Autistic sensory sensitivities are closely related to anxiety.  I hope this isn’t a terribly controversial point.  There are now several studies showing the existence of an association between sensory symptoms and anxiety (e.g., Mazurek et al., 2013; Uljarević et al., 2016).  Furthermore, it just makes sense that sensory sensitivities would be associated with anxiety.  When my sensory sensitivities were really bad, they caused genuine distress.  Naturally, I didn’t enjoy being overwhelmed by my environment and experiencing sensory distress.  Therefore, I came to dread sensory stimulation.  My worries about different sensory environments eventually became serious enough that I would guess that, for a while, they deserved to be considered clinical anxiety.[1]  Unfortunately, this anxiety just made the sensory experience worse: when I was dreading the sensory stimulus, and closely monitoring the sensory environment in fear of overstimulation, I just became more and more distressed from sensory stimuli.

This was unpleasant.  It made many environments inaccessible to me.  For me, it was the worst symptom of my autism.  Some autistic people have lost jobs or dropped college classes because of their own sensory sensitivities (Shore, 2012; Willey, 1999).

So, sensory anxiety is a problem.  Now, what do we do to treat anxiety?

Often, we gradually expose the individual to the anxiety-provoking stimulus in a safe, controlled environment.  This way, the person learns that their anxiety is irrational, that the anxiety-provoking stimulus isn’t all that bad, and that they can confront it and endure it.

That works fine – if we assume that the anxiety is irrational.

To be fair, sensory anxiety is sometimes irrational.  Here are a couple of examples of (more or less) irrational sensory anxieties:

• I used to dislike pretty much any food when I tried it for the first time. In my defence, it wasn’t completely irrational – I had taste sensitivities to the point that any new food could very well be a legitimately aversive stimulus!  But sometimes, I just hated a food because I assumed it would be horrible, and that wasn’t rational.  There are various foods I now enjoy (e.g., pizza) that I formerly claimed I hated.  Only gradual exposure convinced me that they were safe.  (Unfortunately, when it comes to taste, it can be difficult to distinguish genuine sensory distress from mere sensory anxiety.)
• A lot of people find some very specific types of sound upsetting. Sometimes, that’s because the properties of the sound just happen to be aversive.  High-pitched sounds and hissing sounds can be genuinely awful, and it’s only natural to be afraid of them.  However, sometimes somebody might be distressed by a sound that they’ve learned to dislike, independent of the sound’s acoustic properties, perhaps through some kind of conditioning.  In that case, exposure might be useful.

But often, sensory anxieties are perfectly rational, because some sensory stimuli are just inherently distressing.  They’re overwhelming – sometimes to the point that there’s just no coping with them.  In such a case, exposure is not only unhelpful – it’s harmful.  If a stimulus is inherently harmful, there’s no way that you can expose somebody to it in a safe, controlled environment.  How can something that is inherently harmful be safe?  Thus, exposing someone to a stimulus that is inherently harmful could aggravate their existing anxieties because they will, naturally enough, simply come to further dread exposure to the stimulus.

I’m pretty sure that’s why my own sensory sensitivities got worse and worse the longer I was in the overwhelming sensory environment of the mainstream school.  It’s also the reason my sensory sensitivities got much better after I left that overwhelming environment – because I wasn’t always dreading exposure to sensory stimuli, I became less anxious.

There’s also the issue of sensory distraction.  This is not something I’ve had to deal with as much as some other people, but I gather there are autistic people who can’t focus because of sensory stimulation.  Something in their environment – a soft sound from the ventilation system, a light that won’t stop flickering – persistently distracts their attention away from whatever they’re trying to do.  Now, like I said, I don’t fully understand these distractions, since they’re not something I really experienced.  But as best as I can understand, these distracting stimuli might be extremely aggravating, though perhaps not be overwhelming in quite the way I’ve described.  But again, exposure won’t work well for them.  If the issue is that someone can’t stop thinking about a stimulus, how is repeatedly exposing them to the stimulus going to help?

To summarize, then, we should be very careful about using exposure to work with sensory sensitivities and sensory anxieties in autism.  Although exposure may be useful for some sensory anxieties, it will probably worsen other sensitivities.  Ultimately, it comes down to the fact that, when we use exposure, we’re assuming that the anxiety is irrational – but sensory anxieties are sometimes rational, natural responses to inherently distressing stimulation.

If a sensory stimulus is inherently distressing, trying to treat it with exposure makes about as much sense as trying to treat a fear of heights by exposing people to heights through having them repeatedly jump out of buildings and injure themselves.  It makes as much sense as treating a fear of spiders by exposing people to spiders through having venomous spiders bite them.  Exposure to height- or spider-related injuries will worsen fears of heights and spiders, just like exposure to distressing sensations can worsen sensory anxieties.

If you have sensory sensitivities, does this reflect your own experiences?  Is there anything to add?  If you don’t have sensory sensitivities, does this surprise you?  Any other comments?  Please add them below!

Footnotes

[1] I don’t have an official diagnosis to back it up, though.  It was many years ago.

References

Mazurek, M. O., Vasa, R. A., Kalb, L. G., Kanne, S. M., Rosenberg, D., Keefer, A., … Lowery, L. A. (2013). Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. Journal of Abnormal Child Psychology, 41(1), 165–176. https://doi.org/10.1007/s10802-012-9668-x

Shore, S. (2012). Chapter 2: Stephen Shore. In T. Grandin, Different…Not less: Inspiring stories of achievement and successful employment from adults with autism, Asperger’s, and ADHD (pp. 43-72). Arlington, TX: Future Horizons.

Uljarević, M., Lane, A., Kelly, A., & Leekam, S. (2016). Sensory subtypes and anxiety in older children and adolescents with autism spectrum disorder. Autism Research, 9(10), 1073–1078. https://doi.org/10.1002/aur.1602

Willey, L. H. (1999). Pretending to be normal: Living with Asperger’s syndrome. London, UK: Jessica Kingsley Publishers.