When the anxiety awakens it’s as if a wild beast wanders into my home, sits down on the middle of my coffee table, and lies there, observing me with cold eyes. It growls hungrily, licks its mouth. It’s ready to leap at me, but doesn’t. It just lies there. I know that this animal is not real, so I try to ignore it. I try to read. Write. Watch a movie. Play a game. But I can’t focus. There’s a hungry predator on my table! It smiles at me, like a cat playing with a trapped mouse.
The fear fills my head. There’s no room for other thoughts. All I can do is look back at the beast. Look and wait.
It’s the spring of 2014. In two days I’m going to do something I’ve avoided for years: Fly on an airplane. I spend every waking minute of the following days in fear. The beast never lets me out of sight, not for a moment.
Fear is supposed to be for children, but it’s young adults who tend to develop anxiety disorders. The most common anxiety disorders are social anxiety, where one fears other people, and specific phobias, where one fears a particular thing: Spiders, snakes, closed spaces, heights – or flying.
Specific phobias are quite simple disorders. They work in a simple way, and there’s a simple, but unpleasant, cure.
The phobia starts with something you find unpleasant. The reason you don’t like it doesn’t matter. What matters is what you do next: You start avoiding the thing you find unpleasant. Every time you face it you stop. You turn around, go away, and do something else.
Every time you do this, the fear grows stronger. Avoid it often enough, and the initial seed of unpleasantness may grow into a seemingly unbeatable phobia.
Fear is good
Fear is, for lack of a better word, good. Listen to your fear. If you suddenly start feeling scared, and you do not have an anxiety disorder, it is possible that you’ve noticed something important. You’re descended from animals that were very good at detecting dangerous situations. Respect that inheritance.
Fear is a powerful, unconscious reaction. It comes and goes as it pleases, and there’s nothing you can do to will it away. It’s like the reflex that makes you pull your hand away from a burning hot plate. When your fear detects that you are in danger, it puts you into survival mode. Your pulse increases. You become extra aware of your surroundings. You’re overwhelmed by a sense of “I. Do. Not. Want. To. Be. Here. Let. Me. Out. Of. Here. NOW!”
And then you do one of three things: You flee, fight, or play dead. This works. It is a strategy that has been developed by animals in danger of their lives through hundreds of millions of years. Fear is good. Fear keeps you from being eaten.
But for some us, fear fails. The fear part of our minds can be quite stupid. Imagine that you once got stuck in an elevator. You were in no danger, but it was unpleasant, so you start feeling a little anxious about lifts. The next time, you choose to take the stairs. Now your fear observes your actions and thinks: “Aha! I knew it! Elevators are dangerous!” This makes you more anxious about elevators, which in turn makes you more likely to avoid them, which makes you more anxious. And so it continues, round and round, until you have a phobia.
It’s not your discomfort that causes the phobia, but your avoidance of the thing you fear. Fear reinforces itself. It balloons outwards, for as long as you allow it to. It eats up everything in its path, until you don’t only avoid the fearful thing itself, but anything that can remind you of it.
I almost never flew when I was a child. When I started flying as an adult, I thought the movements of the plane were unpleasant. They were abnormal, like nothing I was used to on the ground. I flew rarely, and every time I did, the discomfort and fear increased. Eventually I started saying no to interesting trips. When I did fly I would become more and more sensitive to the tiniest movements. After one particularly turbulent trip, I was barely in the air for years.
I used to be able to read books on planes. Now I would spend the entire trip in a desperate attempt to distract myself. I would put on a podcast, close my eyes, and flee into myself and hide until it was over.
But all fleeing makes the phobia stronger. Fleeing confirms the fear.
Phobias affect you in two stages. The first is while you wait for the thing you fear, for instance if you have social anxiety and you know you’re going to hold a lecture tomorrow. This is called anticipatory anxiety. It may start hours, days or weeks before the event. It makes it hard to focus. All you can think about is the thing that will happen, and how much you wish you didn’t have to.
Anxiety is one of the most motivating forces there is. After a few days of anticipatory anxiety you’ll easily think of excuses to escape. You’re not really feeling well. It’s not all that important. Go ahead, cancel it, it’s okay! So you cancel the plane trip or the lecture, and at that moment an amazing sense of relief washes over you. The anxiety is gone! You feel strong and brave again, and you tell yourself that next time you’ll go through with it.
But you won’t. Next time will be harder.
The beast in the living room I described above is anticipatory anxiety, the way I’ve experienced it at its worst.
The fear you experience when you actually do the thing you’re afraid of is different. To me, it feels like being force-fed an unpleasant liquid. I swallow as fast as I can, but I can’t control when it starts or stops, or the volume. I’m fine right now, but what if there’s too much? What then? What if I can’t handle it? What if I panic? What if I go crazy?
Phobias are simple, and the treatment is simple too: You need to expose yourself to the thing you fear. But don’t come here with your film clichés. If you know somebody with a phobia, please don’t tell them that “you just need to jump into it and learn that there’s nothing to fear!” They know that there is nothing to fear. They’ve already tried jumping into it. Possibly it made everything worse.
You don’t cure arachnophobia by bathing in spiders.
Exposure is a tool. It has to be used properly. You need help from somebody who knows what they’re doing. Therapy for a phobia may consist of learning more about the thing you fear, learning how phobias work, and learning breathing techniques that help you to calm down. You may learn thought patterns that steer your mind in the right direction. (Embrace uncertainty! Wish to be challenged!) You learn to observe yourself objectively. “Yes, I am afraid right now, but exactly how scared am I on a scale of 1 to 10?”
But sooner or later you’re going to have to face the thing you fear. Therapy cannot remove the fear, only prepare you to face it. Exposure works best gradually, with frequent, controlled amounts of discomfort. An exposure session is supposed to be unpleasant. You’re supposed to face something you’re not fully comfortable with. That’s the only way to learn.
The purpose of exposure is to learn. The learning happens after the session is over. Your fear thinks: “Yes, that was uncomfortable, but I managed to cope with it. It went pretty well.” So now the fear becomes weaker, and the next time you do it, it will be easier, and you can push the boundary a little further. All people with phobias have security blankets that they think they need in order to cope with the discomfort. Getting rid of these is part of the cure.
And finally, if you’re motivated enough, then you really can bathe in spiders. Phobias should be overtreated, so that you learn to love the thing you once feared. Otherwise they may return.
I didn’t go into therapy to cure my fear of flying, but I read everything I could find about phobias and anxiety. I found the articles on Anxieties.com and the book Mastering Your Fear and Phobias to be useful.
I learned that phobias are best treated with frequent, controlled, educational doses of discomfort. But this is difficult when you’re scared of flying. It’s too expensive to fly every day, and there is no way to gradually ease into a plane trip. You’re either up in the air or down on the ground. Nothing in between.
So I asked my doctor for sedatives that would reduce the anxiety. And then, in May 2014, I bought tickets for my first flight in nearly two years. Oslo to Stockholm. One of the shortest trips available. I spent the following days paralyzed by anticipatory anxiety. I used medication during the flight, but it didn’t really help. The fear was so strong that it cut through the haze, and dragged me into the awful now.
Three weeks later I flew to Dublin. I thought the second flight would be easier. It turned out to be worse. Now the anxiety began a week before the flight, and didn’t release its claws until we’d landed. I doubled the dose of sedatives, and I don’t remember much of the trip, other than that I hated every second of it.
I decided that three weeks was too long to wait between each trip. Exposure is supposed to happen frequently, so I increased the frequency. During the summer of 2014 I went on flights every one or two weeks. Up and down. Again and again. Copenhagen, Stavanger, Bergen, Gdansk, Berlin, Geneva, Nice.
Gradually, I got better. The anticipatory anxiety disappeared almost completely. I was less fearful during the flight. It was as if I was building new muscles in my mind, one unpleasant workout at a time.
The effect was greatest at the beginning. After a while it slowed down. But I continued to fly. Over the last year, I have gone on plane trips every month. I took a break for two months, but the fear came back. You can’t kill phobias with one blow. You must be patient. So I’ve continued to fly, and will continue for a long time.
The fear hasn’t disappeared completely. I still find flying to be an unpleasant experience. I haven’t worked myself up to long distance flights yet.
But it worked. It worked.
I felt pretty tough after those first trips. I have never in my life done anything as brave as when I walked those steps towards the plane, while my inner two year old was screaming and my body was in “I’m about to get eaten by a tiger” mode. I know that I’m bragging, but it’s well deserved. Those of you who have or have had an anxiety disorder know what I mean. The rest of you will just have to try to forgive me.
But I’ve had it easy. Only the first few weeks of flying were truly horrible, and specific phobias are the kindest of all anxiety disorders. The others are much worse.
OCD and PTSD
PTSD. OCD. Panic attacks. Agoraphobia. It wasn’t until I began to treat my fear of flying that I got a small taste of what lies behind those words. It was as if I went on a summer vacation to Hell, and discovered that some people are permanent residents.
All anxiety disorders are somewhat similar, because they’re all caused by cross-wiring in the part of your mind that deals with fear. OCD, obsessive compulsive disorder, gives you anxiety when you fail to conduct certain rituals over and over again, such as washing your hands or checking that the door is locked. The rituals are absurd, but there’s a logic to them: It is possible that you forgot to lock your door. The possibility causes anxiety. The anxiety motivates you to check if the door is locked. Checking confirms and reinforces the fear, and so you have to check the door the next time too.
When you suffer from PTSD, posttraumatic stress disorder, fear is triggered by something that reminds you of a traumatic experience, such as abuse, violence, or an accident. You’re held captive by your own memories, and these memories can be triggered by everyday events. You start avoiding situations that may trigger the memories, which reinforces the fear.
Panic attacks are episodes of extreme fear that strike you suddenly, without cause. You may be out on the street, in an elevator, or in a mall. Suddenly your body reacts as if you are in mortal peril. You think you’re going to die. Perhaps you’re alone, surrounded by strangers who don’t understand what is happening to you. They may think you’re drunk or dangerous. Or they want to help, but make everything worse.
Panic attacks can last from minutes to hours. I have never experienced one myself, not even when I’m flying. But a friend of mine, who describe panic attacks as the worst experience you can imagine, have them so often that it has triggered an even worse anxiety disorder: Agoraphobia.
All anxiety disorders are awful, but there is something uniquely cruel about agoraphobia. At its worst, it is a kind of super phobia that attaches itself to so many different situations that you end up being stuck in your own home. It may start with a panic attack in a shopping mall. This makes you anxious about shopping malls. Then you have another one while driving. This makes you afraid to drive. You stop visiting malls, you stop driving. But the panic attacks keep on coming.
Each panic attack creates more anxiety. Fear eats your life. You become extra sensitive to the signals your body is sending. If your pulse increases you may think: “Oh no, I’m getting another panic attack!” This fear creates more fear, which triggers an actual panic attack, which reinforces the anxiety the next time you get a high pulse. You become afraid of fear. Afraid of even thinking about anxiety.
The circle of situations you feel safe in becomes smaller and smaller, until the only place you can tolerate to be in is your own home. Imagine the thing you fear the most, such as spiders. Imagine that the whole world consists of this. The whole world, except for your home, is covered with spiders.
All anxiety disorders can be treated, but the road is difficult. My agoraphobiac friend has lived almost as if in a prison for several years.
A dark parallel reality
I didn’t truly know fear until I began to cure my fear of flying. Now we’re on speaking terms, my anxiety and I. We have learned to respect each other. But I don’t have to face it very often any more. I felt sorry for myself when I started this treatment, but I’ve learned that I’m one of the lucky ones.
I’ve also discovered that something odd happens when I talk openly about my fears. People I thought I knew start to tell me about their own dark sides. Anxiety, depression, panic attacks. It’s like opening the door to a hidden parallel reality where everything is darkness.
I’ve made some visits to that dark reality over the past year. But others go there more often, and some live there permanently, and can’t find their way out.
But out in the sunlight reality everything is summer and joy, and nobody notices the ones who have gone missing.
[Originally published in Norwegian in Aftenposten.]