If you frequently feel intense irrational amounts of panic or anxiety in seemingly harmless situations and the need to escape to alleviate the physical symptoms you may be developing a phobia. Usually this leads to a strong desire to avoid these situations and a laundry list of behaviors that may look something like any combination of these:
You may find yourself making excuses to skip out on taking the elevator or subway. You may suddenly find you prefer to take the local bus rather than the express train.
You may find yourself preferring not to fly on long flights or during the evening. You may start avoiding visiting friends who live on high floors or work above a certain level.
You may find yourself feeling angrier in traffic, even avoiding tunnel or bridge routes or particular highways.
You may find that you don’t enjoy sporting events or music concerts as you once did. Or now when you attend the theater, your first job is to notice all of the exit signs. You may opt to sit in the aisle or purposely arrive late at meetings so you can sit close to the door.
You may avoid one-on-one meetings or limit dates to specific situations or places where you feel comfortable. You may find yourself feeling unsafe outside of your home or neighborhood.
You may find yourself leaving parties early or being able to cope with making small talk only after consuming a few alcoholic beverages. You may find yourself becoming less verbal in group-settings where you know a smaller percentage of the people, or making fewer requests for simple things as your anxiety worsens.
Your Body Has Memory!
Phobias can develop for a number of reasons such as modeled behavior from a parent, the result of a traumatic event or a biological predisposition, but commonly it is a conditioned response that maintains and worsens the problem. A conditioned response is a learned automatic (physiological) response that is connected to the situation. So your body activates a knee jerk reaction ticking off an automatic nervous system response, which acts as an alarm warning you of danger. The alarm response is neurological sympathetic arousal and looks something like this: increased heart rate, constriction of muscles, sweaty palms, shortness of breath, pins and needs in the fingers or toes, butterflies in the stomach, headache or clenched jaws or fists.
FALSE ALARM! Only, in the phobic scenario, the danger is not real so the alarm is a false alarm and one THAT YOU SHOULD COME TO EXPECT. This is an important point to grasp, and the essence of the cognitive therapy work I do with clients who experience phobias. As one of my clients writes me shortly after flying to Africa after 3 weeks of hard work with me:
While walking down the aisle and entering the plane, I had doubts about being able to do it. But the concept that you told me about it being my body lying to me, kept me going with minimal problems, just a few tears. Once seated the nervousness went away almost entirely, and there was rarely bad feelings. Other than that I was perfectly fine, and about 45 minutes into the flight I slept. When I woke up there was an hour left in the flight. I now have no worries about making the flight back, worrying about the boat ride, etc. It all seems to have disappeared upon takeoff. I feel (at the moment, like I could fly anywhere). Thanks a million. You’re a lifesaver.-DR
RELAXATION On the behavior side, practice shutting down the alarm response (sympathetic arousal) by practicing getting into the neurologically opposite position- parasympathetic arousal or simply put a true relaxation response.
Some great techniques to practice are deep diaphragmatic breathing, cardiovascular exercise, transcendental meditation, yoga and incorporating biofeedback. My clinical specialty relies on a combination of breathing and meditation exercises that include biofeedback training to facilitate the clients’ ability to become neurologically and emotionally relaxed in challenging situations.
FACE YOUR FEAR Then figure out ways to slowly challenge yourself rather than avoiding situations. Start with small incremental exposures. Staying in the situation will not only give your body an opportunity to learn a new response to the situation, but it will also stop validating to your body that the alarm was a real indication of danger.
REWARD FOR STAYING NOT ESCAPING If you are used to leaving a situation to obtain symptom termination, you have been rewarding the behavior with the sense of relief. Learn to reward yourself for staying in the situation so that your body learns to relieve itself and you feel good for challenging your self.
YOU ARE NOT SOLO Although most people dont generally talk openly about their phobias, the fact is that they are a very common condition. It is estimated that over 20 million Americans suffer from a Phobia and more than 40 million Americans suffer from an Anxiety disorder. So the next time you are putting yourself down for having such a condition, calling yourself weak, or feeling embarrassed by potential judgments from on-lookers, do your self a favor, pause for a moment to look around the situation 1. Odds are, you are probably NOT alone in your state of anxiety and others are feeling the same way! 2. Realize most people are too busy dealing with their own lives to pay attention to your anxiety behavior that closely or really care. 3. Remember that Anxiety disorders are the most common mental problems and that your problem doesn’t need to be faced alone.
More Help If you are feeling overwhelmed by challenging your anxiety elicit the aid of a professional cognitive behavioral specialist such as myself who can help you with the process. For more information on the treatment, contact me at DrJayme@ASKtheCBT.com or 212-631-1133. Email me DrJayme@askthecbt.com
You can also read more about my methods of treatment for phobias and about a study I conducted demonstrating the effective use of Biofeedback and Virtual Reality Therapy in helping people overcome their Fear of Flying. "Treating Fear of Flying Using Biofeedback & Virtual Reality "]
Treating Fear of Flying Using Biofeedback & Virtual Reality "] 
The important thing to realize is that you can work against your phobias and live anxiety free!
Best, Dr. Jayme
