Question 1

What factors need to be taken in consideration with HSPs that might alter a CBT treatment approach?

Elaine Aron · Accepted Answer

Please read Psychotherapy and the Highly Sensitive Person for general advice.  Specific to SBT, I would be careful of shaming a client who cannot do what you ask them to do.  As you probably do, explore why in a very accepting, positive way, highlighting what the person could do.  Consider what parts of their innate trait might be making it harder for them, using DOES.  How greater depth of processing, emotional responsiveness, or awareness of subtle stimuli enter in, and especially how all three of these lead, naturally, to being more easily overstimulated and overaroused.  Overarousal means poorer performance for anyone doing anything.

Question 2

Question 3

Hello, I need to attend a course for HPS , can you help me please?

Elaine Aron · Accepted Answer

You are right that you need to attend a course for HSPs if you have not already.  It is a very good idea, for many reasons.

I am writing this during the pandemic, so there are only online courses.  But watch hsperson.com, the tab for Events, for what is happening.  Or subscribe to my email, although that is on pause until February.

Right now there are two regular events.  You can attend an "Are You Highly Sensitive LIVE" webinar with Alane Freund on first Fridays of the month for general topics and 3rd Mondays for parents.   These are $37/mo., but no one is turned away for lack of funds. Go to Areyouhighlysensitive.com

Jacqulyn Strickland, who has been running HSP Gathering Retreats, in person, all over N. America and Europe, has some courses on line.  You can find them at lifeworkshelp.com.

One time only:

December 5--Second Highly Sensitive Men’s Seminar, this is by Zoom:  "Meaningful Work for a Fuller Life."  This will cover all kinds of work, whether you are retired, a student, or currently “working” in the usual sense.  Led by Tracy Cooper, John Hughes, Will Harper, and Tom Falkenstein.  Search for eventbrite HS men.  That should get you there.

March 6, 2021—San Francisco Jung Institute. "Psychotherapy with Highly Sensitive Patients:  From Jung to Now."   I will discuss Jung’s concept of sensitiveness and then the best practices when psychotherapists are seeing HSPs.  Anyone can attend.  Continuing Education (3 hrs) available. Searching for SF Jung Elaine Aron should get you there.

Question 4

Are there gender differences in the trait of high sensitivity?

Elaine Aron · Accepted Answer

There are no differences in the number of males and females born with the trait.  But in many cultures the trait is discouraged, so that men seem to cover it up, consciously or not.  Probably this is why men score lower on the HSP Scale than women.  It is interesting that when the scale was constructed, no item was included that showed any differences in how the sexes responded.  But when men answer the entire scale, they score lower, so taking the entire scale seems to have some special effect on how they answer.

Question 5

Is equine assisted therapy beneficial for HSP? When might I think about referring a client on for this?

Elaine Aron · Accepted Answer

I think almost always.  We run a Highly Sensitive Person and Horses workshop when we can (not now) and have witnessed so much growth from it.  Just quietly observing horses seems to help.  As for when, I trust your clinical skills to decide!

Question 6

I am a psychotherapist and a HSP. Am I in the wrong career? I do worry that I take on too much.

Elaine Aron · Accepted Answer

No, you are not in the wrong career, but yes, you probably do take on too much!  I have written extensively about this on my webpage.  Please read https://hsperson.com/resources/just-for-highly-sensitive-therapists-and-coaches/

Question 7

Do HSP struggle more with emotion regulation than non-HSP? What interventions best help with this?

Elaine Aron · Accepted Answer

I have written about emotional regulation here.  https://hsperson.com/emotional-regulation-and-hsps/  There are over 100 comments on the article that may be helpful as well, giving a good sense of what others struggle with and solutions they have found.

Question 8

Do highly sensitive people often present with somatic symptoms?

Elaine Aron · Accepted Answer

Naturally they do, partly because stress often manifests as somatic symptoms, and they are often under more stress.  Somatic symptoms can also be the result of dissociated trauma, and HSPs have often been exposed to trauma.

If the question is, do they often have somatic symptom disorders, be aware that they are by nature more aware of their bodily processes, so that they will notice symptoms sooner and be more concerned and affected by them.  They also tend to have lower pain thresholds, more reactive immune systems, and undoubtedly stronger reactions to consciousness-altering substances.   They have more side effects from medications, so that they need lower doses and still may not be able to tolerate these effects (Jagiellowicz et al., 2007).

Finally, they may be anxious about their health simply because their trait involves considering all possibilities, including that their doctor has overlooked something or they did not explain something clearly enough. They will have more questions about tests and treatments and be more interested in alternative medicine and prevention.

Since most physicians are presumably not highly sensitive, they often have a low view of these time consuming, "complaining" patients, and psychotherapists may accept the perspective of their fellow professionals and see a HSP's somatic preoccupations as excessive.   Obviously too much focus on symptoms that are not a problem can occur, but remember of course you are not trained to decide about the actual health significance of physical symptoms.  (One must also watch out for highly sensitive patients who fail to seek medical attention when they ought to because of past experiences of feeling shamed or just being wrong.)

Question 9

How do you differentiate between trait high sensitivity and an anxiety disorder e.g., GAD or SAD?

Elaine Aron · Accepted Answer

In Psychotherapy and the Highly Sensitive Person, Appendix B, I deal with differentiating between DSM diagnoses as well as co-occurrences.  It is a bit out of date, based on DSM 4, but it will be clear enough, I think.

For both disorders, the decision is  highly dependent on defining “excessive” (“excessive anxiety and worry occurring more days than not for at least 6 months”).  Many HSPs, especially those under stress and with poor childhoods,  would meet the symptoms criteria, such as, those for GAD:  feeling on edge, easily fatigued, trouble concentrating or mind going blank, irritability, muscle tension, and sleep disturbance.  It all would depend on the level of distress and impairment.  The question is whether a diagnosis is really needed, for treatment or insurance purposes.  There are co-occurrences of course, and the history helps to determine if past events have rendered a patient more chronically anxious than others with the trait.

The criteria for SAD are perhaps some of the vaguest in DSM 5, in that almost everyone has had, at some point in life, bouts of “marked” fear of one or more social situations in which they fear being “exposed to possible scrutiny by others.”  It is a disorder if it “out of proportion” or lasts for six months or more. DSM views this as different from “normative shyness,” and explains that only 12% of self-identified shy persons see themselves as having symptoms that meet the criteria for this disorder, which must interfere significantly with an individual’s normal routine and cause them distress.

That is, if a person can design a life in which fear of being judged by others does not occur, they would not meet criteria. Keep in mind that sensitive persons are even more aware of the fact that people do scrutinize each other and that these situations are overarousing, and overarousal impairs their response, causing them to feel even more scrutinized, and this cycle may well make their fear a reality.  All of this becomes a disorder when they are utterly powerless to overcome their fear in almost all situations.  You may also see persons with true Social Phobia who are not highly sensitive.

Question 10

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