Graded exposure can be a more manageable way to get to the end result (fear extinction), but reminding yourself that the threat isn’t real is a fear-neutralizing behavior that will limit the effectiveness of the treatment. The point of exposure therapy is to feel the fear and to do nothing about it other than let the feeling (eventually) climax and dissipate. (In fact, “lean in harder” can be even better than “do nothing”.)
[Edit: I want to emphasize this point for others who may find this post: if you are doing exposure work or you’re supporting someone who is, please don’t reassure yourself/them that the exposure isn’t dangerous. At best it undermines the treatment; at worst it reinforces the fear. When you violate your anxiety by facing a feared situation or idea, it will and should feel like you are doing something bad and dangerous.]
Second, graded exposure isn’t always necessary - flooding (direct exposure to the high level fear situation) works too, and can work a lot faster.
But I think most people with anxiety disorders have a number of fears not just a single isolated phobia - and they’re connected in a network of sorts. It’s often helpful for the person to experience success in extinguishing a low-moderate grade fear first, to grok the process and build confidence to approach their worst fears successfully.
In my experience, over-exposure to terrifying situations leads me to full-blown panic attacks, emotional dysregulation, crying, sometimes being trapped in a situation miles from safety with no way to get back, and being traumatized for days afterwards and (very rationally) avoiding the situation in the future. The people who want me to put myself into fearful situations are people who want to hurt me.
I’ve been there, and I get it. But if you’re on the path to extinguishing Big Fears, this is simply what the process entails. It’s really uncomfortable - until it isn’t.
> sometimes being trapped in a situation miles from safety with no way to get back
I’m not sure what you mean by this part. If you’re referring to the symptoms above (panic attacks, crying, dysregulation), I think you’d be better served to refrain from thinking of these symptoms as a loss of “safety”. They’re feelings of intense discomfort - but not danger. And they’re temporary.
> being traumatized for days afterwards and (very rationally) avoiding the situation in the future
Avoiding the situation post-exposure unfortunately “un-does” much of the benefit of the exposure: it reinforces the neural pathways that make you feel a sense of danger in the first place.
This is not the pattern you went to be in. If you’re finding it too difficult to resist this, it might be a good idea to begin with smaller steps. That means doing less intimidating exposures so that you can be more successful in sticking with it until the fear comes down.
> The people who want me to put myself into fearful situations are people who want to hurt me
This is absolutely not true. No one gets sadistic pleasure out of the temporary pain that anxiety treatment brings. It’s just the price of getting better: to conquer your fears, you have to go all the way through them. By analogy, you can’t get physically fit without first going though some soreness and discomfort.
Based on what you wrote, I’d highly recommend finding a therapist who has expertise in exposure with response prevention. They will know, from having treated many others in your situation, how to design a treatment program that meets your needs and that you can succeed in.
The specific situation was trying to bike to a doctor's office late in the afternoon after being unable to go earlier due to non-24 sleep disorder and executive dysfunction and struggling to pack and get out of the door. After being slowed down beyond my plans by unpaved roads, traffic lights, and parking lots, I got turned away from the door when the office closed, and did not have a safe way to get back home, since the sun was setting, I was not prepared for the cold weather, and I could neither safely stay outdoors at night in an office park without food or shelter, nor safely bike home while crying, and did not have a ride arranged.
Growing up, my parents punished and traumatized me for not getting straight As in classes and cramming for extracurriculars, judged my worth based on academic performance and following their orders, fed me stories about how not getting into a top college would turn me into a burger-flipper, then forced me to the most difficult computer science program in the country, which together pushed me into burnout, dropping out, and a years-long CPTSD mental breakdown. They tried to force me to become their idea of a top student, ignoring the existential harm they caused.
Similarly, other people ignore the harm they cause (regardless if they want to hurt me or not) when they want me to put myself into unpleasant situations which have hurt me in the past for little gain (for example failing driving exams time and time again, the above-mentioned biking trip, rude and disrespectful doctors delaying care for an hour and then complaining when I asked questions and couldn't make decisions quickly enough, and psychiatrists who refuse care when I go nonverbal and want to communicate over text), and blame and accuse me of being "self-destructive" when I refuse to do as told.
> Avoiding the situation post-exposure unfortunately “un-does” much of the benefit of the exposure: it reinforces the neural pathways that make you feel a sense of danger in the first place.
It is perfectly rational for me to not harm myself further by seeking out situations which (promise benefits, cause substantial harm, and the benefits fail to materialize as expected), and for me to avoid people who pressure me to do so. If I find a route to doing things which benefits me more than it hurts, then I will start doing it.
I’m very sorry you’ve had bad experiences and difficult circumstances. Of course, no one can make you follow a treatment protocol: you have to want the freedom that comes with conquering your fear, and be willing to go through some discomfort to get there. It’s a very personal choice.
I will say again that if you’re inclined, you might consider starting with something that seems like a small challenge. Even a small victory can really boost your confidence and motivation. Finally, you might consider working with a therapist. Telehealth is a nice option that works well for many people.
Graded exposure can be a more manageable way to get to the end result (fear extinction), but reminding yourself that the threat isn’t real is a fear-neutralizing behavior that will limit the effectiveness of the treatment. The point of exposure therapy is to feel the fear and to do nothing about it other than let the feeling (eventually) climax and dissipate. (In fact, “lean in harder” can be even better than “do nothing”.)
[Edit: I want to emphasize this point for others who may find this post: if you are doing exposure work or you’re supporting someone who is, please don’t reassure yourself/them that the exposure isn’t dangerous. At best it undermines the treatment; at worst it reinforces the fear. When you violate your anxiety by facing a feared situation or idea, it will and should feel like you are doing something bad and dangerous.]
Second, graded exposure isn’t always necessary - flooding (direct exposure to the high level fear situation) works too, and can work a lot faster.
But I think most people with anxiety disorders have a number of fears not just a single isolated phobia - and they’re connected in a network of sorts. It’s often helpful for the person to experience success in extinguishing a low-moderate grade fear first, to grok the process and build confidence to approach their worst fears successfully.