-a-session-improve-it

## Should I know what I want to change before starting therapy?

- Gap Number: None. This is a critical editorial, not a study of participants. It weighs decades of research, most of it on smoking, where the model was built.
- Finding: Not necessarily. It helps to have a rough sense of direction, but you do not need it all figured out first. A leading researcher argued the tidy stages of change model, which says you must reach a ready to act stage before you begin, does not hold up. Uncertainty is a normal place to start.
- Study: West, R. (2005). Time for a change: putting the Transtheoretical (Stages of Change) Model to rest. Addiction.
- DOI: 10.1111/j.1360-0443.2005.01139.x (https://doi.org/10.1111/j.1360-0443.2005.01139.x)
- Page: https://www.asendar.com/gap/q/should-i-know-what-i-want-to-change-before-starting-therapy

## Does the time between therapy sessions affect how well it works?

- Gap Number: 21,488 university counseling center clients, tracked session by session over 17 years
- Finding: Often, yes. A large 2015 study tracked more than 21,000 people in real therapy and found that those seen weekly tended to recover faster than those seen every two weeks. Shorter gaps were linked to quicker progress. It measured speed of recovery, not a promise, and people were not randomly assigned.
- Study: Erekson, D. M., Lambert, M. J., and Eggett, D. L. (2015). The relationship between session frequency and psychotherapy outcome in a naturalistic setting. Journal of Consulting and Clinical Psychology.
- DOI: 10.1037/a0039774 (https://doi.org/10.1037/a0039774)
- Page: https://www.asendar.com/gap/q/does-the-time-between-therapy-sessions-affect-how-well-it-works

## How do I make sense of what came up in a session?

- Gap Number: developed across several rounds, with a final validation sample of 600 adults
- Finding: You make sense of it through integration, the plain and repeatable work of processing an experience after it ends. A 2022 study mapped this into two scales, one for what you do, like journaling and talking it over, and one for how integrated you come to feel inside. The doing and the feeling are closely linked.
- Study: Frymann, T., Whitney, S., Yaden, D. B., and Lipson, J. (2022). The Psychedelic Integration Scales: Tools for Measuring Psychedelic Integration Behaviors and Experiences. Frontiers in Psychology.
- DOI: 10.3389/fpsyg.2022.863247 (https://doi.org/10.3389/fpsyg.2022.863247)
- Page: https://www.asendar.com/gap/q/how-do-i-make-sense-of-what-came-up-in-a-session

## Why do I cry during a therapy session?

- Gap Number: 1,404 adults across two online samples of 623 and 781 people, ages 18 to 81
- Finding: Crying in a session is a normal response to strong feeling, not a sign of weakness. Research on adults links how readily you cry to your attachment style and your beliefs about crying. Tears often show up when you finally feel safe enough to let something surface.
- Study: Millings, A., Hepper, E. G., Hart, C. M., Swift, L., and Rowe, A. C. (2016). Holding Back the Tears: Individual Differences in Adult Crying Proneness Reflect Attachment Orientation and Attitudes to Crying. Frontiers in Psychology.
- DOI: 10.3389/fpsyg.2016.01003 (https://doi.org/10.3389/fpsyg.2016.01003)
- Page: https://www.asendar.com/gap/q/why-do-i-cry-during-a-therapy-session

## Does being motivated for therapy change how well it works?

- Gap Number: A meta-analysis pooling studies of motivational interviewing that measured both what happened inside sessions and how people did afterward
- Finding: In part, yes, but not as simply as it sounds. Being motivated helps you show up, speak openly, and do the work between sessions, and that engagement is part of what helps. Still, research finds the link between how motivated you feel and how well therapy turns out is real but modest, and often mixed.
- Study: Pace, B. T., Dembe, A., Soma, C. S., Baldwin, S. A., Atkins, D. C., & Imel, Z. E. (2017). A multivariate meta-analysis of motivational interviewing process and outcome. Psychology of Addictive Behaviors.
- DOI: 10.1037/adb0000280 (https://doi.org/10.1037/adb0000280)
- Page: https://www.asendar.com/gap/q/does-being-motivated-for-therapy-change-how-well-it-works

## How do I keep anxiety from coming back after therapy?

- Gap Number: A synthesis of decades of laboratory and clinical research on fear, extinction, and exposure therapy
- Finding: Keep practicing what you learned, in many places, after you feel better. The fear you worked through is not erased. Your brain learns a new sense of safety that sits on top of it. That new learning stays strong when you use it often and in different settings, so calm holds when life changes around you.
- Study: Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy.
- DOI: 10.1016/j.brat.2007.10.003 (https://doi.org/10.1016/j.brat.2007.10.003)
- Page: https://www.asendar.com/gap/q/how-do-i-keep-anxiety-from-coming-back-after-therapy

## What does the Apple Readiness score measure, and what does it miss?

- Gap Number: 14 composite health scores from 10 wearable makers, including Oura, Garmin, WHOOP, Fitbit, Polar, Samsung, and Withings
- Finding: Apple's Readiness score is a 0 to 10 number built from your recent activity, training load, vitals, and sleep score. It tells you whether your body is ready to push or needs rest. It does not measure stress, mood, or state of mind. Research shows these body scores often disagree with how a person says they feel.
- Study: Doherty, C., Baldwin, M., Lambe, R., Burke, D., and Altini, M. (2025). Readiness, recovery, and strain: an evaluation of composite health scores in consumer wearables. Translational Exercise Biomedicine.
- DOI: 10.1515/teb-2025-0001 (https://doi.org/10.1515/teb-2025-0001)
- Page: https://www.asendar.com/gap/q/what-does-the-apple-readiness-score-measure-and-what-does-it-miss

## Are specific therapy goals better than vague ones?

- Gap Number: A synthesis of goal-setting research spanning 35 years and more than 400 laboratory and field studies
- Finding: In general, yes. A specific, challenging goal gives your effort a clear direction, and decades of research find that beats a vague hope like do your best. In therapy, that means naming what you want to be different in plain, concrete terms, rather than aiming to simply feel better.
- Study: Locke, E. A., & Latham, G. P. (2002). Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American Psychologist.
- DOI: 10.1037/0003-066X.57.9.705 (https://doi.org/10.1037/0003-066X.57.9.705)
- Page: https://www.asendar.com/gap/q/are-specific-therapy-goals-better-than-vague-ones

## Does understanding why I do something actually help me change?

- Gap Number: 23 independent effect sizes, drawn from 13,849 screened abstracts, across a range of therapy types
- Finding: Usually it helps. A 2018 meta-analysis pooled 23 studies and found a moderate link between a person's insight, their understanding of their own patterns, and how well therapy went, with a correlation of 0.31. Insight is not the whole story, but it is one of the things that travels with getting better.
- Study: Jennissen, S., Huber, J., Ehrenthal, J. C., Schauenburg, H., and Dinger, U. (2018). Association Between Insight and Outcome of Psychotherapy: Systematic Review and Meta-Analysis. American Journal of Psychiatry.
- DOI: 10.1176/appi.ajp.2018.17080847 (https://doi.org/10.1176/appi.ajp.2018.17080847)
- Page: https://www.asendar.com/gap/q/does-understanding-why-i-do-something-actually-help-me-change

## Does a mystical experience during a session lead to better outcomes?

- Gap Number: 20 patients with treatment-resistant depression, each with two psilocybin sessions (a lower and a higher one)
- Finding: Often, yes. In a 2018 study of 20 people with hard to treat depression, those whose session felt more mystical, deep, connected, and boundary dissolving, had lower depression five weeks later. How vivid the visuals were did not predict the benefit. The emotional depth of the experience mattered more than its surface intensity.
- Study: Roseman, L., Nutt, D. J., and Carhart-Harris, R. L. (2018). Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression. Frontiers in Pharmacology.
- DOI: 10.3389/fphar.2017.00974 (https://doi.org/10.3389/fphar.2017.00974)
- Page: https://www.asendar.com/gap/q/does-a-mystical-experience-during-a-session-lead-to-better-outcomes

## Does believing therapy will work make it more likely to help?

- Gap Number: 12,722 patients across 81 independent samples
- Finding: Believing your therapy will help does make a modest difference. Across 81 studies of more than 12,000 people, those who expected treatment to work tended to do a little better than those who did not. The link was small and steady, not a promise. Hope is a real ingredient, not the whole recipe.
- Study: Constantino, M. J., Vîslă, A., Coyne, A. E., & Boswell, J. F. (2018). A meta-analysis of the association between patients' early treatment outcome expectation and their posttreatment outcomes. Psychotherapy.
- DOI: 10.1037/pst0000169 (https://doi.org/10.1037/pst0000169)
- Page: https://www.asendar.com/gap/q/does-believing-therapy-will-work-make-it-more-likely-to-help

## How do I avoid sliding back after I start to feel better?

- Gap Number: 2,742 participants across 29 randomized trials
- Finding: The strongest lever is to keep doing the work after you feel better, not to stop once the low lifts. In a review of 2,742 people who had recovered from depression, continuing a structured therapy-based practice cut the risk of sliding back by about a fifth over the next year.
- Study: Clarke, K., Mayo-Wilson, E., Kenny, J., & Pilling, S. (2015). Can non-pharmacological interventions prevent relapse in adults who have recovered from depression? A systematic review and meta-analysis of randomised controlled trials. Clinical Psychology Review.
- DOI: 10.1016/j.cpr.2015.04.002 (https://doi.org/10.1016/j.cpr.2015.04.002)
- Page: https://www.asendar.com/gap/q/how-do-i-avoid-sliding-back-after-i-start-to-feel-better

## How do I hold on to what I learned between sessions?

- Gap Number: 159 effect sizes from published testing-effect experiments
- Finding: To hold on to what you learned between sessions, do not just look over your notes. Bring what you learned to mind on your own, out loud or on paper, in short moments across the week. In memory research, that kind of active retrieval is what makes learning last.
- Study: Rowland, C. A. (2014). The effect of testing versus restudy on retention: A meta-analytic review of the testing effect. Psychological Bulletin.
- DOI: 10.1037/a0037559 (https://doi.org/10.1037/a0037559)
- Page: https://www.asendar.com/gap/q/how-do-i-hold-on-to-what-i-learned-between-sessions

## Why do insights from a session fade so fast?

- Gap Number: one dedicated participant who completed about 70 hours of learning and relearning
- Finding: Insights fade fast because that is how ordinary memory works. Research that repeated the classic forgetting curve found people lose most of what they learn within the first day, with the steepest drop in the first hours. An insight is a memory too, so it blurs quickly unless you capture it and come back to it.
- Study: Murre, J. M. J., and Dros, J. (2015). Replication and Analysis of Ebbinghaus' Forgetting Curve. PLOS ONE.
- DOI: 10.1371/journal.pone.0120644 (https://doi.org/10.1371/journal.pone.0120644)
- Page: https://www.asendar.com/gap/q/why-do-insights-from-a-session-fade-so-fast

## What does it mean to surrender during a session?

- Gap Number: 183 people who had taken psilocybin on their own in the past year
- Finding: Surrender means letting go of the urge to control the experience and allowing it to unfold. In plant medicine research, the state of surrender a person carried into a session was the strongest predictor of a deep, mystical-type experience, while a mind stuck on worry was the strongest predictor of a harder, more distressing one.
- Study: Russ, S. L., Carhart-Harris, R. L., Maruyama, G., and Elliott, M. S. (2019). Replication and extension of a model predicting response to psilocybin. Psychopharmacology.
- DOI: 10.1007/s00213-019-05279-z (https://doi.org/10.1007/s00213-019-05279-z)
- Page: https://www.asendar.com/gap/q/what-does-it-mean-to-surrender-during-a-session

## Can holding on to the wrong intention slow your progress?

- Gap Number: 31 samples, 421 effect sizes
- Finding: Maybe. Research on goal adjustment suggests that clinging to a goal you can no longer reach is linked to more distress, while being able to let it go and aim at a new one is linked to better well-being. The wrong intention is one you have outgrown but keep holding anyway.
- Study: Barlow, M. A., Wrosch, C., & McGrath, J. J. (2020). Goal adjustment capacities and quality of life: A meta-analytic review. Journal of Personality.
- DOI: 10.1111/jopy.12492 (https://doi.org/10.1111/jopy.12492)
- Page: https://www.asendar.com/gap/q/can-holding-on-to-the-wrong-intention-slow-your-progress

## What does a mental maintenance routine look like?

- Gap Number: 1,258 adults with recurrent depression, across nine randomized trials
- Finding: A mental maintenance routine is a small, regular practice you keep after the intensive work ends. In one large review, people who kept up a structured mindfulness routine were less likely to slip back into depression. It does not need to be long. It needs to be steady and repeated.
- Study: Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Dalgleish, T., et al. (2016). Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA Psychiatry.
- DOI: none
- Page: https://www.asendar.com/gap/q/what-does-a-mental-maintenance-routine-look-like

## Why does progress feel slower between sessions?

- Gap Number: 1,104 people across 16 treatment studies
- Finding: Often because change in therapy is not smooth. It tends to come in jumps, not a steady climb. A large review found that a big share of a person's total improvement can arrive in a single stretch between two sessions. So the flat weeks can feel like nothing, even when the overall path is upward.
- Study: Aderka, I. M., Nickerson, A., Bøe, H. J., and Hofmann, S. G. (2012). Sudden gains during psychological treatments of anxiety and depression: A meta-analysis. Journal of Consulting and Clinical Psychology.
- DOI: 10.1037/a0026455 (https://doi.org/10.1037/a0026455)
- Page: https://www.asendar.com/gap/q/why-does-progress-feel-slower-between-sessions

## Does talking about a session help you process it?

- Gap Number: 88 adults with a strong fear of spiders
- Finding: Yes, and the way you talk matters. Naming what you feel out loud, in plain words, helps your body settle and helps you face hard things. In one study, people who put their fear into words during exposure showed a calmer stress response a week later than people who distracted themselves.
- Study: Kircanski, K., Lieberman, M. D., and Craske, M. G. (2012). Feelings Into Words: Contributions of Language to Exposure Therapy. Psychological Science.
- DOI: 10.1177/0956797612443830 (https://doi.org/10.1177/0956797612443830)
- Page: https://www.asendar.com/gap/q/does-talking-about-a-session-help-you-process-it

## Why do some sessions feel more intense than others?

- Gap Number: 409 psilocybin sessions given to 261 healthy volunteers, pooled from 23 controlled studies
- Finding: Sessions differ because more than the medicine shapes them. In a large analysis of psilocybin sessions, how intense and how pleasant an experience felt depended on the person's mood going in, a trait called absorption, and the setting around them. The same medicine can land very differently on different days.
- Study: Studerus, E., Gamma, A., Kometer, M., and Vollenweider, F. X. (2012). Prediction of psilocybin response in healthy volunteers. PLoS ONE.
- DOI: none
- Page: https://www.asendar.com/gap/q/why-do-some-sessions-feel-more-intense-than-others

## Why do therapists ask you to set an intention?

- Gap Number: 295 studies, more than 30,000 people in therapy
- Finding: Therapists ask because naming what you want to work on is part of building the therapeutic alliance, the shared, working bond between you and your therapist. A 2018 review of 295 studies and more than 30,000 people found that the strength of that alliance was one of the steadiest markers of how therapy turned out.
- Study: Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy.
- DOI: 10.1037/pst0000172 (https://doi.org/10.1037/pst0000172)
- Page: https://www.asendar.com/gap/q/why-do-therapists-ask-you-to-set-an-intention

## How often should I revisit my therapy goals?

- Gap Number: 58 studies, 110 effect sizes, 21,699 people
- Finding: There is no magic number. But checking your progress on a steady rhythm helps. A 2021 review of 58 studies found that regular progress feedback modestly improved therapy outcomes and cut dropout by about a fifth. The benefit was largest for people whose progress had drifted off track.
- Study: de Jong, K., Conijn, J. M., Gallagher, R. A. V., Reshetnikova, A. S., Heij, M., & Lutz, M. C. (2021). Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical Psychology Review.
- DOI: 10.1016/j.cpr.2021.102002 (https://doi.org/10.1016/j.cpr.2021.102002)
- Page: https://www.asendar.com/gap/q/how-often-should-i-revisit-my-therapy-goals

## Is it normal to feel flat between sessions?

- Gap Number: 752 adults with depression who were taking a prescribed antidepressant, surveyed online in Brazil, Canada, and Spain in 2021
- Finding: Yes, feeling flat, numb, or emotionally muted is common, and it does not mean something is wrong with you. In a survey of 752 people with depression, emotional blunting was widespread, and most people in an active phase of depression described it as severe. For many, the flatness eases over time.
- Study: Christensen, M. C., Ren, H., & Fagiolini, A. (2022). Emotional blunting in patients with depression. Part I: clinical characteristics. Annals of General Psychiatry.
- DOI: 10.1186/s12991-022-00387-1 (https://doi.org/10.1186/s12991-022-00387-1)
- Page: https://www.asendar.com/gap/q/is-it-normal-to-feel-flat-between-sessions

## What should I do the day after an intense session?

- Gap Number: 158 studies pooled, 450 separate results, 13,101 people in total
- Finding: Keep it gentle and small. The day after often feels flat, and one of the best-supported ways to lift a flat mood is a short, easy walk. A large review of exercise studies found that light movement reliably raised energy and mood, and the boost was biggest in people who started out low. Rest too. Go slow.
- Study: Reed, J., and Ones, D. S. (2006). The effect of acute aerobic exercise on positive activated affect: A meta-analysis. Psychology of Sport and Exercise.
- DOI: 10.1016/j.psychsport.2005.11.003 (https://doi.org/10.1016/j.psychsport.2005.11.003)
- Page: https://www.asendar.com/gap/q/what-should-i-do-the-day-after-an-intense-session

## How does music shape what happens in a session?

- Gap Number: 19 patients in psilocybin therapy for treatment-resistant depression
- Finding: Music is not background. In sessions, it shapes what you feel and see, guides where your attention goes, and can steady you when things get intense. In one study of psilocybin therapy, how patients related to the music predicted their mood a week later, more than the drug itself did.
- Study: Kaelen, M., Giribaldi, B., Raine, J., and colleagues (2018). The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology.
- DOI: 10.1007/s00213-017-4820-5 (https://doi.org/10.1007/s00213-017-4820-5)
- Page: https://www.asendar.com/gap/q/how-does-music-shape-what-happens-in-a-session

## Does writing down your goals before therapy help?

- Gap Number: 141 studies, 384 effect sizes, 16,523 participants
- Finding: Writing a goal down is a simple way to make it specific, and specific goals are what the research supports. A 2017 review of 141 studies found that setting a clear goal makes behavior change more likely. The effect was stronger when the goal was challenging and when it was shared openly.
- Study: Epton, T., Currie, S., & Armitage, C. J. (2017). Unique effects of setting goals on behavior change: Systematic review and meta-analysis. Journal of Consulting and Clinical Psychology.
- DOI: 10.1037/ccp0000260 (https://doi.org/10.1037/ccp0000260)
- Page: https://www.asendar.com/gap/q/does-writing-down-your-goals-before-therapy-help

## Does a daily check-in habit help mental health?

- Gap Number: 138 studies, 19,951 participants
- Finding: Checking in on yourself regularly is one of the more reliable ways to actually reach a goal. A large 2016 review of 138 studies found that people who monitored their own progress more often were more likely to follow through. Recording it, or sharing it, made the effect stronger.
- Study: Harkin, B., Webb, T. L., Chang, B. P. I., Prestwich, A., Conner, M., Kellar, I., Benn, Y., & Sheeran, P. (2016). Does monitoring goal progress promote goal attainment? A meta-analysis of the experimental evidence. Psychological Bulletin.
- DOI: 10.1037/bul0000025 (https://doi.org/10.1037/bul0000025)
- Page: https://www.asendar.com/gap/q/does-a-daily-check-in-habit-help-mental-health

## How long does the afterglow last after a session?

- Gap Number: 48 studies pooling 1,774 participants, spanning research from 1950 to 2021
- Finding: There is no exact clock. Researchers call this the afterglow, and they study it as a subacute window that runs from about a day to a month after a session. In a 2023 review of 48 studies, lifts in mood and connection were common in that window, then faded. Give it weeks, not hours.
- Study: Evens, R., Schmidt, M. E. S., Majić, T., and Schmidt, T. T. (2023). The psychedelic afterglow phenomenon: a systematic review of subacute effects of classic serotonergic psychedelics. Therapeutic Advances in Psychopharmacology.
- DOI: 10.1177/20451253231172254 (https://doi.org/10.1177/20451253231172254)
- Page: https://www.asendar.com/gap/q/how-long-does-the-afterglow-last-after-a-session

## How long does it take to integrate a big session?

- Gap Number: 51 healthy adults, assessed before and after psilocybin sessions
- Finding: There is no fixed clock. Integration unfolds over weeks and months, not hours. In one study of a single psilocybin session, a meaningful shift showed up at one to two months and was still present more than a year later. So give a big session time. The work is slow by design, and that is normal.
- Study: MacLean, K. A., Johnson, M. W., and Griffiths, R. R. (2011). Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. Journal of Psychopharmacology.
- DOI: 10.1177/0269881111420188 (https://doi.org/10.1177/0269881111420188)
- Page: https://www.asendar.com/gap/q/how-long-does-it-take-to-integrate-a-big-session

## What does it feel like to dissociate during a session?

- Gap Number: a clinically diverse group of more than 100 people, including trauma survivors, people with other psychiatric conditions, and healthy volunteers
- Finding: Dissociation during a session often feels like detachment. You may feel disconnected from your body, as if you are watching yourself from a distance. The room can look unreal or dreamlike. Time may speed up or stall. Researchers built a validated scale that captures these exact sensations, so the experience is known and measurable.
- Study: Bremner, J. D., Krystal, J. H., Putnam, F. W., Southwick, S. M., Marmar, C., Charney, D. S., & Mazure, C. M. (1998). Measurement of dissociative states with the Clinician-Administered Dissociative States Scale (CADSS). Journal of Traumatic Stress.
- DOI: 10.1023/A:1024465317902 (https://doi.org/10.1023/A:1024465317902)
- Page: https://www.asendar.com/gap/q/what-does-it-feel-like-to-dissociate-during-a-session

## How do I prepare mentally for my next therapy session?

- Gap Number: 17 controlled studies of adults in individual therapy, pooled across outcomes
- Finding: Prepare by getting clear on two things before you go: how therapy works and what you want from the next hour. Research on role induction, a short primer on your part in the process, links this kind of preparation to fewer early dropouts and better results. A few honest notes are enough.
- Study: Swift, J. K., Penix, E. A., & Li, A. (2023). A meta-analysis of the effects of role induction in psychotherapy. Psychotherapy.
- DOI: 10.1037/pst0000475 (https://doi.org/10.1037/pst0000475)
- Page: https://www.asendar.com/gap/q/how-do-i-prepare-mentally-for-my-next-therapy-session

## Why do I feel worse a few days after a session?

- Gap Number: 192 women in trauma-focused therapy for PTSD, pooled from two randomized trials
- Finding: Feeling worse for a few days after a session is common, and it usually does not mean therapy is failing. In trauma therapy research, a minority of people have a temporary symptom bump, and they still improve by the end. The dip often passes as you process the work.
- Study: Larsen, S. E., Stirman, S. W., Smith, B. N., & Resick, P. A. (2016). Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. Behaviour Research and Therapy.
- DOI: 10.1016/j.brat.2015.12.009 (https://doi.org/10.1016/j.brat.2015.12.009)
- Page: https://www.asendar.com/gap/q/why-do-i-feel-worse-a-few-days-after-a-session

## Why do old patterns come back after therapy?

- Gap Number: A review integrating decades of controlled extinction experiments in humans and animals
- Finding: Old patterns come back because therapy does not erase the old learning. It builds new learning on top of it. In the lab, the first response returns when the setting changes, when time passes, or under stress. So a slip is not failure. It means the new path needs more practice.
- Study: Bouton, M. E. (2004). Context and behavioral processes in extinction. Learning & Memory.
- DOI: none (https://learnmem.cshlp.org/content/11/5/485)
- Page: https://www.asendar.com/gap/q/why-do-old-patterns-come-back-after-therapy

## Does journaling after a session actually help?

- Gap Number: 146 randomized controlled trials of expressive writing, across clinical and healthy groups
- Finding: Yes, a little. Research on expressive writing, which means journaling about your thoughts and feelings after something stirs you up, shows a small but real average benefit for how people feel and function. It is not a fix for everything, and it helps most when you write honestly about the emotion, not just the events.
- Study: Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin.
- DOI: 10.1037/0033-2909.132.6.823 (https://doi.org/10.1037/0033-2909.132.6.823)
- Page: https://www.asendar.com/gap/q/does-journaling-after-a-session-actually-help

## Why does the environment matter during a therapy session?

- Gap Number: 80 volunteers, randomly assigned across four room conditions
- Finding: The room you sit in shapes the work you do in it. Lighting, comfort, and a sense of safety change how at ease you feel and how openly you speak. In one controlled study, people in a softer, dimmer room felt more relaxed and shared more with the counselor.
- Study: Miwa, Y., and Hanyu, K. (2006). The Effects of Interior Design on Communication and Impressions of a Counselor in a Counseling Room. Environment and Behavior.
- DOI: 10.1177/0013916505280084 (https://doi.org/10.1177/0013916505280084)
- Page: https://www.asendar.com/gap/q/why-does-the-environment-matter-during-a-therapy-session

## What does it mean to set an intention before a therapy session?

- Gap Number: 54 studies, 7,278 people
- Finding: Setting an intention before a session means naming, in plain words, what you want to work on. It gives the session a direction and gives you and your therapist a shared focus. Research links that kind of agreed direction to better therapy outcomes. It is a focus, not a promise about the result.
- Study: Tryon, G. S., Birch, S. E., & Verkuilen, J. (2018). Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy.
- DOI: 10.1037/pst0000170 (https://doi.org/10.1037/pst0000170)
- Page: https://www.asendar.com/gap/q/what-does-it-mean-to-set-an-intention-before-a-therapy-session

## How do I keep the gains from therapy over time?

- Gap Number: 28 studies, 1,880 adults treated for depression
- Finding: Keep practicing the skills therapy gave you, because gains can fade if you stop. Research on cognitive behavioral therapy found that many people slip back over the first two years once active treatment ends. The good news is that continued practice is linked to holding your ground longer.
- Study: Vittengl, J. R., Clark, L. A., Dunn, T. W., & Jarrett, R. B. (2007). Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects. Journal of Consulting and Clinical Psychology.
- DOI: 10.1037/0022-006X.75.3.475 (https://doi.org/10.1037/0022-006X.75.3.475)
- Page: https://www.asendar.com/gap/q/how-do-i-keep-the-gains-from-therapy-over-time

## What should I do in the two weeks between sessions?

- Gap Number: 46 studies, 1,072 clients in cognitive and behavioral therapy
- Finding: Use the time to practice what your session started. In therapy research this between-session work is called homework, and people who do it tend to do better than people who do not. So keep it simple. Pick one small thing from your session and carry it into your week.
- Study: Kazantzis, N., Whittington, C. J., & Dattilio, F. M. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice.
- DOI: 10.1111/j.1468-2850.2010.01204.x (https://doi.org/10.1111/j.1468-2850.2010.01204.x)
- Page: https://www.asendar.com/gap/q/what-should-i-do-in-the-two-weeks-between-sessions

## What does set and setting mean in therapy?

- Gap Number: 654 adults at the start, followed to 212 four weeks later
- Finding: Set and setting means the two things around a session that are not the treatment itself: your inner state, your mindset and intentions, and the outer environment, the place and the people. A large prospective study found both shape the experience and how you feel in the weeks after.
- Study: Haijen, E. C. H. M., and colleagues (2018). Predicting Responses to Psychedelics: A Prospective Study. Frontiers in Pharmacology.
- DOI: 10.3389/fphar.2018.00897 (https://doi.org/10.3389/fphar.2018.00897)
- Page: https://www.asendar.com/gap/q/what-does-set-and-setting-mean-in-therapy

## What is integration after a therapy session?

- Gap Number: 886 adults, surveyed before and after a plant medicine experience
- Finding: Integration is the work of making sense of a therapy session after it ends and turning what surfaced into lasting change. It happens in the days and weeks that follow, through reflection, talking, journaling, and small new habits. The session opens something up. Integration is how it takes root.
- Study: Peill, J. M., and colleagues (2022). Validation of the Psychological Insight Scale: A new scale to assess psychological insight following a psychedelic experience. Journal of Psychopharmacology.
- DOI: 10.1177/02698811211066709 (https://doi.org/10.1177/02698811211066709)
- Page: https://www.asendar.com/gap/q/what-is-integration-after-a-therapy-session

## Does setting an intention actually help you follow through?

- Gap Number: 94 independent tests
- Finding: Setting an intention helps most when you turn it into a specific plan. A large research review found that people who spelled out when, where, and how they would act followed through far more often than people who only held a goal in mind. A vague wish moves less than a concrete plan.
- Study: Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology.
- DOI: 10.1016/S0065-2601(06)38002-1 (https://doi.org/10.1016/S0065-2601(06)38002-1)
- Page: https://www.asendar.com/gap/q/does-setting-an-intention-actually-help-you-follow-through