Why Five Minutes a Day Beats an Hour a Week

Fifty minutes is the usual length for a session of psychological treatment, with one session held each week. It has become so well established that almost no one questions its origin.

It wasn't the result of research into the interval that leads to the best outcomes; instead, it was based on the practical considerations of managing a private practice — specifically, a duration that enables a clinician to see a reasonable number of patients each day, with sufficient time available between them to write up notes, and one that occurs at a frequency affordable to the average person.

That makes a perfectly reasonable basis on which to organise a practice since it is not a clinical finding but has been regarded as such for a long time.

With addiction in particular, there is a kind of structural issue that we should be straightforward about.

##The 167-hour problem

There are 168 hours in a week.

A weekly course of therapy looks at one of these issues.

The other 167 are where the drinking happens. Where the craving arrives on a Wednesday at half past five. Where the argument occurs, the bad news lands, the evening stretches out empty. Every moment that determines whether someone drinks happens in the hours when no clinical contact exists.

This means weekly treatment is, in its structure, retrospective. You turn up on Thursday and report on a week that has already taken place. If Tuesday went badly, it went badly forty-eight hours earlier, and what you're doing now is a post-mortem rather than an actual intervention.

That isn't useless, since reflecting has real value, and effective therapy does much more than keep a record of events. However, it operates at a level of resolution that doesn't match the phenomenon it addresses. Cravings don't follow a weekly cycle; instead, they occur daily, sometimes hourly, with patterns linked to the time of day, certain locations, and particular internal states.

A treatment that acts on the person once a week is equivalent to sampling a process that occurs daily at a rate of once a week. Most of it is unseen.

##What daily contact changes

It captures things while they are still small. If a difficult Tuesday is dealt with on the same Tuesday, the problem becomes manageable. But if the same Tuesday is addressed the following Thursday, it has had two days to develop consequences.

It establishes an actual record. Since our memory of our own moods and behavior is generally unreliable—and even more so in the early stages of recovery—if you ask a person on a Thursday about their week, then the reply you get will be a summary biased towards how they feel at that moment. A daily written record, on the other hand, results in a quite different outcome, and it is often the case that when you look back at what you wrote on Day 3 from the point of view of Day 60, it proves more convincing than anything a clinician could say.

It reveals patterns. Ninety daily data points show you things no weekly summary can — that the difficult moment is consistently between five and seven in the evening, that it follows contact with a particular person, that it is worse on days you have not eaten properly or slept. Pattern is only visible at sufficient resolution.

It has a presence; this aspect is the most important one and the most difficult to measure. Unlike something that affects you once a week, there is a kind of presence in your life regarding something that touches you every day. It ends up becoming part of the everyday structure rather than something you have to schedule.

##Why five minutes rather than thirty

The part that may seem counterintuitive is as follows.

An obvious objection is that since daily is better than weekly and more is better than less, the program should request thirty or sixty minutes each day in order to achieve maximum contact and maximum benefit.

That is wrong for two reasons, and the second is the more important.

Reason one: adherence collapses

A program demanding an hour a day gets excellent compliance for about nine days.

When a child falls ill, a deadline comes around, or there is a family emergency, or it's just one day that is so tiring that no hour is free. The hour is then missed. The next day it is missed once more, so that there now occurs a two-day gap, which creates the feeling of having fallen behind—and falling behind is one of the sure signs that someone will completely give up.

All of that can be survived for five minutes. The five minutes occur on the day when the child is ill. They take place on the day of the deadline. They happen on the day when you feel awful and have no desire to do anything, and it is exactly this day that is most important, since it was the day when drinking used to happen.

The appropriate comparison isn't between five minutes and an hour; it's between five minutes carried out ninety times and an hour carried out eleven times before being given up. The first option involves a greater amount of total contact, distributed over the days that count, including the bad ones.

Consistency is better than intensity; this holds true in almost every area of behavior change and certainly does so in this case.

Reason two: the program should not become your life

This is the clinical reason and, in fact, determines the entire design.

At the heart of PocketPower addiction recovery lies the idea that the opposite of addiction is not sobriety but connection.

Addiction is mainly a disorder of connection – a substance taking the place of relationships, meaning, and a sense of belonging. If the substance is removed without tackling that space, a vacuum remains, and vacuums end up being filled.

They are often filled in by some other compulsion, sometimes even by the recovery process itself.

Someone who takes two hours each day in a recovery program—spending that time reading about recovery, keeping records of their recovery and talking about their recovery—has discovered an activity that is engaging and which gives them a sense of structure, identity and comfort. It appears to be a healthier alternative to drinking and is, in most respects, indeed healthier. Yet structurally it might be achieving something quite similar: it occupies the time without actually filling it with people.

The cap serves as a clinical boundary, not just a convenient feature—carry out the task, then close it and go and speak to someone.

The program is designed to make itself progressively less necessary. Much of the daily content pushes outward — a conversation to have, a person to contact, something to do that involves another human being. That is not an add-on to the therapeutic content. It is the therapeutic content.

What this implies about recovery apps generally

It's worth mentioning since it's useful to know when you're comparing different options.

Most consumer wellness and recovery apps use an engagement approach, with success judged by daily active users, session length, retention rates, and streaks. Design choices aim to maximize the time users spend in the product, since that is what the business model encourages.

The fact that the aim of such a product is at odds with the clinical objective means that a program which manages to keep you in it for one hour each day is one that is achieving something which doesn't assist you and may in fact be doing you harm.

When you're assessing any digital data recovery program, it is a worthwhile question to ask yourself whether this one is intended to keep me here or whether it is intended to send me away?

The limits of this argument

Being honest regarding the situations in which the five-minute model does not apply.

It cannot replace intensive therapy when needed. In cases involving significant trauma, serious comorbid psychiatric disorders, or complex presentations, ongoing one-on-one clinical care is necessary, and brief daily contact should be seen as a supplement rather than a substitute. For this reason, the program includes a route by which patients can be escalated to direct psychological consultation.

It can't take the place of medical care; in fact, detox is a medical procedure.

Five minutes is a minimum, not a maximum. On certain occasions, the material may take longer since something has opened up, and that is acceptable. What is important is that the amount of commitment needed is small enough to endure the worst days.

##The practical version

Ninety days, about five minutes a day, consisting of a short piece of material, a question to answer in writing, and generally one small offline task involving another person.

It is based on the first evaluation, focusing on the actual effect of your behavior rather than on a general curriculum.

It then stops interfering.

Start at pocketpower.health.

This article is general information, not medical advice. If you are in crisis, contact emergency services. In South Africa, SADAG provides mental health crisis support.