Personality Disorders Community Check-in: August 22nd–August 28th

@Xe

The exposure therapy stuff is super-interesting. Was reading through this book and was really impressed with the amount of research and how unexpectedly nuanced/individualized/compassionate the process is:
https://archive.org/details/prolongedexposur0000foae/mode/2up

The classical understanding of the exposure stuff seems to be that that there's a habituation that takes place:
1) Within-session habituation: if a person experiences something, initially there might be a big response but the longer they experience it, the less of a response they have to it (within a single experience)
2) Between-session habituation: the next time they come across that thing, the initial response is diminished

Source

[This is research from like 40 years ago, but the graphs really felt like they clarified what's happening and what the time scale is. Like people really have to wait 20, 30, 40 minutes before their nervous system acclimates.]

It seems like recently there's a bit more controversy around the actual mechanism of what's happening, and some researchers are saying that it's not so much habituation but rather that people just get used to experiencing fear and become more accepting of it. (Either way it seems to work somehow.)

An important part of that process, which I like, is that there's this initial step of creating an exposure hierarchy (grading a bunch of situations from least anxious to most anxious) and only working on the low end of that spectrum and waiting until those situations become less anxious before moving up to the next thing. Addresses a concern that I had of "aren't you just re-traumatizing people and increasing their fear". The book was really sensitive to that. I imagine people who try to do self-directed exposure but don't have success with it maybe go up the hierarchy too quickly.

The book also mentioned that self-directed exposure sometimes isn't as effective because it can help a ton to have a therapist be there basically cheering you on, telling you you're doing a great job, encouraging you to keep going even if it's challenging, and giving some authority/trust to the process of "this is exactly what's supposed to happen and don't worry it'll get better and here's why based on the theory/research that underlies what we're currently doing".

Another key point that I wasn't aware of is that clients aren't supposed to do any relaxation techniques, deep breathing, etc. during exposure. Because then the association/interpretation will be "I felt better because I did this relaxation technique" rather than "this thing is less scary".

I wonder though if there are certain populations where this kind of thing just simply doesn't work, or maybe the exposure process would need to be much more slow/gentle (e.g. autistic spectrum)