Sunday, December 6, 2009

Fear of Flying Part III - The Cure (Really!)

The irony did not escape either of us – a psychoanalytically trained psychotherapist, sitting in the consulting room of a cognitive-behaviorist. Penny appreciated the irony as well, but pointed out that symptom relief could be a good thing. I found that hard to argue with. She spent the first session taking a history of my specific experiences with flying, and interrogating me about my specific fears (the plane dropping like a rock out of the sky!) She taught me a breathing technique I had not heard of before, called “square breathing.” Breathe in for 2 counts, hold for 2, out for 2, hold for 2. Do this twice. Then increase to 3 x 3, and 4 x 4, etc. As a singer and a therapist I could buy this – it would help control the autonomous nervous system, and keep my diaphragm from rising up into my nasal passages. So, feeling a little silly, I tried it while she looked on. I’m a perfectionist, and always was a bit of a teacher-pleaser (read: suck-up). I got to 6. She said “Wow, you can stop now.” I tucked the information away. I might not be cured, but I sure knew how to breathe.

Next session I told Penny that I would have to fly again in about a week. I was scheduled to accompany Michael on a business trip to Santa Fe. Santa Fe requires two, if not three flights to reach from Philadelphia. My frugal husband, of course, chose the three-leg trip. “OK, then,” she said, “We’ll have to work fast.” She asked me where I lived, where I routinely drove and walked, where I worked and what I did on a daily basis. She said, “statistically flying is a very low-risk activity for you” and gave me some stats to back it up. I was much more likely to die of a car accident, being run over by a truck, mugged, exposed to a fatal disease, or struck by lightning, than I was likely to die in a plane crash. Michael rolled his eyes when I got home – she had told me pretty much the same things he had said about the redundancy of safety systems, etc.—but coming from someone other than a loved one I was able to hear it more objectively. She told me it was in the airlines’ very best self-interest to keep me and my fellow passengers alive no matter what. And it was needless to say in the pilots’ self-interest to land the plane safely. (Therapy à la Ayn Rand?) She told me (and this is the big cognitive-behavioral moment) that I had come to believe something that was entirely false—that flying was unsafe—and I simply (hah!?) needed to learn a new message. She sent me on my way and I prepared for the Santa Fe flight with my usual anxiety, but now also just a bit of…well, curiosity. Would these 2 measly therapy sessions be enough to help me?

The flights to Santa Fe were relatively uneventful. I did my “square breathing.” I told myself over and over that I was safe. And suddenly, the penny dropped (really, no pun intended). It wasn’t anything Penny had said specifically, but armed with her confidence, and attempting to take on the attitude of “fake it ‘til you make it,” I had actually remained calm. I had relinquished my efforts at superstitious control and lo and behold, I didn’t die. Even more surprising, this didn’t even feel especially momentous. What I realized was that all my life my body had been going into panic mode, with shallow rapid breathing, sweating palms, the whole bit. And I had believed my body.

All my life I’d been taught the message “Trust your body.” In dance class and movement class: “Trust your body.” As a professional singer, “Trust your body.” In yoga: “Trust your body.” And in my therapy training, especially working with abuse survivors whose bodies remembered traumas their minds had never even stored: “Trust your body.” But at least in this one situation, I needed not to trust my body! My body had been giving me false, panicky information—and had been reinforcing one bad experience after another. My body took the scraps of mis-information I had in my brain about flying being unsafe, and turned each flight into the feeling of a death trap, in which the body’s instincts to fight or flee could not be activated.

No wonder nothing I’d tried before had worked. All those remedies masked my body’s response, but did nothing to change my firmly held false belief, that I was going to die. Because my body was telling me so. My body was telling my brain: “We’re gonna die we’re gonna die we’re gonna die” and no amount of meditation or medication would mute that repeated message of doom.

This time around, I was able to send communication in the opposite direction. My brain told my body “We’re OK we’re OK we’re OK.” I breathed to help the body relax and take in the message. I remembered the statistics, and the self-interest of the airline and the pilots. I shelved my normal democratic socialist ideas for the duration of the flight and took Ayn Rand to heart—enlightened self-interest would keep us all safe. We landed. Three times. By the time we got to Santa Fe, I was positively congratulating myself on my newfound calm.

The flight home was a different story. We boarded the plane while the sky piled higher and higher with thunderheads. We waited, and waited some more. We finally took off. The turbulence was unbelievable. The plane bounced above the clouds like a puny basketball with flapping wings. (How do those metal wings flex so much!?) We landed once. (Actually, we hit the tarmac about 3 times before we officially “landed.” I think that counted for 3 landings all in one.)

After sitting in the plane for a while, breathing re-processed air and waiting for Air Traffic Control to send the signal, we took off a second time and banged around in the sky some more. The pilot came on and told us that the storms were building so rapidly in the Philadelphia area that we would have to circle some place in Ohio until we were cleared to land. We did this for about an hour, banking vertiginously over clouds that seemed to reach up and grab at the wings of the plane. Nervous chatter had subsided to a somber silence in the cabin. Finally, growing low of fuel, the pilot came on again and informed us that we would have to divert to Norfolk, VA. There was a collective groan among the passengers. It was about midnight when we landed in Virginia. The flight attendants came on and informed us that the pilots and crew were now at the legal limit of their flying time, and we could not go on. We all settled in on the floor of the near-deserted Norfolk airport. Some of us curled up and attempted to sleep.

Suddenly, there was a flurry of activity at our gate. One of the flight attendants got on the microphone. The pilot and crew had been granted an extension of their time. The weather was clearing enough for us to go on to Philly. In minutes, we were all up and being hustled on the plane. I saw two flight attendants grappling with one of the airplane’s heavy door, and slamming it shut. We barely got our carry-on’s stowed and our seatbelts fastened, and we were taxiing once more. The flight attendants hastily babbled through the safety message as the plane was approaching the runway. We were off once more, and again we were being batted up through the roiling heaps of clouds, and then quickly bouncing back down on our final descent.

And I realized I was completely OK. Calm, even, give or take a couple of quick inhales. (Michael of course was sleeping the sleep of the blasé.) I looked a couple of rows ahead of us where one of Michael’s colleagues was seated. In the orange spotlight of his reading lamp, I could see him sweating. He looked like a wreck. He looked, well, like me on previous flights. I am a good person. I did not gloat. (Much.)

Ever since that acid test, I have built on subsequent successful flights to reinforce the message: “We’re OK.” If my body gets a little stirred up by the speed of takeoff, or a lurch in-flight, I remember my square breathing, and I go back to practicing my nonchalance. I can board a plane now with almost as much sangfroid as I feel on a train or a subway car. I can drink caffeine and not get wired, and I can get work done. Occasionally, I can even sleep.

Needless to say, I am very grateful to Penny for her intervention! I do not feel the need to abandon psychoanalysis, however, and throw myself entirely over onto the cog-behavioral side! It’s my conviction that both have their place. Nothing replaces the quick and effective symptom relief of CBT. I am living proof. But who is to say that all the in-depth exploration I did previously in therapy and analysis, and in my continued reading and teaching of psychoanalytic theory, did not and do not continue to make such “cure” possible. I was already ripe for a new way of thinking and feeling – and living! Let no good introspection go to waste – that continues to be my mantra. Nor do I believe that any of my prayers during my phobic years (or since!) have gone to waste. No God worth his or her divine salt would fail to pour solace and courage on my times of terror, and perhaps even to open the way for healing to begin—slowly, subtly, and at last surely.

We will be landing soon. There is an orange sunset mist over the gentle, tree-covered hills of Virginia and the Carolinas. A few lights have come on in the miniature houses below. There will not be any fireworks on this November night. But I have finally regained the excitement I once had as a very young woman. I am flying, and my heart beats just a little faster, not in fear, but in anticipation. Soon, once again, there will be things to do down on the ground, and loved ones to greet. My prayers tonight will be filled with gratitude—not for surviving a deadly ordeal, but for living, yes, and all its wonders—even the wonder of flight!

6 comments:

  1. Dear Pamela,

    Cognitive MAY be helpful for fear of flying, but it can't help people who cannot do introspection, or people whose feelings develop rapidly. The problem is, when feelings develop rapidly, cognitive ability declines.

    The underlying problem is insecure attachment. The parent IS the infant’s world. Subsequently, the bigger world does not feel safe either, and we turn to control or escape for emotional security.

    We are born with HALF of the emotion regulation system in place (the half that revs us up). Half does not exist whatsoever (the half that calms us down). By 18 months the part of the brain that has the POTENTIAL to become able to calm us starts to be available. The young child begins to memorize what caregivers do to provide calming. And here is where the problem becomes critical: the only way a human learns to effectively self-calm is be memorizing the steps received from someone who is very, very good at providing calming.

    Obviously, caregivers – regardless of how much they care – vary in their ability to tune in the the child and assure the child in a way that works. As a result, on a scale of zero to ten, a few of us get a “ten” level of ability to calm ourselves, and most of us get far less. People who get a “one” or a “two” are the people who become addicts. Those of us in the middle have enough ability to calm ourselves that we can develop strategies to make up for what we were not given during those early formative months.

    During teenage years, we tend to think bad things only happen to others, so we get by that. But when we realize, as we get into our twenties, that something can happen to use, we turn to strategies to keep anxiety under control. The strategies typically involve (when dealing with uncertainty)

    control
    escape

    Control: if we control a situation, we often believe (whether really true or not) that we can make sure everything works out OK, such as when driving a car. Though it is not nearly as safe as flying, we FEEL safer because our hands are on the wheel.

    Escape: this means not only a way out if things don’t go well, but a way to maintain a certain distance, either physically or psychologically. Physical escape may mean not flying. Psychological escape may mean trying to keep the mind elsewhere during the entire flight.

    On the ground, we do OK with control (except it messes up relationships) and escape (except for need to avoid or to get out of close relationships). But when we get aboard a plane, we have no control and no escape. Frankly, all this does is put up back to the level of ability to regulate emotions we were originally given. But that ability originally given simply leaves us exposed to the terror of anything we can imagine. (There are reasons - too complex to explain here - that cause what we imagine to become so real that it causes terror.)

    That is the underlying problem. If you can get cognitive to work for you, great. But most fearful fliers can't use it, and for for them, the the only way to prevent the feelings that cause distress is to increase the calming that works unconsciously and automatically. For them, fear develops too fast for the rational mind to keep up and counter the feelings with reason.

    I used cognitive back twenty-some years ago, but found it so limited in effectiveness that I kept looking for something that would work for everyone. What I lucked upon was a way to link a moment of empathic connection (with a person, or even a pet) to each moment of the flight that is a challenge. The amazing thing is this: in moments of empathic attunement, oxytocin is produced. Oxytocin shuts down the amygdala (the part of the brain that triggers the release of the hormones that cause fear). Thus, after the good moment (empathic attunement) and the bad moments (flight) are linked, the bad moments trigger oxytocin that prevents fear, and thus stops high anxiety and panic before it can start.

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  2. P.S. Breathing exercises are, according to research, useless. See: http://pn.psychiatryonline.org/content/42/13/25.full

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  3. That's fabulous. I've never heard such a dramatically successful story of someone cured of flying. Congratulations.

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  4. These comments are great - really interesting! I should add a caveat that this blog is a memoir, not intended as a scholarly or clinical description. It's just my personal experience. I couldn't agree with Capt. Bunn more, coming from a relational psychoanalytic framework myself, that there are always deeply determinative experiences from early in life that are intertwined with the cognitive structures of anxiety and symptomns! But that's for a journal article in another venue. I continue to be somewhat awed by the power of the intervention I experienced, and humbled by the irony that it was CBT in this instance that shook loose the phobia of a psychoanalytic therapist!

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  5. Just thought of one more connection to Capt. Bunn's comment - one of the few things that did help me in-flight during my phobic period was if I saw another person, especially a child, who looked more frightened than I was. If I was able to connect with that person and be comforting, I did often feel calmer. Flying with my young daughter also created this type of calm borne of care. I'm not sure whether he means giving or receiving care in his post, but at least in my own experience, giving care was the most helpful!

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  6. Something I had to memorize for AFROTC comes to mind: High Flight

    Oh! I have slipped the surly bonds of earth
    And danced the skies on laughter-silvered wings;
    Sunward I've climbed, and joined the tumbling mirth
    Of sun-split clouds - and done a hundred things
    You have not dreamed of - wheeled and soared and swung
    High in the sunlit silence. Hov'ring there
    I've chased the shouting wind along, and flung
    My eager craft through footless halls of air.
    Up, up the long delirious, burning blue,
    I've topped the windswept heights with easy grace
    Where never lark, or even eagle flew -
    And, while with silent lifting mind I've trod
    The high untresspassed sanctity of space,
    Put out my hand and touched the face of God.

    Pilot Officer Gillespie Magee
    No 412 squadron, RCAF
    Killed 11 December 1941

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