Thread by @paytonjjones

Exposure therapy should always be voluntary because humans have dignity and should have choices over how they live their lives. Forcing involuntary exposure irreparably damages the therapeutic relationship.

But that doesn't mean that involuntary exposure doesn't *work*

In fact, all the evidence suggests that it *does* work (in terms of reducing fear regarding the target stimulus).

All of our foundational research on fear learning comes from rats, and we never exactly gave them a choice about whether they wanted to be in the experiments.

Imagine you are an evil villain who locked a spider phobic in some kind of nightmare prison and forced them to have many close encounters with tarantulas.

Eventually, it's almost certain this person would lose their fear of tarantulas.

Why?

The reason is simple: humans are pretty smart and tarantulas are not, in fact, very dangerous (it takes some serious dedication to provoke them to even bite, and their bites aren't dangerous).

With enough exposure, every human will figure out that truth.

But importantly, the former spider phobic will rightly learn to fear YOU. After all, you are an evil villain who locked them in a nightmare prison.

*Forcing* someone to confront their fear is unethical and wrong-headed for several reasons.

But it's important to simultaneously remember that exposure in any form is not dangerous, risky, or likely to backfire. Strongly encouraging exposure is caring and healing.

(Of course when I say "exposure in any form" I'm referring to exposure to non-dangerous stimuli such as interoceptive cues, social mishaps, trauma triggers, and other common targets of exposure therapy. Don't expose people to lions)