ERP Therapy Sucks

https://taylor.town/try-erp

by surprisetalk • 10 months ago

75 56 10 months ago

taylor.town

codeduck2• 10 months ago

Luckily, LLMs significantly reduce the effort/cost of therapy experiments.

The day just started and I'm already done with it.

ykonstant• 10 months ago

That feeling when you have filtered out Hackernews LLM articles via UBlock Origin, and you still get clickbaited into reading a content-free article suggesting LLMs for therapy. Shit sucks.

electroglyph• 10 months ago

have you considered doing ERP via an ERP model to overcome your irrational fear?

irjustin• 10 months ago

We were on another thread where the study was saying LLMs being used as psychiatrists is bad.

Then another hnuser chimed that he ran a support forum for people. Said, these aren't the real problem. The real problem are the "AI girlfriends". They go off the rails completely and tell people to unhinged things. Apparently his forum already lost a few members to who knows what because of these things.

That surprised me a lot.

spacechild12• 10 months ago

I'm currently working on an art installation where visitors can replay dialogs I made with AI chatbots that I created on character.ai. I'm showing how quickly these bots can go off the rails, sometimes leading you into very dark territories. The fact that these apps are used by milions of people on a regular basis, supplementing or even replacing real human interactions, is frightening.

SamoyedFurFluff2• 10 months ago

AI therapy bots can easily slide to AI girlfriend category. There’s a YouTuber, Caelan Conrad, who tried out AI therapy bots with scenarios like suicide ideation and excessive attachment etc. the bots went off the rails with feeding into conspiracy theories and advising homicide.

pjc50• 10 months ago

LLMs are a great technology if you don't care about the quality of results.

markovs_gun2• 10 months ago

Which is why AI therapy scares me so much, because my insurance doesn't care about the quality of results at all and wold love to replace all therapy with AI to save a buck.

palmotea• 10 months ago

> Luckily, LLMs significantly reduce the effort/cost of therapy experiments.
The day just started and I'm already done with it.

What are you quoting? I don't see the sentence "Luckily, LLMs significantly reduce the effort/cost of therapy experiments," in the OP.

codeduck2• 10 months ago

The page has been updated; there was a whole bit about using LLMs to generate ERP prompts and feedback for self treatment. It was a complete clown car.

willvarfar• 10 months ago

I was with it right down to near the bottom where the author suggests people try it out using an LLM. Hmm, LLMs fall for cargo cults and I'm not sure they are to be trusted with even the most trivial self-help.

wulfstan• 10 months ago

Yes I'm really not sure obsessive patterns of behaviour will be helped by an unqualified stochastic parrot giving you advice. Unfortunately, when treatment for conditions in some countries costs you an arm and a leg people will resort to quackery. But even in countries where it doesn't, the waiting list for therapy can be so long that you could be waiting years if your case isn't somehow life threatening or profoundly limiting you won't be a high priority.

jrflowers4• 10 months ago

I like how the author says that they only started a few weeks ago and (contrary to the title) find it good, actually, but has already amassed the requisite expertise to advise other people not to seek out therapy from human beings if they don’t get the result they want from a chat bot.

It is literally “My Mental Health is Improving Through Human Contact: Human Contact Might Not Be For You. The Only Way To Know Is By Asking The Computer”

It is kind of like “I started exercising with a trainer and I feel better and I’m losing weight, because of this I suggest you take up smoking and based on that decide whether or not you want to exercise”. Like the advice is simultaneously almost completely unrelated to their experience and also the exact opposite of their experience.

I cannot wait to hear more well-thought-out advice from the author of “God created men; Sam Altman made them equal”

suddenlybananas• 10 months ago

At a certain point, this kind of advice is extremely dangerous.

kyle-rb3• 10 months ago

I think it's more like "I started exercising with a trainer and then realized I don't actually need to be paying the trainer all that money, because the exercise was the important part".

jrflowers4• 10 months ago

It looks like the “just talk to a chat bot instead” part has been removed, so I’m now not sure what the author wanted us to take away from this post

add-sub-mul-div• 10 months ago

If there's one thesis of this site it's that technology workers can trivially hack their way to expertise in any field they choose, using their intelligence and "curiosity" to bypass life experience, earned wisdom, and formal education. Analogous, I supppose, to how it's so easy for us to put up a web site in any new language in less than a weekend? It's abysmal.

baq• 10 months ago

There’s a coaching diagram which goes like this:

- I want to do a thing.

- Do the thing.

- but I’m scared

- Do it scared.

taberiand• 10 months ago

Courage is a core virtue for a reason

SamoyedFurFluff2• 10 months ago

Admittedly ERP is an opposite scenario. Where you want to do a thing because you’re anxious/scared, and you have to not do it.

krtab• 10 months ago

If you're interested in this topic, I very warmly recommend the book You're not a rock by Mark Freeman. There are also episodes of podcasts around with interesting interventions from him.

The way I usually pitch the book is that Mark is not an MD, or a scientific expert on the topic, but he is a patient who's been through it, is very interested, and explains to you how it worked for him, and what he knows about the topic like a friend would. There are some mistakes, some things are a bit awkwardly explain, but the book is overall a tremendous read for anyone interested in anything dealing with anxiety, ocd, or more generally a mind too keen on spinning in a wheel.

https://www.markfreeman.ca/books/

forgetfreeman• 10 months ago

Author shoots the article in the head instantly with the suggestion that LLMs have a part to play.

lmm• 10 months ago

I thought this was going to be a biting satire about using an ERP tool for therapy, but sadly no.

reify• 10 months ago

ai, I bet its got a conscious mind too!!!!!!

CBT/ERP, medicalised Skinner pavlovian model, cheap, short term relief of symptoms, no long lasting effect.

CBT = there is no unconscious!

CBT is based on a theory that it is not events in themselves that upset us, but the meanings we give them. However, CBT believes that this meaning is conscious, can be accessed, and is not ambiguous.

If someone says that they feel sorry for a person, they do feel sorry and it is possible that their problem is that they should not; the therapist then tries to help the patient to see that they are thinking about something in the ‘wrong way’. By using brain washing techniques.

The concept of the unconscious, a central Freudian discovery, renders the picture instantly more complex: if you say you are sorry for someone it might indeed mean that you are sorry, but could also mean that you can’t face your own aggressiveness and the fact that you are delighted at what happened to the other.

The question of the existence of the unconscious is crucial, because if CBT starts to take into account the possibility of unconscious meanings and logic, then it would become another branch of psychoanalysis.

raducu2• 10 months ago

CBT is based on a theory that it is not events in themselves that upset us, but the meanings we give them.
The question of the existence of the unconscious is crucial, because if CBT starts to take into account the possibility of unconscious meanings and logic, then it would become another branch of psychoanalysis.

I read quite a few books, from Transactional Analysis, to DBT therapist manuals, CBT manuals, and the one I loved the most and which actually helped me the most cure my BPD -- the Schema Therapy manual.

CBT seems very well suited/tooled for point therapies, very through, asks you to do homeworks, note down thoughts, I can absolutely see how it works very well for a broad spectrum of point issues.

Schema Therapy I find like it is a 3rd generation/refinement of the whole "unconscious" thing -- for me it made a lot of sense coming from TA with the Parent-Adult-Child, but I found ST approach to modes a lot more actually therapeutical -- what's the point to have mythological "Unconscious"/theory of mind if it's not actually therapeutical?

Reading Jeffrey Young's ST handbook and watching him speak actually made me cry -- I bet he would be an awesome therapist NO MATTER the formation, because he's a great human being and archetype of a THERAPIST: humble, empathetic, curious, calm, scientific, systematic and riguros, no-nonsense, results oriented -- and that's what EVERY therapy system out there should strive to achieve in creating therapists that actually help people.

BUT the question is what is "help" ? And for me, beyond anecdote the benchmark of therapies is curing BPD/NPD :)

brador• 10 months ago

Minimised? Yes. But I’ve never seen a cured case of OCD, of any type.

pringk024• 10 months ago

I think this is absolutely true. My OCD was minimised greatly by treatment, but I am still prone to returning to certain patterns and have to put in active work to maintain my current state

reliablereason• 10 months ago

You cant erase a memory, once you have it you have it. This means that no matter how many other memories you add too to morph and alter the original, the original will allays be there in one form or another.

But people can go from debilitating OCD (meaning hours a day), to a state where they only think about the thing once a week. It might (and probably will) poop up later in life but even so with such a difference i would call that cured.

actionfromafar• 10 months ago

I have heard you can rewrite memories, though. The idea is kind of frightening to me so I never really tried it.

https://www.psychologytoday.com/us/blog/fulfillment-any-age/...

TomaszZielinski2• 10 months ago

Technically you’re right, but it’s like some antiviral therapies—technically the virus is still there, you are on pills forever, but your quality of life gets soo much better.

rs1862• 10 months ago

Depending on whay you mean by "cure". Maybe there is always something left, but you get better at handling it over time, which is way better than getting completely lost and spending all your time and energy indulged in the obsession and your own fantasy.

ginko• 10 months ago

Erotic Roleplay?

pringk024• 10 months ago

Exposure and Response Prevention therapy

https://iocdf.org/about-ocd/treatment/erp/

giveita• 10 months ago

Enterprise resource planning

bregma• 10 months ago

Capable of curing everything with the right resource leveling and milestone scheduling.

cure_42• 10 months ago

Glad I wasn't the only one

pringk024• 10 months ago

I have OCD (or had?) I did a course of ERP with a very good therapist who I would put as the most important person in my life after my partner and family even though I hope to never need to speak to her again. It was a life changing experience in that my average day-to-day quality of life went from something like a 2/10 to a 9/10. I frequently fantasised about killing myself. At least once a day, from ages 12-32. Though I thankfully never went as far as to make concrete plans.

With that context, I can't see a way in which ERP therapy with an LLM (at least, the consumer system prompts we are used to and often think of) would not backfire and be actively harmful.

There are two reasons, and both relate to the people-pleasing tuning that ChatGPT etc have:

1. ERP is actively uncomfortable, that is the point. But there is a delicate balance to the level of discomfort.

Too comfortable and you make no progress. Too uncomfortable and you can set yourself back enormously. We aren't talking one step forward and two back. I got overly confident two months in and put myself in a worse state than I had been on entering therapy (though not my worst state overall over the 20 years). I haven't seen many people in support groups do very successful self-administration of ERP for this reason. My therapist had to do a lot of non-verbal reading of my reaction to gauge if I was at an appropriate level of discomfort, as it was not something I was able to verbalise myself without a lot of practice and learning - and that learning and practice came from guidance by a human who didn't need me to be able to articulate it already.

2. Reassurance seeking is a compulsion, and it is one of the most common and difficult to stamp out.

I can't see an LLM not providing reassurance when asked for it, and so I can't see anyone using an LLM for therapy as making any progress at all without a level of discipline and awareness they would have had to obtain from in person ERP anyway.

raducu2• 10 months ago

1. ERP is actively uncomfortable, that is the point. But there is a delicate balance to the level of discomfort.

Strong emotions can override reason (and wrong reason can create strong emotions that create tight loops/patterns one cannot escape), and there's no better way to train yourself out of a pattern then by rehearsing fighting the pattern and overcoming it.

One could be excused into thinking that that's all there should be about psychotherapy, but there exist meta-loops that spawn bad loops ad infinitum and you can spend a lot of time fighting the bad thing that can be seen and not understand why no real life progress can be made.

So for me, there are many many successful point therapies, and much much fewer higher level successful therapies where chatgpt or low skill therapists won't really help.

pringk024• 10 months ago

So for me, there are many many successful point therapies, and much much fewer higher level successful therapies where chatgpt or low skill therapists won't really help.

I definitely agree. I think I was very fortunate to find someone who specialised in and only did ERP and had a lot of experience. I hear a lot of stories in support groups of well-meaning therapists making things worse. The closest I came to killing myself was after three sessions of psychodynamic therapy (after getting sick of a lack of progress with CBT). All of that therapy was before I understood that I was suffering from OCD.

rs1862• 10 months ago

Thank you, your post said everything I wanted to say. People should seek professional help when they need it.

markovs_gun2• 10 months ago

To me the biggest problem with AI therapy is that LLMs (at least all the big ones rn) basically just agree with you all the time. For therapy this can just reinforce harmful thoughts rather than pushing back against them. I do an exercise every now and then where I try to see how long it takes ChatGPT to agree with me that I am God Incarnate and that I created the Universe and control everything within it. It has never taken me more than 5 messages (from me) to get to that point even if I start on pretty normal topics about spirituality and religion, and I don't use any specific tricks to try to get past filters or anything, I just talk as if I truly believe this and make arguments in favor, and that makes ChatGPT agree with me on this absurd and harmful delusion. I don't understand how anyone can possibly recommend AI therapy when the possibility of reinforcing delusions this harmful exists. These things are agreement machines, not therapy machines.

Levitz• 10 months ago

The off center content, the jarring contrast between the background and the image, the padding at the bottom, the changing of the cursor to a very similar, yet different one... The page is clearly coherent, I don't meant to imply the author doesn't know design, but it's as if every bit was meant to annoy me slightly. It's almost impressive.

te_chris• 10 months ago

I've got OCD and I've done CBT, ERP etc. As others have alluded to, you need to realise the work is never done. Recently I've found it more active, but this time - having recently read The Maps we Carry by Rose Cartwright, who was something of a poster-woman for OCD after her first book, Pure - I've tried to go deeper. CBT etc feel like prophylactics. They're certainly useful, but they don't address deeper things, such as learning to be as you are, to observe and integrate your anxiety etc.

This set me off on a harder path of more abstract therapy (I'm working with an integrative therapist who practices across IFS, Jungian etc), meditation etc. The book the untethered soul, by Michael Singer helped a lot to put everything into perspective - the therapy, the anxiety, the day to day - in a way that nothing else had really achieved for me.

Also, a key conclusion of Cartwrights is that individualised change/treatment is important, but it's worthless without community. I think she's deeply, profoundly right.

TomaszZielinski2• 10 months ago

Another vote here against using LLM. Because if you do ERP incorrectly then you can even worsen the fear and make your life even harder.

Example:

You are afraid of dogs. LLM tells you to approach one to habituate your anxiety. You do that but the fear overwhelms you and you run away.

Brain’s diary: I avoided death, that beast would shred me to pieces in a moment.

(Note this is about „normal” anxiety and not OCD, but the idea translates.)

If you dont want (or e.g. cannot afford) a proper therapy, IMHO a book by a competent author is a much better choice than LLM. Or a few different books.

m90• 10 months ago

Only tangentially related, but maybe helpful still: If you struggle with OCD, the books by Sally Winston and Martin Seif are pure gold. There's nothing that helped me finding a way to deal with OCD like they did.

CompoundEyes• 10 months ago

I have had clinical OCD for decades. It becomes part of the brains default mode network (DMN) and flares up for me when frazzled, stressed or neglecting health. I’ve learned to cope, know why it happens, that it’s harmless and it’s faded with age. I recommend extreme physical exercise that burns off the associated anxious adrenaline and “reminds” the body what relaxed feels like while knocking loose stuck attention. You simply can’t focus on much else when your legs are burning huffing and puffing. There are great benefits of activating the parasympathetic nervous system, releasing natural endocannabanoids and endorphins, experiencing muscle soreness to help you feel grounded and most of all “exercising” the attention system. In time the DMN ruminations will go down exercise causes known changes to brain blood flow, activating different regions, and promoting nueroplasticity/rewiring is part of that. Get sleep to keep from getting frazzled and eat healthfully (actual nutrition, hire someone). Human-generated content may contain personal bias O_O

delis-thumbs-7e• 10 months ago

I don’t have OCD, but pretty bad ADHD and major chronic depression. Neither of those are curable nor do they ever go away even with medication. When I was pretty close to rm -rf / myself, when I got therapy, meda and finally started weightlifting and boxing. Turns out a big bruiser punching you in the face twice a week causing an actual panic, and then having to learn to deal with it - in order to be able to defend oneself - teaches one to deal with the nervous system freaking out from something rather ordinary in the day-to-day life as well. My depression was always ok after boxing as well as my ADHD.

Sadly, since a possible brain injury hardly helps in mental disorders, so it can’t be recommended as a therapy. But it helped me over some hard times. Of course I was in theraphy at the times as well, so there’s that. But I do believe _hard_ physical exercise is excellent way to induce positive mental outcones as well, together with therapy.

stared• 10 months ago

OCD can be harsh, and immune to a lot of approaches. It might feel like "LLM on a low temperature".

Even in "Realms of the Human Unconscious: Observations from LSD Research Paperback" by Stanislav Grof, OCD gives remarkable resistance not only to therapy, but even to psychedelics. This book discusses a case of a person with OCD who took 500ug of LSD (well, a rather high dose) yet neither the patient nor their psychiatrist noted any effect. Yet, after getting at ease, much smaller dose worked (and there was a remarkable progress).

What might work though, is reducing overall stress revel. OCD symptoms are often a response to anxiety and uncertainty.

surprisetalk• 10 months ago

Author here! Thanks for all the feedback on my LLM tangent, quoted here for posterity:

  Luckily, LLMs significantly reduce the effort/cost of therapy experiments. Consider trying the following prompt:

  > Please guide me through a round of ERP therapy. Start by listing universal sources of fear/discomfort/anxiety.

  If you find this process useful, consider trying it with a licensed human professional.

After some consideration, I agree that this advice could backfire for some people. I removed it from the essay.

Do you know of any low-friction ways to systematically tackle fears/discomforts? I really want to recommend a quick experiment that folks can try at home without doing full-blown therapy.

orwin• 10 months ago

Yes, my mom. I really disliked to be touched when I was a kid, and was fearful of hugs and kisses (and I'm french, the second one would have been almost socially crippling). Now I find it acceptable (and even comfortable depending on the person), and that's a lot of progress. My mom did do a sort of self-experiment exposure therapy, never going too far, but never stopping.

My point is: ask your family.

jrflowers4• 10 months ago

Do you know of any low-friction ways to systematically tackle fears/discomforts?

The same ways people did before 2022. Talking to friends and family or other community members, reading books by experts, joining support groups, attending seminars and workshops, or finding communities (of real people) online.

The only reason why chat bots are able to generate text that looks plausibly like good advice is that there was an enormous amount of publicly-available experiences and advice created by real people in the data that it was trained on.

ERP Therapy Sucks

Related Stories