cognitive behavioral therapy


High Anxiety: How I (Sort Of) Overcame My Fear Of Flying

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Imagine this tense scene at Logan International Airport’s Terminal E earlier this summer:

A woman with two young children rummages through her medication bag while awaiting an overnight flight to Europe. She pulls out a bottle of pills, then grabs her phone to text her therapist:

Woman: How early can I take half a Xanax? Flight at 8:20. Getting shaky.

Therapist’s response: You can take it now. You can do this!!!!

The scene, sadly, is all too real; that frantic woman is me.

I hate flying. Just writing the word ‘flying’ gives me a pang of dread, twinges of imminent diarrhea and the feeling that I might choke on my own fear.

I’m like Woody Allen on the plane in “To Rome With Love,” a death-grip on Judy Davis’ arm when turbulence hits. “I can’t unclench when there’s turbulence,” he says. “I don’t like this, the plane is bumpy, it’s bumpy… I don’t like when the plane does that… I get a bad feeling.”

In my case, to avoid this excruciating feeling, I have cancelled family trips at the last minute, pretended to be ill, and dragged my children on a 30-hour train ride from Boston to Orlando.

This summer, I’d finally had enough of my fear and its invasive grip on my life. But could I overcome it? I honestly wasn’t sure.

(Before I go on, let me say clearly that mine is definitely a “first-world problem.” There’s no poverty, abuse or major life-threatening illness going on here — just a “problem bred of privilege,” as one friend put it. Still, it’s fairly widespread, and worse since 9/11. Though precise prevalence numbers don’t exist, a 2008 study published in the Journal of Anxiety Disorders says fear of flying is “estimated to affect 25 million adults in the United States and nearly 10–40% of the adults in industrialized countries.” Similarly, a 2007 New York Times report quotes an NIH estimate that about 6.5 percent of Americans fear flying so intensely that it qualifies as a phobia or anxiety disorder.)



Russian Planes With Duct Tape

It wasn’t always this way for me. As a single, childless reporter, I flew all over: to Africa and Vietnam, to Cuba on a Russian-made plane lined with duct tape and in China on a domestic flight on which the pilot told everyone to move to the left side of the plane for “balance.” I flew in tiny, private planes across Washington state in bad weather, and to Provincetown on a little 9-seater.

Then, while walking to work across the Brooklyn Bridge on September 11, 2001, I saw the second plane hit the World Trade Center.  A year later, when I was pregnant with my first child, my flying anxiety suddenly took hold.  When the baby was six months old, I rescheduled a family trip abroad to avoid heavy rain. After that, for the next 10 years, I never took a flight more than three hours long.

I said “no” to weddings, work trips and excursions with my husband to romantic locales. I always had a good excuse not to travel, but in reality, avoiding these trips was all about my fear.

Flying Coffins And Familial Anxiety

There are likely genetics at play here: anxiety is a family trait, and several of us have suffered with flying fears. Years ago, a close relative freaked out on a flight from D.C. to San Francisco and, after a scheduled layover in the midwest, refused to get back on the plane. Instead, he took a train home. For a while, my father called planes “flying coffins,” and took a heavy dose of Klonapin, usually prescribed for seizures and panic attacks, before flights. Continue reading

Psychology Versus Psychiatry: Do The New Depression Guidelines Take Sides?

New guidelines on how to treat depression stress medication over talk

In our post-Freudian, post-Prozac-crazed era, you’d think the fierce debate over what works better — psychiatry (drugs) or psychology (talk, lots of it) might have quieted. Most professionals I interact with these days take a more pragmatic, mash-up approach to mental health, trying to figure out what combination of therapeutic talking, behavioral retraining, and (conservative) medicating, offers relief to each individual patient.

But on the front lines of mental health, the debate still rages, according to Time Healthland, which has a niece piece today on the new American Psychiatric Association guidelines for treating depression, and why all these various mental health providers can’t just get along. The bottom line? In this latest battle, at least, the psychiatrists (or is it the drug industry?) won.

According to the new guidelines — which will govern treatment for the 200,000 in-patient psychiatric patients in the U.S., as well as the 20 million or so who get out-patient treatment — the No.-1 preferred approach is drugs. Just drugs. The guidelines don’t mention psychological approaches like cognitive-behavioral therapy until No. 3, just after electroshock therapy. Ouch.

The new guidelines underplay an enormous body of data from the past decade showing that even the best psychiatric drugs work better than sugar pills only when the drugs are used in conjunction with psychological therapies that help patients change how they behave and how they form their thoughts. Neither a strictly psychiatric approach (just drugs) nor a strictly psychological approach (just talk therapy) works much better than a placebo pill on its own. But when used in combination, the psychiatric and psychological treatments help a majority of people get better.

Medscape offers a less pointed analysis of the new guidelines.

Clearly, the questions raised here aren’t going away soon. An accompanying story reports that 1 in 10 Americans, or 9 percent, suffer from depression and 3 percent suffer from major depression.