Insight into social anxiety and exposure therapy

[Ecdysis]

Huh... I'm currently listening to a DIY CBT audiobook... It's pretty good...

The author just pointed out something really critical about the treatment of social axieties that all therapists I've had in now nearly 30 years (siiigh) have missed:

He was saying that with specific phobias, say the fear of spiders or dogs or elevators, you can objectively say whether or not a certain feared incident happened or not (ie. did the elevator get stuck? did the dog bite you?)

However, with anxieties based around social stuff and interactions with other human beings, you can hardly ever ascertain whether the feared incident happened or not (did they think poorly of me? did I behave embarrassingly?) It's all mindreading and guesswork. And even if you managed to ASK someone, they might just give a "fake polite" answer which doesn't correspond to the truth...

No wonder that when therapists have attempted exposure therapy for my social anxieties in the past, it's failed and backfired completely... (Another reason was that I'd dissociate during the exposure situations, making the whole desensitisation thing f*ck up anyway...) But the underlying problem, I now see was that lack of ability to test a fear hypothesis - was I making a fool of myself? were other people snearing at me and rejecting me?

Gonna try and noooot be annoyed at how many therapists have f*cked that up over the years.... siiiiiiiiiiiiigh....

 

[Bamma]

I don't think I understand how your therapists f*cked up. For "simple phobias" (spiders, etc.), "systematic desensitization" can be used (by someone specifically trained). I'm not sure that means other kinds of "exposure therapy" can't be used for things like social phobia.

 

[arfie]

i'm okay with snakes, spiders, and other underdogs of the natural world, but humans give me the heebeegeebees and i have actively used and still use exposure therapy to address the pp (people phobia). it was a 70's therapist who exposed me to the exposure therapy tool for my pp. half a century later, i am still a social distancing champ, but there is a pretty wide margin between enjoying my human-free time and being deathly afraid to go grocery shopping.

my early exposure therapy was to go to a crowded place --outdoors worked best for me-- and sit calmly. i nudged myself to make eye contact and smile whenever possible. as the therapy progressed, i started asking directions or some such. social events are still unpleasantly difficult for me and i still avoid them at all costs. being able to handle people far enough to enter a grocery store without dissociating to a paralyzed heap is plenty for me.

i'll second @Bamma 's notion that not knowing this approach (by whatever name) is not a f*ck up on the part of the therapist. none of us can do any more than our honest best with what we have to work with and psychology is so far from an exact science than many don't consider it science at all. psychology was even less of an exact science in the 70's. the therapists had to get creative beyond what the 70's training had assimilated.

 

[Friday]

Exposure Therapy is WILDLY different, depending on which disorder is being addressed.

With PTSD? It is one thing. With Anxiety disorders? Another. With phobias? A third.

Similar to how “procedure” or “testing” differs amongst medical specialities.

A generalized term, varying tremendously, between specialities.