Exposure Therapy and Building Expertise

Do you follow me on Instagram?

It’s not professionally very interesting (I try to save that for Twitter, and, of course, this blog).

In the description of my Instagram profile, I mention:

I live with The Doctor (a doctor), Mango (a baby) and Elmira (a cat).

The Doc is, more specifically, a clinical psychologist. We met in college – I was in graduate school for philosophy, and she was finishing her PhD. Our relationship is rich: we’ve moved across states, have a second kiddo on the way, and have successfully kept a Maine Coon alive (and very sassy) for almost a decade.

I count myself lucky because I learn things from the Doc all the time – she’s the closest thing to a genius that I’ve found, and has a gift of being able to share complex ideas in a way that overlaps with and takes on the character of the experience of the person she’s sharing with.

One idea that she and I have discussed at great length is an approach to treating anxiety disorder, called exposure therapy. Broadly, the big idea behind exposure therapy is that exposing a person to small amounts of something that makes them anxious (or stressed, or afraid), starts a process that can eventually help that person overcome the anxiety or fear at a larger level.

(I’m very likely butchering this concept by working in broad strokes – read the Wikipedia page, it’s good, and short.)

If, like me, you have an unhealthy obsession with Nassim Nicholas Taleb’s work Antifragile, you may have already identified that there’s a parallel here between exposure therapy (exposing someone to a small amount of what makes them anxious in order to help them become less anxious) and hormesis, the concept in medicine and (since Antifragile) economics, that shows us that benefits do not always follow a linear or even exponential path – but rather many inputs have a hyperbolic curve, where limited benefits can be found in one particular application, but then the downside becomes infinitely worse as the input is continued to be applied.

One example is water – in too-small amounts, lack of water will kill you. A somewhat narrow band of water application is ideal, enough so you’re not thirsty and are able to operate in a healthy biologically appropriate way. Once you exceed that healthy space though, any additional water will have more and increasingly horrible effects – pretty quickly leading to death and only death on down the line.

The mental model of hormetics is controversial: it’s not universally accepted nor is it universally applicable. In this case, it’s a helpful way to think about a bigger model for our otherwise more specific cognitive behavioral exposure therapy.

The reason all of this is meaningful is because it ties into a bigger question that I have about my life, and I figure some of you all do, too – how do we build expertise? How do we get better at a skill or practice?

The answer is, like in exposure therapy and in hormesis: with a little bit at a time. You don’t go from being horrified of public speaking to a keynote lecturer overnight: you have to create a plan, exposure yourself to the stressor in small amounts, building over time, and move toward your goal.

One point that I want to make very clear here is that executing this idea necessarily means pushing yourself out of your comfort zone – pushing a little into that uncomfortable place, and sitting there, working there, allowing yourself to survive and thrive though that low level discomfort. That’s how we get better. That’s possibly the only way we get better.

Recognize that both exposure therapy and the hormesis model agree: large jumps are not productive. Too much water will kill you. Start small, and recognize that you have to climb a ladder from the bottom – small steps, building on one another, is where change comes from and what makes things stick.

Once I started to think about exposure and hormetics in this way, as a mental model, it’s the type of idea that is very sticky, and has started to map onto my work in many other interesting ways. You can see how exposure therapy has clear parallels to things like delegation, helping your team build expertise, and even in customer relationships.

The next time you want to build your skills or hone your practice, ask yourself: what part is the scariest for me? What looks like it’s the hardest, most out of reach bit? Then, break off the smallest chunk you can, and attack that, and only that, until you’re comfortable. Then, get started on the next chunk.


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