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CHAPTER 1

A Future Free of Panic and Claustrophobia

If you have struggled with panic and found no relief, I know the frustration. As an airline pilot, I tried for years to help fearful fliers control panic, using every known method. Nothing worked.

After years of experimentation, I stumbled on a solution. Since then, every client who has learned this new way to manage anxiety has been able to control panic when flying. Though our principal aim was to control panic in the air, clients reported an unexpected benefit: they were free from panic on the ground as well. This approach changed their lives. It can change yours, too. This book can lead you to a future free from panic and claustrophobia.

This breakthrough, like many important discoveries, took place accidentally after years of searching for a solution. The search began in 1980 at Pan Am, where I was a pilot and volunteered to help with the airline's fear-of-flying course. The pilot who led the course told participants they could conquer their fear of flying by letting go of control and by using breathing exercises to stay relaxed. The course ended with a "graduation flight." Some participants got through the flight all right, but others panicked despite diligently performing their breathing exercises. The pilot in charge believed his advice was adequate. Unable to fault them on their breathing exercises, he told them, "You didn't let go."

Panic is an awful experience. Being blamed by people who don't understand makes it worse. It was distressing to watch this scenario play out in course after course. The suffering — and my powerlessness to relieve it — set me on a quest. I set up a fear-of-flying course of my own, called SOAR. It included every known technique for combating panic. Some techniques came from mental health professionals; some came from panic sufferers. Each technique was helpful to some people in some ways. But all these techniques put together still weren't enough to help every participant control panic.

The search continued. I went to graduate school, became a licensed therapist, and attended one postgraduate training institute after another. I studied Gestalt therapy, neuro-linguistic programming, psychodynamic psychotherapy, Ericksonian hypnosis, and cognitive behavioral therapy. Again, various aspects of these therapies helped some clients, but not all.

Cognitive behavioral therapy (CBT) was a new and seemingly promising approach. It is based on the idea that what we feel is caused by what we think. Therefore, to control our feelings, we must learn to control our thoughts. I developed new CBT-based techniques for clients to use on their flights. These new tools worked for some clients, but they did not work for those whose panic developed rapidly. For them, the slightest movement of the plane was like a spark that quickly turned into a wildfire. Emotion instantly overcame them. Even while using the breathing techniques I had taught them, they went straight into full-blown panic.

Looking back, there are two obvious reasons why CBT could not help these clients. First, though it's true that panic can be caused by thoughts, it can also erupt with no conscious thought at all. Second, whether panic is triggered consciously or unconsciously, the real issue is something else: inability to regulate the intensity of feelings. Normally, intensity is regulated by unconscious processes. If these processes fail, imaginary threats can escalate quickly into the belief that life-threatening dangers exist. If escape is not immediately at hand, a person feels trapped, and panic results. CBT did not address the lack of unconscious regulation.

We can think of regulation as working like the thermostat in a home, which is supposed to keep the ambient temperature in a comfortable range. The thermostat does this job without our needing to think about it. We may not know how it works, but we know it isn't working right if the room temperature soars to one hundred degrees. Similarly, your emotional thermostat is supposed to work without your needing to think about it. When you panic, something has gone wrong with that thermostat.

Which takes us back to the snag with cognitive behavioral therapy. Cognition is a conscious process, but the regulation of arousal — arousal being how revved up we are — is an unconscious process. CBT does not engage the unconscious part of the brain where regulation of arousal should take place. You probably know the old joke about the drunk looking for his keys. Though he lost them elsewhere, he's looking for them under a lamppost because "that's where the light is." Unfortunately, when looking for the keys to unlock panic, I was like the drunk. I was looking not where the action was — where the processes of arousal regulation were taking place — but where the conscious processes were observable. It didn't work. To find a solution to panic, I had to do what the drunk needed to do: leave the lamppost and grope around in the dark. I needed to stop looking at processes I could observe and start finding ways to understand and manage processes I couldn't observe.

If a technique could be devised to control panic, it would have to work the way regulation is supposed to work: automatically and unconsciously. Once panic starts to develop, what a person does consciously — which is to say, cognitively — is unlikely to help. If we believe something life-threatening is happening, and there is no possible way to escape it, we panic. If, however, we can examine our thinking and see that the life-threatening thing is not actually happening, we won't panic. CBT trains people to stop and examine their thinking. If they can do that, they can prevent panic. But in a state of near panic, most people are simply incapable of rational thought. Under stress, imagination takes over, and a situation that is not life-threatening is experienced as life-threatening. That is the first factor that causes panic. The second is the conviction that this situation, truly believed to be life-threatening, cannot be escaped. The person's cognitive abilities desert them. As a client told me, "If you asked my name, I couldn't tell you." Someone in this state can't examine what is going on in their mind skillfully enough to recognize its inaccuracy.

The therapist Jerilyn Ross was also looking for a way to help clients control panic that did not rely on cognition. She came up with a technique she called "thought stopping." She instructed clients to wear a rubber band on one wrist and to snap it every time an anxiety-provoking thought entered their mind. She believed that the association of pain with the anxiety-provoking thoughts would inhibit the thoughts and keep them from causing panic.

Though this reasoning made sense, the idea of self-inflicted pain didn't sit well with me. Instead of thought stopping, I tried thought redirection. I trained my fear-of-flying clients to bring a positive memory to mind each time an anxiety-provoking thought arose. For example, I taught an athlete to automatically shift anxious thoughts about flying to her memory of running the New York marathon. In her case, thought redirection worked. I taught a young man to redirect thoughts of flying to the moment he proposed to his wife. He did fine. So did several clients who redirected thoughts of flying to memories of making their wedding vows. But overall, the results were hit or miss. For some clients, this technique was helpful. For others, it did nothing at all.

One day, I was teaching thought redirection to a new client, the mother of a small baby. I asked her to name a powerful, positive experience she could use to shift her anxiety-producing thoughts. She said, "Nursing my baby." I thought to myself, "You've got to be crazy. You're going to get on the plane and think you'll never see your child again." Fortunately, I kept my thoughts to myself and went along with her idea. To my amazement, when she reported back, she said the flight had gone perfectly. She did not experience a single ripple of anxiety!

In the months that followed, a few more mothers chose to redirect anxiety-producing thoughts to nursing. They, too, reported complete success. Had we stumbled on a key to the problem? If so, what was it? Why did a memory of nursing a baby work better than a memory of running a marathon, scoring the winning goal, or graduating from college?

It soon became clear that these exceptional results were not due to thought redirection. Research by Sue Carter, Kerstin Uvnäs Moberg, and others has found that mothers produce oxytocin during nursing, and that oxytocin inhibits the release of the stress hormones that give rise to feelings of fear, claustrophobia, and panic. When my clients redirected their thoughts from their fear of flying to their memories of nursing, flying actually became associated with nursing, and being on the plane triggered the release of oxytocin, which blocked the stress hormones.

Nature inhibits the release of stress hormones to prioritize the child's needs for nourishment. Suppose a new mother is nursing her child when she gets a call that relatives are on the way over to see the new baby. The house is a mess. Will the relatives understand it is impossible to keep up with housework when there is a new baby? Or will they criticize her? If the mother becomes anxious about their visit, she might stop nursing and clean the house. The baby would not get proper nourishment. Nature takes care of that problem. Though things that need to be done come to mind, oxytocin prevents the release of stress hormones so that she feels no anxiety to stop nursing and prepare for the arrival of the relatives.

Since I stumbled on this discovery, I've been able to help several thousand formerly anxious fliers control panic by linking flying to one or more of the ways nature causes us to produce oxytocin. This is an amazing result, because no environment is more problematic for panic sufferers than being high above the earth, with no control of the situation and no means of escaping it. It's easy for them to persuade themselves that their fear is rational. After all, planes do crash. Turbulence can make a plane shake so hard that it may feel as though it's about to fall out of the sky.

This special panic-inducing environment became the lab in which my clients and I developed advanced methods to control panic. The oxytocin link was only the first discovery. I knew that redirecting thoughts about flying to memories of getting engaged or saying wedding vows could be effective in controlling anxiety, but why? It is because in these special moments, the brain and the body are signaled to override the effects of stress hormones. This gave us two ways to control fear, panic, and claustrophobia. The first prevents the release of stress hormones; the second overrides their effects. We will be exploring both methods in this book.

A bonus of this discovery was that as my clients succeeded at controlling their fear of flying, they also succeeded at controlling panic attacks on the ground — triggered by environments like bridges, tunnels, elevators, and MRI (magnetic resonance imaging) machines.

In parts 1 through 3 of this book, I first explain the physiological and psychological mechanisms that lead to panic. Then, in part 4, I lead you step by step through a ten-day program to establish automatic control of panic. In ten days, you can learn to put behind you the frustration, the worry, and the distress of panic and claustrophobia, in the air and on the ground.

Before You Start

Before embarking on the ten-day program, you must confirm that what you are dealing with really is panic and not an underlying medical condition.

Though symptoms of panic vary from person to person, the following symptoms are common:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or suffocation

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, light-headed, or faint

• Chills or hot flushes

• Numbness or tingling sensations (paresthesia)

• Feelings of unreality (derealization)

• Feelings of being detached from oneself (depersonalization)

• Fear of losing control or going crazy

• Fear of dying

Some of these symptoms, however, are also associated with other disorders. You need to discuss your symptoms with a physician to rule these out. And even if you have already talked them over with your doctor, it's a good idea to review your symptoms and any changes at your yearly physical examination.

The Panic-Proof Part of Your Brain

Jan, an emergency room nurse, emailed the following:

In training, I was taught about dozens and dozens of situations. For everything that could happen, there was a plan. My instructor said, "If this happens, you do that, and if you see this going on, you have to fix it this way." The number of things I had to know how to react to was overwhelming. Even after we practiced responding to each situation again and again, I really doubted I could do the job. But I was surprised. Even the first day in the ER, what I had practiced kicked in.

You would think that a person who can operate as an ER nurse could handle anything. And, in general, I'm fine. But put me in a place where I can't get out, and I panic. I've done therapy to get rid of it, but nothing worked until I did this [the SOAR Fear of Flying Program].

It is said that first responders and emergency medical professionals do not "rise to the occasion" in life-and-death situations: rather, they "descend to the level of their training." Why? In life-threatening situations, the release of stress hormones can impede their high-level thinking. To function under extreme stress, they depend on a part of the brain that is immune to stress hormones: the unconscious procedural memory in the subcortex. In training, they repeatedly perform the various procedures they will need to carry out when under stress, installing every step of these procedures in this part of the brain so that they can perform them without having to depend on high-level thinking.

Though the concept of unconscious procedural memory may be new to you, if you are an experienced driver, you have been using it for years. You can drive and think of other things at the same time.

How did your unconscious procedural memory learn to drive a car? When you were a new driver, you focused your conscious mind (in the cerebral cortex) on the task. While you were doing this, your unconscious procedural memory (in the subcortex) was memorizing what you were doing. It learned to steer the car and keep the speed steady. Unconscious procedural memory can't make decisions, though. For example, it can't decide what freeway exit to take. If your mind is elsewhere as you near your exit, you may go right past it on "mental autopilot."

When you are alarmed or highly aroused, stress hormones are released, and your conscious mind, in the cortex, is overwhelmed. That is when panic can arise. But unconscious procedural memory, in the subcortex, is not bothered by stress hormones. Not only can it perform well-rehearsed mechanical tasks, but, if it is trained to do so, it can automatically activate your calming system, the parasympathetic nervous system.

In this ten-day program, you'll train your unconscious procedural memory to serve as your personal panic-controlling first responder. In the high-stress situations that now cause you to panic, it will step in and protect you.

Carole's Holland Tunnel Challenge

Carole, a librarian, lives in Pennsylvania. After the attacks on September 11, 2001, she stopped driving to New York City through the Holland Tunnel, which enters Manhattan a few blocks north of the World Trade Center. The thought of being in the tunnel put her on the edge of panic. So she took a longer route, crossing the Hudson River by the George Washington Bridge. She told me she needed to pick up some friends at John F. Kennedy Airport. Going via the bridge instead of the tunnel would take an hour longer. Having already learned to control panic when flying, she wanted to know if she could train herself go through the tunnel without panic.

It was an easy call. If Carole could control her panic while flying, the tunnel would be a minor challenge. Though flying is remarkably safe, it frequently provokes panic. High above the earth, and especially at night or in clouds, passengers feel disconnected from the earth, the basis of their sense of control. In-flight turbulence can induce the fear that the plane might simply fall apart. Panic sends us the message to flee; but on a plane, there is no way to escape.

To make absolutely sure Carole's trip through the tunnel would be panic free, we did several things. The first was to establish links between the landmarks she would see on her trip and the memory of a calming event in the past. This meant that each landmark would have a calming effect when it came into view.

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Excerpted from "Panic Free"
by .
Copyright © 2019 Tom Bunn.
Excerpted by permission of New World Library.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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