Anxiety and problems with exposure therapy

I’m trying to combat my anxiety.

Apparently exposure should work and I think it does to some extent but then after a while my anxiety level goes up again.

For example - using public transport.

At first I’m terrified and I’m trying to be prepared for every possible situation which makes me super stressed about every detail (what bus/train to take, from where, how to buy a ticket, what to say, how much it costs, where to get out and so on).

If I manage to do it I’ve got horrible headache afterwards and I’m so exhausted that all I want to do is to go home and lay down.

But to get used to doing it I need more exposure.

So I’m forcing myself to do something even though it continues to be anxiety provoking.

But then there are two problems.

First-even through taking train/bus from A to B might be less stressful than it was at the beginning, taking train/bus from C to D is almost as stressful as the journey form A to B was at the beginning.

Second-I noticed that after a while I’m getting more and more stressed and anxious going from A to B. I don’t want to do it anymore and I feel sick thinking about having to do it again.

And I should be fine, shouldn’t I?

Because exposure should work for anxiety.

I would like to be able to go somewhere by myself, without the help of my family.

I must be doing something wrong but what?

Ladybird over 5 years ago

Thank you for the replies.

My family is wonderful but it bothers me that I never go anywhere without them because of my anxiety. That I feel unable to go anywhere by myself without feeling anxious and exhausted afterwards. That others are surprised that I still can’t do something even though I did something similar before (“what’s the problem?you’ve traveled by train before”)

It must be nice to just decide something and do it...”Oh, I’ll go to the seaside this weekend and I’m going to have wonderful and relaxing time there”.

And then just go there and have a nice time.
Lotus over 5 years ago

Exposure therapy does not work for people on the autism spectrum because over exposure to sensory inputs/information causes us to suffer, not get better.

I find that I can cope better if I feel in control. I have to travel by bus to work 4 days a week and I minimise the stress by making sure I know the timetable and downloading an e-ticket from my local bus company's app which covers the area I'm travelling in for a set period of time, so when I board I just hold my phone under the scanner.

However it sounds like you are trying to learn to travel to various places you are not that familiar with, as you say you don't know where to get off? Or is it that you need to travel somewhere and usually someone goes with you but you cannot do it on your own?

If you really need or want to be able to travel on public transport, I can only suggest trying planning with the help of the internet & apps before you go. Find out if the train/bus company has an app that can help you plan your journey & download tickets. Use Google maps to see where you're going, which also has a "directions" function: it should link to local bus services and tell you arrival times and how many stops on your journey, and can show you the street view of places, so you know what your destination looks like. Travelling to the same place at the same time on a pre planned journey a few times may help you, as our brains can respond to routine, but don't be upset if it doesn't work out, it's not your fault.

Hope things improve for you 're the anxiety.
JohnS over 5 years ago

The trouble is that the problems dealing with social situations for Autistic people IS what causes the anxiety. Therefore, the more you expose yourself, the worse the anxiety will get. Your only options are medication to reduce the physical symptoms of anxiety or you avoid these situations all together.
Cupcake over 5 years ago

I get terribly anxious which is exhausting. Well done for challenging yourself. You are teaching your brain to react to a situation in an entirely new way. Perhaps see it as learning a new language or topic and being tested everyday. Keep talking about your experience and keep trying your brain in time will rework itself. Our brains can trick us into old habits. Someone recently said to me it's like an addiction. Your brain is used to using certain receptors and making new habits uses different receptors which require energy and new pathways. Each time you go out its an achievement. However small the step is a step closer to your goal. Reward yourself with the things you love and distract yourself with a song or story. Whatever works.
Kras83 over 5 years ago

Now first of all a disclaimer to this response as I am not yet diagnosed and neither is the friend that I talked to and neither are we any kind of experts, we've both just done a lot of reading to try to understand the reasons for things.

Me and a friend that is very similar in terms of the way that we view the world and the things that bother us had a messenger conversation about this sort of thing a while back as I had had CBT in which I was advised to get out there and do the things that made me nervous while not relying on 'safety behaviors'. The CBT was back when I believed that all of my issues were anxiety based, but this conversation was after the potential ASD realisation had set in.

As we saw it if the problem is purely anxiety then exposure therapy is fine as long as you don't try and take too big a step and hurt your confidence. With baby steps it should be very helpful.

If however anxiety is a symptom of something else and not the root of the issues you are having then exposure to the things you find cause you trouble may not be as good. We thought of it as a case of overloading vs fear, if the problem is that you are reaching the limit of what you can tolerate in a situation in the form of chaos around you, noise, social interaction etc then its not like you can just train yourself to endure more and more. The fact that things become harder again as you persist may be that you may find that your 'defences' are becoming depleted due to exhaustion.

This might not be the best example of what I'm talking about, but I'll use the experience of my families weekly supermarket shop from my point of view as an example. I often have trouble getting to sleep early, and as we go first thing in the morning there is a good chance that I might not have had a full nights sleep the night before. On those times when I have had good sleep and nothing else has bothered me that week shopping is 'fine' - not nice but bearable with my family. Give me a poor nights sleep and I start to find the beeping and other noises deeply unpleasant, and if the shopping trip takes too long I start to have real trouble focusing and turn into more of a hindrance than a help. Combine a poor nights sleep with a time period in which either something else is bothering me or the supermarkets are really busy and you have a trip through hell.

It doesn't matter that this is something I do every week, it becomes a 'straw that broke the camel's back' situation rather than something like building muscles through exercise (which I liken exposure therapy to)