What kind of therapy do I need? (Pt. 2)
June 26, 2024 12:54 PM Subscribe
I have what I consider disproportionate anxiety responses to situations and want help from a therapist, but the therapists I've worked with seem to struggle to treat anxiety that is highly situational. Is there a solution?
The therapists and therapies I've worked on with anxiety seem to expect that my anxiety is something I can track and monitor every day. (All used a combination of approaches but incorporated some CBT, DBT, and ACT.) But I can go days, weeks, or occasionally even months without experiencing anxiety symptoms.
When I encounter a situation that triggers my anxiety, my response is severely disruptive. Not being able to focus, concentrate, or sleep, clenching my teeth hard and often enough to cause dental problems, and having crying meltdowns including in inappropriate settings like at work or in public. These symptoms go on as long as the situation is present and immediately vanish when the situation is over.
After that, I have no symptoms or ongoing concerns to bring to my therapist. I'm content, I sleep well, my body feels relaxed. I show all signs of excellent mental health. Until another triggering situation comes up again.
The issues are not only that these symptoms are disruptive to my life, but also that the triggers or situations don't feel like they are proportionate to this level of anxiety.
I'm working on mindfulness strategies on my own but I want more help than this. What kind of therapy or therapist should I look for? Is this about past trauma? (I don't have a history of physical violence or sexual abuse but my childhood experiences include a parent who sometimes screamed at me and bullying from peers.) Is this typical for autistic people? Is this something a really great therapist can help with and I just need a better therapist?
(Pt. 2 because I asked what kind of therapist I needed before, but - I think? - I'm asking about a different issue than the ones in that question.)
The therapists and therapies I've worked on with anxiety seem to expect that my anxiety is something I can track and monitor every day. (All used a combination of approaches but incorporated some CBT, DBT, and ACT.) But I can go days, weeks, or occasionally even months without experiencing anxiety symptoms.
When I encounter a situation that triggers my anxiety, my response is severely disruptive. Not being able to focus, concentrate, or sleep, clenching my teeth hard and often enough to cause dental problems, and having crying meltdowns including in inappropriate settings like at work or in public. These symptoms go on as long as the situation is present and immediately vanish when the situation is over.
After that, I have no symptoms or ongoing concerns to bring to my therapist. I'm content, I sleep well, my body feels relaxed. I show all signs of excellent mental health. Until another triggering situation comes up again.
The issues are not only that these symptoms are disruptive to my life, but also that the triggers or situations don't feel like they are proportionate to this level of anxiety.
I'm working on mindfulness strategies on my own but I want more help than this. What kind of therapy or therapist should I look for? Is this about past trauma? (I don't have a history of physical violence or sexual abuse but my childhood experiences include a parent who sometimes screamed at me and bullying from peers.) Is this typical for autistic people? Is this something a really great therapist can help with and I just need a better therapist?
(Pt. 2 because I asked what kind of therapist I needed before, but - I think? - I'm asking about a different issue than the ones in that question.)
It's completely normal for autistic people to have meltdowns, as well as to be able to manage really well most of the time but not all of it.
It's also really, really common for autistic people to have CPTSD. Just being autistic in an overwhelming world can be traumatising. On top of that, it's common to end up in abusive situations, with family, friends, school, work, etc. It's common for autistic people to have one or more autistic parents, who aren't well supported and may not have the tools to manage their own condition well, and so the children end up being traumatised by the meltdowns or shutdowns of the parents.
In short, maybe if you look for a therapist who has experience of autism (or is themselves autistic), and maybe also knows about CPTSD, that will get you closer to what you need.
posted by quacks like a duck at 1:08 PM on June 26 [8 favorites]
It's also really, really common for autistic people to have CPTSD. Just being autistic in an overwhelming world can be traumatising. On top of that, it's common to end up in abusive situations, with family, friends, school, work, etc. It's common for autistic people to have one or more autistic parents, who aren't well supported and may not have the tools to manage their own condition well, and so the children end up being traumatised by the meltdowns or shutdowns of the parents.
In short, maybe if you look for a therapist who has experience of autism (or is themselves autistic), and maybe also knows about CPTSD, that will get you closer to what you need.
posted by quacks like a duck at 1:08 PM on June 26 [8 favorites]
"Anxiety" is both a technical term of art in Psychology, and also kind of a general catch-all term that gets used by the lay public.
What you are describing to me sounds less like anxiety and more like fear, panic, or a phobia response.
Clinically, it's common for people who have one type of anxiety disorder to have others as well, but that's not universal. Perhaps you are a somewhat rare person who has only one, but not the others?
Why does it matter? The treatments (both medical and psychological) can be quite different for the various disorders.
You should probably not entirely self-diagnose, but having some ideas of the differences may help you communicate with your therapist better and help them get the right diagnosis.
posted by soylent00FF00 at 1:09 PM on June 26
What you are describing to me sounds less like anxiety and more like fear, panic, or a phobia response.
Clinically, it's common for people who have one type of anxiety disorder to have others as well, but that's not universal. Perhaps you are a somewhat rare person who has only one, but not the others?
Why does it matter? The treatments (both medical and psychological) can be quite different for the various disorders.
You should probably not entirely self-diagnose, but having some ideas of the differences may help you communicate with your therapist better and help them get the right diagnosis.
posted by soylent00FF00 at 1:09 PM on June 26
I found EMDR greatly helpful for similar symptoms which would only show up after specific, infrequent triggers.
posted by CleverClover at 1:11 PM on June 26 [1 favorite]
posted by CleverClover at 1:11 PM on June 26 [1 favorite]
Response by poster: This is really interesting and not what I expected! Which is exactly what I hoped for - a new way to think about this.
Is there a type of therapy that could help me understand and pinpoint complex or non-obvious phobias? I usually think of phobias as “a thing” like “snakes” or “going to the doctor” (same with PTSD triggers for that matter; I usually think of them as something like “the smell of roses” or “the nickname an abuser used”).
Maybe “trigger” is the wrong word. The things that set off these reactions are usually multifaceted situations. And the symptoms are ongoing as long as the situation lasts.
posted by robot cat at 2:52 PM on June 26
Is there a type of therapy that could help me understand and pinpoint complex or non-obvious phobias? I usually think of phobias as “a thing” like “snakes” or “going to the doctor” (same with PTSD triggers for that matter; I usually think of them as something like “the smell of roses” or “the nickname an abuser used”).
Maybe “trigger” is the wrong word. The things that set off these reactions are usually multifaceted situations. And the symptoms are ongoing as long as the situation lasts.
posted by robot cat at 2:52 PM on June 26
Well, a non-typical, weirdly triggered, hard to pin-point 'anxiety', insufficiently addressed by therapy, that lead to meltdowns, ended up being autism for me. Burnout, metal fatigue, overstimulation, sensory triggers, etc, from autism all was grouped mentally as 'anxiety' which is why it was so random seeming, yet intense, didn't respond to CBT, and why I didn't have typical 'panic attacks' but instead something different. Maybe something to explore.
posted by wellifyouinsist at 3:08 PM on June 26 [1 favorite]
posted by wellifyouinsist at 3:08 PM on June 26 [1 favorite]
honestly it sounds like you need as-needed anxiety medication.
posted by knock my sock and i'll clean your clock at 3:37 PM on June 26 [3 favorites]
posted by knock my sock and i'll clean your clock at 3:37 PM on June 26 [3 favorites]
There's a fantastic book called "Looking After Your Autistic Self" by Niamh Garvey -- one of the things she writes about is what she calls "the detective habit" of observation and analysis to identify the particular ingredient(s) of a situation that cause the overwhelm, and then to develop strategies (which may include external physical adaptations) to mitigate them. Depending on what exactly you mean by 'situations', this could be very helpful. (The rest of the book is also really excellent for general autistic quality-of-life stuff.)
posted by heatherlogan at 4:27 PM on June 26 [5 favorites]
posted by heatherlogan at 4:27 PM on June 26 [5 favorites]
So as not to abuse the edit window:
There's a different angle that might be relevant here, in that the 'triggers' of complex PTSD (C-PTSD) are often particular combinations of emotions rather than particular external things (like the scent of roses that you mention) that can be linked back to a singular traumatic event. This is because CPTSD develops over a long period of repeated traumatizing situations, for which it's usually the emotional content that's the connecting thread rather than any particular detail of the external circumstances, since the latter typically changes from situation to situation. Likewise the flashback is the emotional reaction, rather than a particular concrete memory. [Disclaimer: I'm not a therapist and am not sure I'm getting all the details correct here, but this is my understanding.]
posted by heatherlogan at 4:32 PM on June 26 [11 favorites]
There's a different angle that might be relevant here, in that the 'triggers' of complex PTSD (C-PTSD) are often particular combinations of emotions rather than particular external things (like the scent of roses that you mention) that can be linked back to a singular traumatic event. This is because CPTSD develops over a long period of repeated traumatizing situations, for which it's usually the emotional content that's the connecting thread rather than any particular detail of the external circumstances, since the latter typically changes from situation to situation. Likewise the flashback is the emotional reaction, rather than a particular concrete memory. [Disclaimer: I'm not a therapist and am not sure I'm getting all the details correct here, but this is my understanding.]
posted by heatherlogan at 4:32 PM on June 26 [11 favorites]
I found this article helpful in teasing out nuances of the autistic experience. Not all “anxiety” is really anxiety!
posted by lloquat at 6:08 PM on June 26 [5 favorites]
posted by lloquat at 6:08 PM on June 26 [5 favorites]
I was just talking to a therapist with experience treating autistic children, and he mentioned that it was common for them to have huge reactions based on a given situation (classroom situations, in his case) and by the time they came into his school-counseling office, they were fine. Obviously they intellectually remembered that they had been upset, but since the trigger was no longer there, the upset-ness was also no longer there, and so "therapy" in any traditional sense wasn't helpful. His take was that they were often more sensory-overload meltdowns than anxiety or trauma, which meant the treatment was more about finding ways to avoid the sensory overload rather than process emotional stuff. (It came up because another therapist was talking about the same pattern with one of her clients, who also had just gotten a diagnosis of autism.)
Most therapists are going to want to process emotional stuff, since that's mostly what therapy is. I suspect at the very least, you need an autism-affirming therapist with experience working with autistic people (or being one!).
posted by lapis at 6:53 PM on June 26 [6 favorites]
Most therapists are going to want to process emotional stuff, since that's mostly what therapy is. I suspect at the very least, you need an autism-affirming therapist with experience working with autistic people (or being one!).
posted by lapis at 6:53 PM on June 26 [6 favorites]
I think it's common for people to be thrown into mini crisis by a given situation and am surprised you aren't able to find a therapist who can work with you on this situation. I think it's common for even people who live with a pervasive "yellow zone" level of anxiety to first notice their anxiety when something spikes it up into the "red zone." With therapy they might learn to spend more time in the "green zone." Even though you already spend the rest of your time in the green zone, I would expect therapists who work with folks suffering from constant "yellow zone" anxiety to have ways to work with people on situational spikes of anxiety. Those kinds of moments are awful to go through but a blessing in the kinds of insights they can allow you to have. They are easier to grasp and unpack than, like, a vague sense of dread. I would look for someone who says they use a mix of approaches (maybe also mention that you think there could be roots related to the childhood experiences you mention), and ask them how they'd handle this (and especially the intermittent and situational nature of your anxiety). Hopefully you'll find someone who seems to really get it and have some constructive ideas about how to proceed. Wishing you the best!
(I do want to add that I'm not autistic and might not be grasping how that could influence things, so please disregard this as needed due to my lack of knowledge and experience.)
posted by slidell at 7:22 PM on June 26
(I do want to add that I'm not autistic and might not be grasping how that could influence things, so please disregard this as needed due to my lack of knowledge and experience.)
posted by slidell at 7:22 PM on June 26
See if you can find an occupational therapist in your area who specializes in spectrum-related issues and treats adults. What it sounds like is that you occasionally get severely triggered - whether that's a trauma response or you're just one of those people whose dysregulation, when set off, escalates quickly - and do not know how to regulate, and need help learning what you can do with your body, not just with your thoughts, to manage the response better and get some control over your nervous system.
I don't know if Somatic therapy might also be something where you could learn some tools, or maybe shake out some of the factors in this strong response so you just don't respond so strongly.
posted by Lyn Never at 7:55 PM on June 26 [1 favorite]
I don't know if Somatic therapy might also be something where you could learn some tools, or maybe shake out some of the factors in this strong response so you just don't respond so strongly.
posted by Lyn Never at 7:55 PM on June 26 [1 favorite]
My (autistic, ADHD) son goes to a problem-solving therapist, and that sounds like what you're asking about. She's neurodivergence-affirming, and has a broad toolkit of resources and techniques to help people learn how to live and interact in ways that work better for them.
We just had a session on intense fears, which are apparently somewhat common among autistic people. I learned how to respond when my son is triggered and in terror, removing him from the situation, co-regulating with him, and then helping his "logic brain" (frontal lobe) talk to his "fear brain" (amygdala), reassuring him that there was no actual threat. Then he can (slowly) return to the place/activity where he was when he was triggered. It was a life-changing lesson in how to help my son through a really difficult outsized reaction.
I hope you're able to find someone who understands and tailors your treatments to you.
posted by nadise at 9:06 PM on June 26
We just had a session on intense fears, which are apparently somewhat common among autistic people. I learned how to respond when my son is triggered and in terror, removing him from the situation, co-regulating with him, and then helping his "logic brain" (frontal lobe) talk to his "fear brain" (amygdala), reassuring him that there was no actual threat. Then he can (slowly) return to the place/activity where he was when he was triggered. It was a life-changing lesson in how to help my son through a really difficult outsized reaction.
I hope you're able to find someone who understands and tailors your treatments to you.
posted by nadise at 9:06 PM on June 26
I also just found this article on Autistic Anxiety vs Neurotypical Anxiety. Sharing here in case it's helpful. There's a lot of nuance involved.
posted by nadise at 10:44 PM on June 26 [3 favorites]
posted by nadise at 10:44 PM on June 26 [3 favorites]
2nding EMDR - it works specifically on "trigger points" or situations in which you find your [anxiety/etc] greatly increased
posted by london explorer girl at 4:33 AM on June 27
posted by london explorer girl at 4:33 AM on June 27
Unlike you, I have a high constant background level of anxiety, which has been lifelong. I'd love to be able to get rid of it, but I'm used to it, and I'm generally very able to function despite it.
Like you, I find that there are some things that cause me intolerable stress, whereas most people take them in their stride. They trigger disproportionate reactions, during which I am not able to function normally. Some are sensory; others are situational. Some are a result of something actually happening or having happened; others involve me becoming so afraid that the thing is going to happen that I can't cope and have to remove myself to a place of safety where it cannot arise. Some triggers are simple; others are multifaceted and very complicated to describe or even define with certainty.
These disproportionate reactions are pretty disabling, and also make me feel ashamed when they happen in public, which is a fun bonus.
Anyway... when I got down to "Is this typical for autistic people?" I highlighted it and nodded. I think my chronic background anxiety really is anxiety, but my acute reactions - for all that some of them more likely to arise on days when the background anxiety is higher - are autistic meltdowns.
I have not found a solution, other than doing my best to avoid the triggers, which is its own problem. Commenting anyway because I thought it was worth chiming in with another "yes, autism is relevant here" data point.
posted by ManyLeggedCreature at 5:03 AM on June 27 [1 favorite]
Like you, I find that there are some things that cause me intolerable stress, whereas most people take them in their stride. They trigger disproportionate reactions, during which I am not able to function normally. Some are sensory; others are situational. Some are a result of something actually happening or having happened; others involve me becoming so afraid that the thing is going to happen that I can't cope and have to remove myself to a place of safety where it cannot arise. Some triggers are simple; others are multifaceted and very complicated to describe or even define with certainty.
These disproportionate reactions are pretty disabling, and also make me feel ashamed when they happen in public, which is a fun bonus.
Anyway... when I got down to "Is this typical for autistic people?" I highlighted it and nodded. I think my chronic background anxiety really is anxiety, but my acute reactions - for all that some of them more likely to arise on days when the background anxiety is higher - are autistic meltdowns.
I have not found a solution, other than doing my best to avoid the triggers, which is its own problem. Commenting anyway because I thought it was worth chiming in with another "yes, autism is relevant here" data point.
posted by ManyLeggedCreature at 5:03 AM on June 27 [1 favorite]
Response by poster: Just a couple of things I wanted to note/respond to: I don't know if I'm autistic. Never diagnosed. Wouldn't be surprised, though. But the anxiety I'm talking about in this post is more like the neurotypical "worry" example than the autistic "overwhelm" example in the blog about autistic anxiety.
posted by robot cat at 3:39 PM on June 29
posted by robot cat at 3:39 PM on June 29
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posted by metahawk at 1:06 PM on June 26