Dealing with a Therapy Hangover: Recognizing Symptoms and Finding Solutions

Feeling like sh*t after therapy? It's not (all) in your head.

Your body may respond in visceral ways to intense therapy sessions. These therapy hangover symptoms can range from muscle aches to panic attacks. You may have experienced this very real phenomenon without even noticing. Was your last migraine on the same day as your last psychotherapy visit? Did you see your therapist and feel completely depleted for the rest of the day? You're not alone. Experts from all areas of the mental health field verified that post-therapy fatigue, aches, and even physical symptoms of illness are not just real but extremely common.

We turned to therapists to better understand the 'why' behind this physical response to tough therapy sessions. Ahead, we've laid out the science behind the response and how you can practice self-care to combat these symptoms.

This phenomenon is especially relevant when undergoing trauma therapy.

Many people experience some form of trauma, whether they realize it or not. 'Trauma involves something that happened to us that was out of our control, and often results in a pervasive feeling of threat,' explains cognitive neuroscientist Caroline Leaf, Ph.D. 'This includes things like adverse childhood experiences, traumatic experiences at any age, war trauma, and all forms of abuse, including racial aggression and socioeconomic oppression. It's involuntary and has been inflicted on a person, which often leaves them feeling emotionally and physically exposed, worn out, and fearful.'

What differentiates trauma therapy from other types is somewhat nuanced, but therapist Nina Westbrook, L.M.F.T explains it as therapy you receive after a distressing event or a therapy session in which past trauma comes up through the work with your therapist.

'Trauma in the realm of psychology is when a distressing event takes place, and as a result of that distressing event, a person becomes exceedingly stressed and unable to properly cope or come to terms with their feelings regarding the event,' explains Westbrook.

Trauma therapy — whether intended or accidental — isn't the only instance in which you'll experience a 'therapy hangover' of sorts. 'All of the feelings that come up throughout the therapeutic process can leave you feeling fatigued or with other physical symptoms,' explains Westbrook. 'This is why it is important to note that this is a very normal part of the process and should eventually subside as the therapeutic process ensues.'

'Therapy, particularly trauma therapy, always gets worse before it gets better,' says Westbrook. If you've ever done trauma therapy — or just intensive therapy work — you know this already: It's not easy. This is not the 'believe and achieve,' positive affirmation, discovering your inner power kind of therapy, but rather the 'everything hurts' kind.

Digging into past traumas and traumatic events, experiences from childhood, and other similarly deep, fraught memories can take a toll on you — not just mentally, but physically. It's something Leaf calls 'the treatment effect.'

'The increased awareness from the work you're doing on your thoughts (which is very challenging, to say the least) increases your sense of autonomy,' says Leaf. 'This can also increase your stress levels and anxiety because you're starting to become more aware of what you're going through, how you've handled your stress and trauma, and why you'll have to face some deep, internal issues.'

'This is why it's so important for therapists to be upfront about the therapeutic process with their clients,' says Westbrook. '[These symptoms are] very normal and natural, and a perfect example of the mind-body connection. Wellness isn't just our physical being, but our mental being — it's all connected.'

If you're not doing trauma work, therapy might actually leave you feeling more relaxed, confident, or energized, says clinical psychologist Forrest Talley, Ph.D. 'The most common physiological reactions I've seen in my practice are leaving therapy in a more relaxed state or with increased energy; however, changes in a person's physiological state are common after more intense psychotherapy meetings.'

'Because of the intimate connection between the brain and body, it would be odd for [emotional therapy] to not have an impact,' says Talley. 'The more emotionally intense the work, the more likely it is to find some expression in a physical reaction.'

Westbrook says stress can be used as an everyday example to better contextualize and understand this. 'Stress is one of the most common feelings in our daily lives,' she says. 'Whether you're studying for an exam, prepping for a presentation, or going out on a date for the first time with someone new, you might feel anxious and excited. Some people would say they have a 'pit in their stomach,' while others say they 'have butterflies,' — and some people say they're 'going to sh*t themselves.' And sometimes they actually do!'

This is magnified in trauma therapy. 'With trauma therapy, symptoms are significantly present, and in a much bigger way,' she says. 'There's a wide variety of physical symptoms [that can occur] from breaking down issues and breaking through during trauma therapy.' For anyone who has foam rolled, you know how much it hurts before it gets better — think of it like foam rolling some super tight fascia, but for your brain.

You're likely bringing more to your therapy session than you realize. 'When you have stressors that build up — if you don't take care of them — they continue to build, and they sit in your body physically,' says psychologist Alfiee Breland-Noble, Ph.D., M.H.Sc., director of the AAKOMA Project, a nonprofit dedicated to mental health care and research.

Hence, stored trauma. You don't like it, so you pack it away like a mental junk drawer, only the junk drawer is ready to burst from being so full of your worst nightmares.

'We tend to suppress things because conscious awareness of painful toxic memories brings discomfort, and we don't like being uncomfortable or feeling uncertainty and pain,' explains Leaf. 'As humans, we have a tendency to avoid and suppress instead of embrace, process, and reconceptualize pain, which the brain is designed to do to keep healthy. This is, in fact, why suppressing our issues does not work as a sustainable solution because our thoughts are real and dynamic; they have structure and will explode (often in a kind of volcanic mode) at some point in our lives, physically and mentally.'

But don't feel bad about feeling 'bad' — you need to feel those feelings! 'We live in an age where we want to feel good all the time, and where feeling uncomfortable, sad, upset or angry are universally labeled as 'bad,' although they are actually healthy responses to adverse circumstances,' says Leaf. 'Good therapy helps you embrace, process, and reconceptualize your past experiences, which will inevitably involve some degree of pain, but this just means the healing work has started.'

All that packed trauma? It didn't feel good when it was stored, and it's probably going to feel traumatic coming out, too. 'You're literally drawing up established toxic habits and trauma, with their embedded informational, emotional, and physical memories from the nonconscious mind,' explains Leaf.

Digging into this stored trauma and stress will be the most difficult in the first few weeks of treatment, says Leaf. This is 'when your thoughts, with their thousands of embedded mental and physical memories, are moving from the nonconscious mind into the conscious mind,' she says. And it makes sense that bringing painful memories and experiences into your consciousness will feel uncomfortable.

'What compounds all those stored stressors is psychological distress and mental illness,' says Breland-Noble. 'Put all that together, and by the time you sit with a mental health professional and start processing, you're not just releasing the immediate thing [you went in to talk about],' she says, but all the experiences, memories, habits, traumas you've stored. 'It makes sense that it would release in your body the same way it was stored in your body, stored in your cells, in your feelings, in your physicality,' she says.

There's a physiological, scientific explanation for a lot of this, too. 'If therapy has resulted in heightened stress (for example, reviewing traumatic memories), then there is likely to be increased levels of cortisol and catecholamines,' explains Talley.

In a nutshell, cortisol and catecholamines are chemical messengers your body releases during the stress response. Cortisol is a single hormone (known as the stress hormone), while catecholamines comprise several neurotransmitters, including epinephrine and norepinephrine (also called adrenaline and noradrenaline). (Interestingly enough, catecholamines are part of the reason you might get an upset stomach after a tough workout.)

'This may lead to a rapid heart rate, sweating, headaches, muscle fatigue, etc,' says Talley. '[This] is not a complete list of chemical and physical responses to psychotherapy, but just intended to get the main point across. Psychotherapy affects brain chemistry, and this, in turn, is expressed through physical symptoms.'

'The gut-brain interaction is one of the most obvious examples of this — we often feel stress physically in our stomachs,' says Leaf.

'When the body and brain are in a highly tense state, which happens during and after therapy, this can be seen as [changes in] activity in the brain, as well as erratic changes in our bloodwork, right down to the level of our DNA, which impacts our physical health and our mental well-being over the short and long term periods if not managed,' says Leaf.

Breland-Noble shared that this has shown up in epigenetic studies of Black patients. 'Data with Black women and Black men has shown something called the weathering effect — it impacts bodies on a cellular level and is transferable genetically,' she says. 'There are actually changes to African American bodies because of the daily stressors related to exposure to racial trauma, and there is epigenetics that demonstrates it.' Translation: The trauma of racism makes actual changes to how their DNA is expressed.

Every expert here shared similar examples of symptoms to look out for, including the below:

Wild, right? All from trying to feel better — but remember, it does get better.

Breland-Noble cited a Benjamin Franklin quote to emphasize the importance of this step: 'An ounce of prevention is worth a pound of cure.'

If you know you're headed for a deep dive into some of your worst memories and experiences, be strong! You can prepare for this (very necessary) work. Because everyone's brain is different, there are different approaches to this. 'No matter what strategy is used, it should be one that encourages you to develop a stronger mindset, to come away confident that you will prevail in your struggle,' says Talley.

He suggests giving yourself the following intention: 'You want to leave a trauma therapy session firmly convinced that, 'Yes, I've been there, survived, and have gone on with my life. I faced down those demons and won. The things that disturb me are in the past. My life is here in the present and in the future. What tried to beat me down failed, and I've triumphed.''