Mark was a strapping young man. A professional football player by profession. He had achieved much recognition throughout his life. In High School, he was on the state championship football team. He was the Homecoming King. He received a full scholarship to his state university. By all accounts, you would look at him and think that he has lived a blessed life and nothing seemed to stand in his way. However, looks can be deceiving. Throughout his life, he has been afraid of flying. During his childhood and teenage years, he remembers being nervous when playing Hide & Seek when he found a great hiding place. Additionally, he was anxious when his buddies climbed up the trees or went for bike rides up the switchbacks on the local hills. Those concerns no longer overwhelmed Mark, but put them together while on a passenger airline and you have one freaked out adult.
Mark’s wife encouraged him to address his fear of flying as it was interfering with his travel both for work as well as negatively impacting his family vacations.
Definition and Symptoms:
Fear of Flying can be in fact its own specific phobia. Interestingly, most individuals with this condition possess a range of irrational fears. Some individuals are afraid of being trapped in confined spaces (which is referred to as Claustraphobia). Some individuals are deathly afraid of heights (which is referred to as Acrophobia). Specific Phobia, Situational Type is coded in the Diagnostic Statistical Manual for Mental
Disorders – Fourth Edition (DSM-IV, APA, 1994) as 300.29.
A. Unreasonable or excessive fear triggered by a specific object or situation. This could include; flying, heights, injections, animals, blood.
B. Directly associated anxiety or panic attack with the specific trigger stimulus.
C. The individual is aware that the anxiety or panic is excessive and unreasonable.
D. The phobic situation is avoided for short-term relief or is managed with intense anxiety and/or distress.
E. The avoidance, anticipatory anxiety or distress significantly interferes with the individual’s normal daily routine, occupation, academics, social/relational domains.
Mark has seemed to move beyond these concerns during his daily activities. However, put them together when he needs to travel to another city for a football game or when his family is discussing vacation plans and he begins to have intrusive, irrational thoughts. He begins to imagine the worst case scenarios.
Anxiety needs two components in order to exist. The person must be, 1) invested in the situation, event, relationship, etc and 2) perceive a threat. Hence, Investment + Threat=Anxiety (Cortman and Shinitzky, 2009). The brain perceives some trigger. This perception and thought leads to some emotional reactivity. A pattern or compulsive behavior develops referred to as “Motivated Behaviors” (Dr. Paul McHugh, 1998). A four step cycle becomes established.
1. The individual perceives some stress or trigger (external, environmental or physiological).
2. The individual experiences intrusive negative thoughts. Worst case scenarios begin to race through their thoughts. Irrational thoughts expand. Logic is lost.
3. In order to cope with the perceived stress, the individual considers options. A previous behavioral option to decrease the perceived stress is identified. The individual begins to teach themselves that the only way to cope with the perceived stress is by engaging in a predictable behavior. This behavior can take on a compulsive nature.
4. The repetitive behavior provides short-term relief while offering no long-term resolution. The solution did not resolve the issue. Every time the perceived stress occurs, the individual returns to the short-term relief (avoidance). They even begin to rationalize and justify their behavior. This short-term relief becomes reinforced as it decreases the anxiety or perceived stress. Fear of dogs, avoid dogs. Unable to cope with work stress, some people use mood altering substances. As you can imagine, some individuals are aware that they avoided the issue rather than resolving it. They might feel guilty or regretful and even promise to address the issue. However, if they don’t address their coping skills, there will come a point when they cycle begins again and the individual perceives the stress.
There a few treatment directions in which you may find help;
1. When initially addressing the issue, one must develop a range of coping skills in order to manage the perceived threat in a different and healthier manner. Coping with the triggers or the perceived stress can be accomplished by implementing a variety of clinically productive skills. Each of the following skills needs to be practiced while not experiencing the distress. The individual needs to master these skills prior to being able to successfully use them during a stressful time. In essence practice and mastery must exist prior to implementing these management techniques. Through developing a predictable and successful history practicing these skills you will be ready to decrease the perceived stress, manage your emotions, redirect your cognitive focus and increase your adaptive behavior. This article does not have the space to elaborate upon each coping strategy. The following behavioral interventions are not exhaustive, yet provide an excellent framework for you to start.
a. Muscle Relaxation Techniques
b. Deep Breathing/Centering
d. Visual or Guided Imagery
e. Response Prevention and Deliberate Exposure
f. Total Focus
k. Social support network
2. Changing one’s perception.
a. Remember that Anxiety has its foundation in perception. Hence, Investment + Threat = Anxiety (Cortman & Shinitzky, 2009). If you re-evaluate the situation and consider the issues involved that lead to your anxiety, you might determine that the variables no longer has as much weight in the equation.
b. Assimilate reality. Based upon your true, real life past experience, what was the actual outcome subsequent to your fear? The odds are that you employed a “Catastrophizing” style. The “Worst Case Scenario” most likely did not occur. We have not assimilated or taken in the reality. Instead of negating reality, we need to begin accruing a stockpile or war-chest of successful outcomes which shall confront future misperceptions.
c. What you once feared may later turn out to be not as valued. You will discover that once you put goals into perspective, you are less likely to overwhelm yourself.
3. When behavioral interventions have been attempted, practiced and yet the physiological angst continues, it would be prudent to follow-up with your General Practitioner or Psychiatrist to discuss a trial of a medical regimen.
4. The combination of behavioral and medical might provide you with the decrease in physiological arousal and an increase in healthy, adaptive coping skills to manage your fear in a more productive manner. In Mark’s case, we began with introducing him to the variety of possible treatment options. He elected to try the behavioral interventions first and see if he needed to go any further. Our first session addressed his hyper-aroused, physiological reaction. We addressed his tendency to experience a rapid breathing pace and a rapid heart rate. The initial focus was on Deep Breathing/Centering and slowly quieted his system. We then moved to Muscle Relaxation techniques. Moving from one major muscle group to the next, toe-to-head, he was able to further the level and degree of relaxation, physical calm and mental quiet. It was encouraged that he practices these between sessions.
Subsequent sessions focused on Cognitive-Restructuring and Visual Imagery. During the Cognitive-Restructuring portion of the session we learned how he needed to become more aware when negative internal chatter occurred. He oftentimes talked himself out of situations and exaggerated the possible worst case scenarios. We then progressed to Visual Imagery in order to help facilitate an overall peaceful mental state. Visual imagery allows an individual to quickly foster a calm state of mind which can be generalized to any location or situation since it is a state of mind. Again, your perception is your reality.
Later sessions focused on Response-Prevention and Deliberate Exposure in conjunction with Successive Approximations. In Successive-Approximation, we created a ten (10) point scale which starts at one (1) which represents the most peaceful and least fearful situation. We selected the office. At the other end of the spectrum we identified flying in an airplane as ten (10). We then created a scale depicting each of the 10 positions on the scale which moved from least fearful to most fearful. We moved from least fearful to the next step on the scale.
Whenever Mark experienced anxiety or apprehension, we employed the other behavioral interventions (Deep Breathing, Muscle Relaxation, etc) until he was calmed. Each successive step along the scale was managed prior to moving further along the continuum. Through the use of the array of behavioral interventions we were able to decrease the physiological hyper-arousal of his system, address the anxiety and fear when it began, and practiced the above to mastery levels that we decreased his overall anxiety levels to functional experiences and prevent his fear from interfering with his ability to travel by flight. At the time of this article, Mark has travelled comfortable with his professional football team and has gone on one family vacation all by flying to his destination.
Apparently God was able to give him metaphoric wings.
www.nimh.mih.gov, National Institute of Mental Health
www.adaa.org, Anxiety Disorders Association of America
www.hopkinsmedicine.org/psychiatry/specialty_areas/anxiety, The Johns Hopkins Medicine, Anxiety Disorder Program
http://www.semel.ucla.edu/adc, UCLA Semel Institute Anxiety Disorders Program
McHugh, Paul, Clinical Seminar, Johns Hopkins University, Department of Psychiatry and Behavioral Medicine, 1998.
Cortman, C. and Shinitzky, H., Your Mind: An Owner’s Manual for a Better Life, Career Press. 2009
Diagnostic Statistical Manual for Mental Disorders, APA, 1994
Article Submitted by;
Dr. Harold Shinitzky, Psy.D.
Author – Your Mind: An Owner’s Manual for a Better Life