To review Part I, you have created your hierarchy and completed a couple of easier exposures. In this article we will move onto some tougher exposures.
Continuing Your Exposures
Exposure 3: Watch planes in the sky and imagining them crashing. This is a good exposure for several reasons. First, you’re allowing yourself to have the fear that something bad could happen on a plane: This is a thought people with fear of flying try to avoid having. But really, it’s targeting a crucial aspect of making progress in this treatment protocol. Something called thought-action fusion. Basically, thinking something doesn’t mean it will happen. If you can really get on board with this concept then you’ll make progress quickly. By imagining a real plane crashing, real lives on the line, you’ll likely learn that nothing happens (i.e. the plane probably won’t crash). You’re unlocking a door that allows you to have scary thoughts and learn that they are safe. Your thoughts can’t harm you. I would recommend continuing with this exposure until you feel bored, because that means it isn’t causing you anxiety anymore.
Tip: You can try thought-action fusion exposures in various other ways, too. Try to trip someone with your mind. Make a person stop walking, or a car do a u-turn, all with your mind. Try making a bird land on your hand, or make someone use a spoon to stir their drink. You’ll likely not have much luck, but you should try it anyway.
Exposure 4: Target the fear of turbulence. A cool way of tapping into this fear can be done in the car. While you are being driven somewhere, close your eyes and imagine being on a plane. Imagine you’re way high up in the air and that every bump and jiggle is the start of turbulence. You’ll be surprised how realistic this feels! It feels like moderate to heavy turbulence. If you need help imagining, watch a turbulence video first. To get a quiet car ride, you may need to explain to a friend or your family beforehand, or take a Lyft or Uber ride. If you’re really into it, you will likely feel anxiety associated with the turbulence. Do this at least 3 times.
Enhancing Your Exposures
I want you to notice how your body reacts to that fake turbulence in the car. Do your fists clench or your muscles tighten? Do you tell yourself, “It’s going to be ok”? Do you do anything else to keep yourself safe (e.g. cling to a toy, cross your fingers, squeeze a stress ball)? If you’re noticing any patterns, ask yourself whether these behaviors make you less afraid, or help handle your anxiety better. Paradoxically, if they are in fact reducing your anxiety, we want to stop them because it’s likely they are actually interfering with the learning goals. This is similar to how you ice after an injury to improve healing by stopping the swelling (which is the body’s natural reaction.) In exposure therapy you try to counter things that keep you feeling less anxiety. We call these things safety behaviors. We want you to feel high anxiety, and research indicates this is actually a key component needed to make progress. You don’t need ANY safety behaviors, and that is the goal of this treatment. To be able to fly without the need for anything to lower your anxiety.
Tip: To do this, I’d like you to counter whatever safety behaviors you do. For example, unclench your fists, tell yourself, “something bad could happen right now,” leave any toys or medications (especially benzodiazepenes) at home. Doing this will likely increase your anxiety and block any safety behaviors, which will maximize your learning.
Continuing Your Exposures
Exposure 5: Now we should be ready for something scarier. I’m going to combine some of our previous steps. I want you to get into a car, close your eyes, and imagine something bad happening to you in the car. Go for at least 10 minutes straight and notice what happens to your anxiety. Remind yourself that at any point a car could hit you. Or the driver could crash. Every bump you feel could be an indication that the car will crash. You’ll just have to tolerate it and sit with the uncertainty that something bad could happen. While you do this, it is critical you keep telling yourself that something bad could happen and to keep your eyes closed. Again, this helps block any safety behavior. Do this exposure at least 5 times, or until your anxiety decreases. And it will decrease the more you repeat it!
There are many variations of this type of exposure. You can do exactly the same steps on a flight simulator. You can do it on the bus or a gondola. You can do it on something like “wings over Washington”. You can go on a rollercoaster or a ferris wheel. The point is, you’re doing something that has some risk, where a bad event could happen, and you’re actually thinking about that bad event happening. If you’re feeling ready for it, you can even will something bad to happen.
Tip: The rule is that you have to keep doing these exposures over and over until your anxiety decreases and you learn that the bad thing doesn’t happen. You need to learn that your thoughts probably don’t affect the outcome (notice I say probably – this stops the thought being reassurance). You can tolerate those thoughts without pushing them away, even though you know it’s possible that something bad could happen.
Part II Summary
Now you’ve mastered several important steps. You’ve learnt to talk and think about the idea that planes crash. You’ve also sat through an approximation of turbulence sensations in a car. And lastly, you’ve actually put yourself in a situation where something bad could happen without engaging in any safety behaviors! That’s some good progress. Although we all know that most of the time planes don’t crash, you don’t know when you get on a plane that something bad won’t happen. And that’s the trick. There’s no way to know, you just have to risk it. You have to learn to live with the uncertainty that bad things do and can happen, without that fear getting in the way of things you want to do.
In the next article we’re going to complete actual flying exposures!