Doctor says I need 'exposure therapy'

[pjcnet]

Does anyone else find that if you do go out regularly by yourself to places, the neighbours and people around you will start thinking you’re weird always being alone that it stops you from going out at times?

It depends where you go, lots of everyday places are perfectly accepted for people who are alone, E.g. normal shopping including the supermarket. It shouldn't really matter what other people think, but sadly when you visit places where there's entertainment and/or socialising then unless it's designed for singles, it is more accepted that you're with at least 1 other person, this includes going to many bars / night clubs (it can be different if you're a regular that knows many people including staff), restaurants, cinema (I still used to do it even though I was usually the only person I could see on their own), theatre, other ticketed events, day trips (E.g. a coach trip to a theme park), many holidays (and you often have to pay single supplements unless it's a singles holiday), yes it is a shame that our culture can sometimes look at down at people that are alone in certain places, or worse even feel sorry for them.

For instance when I was younger I went on a day excursion coach trip to The Isle of Wight and I felt really out of place as I was the only person alone, it was somewhat worse when an elderly couple started feeling sorry for me asking me to walk around the attractions with them, even though I know they were only trying to help it still felt really uncomfortable. If you go out to a night club alone it can potentially be a lot worse still because if you just stand there not being able to socialise and/or dance you could be noticed by other people thinking that you are "weird" or even "sad and lonely" (these are the words they would probably use), especially if you keep going alone on multiple occasions and it can sometimes be made worse where there's often more younger people due to some of them being immature.

There are however more social groups around these days including for people with social anxiety and/or autism, you may even find some on meetup.com in your area or perhaps via a charity. If you live in the UK non profit activity and social group 18 Plus is very good if there's a group in your area and you are between 18 and 65 years old, they have numerous members who have social anxiety (many have overcome it thanks to the group) and/or autism, they also have quite a few disabled members.

 

[entropy4money]

I saw doctor and she says I must start making myself go to places where there are people. She says a little at first and build to more time. I am supposed to do it every day.

Everything I do is to avoid being around people. This is the most opposite. I think this will be terribly difficult but I think my doctor is right and I agreed. She says things that bother me now will bother me less or not at all after enough exposure to them because my mind will adapt. I may not be quoting her correctly but that is I think, what she means.

Hi grommet,

I totally agree with your therapist. Social interaction comes natural to neurotypicals, and not only that, they enjoy being surrounded by people. Crazy right? I have Aspergers and as you may guess, I don't enjoy being surrounded by people. It is extremely exhausting and stressful.

However, we live in a high social world. If you want to survive, and thrive in this world you simply have to learn how to play the game. It is possible, it worked for me. I might not be socially talented, but I am a rational person. When being exposed and vulnerable, you will learn to adapt by rationally understanding human social interaction. This isn't easy, and it takes a long time to be somehow "normal" in a social environment, because human social interaction is an extremely complex dynamical system.

It is difficult, but it is possible to learn to be somehow social. And in the end you might even start enjoying some parts of it. I like to find somebody who I can have real, productive conversations with, go to a bar that's not loud and doesn't have much people, have a nice craft beer and have interesting conversations with one person. Sometimes I also enjoy sitting and thinking about other people around me, what they do, what they are doing in the bar, why are they wearing certain clothes, why are they having a certain drink, etc... doing this is a little weird and a bit fun, is kind of getting in your own world in a social environment, you might look and feel weird, but try not to worry about it; you will be surprised from what you learn by asking yourself these questions. When you go to the bar, you wear what you wear to be comfortable, you picked a certain drink cause you liked the taste, you are in the bar to learn. Most of other people will be wearing clothes to impress other people, having a certain drink because it is a popular drink to have, being in the bar cause they actually enjoy being in a tuna can, etc... you will learn what people do, and why they do it, and you will learn to copy some behavior and use it to your advantage in certain social situations to get something you want. That's how we succeed in a neurotypical social world.

 

[Haiku]

I saw doctor and she says I must start making myself go to places where there are people. She says a little at first and build to more time. I am supposed to do it every day.

Everything I do is to avoid being around people. This is the most opposite. I think this will be terribly difficult but I think my doctor is right and I agreed. She says things that bother me now will bother me less or not at all after enough exposure to them because my mind will adapt. I may not be quoting her correctly but that is I think, what she means.

Exposure therapy (which, you're right, this is quite arguably a form of exposure) is the quintessential example of a therapy that is effective, but unpopular among patients, and understandably so. That's probably why your therapist didn't say "Great, we're going to do exposure now!" Even the word has an unpleasant connotation.

But, like I said -- it's effective. That doesn't mean, per se, that it works in every single case... but, in the vast majority of people who do exposure therapy under the guidance of a therapist, they see improvement in their anxiety. It may be worth your consideration. But if you really don't want to do it, tell your therapist; just be honest about this. They'll possibly switch to another kind of treatment, like CBT alone -- which has proven to be equally effective if not moreso than exposure alone (Ougrin 2011) -- although they work even better together, which is likely what your therapist is trying to do.

 

[watersprite]

@grommet I am like you in that I have to avoid people.
I did use exposure therapy but I applied it specifically to a situation which mattered a lot. In order to travel, I had to learn how to not panic and run out of airports. (this had caused massive problems for me and my loved one, as well as losing a lot of money)
I still avoid all other crowds.
I found a technique that works extremely well. If you want I can PM you about it.

 

[Kirsty]

It depends where you go, lots of everyday places are perfectly accepted for people who are alone, E.g. normal shopping including the supermarket.

I concur. I deliberately do my food shopping once every few days instead of one go to last me a while as it encourages me to get out the house and add a bit more meaning to my life. The supermarket in my location have two stores spaced out and they have a café that sells hot and cold food that's quite cheap so I go in for a coffee and a bite to eat by myself. I'm comfortable with that. For some reason, it's walking down the street to get there and back home that I stand out more as a loner. I listen to music to distract those thoughts which helps a bit.

 

[Judge]

I have mixed feelings about such things. I mean, I once pushed myself to join a social club thinking it might be a good exercise to put me out there with people on a level I could handle.

I remained a member for about four years, but began to realize that I wasn't getting anything out of it. That I was just "pushing myself" socially for the sake of being pushed. No joy. No sense fulfillment. I still felt completely alone in a room with some 40 men.

I quit some three years ago.

Yes, I can push myself if or when required. But does it actually achieve anything? Maybe- provided it involves a real need to interact with others with an important purpose. But something like this? I just feel let down.

I guess I'll always have that feeling of being on the outside no matter what the circumstances are. Perhaps this is a major tenet of being on the spectrum. That feeling of being alone whether it looks that way or not.

 

[Beguiling Orbit]

Toward what end, @grommet? I think everything should have a purpose. Never mind what your therapist wants you to do. What do YOU want to get out of the experience?

 

[Collector]

I have to admit I first read the title and grinned thinking of it in another inappropriate way. But seriously, while I do believe exposure therapy works I have found for me it is not sustainable when done to a large degree. I favor the approach already mentioned of compromise. Do some in critical areas, but reserve other areas for solitude and recharge/detox time.

 

[ginarex]

There are two things being confused here: Social Anxiety, which may be learned from bad experiences and will respond to "exposure" (cognitive behavioral therapy) and Asperger's, in which the aversion to social stress would seem to be part of our personality; you can't "make it go away". It's who we are.

 

[Judge]

There are two things being confused here: Social Anxiety, which may be learned from bad experiences and will respond to "exposure" (cognitive behavioral therapy) and Asperger's, in which the aversion to social stress would seem to be part of our personality; you can't "make it go away". It's who we are.

Depends on a medical point of view I suppose. Given that there are different schools of thought as to whether social anxiety is a separate, but frequently comorbid aspect of ASD, as opposed to the school of thought that stipulates that social anxiety is an inherent trait of ASD.

I'm still trying to find out which is closer to the truth, but without anything definitive at the moment. Where such things presently remain academic distinctions.

 

[keebles]

I tend to find that exposure therapy doesn't work for me personally, but everyone is different. The more I'm exposed to the outside world, the more I need to retreat for longer periods of time to get over the exposure. Every single therapist and shrink I've had have pushed me to do it and I've stopped fighting them on it...I can't make them understand that I like being anti-social and that I function just fine and always have. I'll never understand why they force it so much, especially on an Asper. I also tend to get meaner the longer I'm forced to exposure therapy, so eventually my bosses will have me tell them to back off for the safety of my job anyway.

But there are times when my anxiety goes through the roof, like right now, and I can barely go get gas, much less go to the shops unless it's an emergency or I can't find someone to go with me. I'm dealing with it, but it is extremely hard and my therapist is screaming at me to do exposure therapy again.

What I'm doing now is, when I start to panic, I just back up in a corner until it subsides. It might mean I'm in the store or wherever longer than I want to be, but it's better than leaving and having to come back later and fearing that they remember me running out in a panic. At work, I just "go to the bathroom" a lot to calm down. Thankfully, I do have my own office, so I can close the door a lot too. But I still don't go out anymore than I have to, probably a lot less, or I wouldn't be driving around with nails in my front tires right now.

In the normal day-to-day, I've trained my brain to imagine I'm alone in social situations, be it the store or work or whatever. My brain tends to go to my "happy place" while my eyes do the work of getting what I need or do the interacting parts and I can blur out everything else until I can get back to the safety of home, like being in a safe bubble. If it's something massively social, like a work thing I can't get out of, I tend to shut down completely and go to auto pilot so my mouth is running, but nobody is home in my head. In times like now though, I can't really do this little trick because my brain is just running way too hard and fast. So I just have to suck it up and hide in corners and bathrooms.

Ultimately, if there is one thing I've learned, if it doesn't feel right in your gut, it's probably not. You just have to differentiate between that gut feeling and just not wanting to do it because that "not wanting to" urge can mimic that "gut feeling" urge just to get out of doing things.

 

[grommet]

People are giving many responses. It is a lot to read and think about but I appreciate all of your thoughts. I am considering things said, what my doctor said yesterday and trying to understand what I think.

I think there are some things that we aspies cannot do and forcing ourselves is unfair and only causes problems. I also think it is easy to pull away so gently from what is difficult that we do not realize we pulled back further than we needed. It is hard to understand what you are capable of. I am good at forcing myself to do things I don't like. I am not good at understanding myself, at knowing what is right for me.

My mind is such a confusing thing and it is always with me.

 

[keebles]

People are giving many responses. It is a lot to read and think about but I appreciate all of your thoughts. I am considering things said, what my doctor said yesterday and trying to understand what I think.

I think there are some things that we aspies cannot do and forcing ourselves is unfair and only causes problems. I also think it is easy to pull away so gently from what is difficult that we do not realize we pulled back further than we needed. It is hard to understand what you are capable of. I am good at forcing myself to do things I don't like. I am not good at understanding myself, at knowing what is right for me.

My mind is such a confusing thing and it is always with me.

There you go! I'm just the opposite...I know myself inside and out, but making myself do something I'm not comfortable with is the ultimate fight, well that and convincing the "powers that be" that I know what's best for me versus what they think is best.

 

[garnetflower13]

Grommet, if you were a plant that thrived in partial shade, and someone decided that you should be put in full sun until you got used to it, it would not be a good thing. Just sayin'...

 

[grommet]

Grommet, if you were a plant that thrived in partial shade, and someone decided that you should be put in full sun until you got used to it, it would not be a good thing. Just sayin'...

Thank you. I think what you are saying is not light, it hints at something serious. In wanting to get better, aspies have followed recommendations that have led to serious consequences for them. A plant that thrived in partial shade would die in full sun. It is a shocking image but perfectly apt. Aspies don't always make it, some die trying. I apologize if me saying this is too upsetting for some. It's just that what Garnet is saying is true and I know aspies and have found out about aspies who couldn't do the unnatural thing they were asked to and try with everything to do. Some aspies have literally starved. Those around them though forcing them into independence was the hard but right thing to do but it turned out those persons did need help and could not manage everything on their own.

We as aspies do have real and not imagined limits. I do not know what to do for myself but I am trying to figure it out. My doctor seemed calm and certain about her idea. I like her and don't want to disregard her but, aspies know aspies, others will never really understand. So I am listening to what I am being told here too. I only want to get along in life better.

I think I am going to try doing a little bit of what my doctor has said and see how it works. I do not know if I will know what the honest limits are. There is an idea in problem solving. It is the idea that the first factor is at your feet where you are standing but you begin figuring after your first step so you always leave out the that first obvious clue. You do not solve the problem no matter how hard you work and keep wondering what is missing. You must start at the beginning but I do not know how much wisdom it takes to know where that is.

I am thinking.

 

[AspieWatchmaker]

Not sure I can add anything more, but I agree with most everything that has been said. Comfort zones have to be broadened slowly over time, by going to your limit and seeing what's there, and how long you can tolerate it. For those of us on the spectrum it can take a lifetime, but it is well worth the effort. Don't let your therapist push you too hard. Knowbody knows you like you.

 

[Ylva]

I thought the whole point of exposure therapy is that you get to see that a threatening situation is not threatening after all. It is entirely possible that most of us are socially anxious because of childhood trauma with social situations. Therapists don't seem to understand the extent of it – I have been to several, and they would not stop minimizing my experiences. I think them all incompetent.

But back to the point… Maybe exposure is the way to go, if you are capable of experiencing it as nonthreatening now, or if you can tell yourself afterwards that it was safe. How long does it take to reverse twelve, fifteen, eighteen years of experiences that told you the opposite? You'd have to ask you're therapist.

 

[Grandmother B]

Then what should I do? When I go out I am .. I take in all the lights and sounds and movement and colors. My brain seems buzzing with it all even after I am alone again and I need a lot of time to make it settle. But I have been having worse anxiety even though I am having fewer of these things I find stressful.

I am only using a few variables in my equation but I am thinking, 1. I decreased exposure to external stress 2. For a while I felt better, then my anxiety grew despite the quiet time alone. I conclude (weakly) that this means that without enough outside stimuli I am creating my own stress and have not solved my problem on my own. If my planning has not worked (assumption) I should listen to someone else. My doctor has authority so I will trust her.

That is my thinking, I am not saying that any of it is correct. Simply, I am having what feels like an increase in anxiety and it has reached a level that I am suffering so I want change. With no further ideas on my own I am taking my doctor's advice about exposure therapy. I am open to other advice as well. I only want to do what's best. I do so much want to feel better. I am embarrassed am I am grown and still capable of so little but I try as hard as I can.

Have you heard of or read anything by Temple Grandin? She is autistic and has made a great success of her life. I am sure she has some advice and help for you. Here is a link for her books on Amazon. I hope you will read about her and how she got to where she is. I pray and hope that you can get a control on your anxiety and be able to enjoy your world. Blessings! https://www.amazon.com/Temple-Grandin/e/B000AP9AQU

 

[Karen S.]

Does anyone else find that if you do go out regularly by yourself to places, the neighbours and people around you will start thinking you’re weird always being alone that it stops you from going out at times?

People really aren't paying that much attention to you, they're focused on their own world. I know it feels like everyone is staring at you, it took me a long time to realize that. Just be aware of your surroundings to keep yourself safe.

I'm nearly always alone because nobody shares my interests! If I waited for a family member to join me, I would never go anywhere. I know this because I had to stop driving for nine months because of Double Vision and trying to get a ride felt like I was asking for the World!

If I know that I'm heading into a busy location I will take Ibuprofen before I leave. it helps prevent getting a Migraine! I also frequently wear a baseball cap to shield my eyes from the Sun and overhead lights, this helps me focus on my path and prevents my eyes from going nutty on me!

 

[Bella Pines]

It depends what it is you need and what you are looking for.

If you need to function in society for some reason then small, short, brief and limited exposure is good practice. You're doctor is mistaken by claiming that things will bother you less or not at all. They will probably always bother you, but you will adapt and by controlled exposure, you will learn how to mimic neurotypical behaviour and mask symptoms.

But the real question is whether you need to or not.