Thread by @anarchoaltruism, Exposure therapy is used mainly for anxiety disorders and phobias as a [...]

Exposure therapy is used mainly for anxiety disorders and phobias as a way of desensitizing the person to the trigger. But when the triggers are things that happen to you every day, and you're still afraid, what do you do? [Thread]

My psychiatrist explained the therapy like this (metaphorically): Your brain thinks there's a tiger at the store, so of course it's going to get nervous about the store and try to keep you from going. It's trying to keep you safe from the tiger.

But the only way to fix that is to go to the store and show your brain there's no tiger. You have to push through your symptoms and show yourself its safe. This is done gradually. First you'd walk outside the store without going in. On a different day, you'd actually go in.

In something like arachnophobia, you'd be exposed to a spider in increments. First looking at a picture, then looking at a real one in a container, then one outside of a container and so on. Over time, you'd see the spider wasn't going to hurt you.

But what happens if, in the nature of your phobia, the tiger is always proven to be there? I have agoraphobic panic disorder because I'm afraid of all the people, sounds, smells, lights of the public, because theyll cause me to meltdown.

The stimuli will always be there, and theyll always be overwhelming in abundance.
In other words, the tiger is always there. And unlike the spider, it does always hurt me. No matter how much I'm exposed to it, I never learn that the tiger won't harm me.

The same is true for things like social phobia, where no matter how much you talk to people you'll always be nervous, and showing that youre nervous makes you more nervous, so you mess up what youre saying and oh fuck its a disaster! You didnt "succeed" in the interaction!

Increments alone dont solve things. When the tiger is ever-present how do you convince yourself it's not a threat?
1) Once you're activated (feeling a twinge of anxiety) step out of the situation and comfort yourself
2) Something called "completing the cycle"

There's no use in facing the tiger all the time if it's still a threat. All that does is reinforce to your brain that it needs to be avoided. But if you learn when to remove yourself from the situation and self-comfort, youre slowly telling your brain there's safety to be found

Comfort is the last step in completing the cycle, or it can be used on its own as above. The idea is that we have physiological responses to fear. In the wild, theyre meant to be burnt off quickly as it saves your life.

The antelope gets a rush of adrenaline that helps it sprint out of the way of the lion.
But when our triggers are maladaptive or psychological, theres either nothing to run from, or the thing youre running from is the trigger youre trying to expose yourself to

So we need to complete this cycle ourselves. Triggered > Adrenaline > Adrenaline burnt up > De-escalating > Comfort > Normal
(fun fact: animals will physically tremble for a while as a way to "shake off" the trauma!)

Generally, you burn off your triggered reaction with physical activity. Jumping jacks, energetic forms of stimming, anything that gets you moving and gets your heart involved.

Then, after you catch your breath and your body starts to calm down, comfort yourself. Comfort is highly personal, but it can be anything from hugging a plushie to calling a friend. It'll take some experimentation to find what works best!

In the long run you might always be apprehensive. Doing certain things might always be not-ideal. Ex sensory overwhelm will never be pleasant for me. But through exposure therapy you can teach yourself to be comforted in these situations, and be able to get through them alright

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