While exposure therapies like Exposure and Response Prevention help many people, especially those who live with Obsessive Compulsive Disorder - it is not for everyone.

For those of us with Complex Trauma / Complex PTSD, exposure therapy can add to our distress. While some argue trauma therapies such as Eye Movement Desensitization and Reprocessing are a type of exposure therapy, the difference is when you are expecting to work on or through your trauma by utilizing a therapy like EMDR you are consenting to this and preparing for it the best you can.

When working with exposure therapies for OCD, there is recognition you could experience distress, however it is not the same as being prepared to handle any trauma-related nervous system activation which may come up.

Then, there are further complications if a client experiences differences in their habituation or inhibitory learning with exposure to fear-based experiences or items. In Autistic individuals, specifically, exposure therapy can prove to be traumatic in and of itself. This means in Autistic individuals, if something causes distress, exposing us to this distress does not necessarily have the desired effect of the distress being tolerated or extinguished - rather it can increase the level of distress and make the activation worse rather than better.

Some people benefit from response prevention without exposures. We are all different and need service providers who will get to know how we react and respond to different experiences to best support us.

Sources:

Sauer KS, Witthöft M. Inhibitory Learning versus Habituation in an Experimental Exposure Intervention for People With Heightened Health Anxiety: Increase of Distress Tolerance as a Joint Mechanism of Change? Journal of Experimental Psychopathology. 2022;13(4). doi:10.1177/20438087221138716

Lobregt-van Buuren E, Hoekert M, Sizoo B. Autism, Adverse Events, and Trauma. In: Grabrucker AM, editor. Autism Spectrum Disorders [Internet]. Brisbane (AU): Exon Publications; 2021 Aug 20. Chapter 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK573608/ doi: 10.36255/exonpublications.autismspectrumdisorders.2021.trauma

van Minnen A, Harned MS, Zoellner L, Mills K. Examining potential contraindications for prolonged exposure therapy for PTSD. Eur J Psychotraumatol. 2012;3. doi: 10.3402/ejpt.v3i0.18805. Epub 2012 Jul 25. PMID: 22893847; PMCID: PMC3406222.