The Extinction Curve And Making A Plan

This past Friday I had the second appointment with the CBT guy who is supposed to help me work through this emetophobia. The appointment included a required background questionnaire that frustrated us both as we plowed through a bunch of extraneous crap that wasted a lot of what could have been otherwise useful time. Eventually the conversation did turn to the topic at hand, and I was able to fill in some cracks in his understanding of my circumstances that became apparent to me after I had time to process our last appointment. I also detailed a somewhat new realization that pretty much every time I have found something that gives me some joy in life it is eventually sabotaged by these fears.

In the short time we actually had to address the important issues he laid out a couple successful treatments he had used for other phobias. The conversation centered around what he called the extinction curve. This is basically the idea that repeated exposure to a phobic stimulus will eventually retrain the brain to react to the actual circumstances rather than some perceived threat. Though I never really knew it had a name the premise is something I am familiar with and actually used in aviation training as both a student and instructor. He also pointed out that while constant exposure can decrease anxiety avoidance will increase anxiety over time, as the mind will allow fears to grow unchecked by any doses of reality.

The two examples he used to explain what he was thinking of doing related to spiders and needles. In the case of needles to ensure the lack of exposure didn’t undermine the patients work the final phase was the repeated donation of blood at the minimum recommended interval. Having actually seen both sides of this, exposure and avoidance, work in airplanes I was buying into everything he had to say. I was having a little trouble trying to figure out exactly how it was going to be applied to my circumstances. The obvious challenge is that I am not afraid of anything that can be isolated in such a way. My problems stems from a fear of my own body’s reactions to scenarios I have no control over. I am essentially afraid of myself because I don’t trust my own body. I was eager for him to explain how he planned to apply the theory to this circumstance when he told me he had some homework for me. He wanted me to consider ways in which my fear could be addressed using this technique. I was a little taken aback by this. I had so hoped that he had dealt with the specific issue in the past, and had some basic framework for a strategy we could apply to me. Apparently he does not. Now I assume he is going to put his own work in considering the question, but initially I was not impressed with this turn of events.

At this point a few days have passed since our conversation and I am coming to look at the problem from a new perspective. He and I have talked about the specifics of this issue for a little over an hour. I have lived with it for thirty years. How could I expect him to come up with a plan to fix something as complex as this with such little information work with? The reality is that when you live with a phobia for this long it finds its way into spaces of your mind that you would never expect. Nobody knows about those spaces but me, and it would take months of weekly one hour conversations for him to even begin to wrap his arms around it. I find this truth somewhat discouraging. I appreciate there is a great deal of value in being part of your own solution, but I really hoped he would bring more to the table initially. Upon reflection I can see that he cannot provide the whole solution on his own, but I am not sure it is in me either. I have some thinking to do.


8 thoughts on “The Extinction Curve And Making A Plan

  1. Don’t underestimate yourself here. This is the point of the process of recovery, and this is why so many people leave it. To be blunt, they come into the therapeutic environment hoping that the expert will be the expert on them. Part of your conclusion is correct; he is an expert on human behavior and on phobias in general. That’s good. Another part of your conclusion is also correct. You are the expert on you. While you are feeling discouraged that he isn’t giving you The Solution after an hour of conversation, you could feel encouraged. Discouragement is a choice. You are right. You have lived with this for over 30 years. He is just getting to know you, and he is choosing to be collaborative. A collaborative therapist is a gift because they are rare.

    What if he did the opposite? What if he did the equivalent of “Take two pills, run around your house with a bra on top of your head holding a lightning rod in a storm, and drink and entire bottle of moonshine, and you’ll be cured.” Would you have felt any better? It takes years for a phobia of your kind to become as entrenched as it is, and you are going to be the one getting your hands dirty, digging out the roots, finding where each piece of it lives, crawling into the hidden places. You’ll be doing the heavy lifting. Ultimately, he can only tell you to lift with your legs, not your back, and make sure that you don’t hurt yourself. This is going to take a long time to get resolved. Why be discouraged when you could just as easily settle in and take your process of recovery a day at a time? Who knows what you’ll discover about yourself? You are the expert on you. You are your best advocate. He’s just helping you find the light switch even if you are finding it awkwardly. Commit to the process, and you’ll find it. I did…

    • Believe it or not I once had a visit with a therapist that was less helpful than “Take two pills, run around your house with a bra on top of your head holding a lightning rod in a storm, and drink and entire bottle of moonshine, and you’ll be cured.” I dont know where some of these people get their training. Needless to say that was my one and only visit. The truth is I am happy to be involved in the process, and I think if anybody in this area is going to be helpful it will be this guy. I dont know, maybe I hoped for a little more guidance? We are not talking about an easily recreatable circumstance. Its not like sitting in a room watching spiders. While it is no doubt terrifying for the patient it is nonetheless an easy scenario to facilitate; Get spiders, Get patient, Stick’em in a room. I am working on it though, and definitely committed.

      • I can believe almost anything when it comes to mental health professionals particularly now. OMFG….why? Why do these people even bother? No, your situation is certainly not simply. I wasn’t normalizing it or oversimplifying it. Exposure therapy in your situation? I don’t know…what would happen if you took a dose of Ipecac? Or, if you went and visited the ER for a while? Just sat in there where sick people are? Got yourself nice a triggered. There are ways to recreate a scenario where you could work yourself up about puking. I can do it. Sometimes if I forget to wash my hands after I’ve been running errands and they *feel* dirty, and I know that a stomach bug is going around? And I remember the last time I puked, how awful it was….then I remember that I ate something and it could be in my system right now….I could be in the prodromal phase of a viral infection….Oh boy….I could get myself nice and worked up. I’m salivating just a bit right now writing about it. That’s exactly what anxiety is. The point is to do it on purpose. That’s how I stopped “blinking”. I had to do it on purpose. I had the “victim blinking” or flinching problem for years, and I didn’t know it. So, I had to do it purposefully. This is hard stuff, and I’m writing too much probably.

  2. Yes that is where I have always stumbled. We essentially fear our own bodies. How will that be dealt with? I am not sure I could come up with much – I look forward to hearing what you come up with. Best wishes xx

  3. You are doing a lot of hard work right now even though you want a black or white answer. The answer is found in the process of being aware of your phobia and considering how it has affected you in so many ways. Good job!

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