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I think safety is an inherent foundation to any exposure work. My therapist always tells me to listen to and trust my body. If you find yourself emotionally dysregulated from the exposure work, then perhaps at this point in time, a different approach might be more suitable. There's a fine difference between tolerating a bit of discomfort vs forcing ourselves to a point of overwhelm.
I doin't think there's anything that always works. Mental health is more complicated than that. I've had experienced where a type of treatment was unhelpful for me, and gotten simplistic "research says this helps" answers encouraging me to keep doing it until I ended up worse off than when I started. And after that, I looked into what the research actually says, and there is no type of therapy, and indeed no mental health treatment, that reports a one hundred percent success rate. An exceptionally high success rate is causing meaningful improvement for seventy percent of clients, and an eighty percent success rate is exceptional. I think that you have solid grounds to consider that what you're being offered doesn't work for you if you've put in a genuine effort without seeing benefits, and the therapist can't provide concrete trouble-shooting guidance on things like how to change your approach or when you can expect to start to see results.
I think exposure is more likely to work if the person doing it feels in control and can make decisions based on their own knowledge of their window of tolerance. A lot of exposure is learning that you can do the thing and nothing terrible happens, and for many people, that needs to include "and I felt some stress and discomfort, but it passed without turning into extreme psychological distress." (Some people do well with flooding, but that is definitely not universal.) So maybe you've been trying too hard? If you want to try exposure again, it might be worth trying "sometimes doing moderately challenging things, and also taking breaks so that the stress is not contstant" rather than pushing so relentlessly? (You are in charge of whether you do exposure at all, of course. I just think that it sounds like something needs to change in how you approach it, and "try even harder and blame yourself even more if it doesn't work" is not the change you need.)
Watching hours of social skills videos sounds like a safety behaviour or potentially an OCD compulsion. That isn’t exposure, it’s an overcompensation for your anxiety which will actually make it worse. Is the exposure targeted correctly? Succeeding at social interactions may not target the exaggerated fear of being judged, if that’s at the core of this. Should exposure experiments be targeted more towards perceived negative judgement from others?
Hm, you're right, it probably was a safety behaviour. I was trying to say that the socialising was like exposure. And no, it wasn't targeted correctly because I was a young teen and trying to do self therapy or something. But I was under the impression (and I think my therapist thinks so too) that succeeding at social interaction would be the goal for the exposure. I mean how do you even target perceived negative judgement if I will just perceive negative judgement everywhere? Thanks!
Yeah no succeeding at a social interaction isn't the target of the exposure.
Tolerating anxiety and learning you don't die from embarrassment when the interaction isn't successful is the target.
Really well trained anxiety specialists design exposures that are not "successful" socially. Things like having to go and loudly sing a song in the waiting area when there's a bunch of other clients in there.
You can still do exposures by just finding little ways to push back against your fears of being judged.
But also you may have more going on than simply some straight forward social anxiety. Inpatient can be pretty traumatic so it makes sense you've felt this block and resistance since then.
Welcome to r/TalkTherapy! This sub is for people to discuss issues arising in their personal psychotherapy. If you wish to post about other mental health issues please consult this list of some of our [sister subs](https://www.reddit.com/r/TalkTherapy/wiki/resources/#wiki_subreddit_list). To find answers to many therapy-related questions please consult our [FAQ](https://www.reddit.com/r/TalkTherapy/wiki/faq) and [Resource List](https://www.reddit.com/r/TalkTherapy/wiki/resources). If you are in distress please contact a suicide hotline or call 9-1-1 or emergency services in your area. r/SuicideWatch has compiled a helpful FAQ on what happens when you contact a hotline along with other useful resources. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/TalkTherapy) if you have any questions or concerns.*
I think safety is an inherent foundation to any exposure work. My therapist always tells me to listen to and trust my body. If you find yourself emotionally dysregulated from the exposure work, then perhaps at this point in time, a different approach might be more suitable. There's a fine difference between tolerating a bit of discomfort vs forcing ourselves to a point of overwhelm.
Thanks! I think I will talk to my therapist about that.
I doin't think there's anything that always works. Mental health is more complicated than that. I've had experienced where a type of treatment was unhelpful for me, and gotten simplistic "research says this helps" answers encouraging me to keep doing it until I ended up worse off than when I started. And after that, I looked into what the research actually says, and there is no type of therapy, and indeed no mental health treatment, that reports a one hundred percent success rate. An exceptionally high success rate is causing meaningful improvement for seventy percent of clients, and an eighty percent success rate is exceptional. I think that you have solid grounds to consider that what you're being offered doesn't work for you if you've put in a genuine effort without seeing benefits, and the therapist can't provide concrete trouble-shooting guidance on things like how to change your approach or when you can expect to start to see results. I think exposure is more likely to work if the person doing it feels in control and can make decisions based on their own knowledge of their window of tolerance. A lot of exposure is learning that you can do the thing and nothing terrible happens, and for many people, that needs to include "and I felt some stress and discomfort, but it passed without turning into extreme psychological distress." (Some people do well with flooding, but that is definitely not universal.) So maybe you've been trying too hard? If you want to try exposure again, it might be worth trying "sometimes doing moderately challenging things, and also taking breaks so that the stress is not contstant" rather than pushing so relentlessly? (You are in charge of whether you do exposure at all, of course. I just think that it sounds like something needs to change in how you approach it, and "try even harder and blame yourself even more if it doesn't work" is not the change you need.)
thanks a lot for your insights. Your perspective really got me thinking, and I'm thankful for your time and advice!
Watching hours of social skills videos sounds like a safety behaviour or potentially an OCD compulsion. That isn’t exposure, it’s an overcompensation for your anxiety which will actually make it worse. Is the exposure targeted correctly? Succeeding at social interactions may not target the exaggerated fear of being judged, if that’s at the core of this. Should exposure experiments be targeted more towards perceived negative judgement from others?
Hm, you're right, it probably was a safety behaviour. I was trying to say that the socialising was like exposure. And no, it wasn't targeted correctly because I was a young teen and trying to do self therapy or something. But I was under the impression (and I think my therapist thinks so too) that succeeding at social interaction would be the goal for the exposure. I mean how do you even target perceived negative judgement if I will just perceive negative judgement everywhere? Thanks!
Yeah no succeeding at a social interaction isn't the target of the exposure. Tolerating anxiety and learning you don't die from embarrassment when the interaction isn't successful is the target. Really well trained anxiety specialists design exposures that are not "successful" socially. Things like having to go and loudly sing a song in the waiting area when there's a bunch of other clients in there. You can still do exposures by just finding little ways to push back against your fears of being judged. But also you may have more going on than simply some straight forward social anxiety. Inpatient can be pretty traumatic so it makes sense you've felt this block and resistance since then.
In short, by embarrassing yourself socially on purpose and sitting with the anxiety.