All of us have fears. However, when the fear of something becomes so severe that it significantly affects our ability to function in life, that is a serious problem. Some fears may be felt strongly but are not encountered in daily life, like a fear of spiders. Since most people do not frequently encounter spiders, while this would be considered a phobia, it is not significantly affecting a person's ability to live life.
Other phobias and fears, however, can greatly limit someone's ability to function in the world and enjoy life. In my practice, a common debilitating fear is the fear of driving. Driving is a very important part of life. The fear of driving can limit one's ability to successfully hold a job. This fear can often lead to depression and negative self-perception because they feel they always need help from others and are not independent. It can even affect their relationships with loved ones if they are not able to leave the home and enjoy life.
The first step in addressing this phobia is identifying a source. Sometimes this fear can develop from trauma, such as a severe car accident. The techniques discussed in this blog can still be helpful to those who have suffered a severe trauma but a more long-term resolution will likely need the assistance of a trained therapist to address and resolve the underlying trauma. There are techniques such as Somatic Experiencing ("SE") and Eye Movement Desensitization and Reprocessing ("EMDR") that can help break the link between the trauma and the body.
Even without trauma, individuals can still develop a fear of driving. Oftentimes this presents itself as ruminating and persistent thoughts and fears of negative things that can happen while driving, i.e. getting into an accident or being lost in the middle of nowhere. Many people report that the mere thought of driving leads to many negative physical problems, such as heart palpitations or butterflies in the stomach. Confronted with these physical symptoms and scary thoughts, those with a fear of driving will simply choose not to do it.
What can be done? With the assistance of a trained therapist, one can address the three components of phobia: 1. Thought, 2. Body/Somatic, 3. Behavior.
Thoughts: The key to addressing the thought component of fear is understanding the deeper emotion or thought underlying the fear. While someone may say they are afraid of getting into an accident as the cause of their fear, this is a surface explanation. Underneath that thought is likely something more basic, such as a fear of not being in control. A feeling of not being safe is often an underlying thought with phobias. The key to helping people address their negative thoughts is to challenge those thoughts. The first step comes when someone is motivated to overcome this fear and are willing to understand where that fear comes from. Oftentimes, phobias such as a fear of driving comes from rigid thoughts, such as the thought that when someone is driving they have zero control and that it is always dangerous. This rigid thought turns into fear because they believe that every time they get behind the wheel they are risking their life and they have no control over it. In order to break these rigid thoughts, it is important to acknowledge those thoughts while at the same time challenging them. We can acknowledge and accept that life in general is not completely within our control while at the same time accepting that there are things we can control.
One of the things I talk to my clients about is focusing instead on what they do have control over. For example, they can focus on driving defensively, adding a GPS to their car or making a number of stops along the way to make sure they are comfortable. Once a client accepts this most basic premise, that there is "something" they have control over, that creates a window of opportunity to slowly pull back on the rigid thoughts and fears that often come with phobias. Once they accept that "something" can be done, then I can talk to the client about what those specific things are that can give them a sense of control over their life and allow them to think practically about what they can do to feel safe while driving. Addressing the thought aspect of fear is a very important component of treatment but it must be done along with addressing the body/somatic component and the behavior component.
Body/Somatic: The body/somatic component addresses the physical manifestations of that phobia. Heart palpitations, chest tightness, shortness of breath and butterflies in the stomach are all common physical manifestations of phobia but there are many others. It is important to understand what each person's specific physical manifestations are so they can tell when their anxiety or fear is starting. The key to the body/somatic component is being in touch with a person's five senses and knowing what things reduce stress for that specific person. Some common things that can help are rolling down the windows to feel the fresh air, listening to music, having something enjoyable to snack on such as peppermint candy, drinking cool water while on the road, smelling a fragrance in the car, or counting different color cars that are seen. There are also breathing techniques that can be used while driving to self-sooth. Timing is important in using self-soothing techniques since these techniques should be started as soon as the first physical signs of fear and anxiety manifest. Preparation is also important to make sure that the appropriate resources are available for whatever self-soothing technique works for the client. For each person, identifying their physical manifestations of fear and anxiety as well as what self-soothing techniques work for them can be discovered on their own through trial and error. However, a trained therapist can also help by talking through moments of fear and understanding how the client's body specifically reacts to that fear. A trained therapist can also observe a client's physical response to discussing their fear. That experience can sometimes catch things the client herself or himself may not notice.
Behavior: Changing behavior is the last component of addressing phobia. Sometimes people will say that all that is needed to overcome fear is to "face your fear." It's not that simple. While changing behavior does ultimately require someone to face their fears, it needs to be done in a methodical and clinically appropriate manner. Addressing the behavior component of phobia requires setting small but achievable goals and then building on them slowly but consistently. For example, the first goal might be to drive five minutes a day around the block. Driving across the Bay Bridge at rush hour is not a realistic first goal. These goals need to be achieved on a consistent basis and then built upon as confidence grows. While someone can develop goals and slowly expose themselves to their fear on their own, it is often helpful to have someone help develop those goals and keep them on track with those goals. Consistency is critical because lengthy gaps in time can result in going backwards in therapy. Knowing when to start a new goal also requires patience and experience to avoid going backwards. Starting with artificial milestones from the beginning, such as "We will start driving fifteen minutes" after two weeks is often unhelpful. The client's own confidence and comfort should determine when to move to the next goal.