Panic Free. Tom Bunn

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 —