Why Some People Feel Worse Before They Feel Better

One of the most common fears about therapy is this:
“What if I start and everything unravels?”

It’s a fair concern.

Sometimes, in the early stages of therapy, people report:

Increased emotional intensity
Heightened awareness of anxiety
More vivid memories
Temporary spikes in distress

This doesn’t mean therapy isn’t working.
In many evidence-based treatments, it can mean the opposite.

1. Increased Awareness Can Initially Feel Like Increased Anxiety

In CBT and Schema Therapy, we help clients identify thinking patterns and emotional triggers.

Before therapy, anxiety often runs in the background — unmanaged but unexamined.
When we bring attention to it, it can temporarily feel louder.

Research on cognitive behavioural therapy shows that symptom activation during treatment is common, particularly in anxiety disorders.

You’re not becoming more anxious.
You’re becoming more aware.

2. Exposure Work Activates Fear Before It Reduces It

In ERP (Exposure and Response Prevention) for OCD, distress increases before it decreases. That’s the mechanism.

Avoidance maintains anxiety.
Exposure allows habituation and inhibitory learning.

If therapy never activates discomfort, change is unlikely.

3. Emotional Processing Can Stir Dormant Material

Avoidance isn’t only behavioural — it’s emotional.

Suppressed grief, anger, shame, or disappointment can surface once safety is established. Research in emotional processing shows that activation is an important part of integration.

This is not destabilisation.
It’s processing.

4. The Difference Between “Productive Discomfort” and Harm

A good clinical psychologist monitors:

Window of tolerance
Risk factors
Capacity and coping resources
Pace of exposure

Therapy should feel challenging at times — but not unsafe.

When to Reassess

You should speak up if:

Distress is unmanageable
Functioning significantly declines
You feel unsupported

Therapy is collaborative.

If you're considering therapy

At Brodie Earl Clinical Psychology, we work at a pace that is evidence-based but psychologically safe.
Growth sometimes feels uncomfortable — but it shouldn’t feel chaotic. Contact us to book an appointment.