The only way to overcome anxiety is through exposure

Well done to her!

agreed. My DD has anxiety and has really struggled with school, but today finishes 6th form with some amazing results already in the bag, and hopefully great A level results. Letting her not attend would have not helped her long term, only hindered.

Maybe I misunderstood, I thought you were saying she won’t retain what the psychologist is saying at all. If it’s working in some other way great.
If not the waiting lists for any help at all via CAMHS are just impossible. Never mind getting any kind of psychological help for adults with extreme needs (which is my experience for a family member)

How charming. No. She has complex needs. If the psychologist can help her to work on her thought processes, the country will save money on medical hospital admissions, the level of social care she requires, psychiatric inpatient care etc., and the NHS will save more than it spends. If the psychologist thought it was a waste of time, she wouldn't offer weekly sessions. She's plenty busy enough without DD1.

goodness, that sounds like a total waste of time and money. Shouldn’t you or the therapist call a stop to it?

"Everyone can learn/change. Everyone. Autistic people might find some things harder. They might really not like some stuff. But with repetition everyone can learn and adapt to some degree."

I think that's the point. People with ASD need:

• much more time spent laying foundations for the work that needs to be done,
• much more time to ensure a shared understanding of the issue, language, definitions, etc.
• much more time working on a solution to the issue
• much more time to understand how the situation that is worked on relates to other situations that are similar but different

DD1's Consultant Clinical Psychologist (NHS) has been working with her for two years. Today is the first day I've seen her meaningfully engage with the concepts that were being worked on, and tbh, I suspect her willingness was more to do with the colour coded paper and pens rather than the concepts. It is very unlikely that she will be able to retain what the psychologist was saying, recognise that a situation fits the criteria they agreed on, remember the new response, make the response and be calm.

6 or even 10 sessions would do nothing.

I'm autistic. Exposure doesn't lessen anxiety because the cause is.npt psychological,.it's neurological. The advice Ive had from two separate therapists is to avoid certain things that give me anxiety and not to force myself to push through.

YABU
How do you overcome anxiety due to sexual assault via exposure?
Or due to ND?

I have this experience - I think I'm probably autistic and have severe social anxiety. I go to every social event required of me - parties, weddings, volunteering, the office twice a week etc but it never gets any better, in fact, it's got worse, so it's interesting to hear you feel the same about anxiety triggers. Obviously I'm sure exposure does work in a lot of other circumstances.

I am afraid of heights. I have tried flooding after studying it in psychology. I have been up various heights like the Whispering Gallery in St Paul’s, the Eiffel Tower, glass lifts - I have been nearly hysterical with fright, and only the thought of being an adult, and the embarrassment, stopped me from screaming out loud hysterically.

All it did was confirm to me, I am quite right to be terrified of heights!

Hmm - I've heard the phrase 'jollying along' used so often by well meaning people - often in teaching and support roles. In fact, we heard it so much we took it to heart and sent our Y7 child to school every day without fail for a year under the completely misguided notion that it was just a case of him learning to adapt and manage his anxieties - essentially exposure would do the trick with a few basic support strategies in place.

We were constantly warned by the GP and head of year that if we took him out we'd never get him back in school. When we finally got to see a CAMH's child psychiatrist (after jumping through endless hoops - Ed Psych and MAST interventions, CBT programmes etc) we were told this had been entirely the wrong approach. His anxiety was so extreme, his mental health and resilience so stretched to breaking point, he should never have been put through that year. The psychiatrist basically told us what we had known all along in our gut but had quashed out of fear of somehow letting him down - that no adult would have been made to suffer in this way and yet children are routinely forced to endure extreme pain under the umbrella of resilience building. What he needed was time out, medication, and then once stable, therapy to address the causes and work out a support strategy.

I get that teachers have lots of experience educating and supporting kids but they're not child psychiatrists or psychologists. Their focus is limited (as it has to be - teaching is a huge job in itself). However, with the best will in the world, this means teachers are not going to have any real insight into the child's life outside those 6 hours a day and the assumptions they make about what is or isn't happening in terms of causes, parental inadequacy etc are just that -assumptions based on their own experiences (or lack of).

We've learned the hard way - yes listen to experts but make sure they really do have the relevant experience and expertise needed and most importantly, as parents, listen to your gut when it comes to your own child's needs. Ultimately, you will be held accountable and left to pick up the pieces whatever happens anyway.

have you heard of masking? It’s what very anxious and/or autistic young people do to survive in school. When you say the parents pandered to it, do you mean they came in to school to ask for reasonable adjustments to be made?

It's some years ago, as I said, but yes, pretty sure it was just anxiety.

No, I don't think he was "trying it on", but yes, I do think he was pandered to by parents and the school to an extent.
He didn't cause me any issues in class. A lovely boy who was never once rude or disruptive to learning in any way. I felt sorry for him that he was burdened with so much anxiety. But I also felt that it was made worse by the constant hand-wringing of many of the adults around him. I personally think a bit more jollying along would have done him the world of good.
Just my opinion.

Oh my kids did and do that. I was flexible but didn’t realise however that it was causing huge MH difficulties and overwhelm- until it was too late.

I think there's a fair balance. The current issue is that the easy things to try, which may well be suitable for a proportion of young people if offered promptly, aren't accessible until it becomes unsuitable.

I fought to get DD2 seen by CAMHS and her referrals, made by GPs, School SENCO, and a specialist SALT, were closed, I think, 4 times. Might have been 5. Finally, someone phoned me and said 'I'm meant to be closing this referral but it just seems like we're missing something here.' They accepted the referral, and then she was offered Single Session Family Therapy. I had to point out that our family makeup made this inappropriate (older sibling with SEN would have dominated the session because she wouldn't have coped). So we had to travel over 20 miles for an individual Single Session Family Therapy appointment, without family. Then the therapist wanted DD2, who by then was in a special school because of her needs, to do an online group therapy course. Once she saw us, it was obvious to her that DD2 wouldn't manage that, so she decided to close the referral at that point because DD2 has ASD. I had to get very assertive, pointing out that I had jumped through all of their hoops, and needed to know at what point somebody would take responsibility for deciding if she needed the medication that the GP and the SALT had both said was vital to making progress. Finally, she was put on the psychiatry waiting list.

In the meantime, DD2 had weekly SALT sessions that were essentially CBA (CBT adapted for ASD). Initially working on helping DD2 to recognise when she was anxious, then to try to recognise feelings, then assign numbers to her mood, etc. We're 5 years on and her school staff are still trying to desensitise her to the very small school setting.

DD3 was very unwell and was referred to CAMHS. She waited 6 months for an appointment, then they said that they needed to offer a DNAV-R group therapy course for her OCD, with a wait of 6 months. She was traumatised and out of school by that point, so there was no way she would be able to join a group of strangers online. They said they knew this, but they had to see her fail, then they would put her on a waiting list for individual therapy, another 9 months, which they knew would fail, then they could put her on the psychiatry waiting list, but the list was about 2 years long. By this point she had been out of mainstream school for a year and hadn't been able to engage with the special school staff who had been patiently working their way up the driveway.

Fortunately, she had already been on the waiting list for ASD assessment for 2 years and got her diagnosis, then someone paid for her to have a home visit from a CAMHS psychiatrist who also did private work (she couldn't leave the house by that point), who confirmed her OCD diagnosis and started medication. That allowed her to cooperate with the psychiatrist enough that he could do the QB check and diagnose her ADHD. The ADHD treatment allowed her to start engaging with her special school staff, eventually let them into the house, then start visiting school.

The psychiatrist tried to use EMDR but DD3 couldn't recognise her feelings enough to notice them in the moment. So now she's having a talking therapy with a Clinical Psychologist through her special school. It's slow progress.

DD1 is complicated by her LDs. She is having psychiatry and psychology support but it's hard to make any progress because she doesn't know what she's feeling and largely acts on impulse.

The NHS are utterly wedded to CBT, which has been so diluted in practice it’s bears little resemblance to the evidence based practice research indicates as effective.

Therapy doesn’t need to be open ended, agreeing say 12 sessions with a clinical review and the possibility of extending would be a good start, as would being open to offering other, relational, models. Not offering CBT for trauma would be another help - offering therapy following Herman’s 3 stage model with the same therapist where that is indicated (eg for complex trauma) instead of the bastardised model on offer under the guise of trauma therapy. Having a decent clinical assessment for readiness and suitability for therapy would also help.

Understanding therapy as a relational process whatever the modality, instead of a tick box treatment would be a very good start.

I’m sorry to read that. With mine it’s worked well - they both tackled things they weren’t initially keen on and have stuck at things, but I hope I would have been flexible enough to change approach if it wasn’t helping.

My dc do hard, upsetting and uncomfortable things all day every day. Hence their NDs being classed as disabilities. Like most ND people they are more resilient and tougher than anybody I know.

It really isn’t bollocks that’s hugely abelist! It isn’t navel gazing either it’s huge difficulties due to a disability .

Do tell me how somebody with Alexithymia and all the other difficulties autism brings can just do CBT, it just isn’t relevant for many and there is no repetition on the NHS let alone autism informed adjusted care.

This thread is about exposure being the only answer. It isn’t. Many people autistic or otherwise learn to mange anxiety without exposure.

I agree to an extent, but it depends on the situation.

When DS started to be unable to attend school - mix of ASD, lockdown, switching from Infants to Juniors, bullying - we pushed him, the school pushed him, and it backfired hugely to the point that for a while he was only able leave the house after dark. A note delivered from a girl in his class saying he was missed led to a massive meltdown.

This wasn't fixable by pushing through, because pushing through would still have meant being with children who had bullied him for being weird, which increased his 'weird' behaviours (stimming etc.) to the point of them being disruptive to the class, and children, particularly the bullies would not have let that go. Pushing through would have been damaging.

For me pushing through my anxiety about flying and getting on a plane has left me never wanting to get on another one ever again, while my post lockdown anxiety about using public transport has been successfully pushed through.

She didnt say autistic people cant change. She said techniques other than cbt have been more useful and gave some examples of why cbt can be less succesful for some people with autism.

I have a child with autism who previously had severe anxiety. His anxiety was treated without cbt or exposure therapy. So i feel like I have a lot to say on the topic that could be useful around techniques that do work...

However I agree with the first person's view that cbt does work for some autistic people and they should be put off trying it just because it doesnt work for everyone.

What do you suggest for me?

Sometimes to get better we have to do things that are:

• hard
• uncomfortable
• upsetting

A bit like physio after a serious physical accident. It can be really really hard but if we don't soldier through, we can lose the mobility.

I'll get flamed here right? But i'll say it because I'm not the only one thinking it.

Im starting to think all this sort of narrative, with the overly academic scientific vocabulary.....

It's actually quite a lot of bollocks really. Excessive navel gazing, overly self involved, too introspective to be useful.

Everyone can learn/change. Everyone. Autistic people might find some things harder. They might really not like some stuff. But with repetition everyone can learn and adapt to some degree.

I guess this is a part of the problem for the NHS.
Estimated cost per session for the NHS is £124 (govt figures) so that £744 for one individual for 6 treatments that you say weren’t helpful.
What do the therapists on this thread suggest should be the approach? obviously open ended therapy on the NHS is a huge investment (and also risks being a pure waste of money?). And private therapy is too expensive for many.