Autism, Exposure Therapy & 'Just Try Again'

Exposure therapy doesn't work. How exposure therapy works with an autistic person. It's the overwhelm. So it looks like I'm fine but I'm so overwhelmed then after I have nothing left for the rest of the day. That then causes anxiety. Then this is like jumping on an anxiety hamster wheel. That's what exposure therapy does. I'd rather accommodate myself. Go earlier or later when it's less busy. Use thing to limit sensory input like ear plugs. Build up supply of spoon, that can be done playing video game for few hours prior.

As a future therapist, I’m glad to have watched this.

Omg, I spent close to a decade, over and over again trying to expose myself out of - what I back then still thought of as - 'my anxiety around people'. And it always went like you'd expect with mounting overstimulation and autistic fatigue. So I thought I was just defective and my therapists all hought I was just doing it wrong. Nope, it was just the 'tism. For reference: I overcame my really very pronounced but also actual fear of spiders all on my own - using exposure therapy. And every single new exposure was a little easier than the last, so that now I love to pick up big hairy spiders and have them dart up my arms and stuff. Exposure might work for fears, but it does not work for autism. What helps with autism is better self-care and coping strategies and a sensory diet and staying the fuck away from stuff that's just too much.

So, here's the thing about exposure therapy... It does "work", much in the same way that yoga "works" or positive thinking "works," which is to say that they only "work" when you're the right kind of person who meets all the prerequisites. For exposure therapy you need to a) actually understand what you're exposing yourself to and how to handle it and b) already be in an otherwise comfortable environment, in an otherwise chill headspace, with the understanding that you can abort at any time. You didn't have any of that by the sounds of things, so it's really no surprise that you had such a bad time with it. Also, your therapist was definitely just straight up doing it wrong. You're supposed to expose yourself progressively and when you have the energy to cope, not throw yourself directly into the thing you can't handle every day. That's a recipe for panic attacks even with allistic folks. Basically, it kinda sounds like they didn't take you seriously, or that they didn't take learning about exposure therapy seriously. Oh, and please don't take this as advice to try again or anything of the sort. Just because it technically "works" doesn't mean it's a good idea for you.

hey Dana, DONT sell yourself short, YOU do know a lot, ESPECIALLY about yourself, and how you experience the world, it's called "lived experience", or PWLED {people with lived experience of disability}; one thing that IS known ONLY by us [asd] is the perspective of the neurodivergent brain, and how it sees the world, and that is what is our Legacies, to voice this sight, and allow people to accept it, and value it's contribution to society, and the solutions to problems such a skill can produce.

I relate so much to this! I had to take busses and trains daily as a child and teenager and I still hate it. It is loud, often smelly and hot, there are too many people and I hate being perceived. Especially busses were such a challenge for me. I also hated going with other people because talking to them meant being perceived even more. Being stuck there and having no other choice didn't help either. As a teenager I developed chronic derealization on my way to school. It would happen every morning and one day it just didn't go away. Still have it. I struggle with having no choice. I can't work a full time job right now because the thought of having to show up every day is awful. I need to have options and choice. Otherwise I burn out very quickly.

recently had a talk with a then colleague during a massive burnout phase and he was talking about how much I've been through universities etc etc and how we learn from those hard & trying experiences so we become better at the stuff life throws at us later etc. some 'what doesn't kill you makes you stronger' kind of wisdom essentially. this is not my life experience. i didn't even get what he was trying to tell me first. i've barely gained any confidence or sense of accomplishment from anything i've managed in life, even when stuff came together successfully somehow. and it keeps taking a lot out of me. i don't feel stronger afterwards even when i succeed. it's more like a 'what doesn't kill me will break me in the end' typa deal it feels like. ps: i Am able to feel accomplished or confident, but that's related to stuff i actually value and am aligned with, that is, unrelated to masking

Dana, sometimes doing new things for asd's isn't itself about the 'doing', but about how to execute the whole thing, the lead up, mindset, capacity to endure this task, and having a planned reward for its completion, or attempt at it, to cool down, and reset.

practice often sounds like some sort of self-inflicted ABA. That said - I think the more you do something, chances are you will gain experience of on all the contingencies. My problem is wondering what to do if something does not go per the plan I made in my head.

I completely switched from CBT to Systemic Therapy cuz it never worked or made it worse...Those who are privileged to get into therapy and struggle with the classic school might wanna try it out. Good luck homies <3

If I'm going by my own experience the older I get the harder life gets, even if I have grasp of basic life stuff. I just hope it isn't a maxim for autistic people. I just hope society in the future will be a better place for autistic people.

First day of college I had I took the bus, never took it again for the two years I was in college xD walked 40 mins there and back every day just to avoid that. I am a little better with it all now but anxiety is still there, so if I can avoid I do.

the only time ive found exposure therapy work is when I get better at masking in certain situations

Yes! I think the key with exposure therapy is that it needs to be an irrational or misappropriated fear, one that will be found to be unnecessary through increased experience. If however, the fear is linked to a neurological overwhelm, that is real, and will continue to manifest with every additional experience, the fear will only be reinforced. Accommodations (ways to reduce to the neurological overwhelm), rest/recovery time (feelings can dissipate and be processed/released), and supports (reduce one load to increase capacity elsewhere), seem like the only logical helpful things.

Very few people realise that treating psychological conditions is much harder than treating physical ones. Psychological problems are often years or a lifetime in the making yet people think they can be undone in a few weeks. That doesn't mean that therapy is pointless but that it needs to have much more realistic and modest aims - an acceptance that it will work slowly, or sometimes not at all and if the progress is slow or even non-existent that isn't the fault of the person receiving treatment. When these conditions occur with autism it's even harder to change things because autism is often the root cause and that can't be removed; techniques can still have some success with autistic people but more slowly and modestly.

I relate so much. I can do public transit now without too much discomfort or anxiety (at least, where I live) because I know how it works and I was able to figure it out when I wasn't under any pressure. I can potentially do it elsewhere as well, if I take the time to figure it out in advance. Practice can help, but it has to be productive practice. Making the same "mistake" over and over again won't create mastery. What your therapist had you do was not proper exposure therapy. That was a recipe for retraumatization. What would have been better would be having someone assist you through the process, so that you could actually succeed. And repeated success can help. But if you're just getting overwhelmed every time, it's only going to make things worse.

Thank you for sharing. Hearing your real lived experience and your opinions is much more meaningful than listening to statistics or being read a list of clickbaity items.

I can relate to all this. For me exposure therapy or my failure at it was what led my therapist to suggesting I might have autism. It was awful trying the stuff that was giving me anxiety. I tried very hard at it too thinking it would finally "cure" me. It definitely didn't.

Strangely enough, feeling that I have to do something overwhelming can make it harder for me to do it. Often, when I allow myself to feel okay about not being able to leave the house, for instance, I find I’m able to do it in the end. I can see how exposure therapy could be highly damaging. NHS CBT is regularly meant to just treat anxiety. One of the problems with it is although it can be very helpful and I found it very useful in the past, a lot of experiences that affect anxiety like unemployment are often ignored or dismissed. To be told that you are catastrophising when you say you worry that you’ll never have regular full-time employment can come across as invalidating and also make you feel that if you had tried harder you could’ve just got a permanent job, so it’s your fault. I really think it’s vital to see a therapist who really understands neurodivergence if that’s at all possible. I’m using the DBT app and working through the activities in my in my own time. It’s been quite helpful so far. I hope that somebody listens to you because you’re right that there’s more than one way to get the same result and be successful without needing to get on trains every day or at all.

If you need any more evidence of how callous and irrational neurotypicals can be, just look at the extent to which the phrase "pull oneself up by their bootstraps" has been incorporated unironically as advice for anyone in a difficult situation. They've completely missed the point that it was meant to satirically refer to something that's physically impossible.