This is a linkpost for https://chrislakin.blog/p/just-one-more-exposure-bro
Just one more exposure bro
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I guess you could do both kinds of mistakes: more exposure when what you need is an insight, and more insights when what you need is exposure. Among the nerds, the latter is probably much more frequent. But yes, if you tried more exposure and it didn't work, what you may need is the right insight.
“But exposure works!” people yell from across the street.
Do not cite the Deep Magic to me, Witch.
In some ways, that's my fully general response to being given Standard Advice(TM). The giver may not know the Deeper Magic.You may not either, and you may not have been there when it was written, but if it doesn't sound right to you, you can look before deciding whether to buy into it.
In this case, that may be the layperson's standard advice, but it's definitely not the professional's standard advice, which can't be condensed to a single short phrase. Five Words Are Not Enough, because "exposure" and "works" are both so underspecified.
I'm also not a professional, so my version is also very incomplete, but at a bare minimum, exposure therapy needs to be done kinda the way building up tolerance for poisons or allergens is done - carefully, in risk-minimizing contexts, with support systems on standby if things go wrong.
To quote SSC, I think accurately despite being in a very different context:
Psychotherapists treat arachnophobia with exposure therapy, too. They expose people first to cute, little spiders behind a glass cage. Then bigger spiders. Then they take them out of the cage. Finally, in a carefully controlled environment with their very supportive therapist standing by, they make people experience their worst fear, like having a big tarantula crawl all over them. It usually works pretty well.
Finding an arachnophobic person, and throwing a bucket full of tarantulas at them while shouting “I’M HELPING! I’M HELPING!” works less well....
There are two problems with its approach. The first is that it avoids the carefully controlled, anxiety-minimizing setup of psychotherapy.
The second is that YOU DO NOT GIVE PSYCHOTHERAPY TO PEOPLE WITHOUT THEIR CONSENT.
If a person... doesn’t want psychotherapy, then even as a trained psychiatrist I am forbidden to override that decision unless they become an immediate danger to themselves or others.
Although, in another SSC post:
Exposure therapy can also be useful for panic attacks or specific phobias. This is where they expose you to the thing you’re scared of (or deliberately initiate a panic attack) and keep doing it until you stop being scared and start being bored. According to a bunch of studies it works neither better nor worse than cognitive-behvioral therapy for most things, but my unsupported impression has always been that it’s better at least for panic disorder. Cognitive-behavioral therapy seems clearly superior for social phobia.
1There's a form of exposure that does lead people to suppress certain emotions and become more functional in certain contexts. I think that frequently happens when people try to do a bunch of exposure therapy.
What that can prevent exposure for social anxiety from working are safety behaviors, e.g. having certain types of clothes or make up on, favorite item, mobile phone close/in your hand, etc., because you are then taught the wrong lesson from the exposure, i.e., "I only managed situation X because of [insert safety behavior]".
I wrote (in Hebrew, alas) two years ago, about locally-useful methods that doesn't have stopping condition. I'm sure there are people out there that will benefit from exposure. the attitude you described come from them, and from people whose bubble includes mostly them.
the problem is the luck of stopping condition. who many tries before you decide this method doesn't work? before stopping and re-evaluating? before trying something else instead?
also, what Scott Alexander wrote about exposure, and Trapped Priors.
I think you make the same mistake the exposure people do? you. are in a bubble when insight is what needed, so you advocate insight without stopping condition.
the interesting question, to me, is when, in for who long, try either.
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