When exposure doesn't seem to help

This is mainly about social anxiety.

The big long term treatment for anxiety is exposure. You all know the drill. Start with smaller things and work up to more difficult ones. Challenge yourself, but don't overwhelm and fail too often. Be mindful of the experience and aware that it's actually okay. Repeat until symptoms lessen, mastery and confidence improve.

Supposedly your life gradually improves and expands. Supposedly you feel better because of your successes.

Okay. Great. Makes sense.

What about when it doesn't ever seem to help? I can't begin to tell you how many times I've gone out there and pushed myself and got things done. It was hard. Some of it was unbelievably hard. But I often got it done. The problem is I just feel worn out and not at all more comfortable with things. No matter how many times I do it.

Sure I know I can usually do it if I expend my energy and eventually burn through my emotional resiliency and reserves. I can't sustain it. It doesn't get rid of the anxiety or the bad self-talk. Cognitive therapy hasn't worked out for me either. It never gets any better.

At this stage in my life I do actually have skills in this regard. It just still feels rotten. And yes, I do want more out of life.

Something really isn't working or is missing with my exposure experiences. Any ideas?

In your personal experience, how does one successfully do exposure? What process or details help you derive benefit from it, rather than just getting through it?

Hate to sound like a pill pusher, but have you tried anxiety Meds?

Here's two things that help me personally:

1) It helps if the exposure is something I actually genuinely WANT to do but would usually avoid. If I feel forced into it it's not on "my terms" and so I don't get a sense of control and the anxiety remains. I grow a lot more when it comes from inside.

2) While doing it, pay attention to your mindset. If the mindset is "ok I just have to get through this and then I can go away and relax" then that will not help as much. The mindset needs to be "I will find a way to become more relaxed right now, WHILE I am doing this." Always turn your attention back to your own needs rather than what is required of you or what other people may be thinking/expecting. If the focus remains on "getting through it" the anxiety will also not subside. You want to get away from the mindset of being relieved that it's over and instead trying to break it down into smaller pieces. Like if you were anxious about public speaking, maybe it feels like "okay I have to do the speech and just get it over with" but maybe you want to shift that to "ok first I have to walk up to the podium--good! I did that, what next? Oh yeah, now I have to bring up my slides. How do I do that? Okay, I brought them up." etc. Then you can learn to get better at each step individually and that makes it easier to raise your confidence level.

Usually the anxiety fails to get better if there is a lack of specific awareness of what is happening. So it's important to notice the steps and the details and ask yourself how you are feeling in each moment. Don't know if that helps but thought I'd chime in!

It feel like I could have written your OP. I've been battling the social anxiety issue for a long time as well, and like you the exposure hasn't done much. Nowadays I can 'perform' better when I go out, but it is still exhausting, and no more comfortable than it was 20+ years ago. I'll still experience visible shakes from the fight or flight adrenaline response being so strong, and the stress will start burning through my stomach if I do too much.

Only in the past year have I finally begun to make any kind of progress, and I would attribute that progress to having been referred to a therapist who appears to be better tuned in to what I need, and is more responsive to what I bring forward during our sessions. As I work through exposure with my therapist we are also approaching what is behind the anxieties, rather than simply trying to deafen myself to the symptoms. This part I am struggling with since I'm not really able to open up, but hopefully I'll get there at some point.

If you feel like something is missing from your exposure experiences, perhaps the support you have is not enough? Getting matched up with my current therapist felt a bit like I went from wandering aimlessly in a maze, to having someone in my earpiece guiding me through that maze. It makes a world of difference.

Shazerac, I'd be willing to try. Sadly they are not on offer for complicated reasons that would drag this thread unhelpfully all over the map. But thanks for the thought.

magicalprince, thank you.

Item one is usually okay for me these days.

Item two is what I'm mostly thinking about. It's hard to stay focused on those mindfulness things when all my neurotic, hyper-vigilant and ruminating mind wants to do is fuss and gnaw at the details. But I'm glad you chimed in. That all sounds about right. I just wish I had more of a guide or support -- which brings me to ....

Thanks nextstep_butwhat. Yeah I truly wish I could find a therapist that was a good fit for me. I think that would really help with this and a few other things. My experiences with therapists have tragically ranged from ineffective to "sub-optimal" to quote another PC denizen.

I have a limited duration therapist at the moment, and honestly, so far it hasn't been great. But he's trying, and I'm trying. I'm hoping it will be adequate when I bring this up with him in detail. But I'd still be happy to hear any thoughts, methods or experiences from other people here on PC.

Hi Cep. Sorry you're struggling! And that I haven't been around PC as much as I used to. I'm still checking in regularly!

I sympathise with your post.

It isn't that we can't do the things that test us. It's that it is just very tough on us, all the time.

I recently remembered a book that had a big effect on me about fifteen years ago. One of the few self-help books that really works. (It's available as an e-book now for a few pounds).

It's called 'Hope and Self-Help for Your Nerves', by Dr Claire Weekes.

You can also find clips of her on Youtube.

She was one of the originators of the CBT idea.

She was a sufferer herself.

I'm about halfway through the book, and I'm really impressed! She has very interesting things to say about the 'exposure' model. In essence, she seems to think it can do more harm than good, as it adds to the stress.

If we're forcing ourselves to do things, and feel physically wretched afterwards, that is going to make us want to avoid the situation even more.

She has an ingenious (and gentle) alternative. It might be worth taking a look.

Big hugs.

I know that feeling. It's like, compulsive and you can't get a handle on it. Honestly I was never able to make any headway until I was first able to do so within the context of a supportive relationship. Sometimes these things are just deep trauma networks that are hard to get a handle in in an environment where you don't feel like someone is there for you. Maybe it's like that for you too and you're right about finding enough support being the issue here. Hope you can figure something out

Hey Purple!

I'm actually doing okay the last few days. I thought this would be a good thing to ask here.

(But then, I thought commenting on meatloaf was a good idea -- so there you go. )

It's always good to see you around.

Oh that sounds interesting. Thank you, I'll take a look.

And since I'll still have to expose myself to life at least a little, I can work on the other and do A/B testing on the two methods.

I hope you're doing alright.

Hey Ceph .. I’ve found similar, exposure often doesn’t really help..
(Pills .. heh, if only. Sorry about that bit.)
I agree that Claire Weekes is worth reading
(I read something by her long ago.. maybe I’ll take another look ..yeah I agree that forcing ourselves to “do things” that make us feel absolutely wretched isn’t always the “best” approach It can increase “avoidance” too )

This! Exhausting is the word that sums up the social anxiety experience for me. Even when I'm in a good state of mind & feel up to interacting, doing so is so doggone tiring - it's like running a marathon whilst balancing a stack of wine glasses.

As per magicalprince's post - limiting exposure to things that I genuinely want to do, seems to help - forcing myself to do things I hate, seems to set me back. Sadly, that approach is not always possible...

Sorry you're allergic to the meds, Fuzzy. That must be really tough. And I see that you tried them again recently

You've read Claire Weekes, too!

Cep, Claire's approach is all about acceptance. The part where she deals with accepting physical symptoms (of dread and fear etc) is the most interesting to me.

At one point, she teaches the reader how to (safely) induce a panic attack!