1. Do not avoid any places or set of circumstances because of the phobia. A panic attack will not incapacitate you no matter what you are doing, no matter where you happen to be. A very few endeavors will suffer from extreme anxiety-a musical performance or an important examination, for example–but even then not usually to any considerable extent. In any case, the only way to cope with such “stage fright” is to engage in that particular activity repeatedly until it becomes somewhat accustomed. Those medications that temporarily reduce anxiety to a more satisfactory level may interfere with performance because of their other effects. This is more a problem of professional performers than of people prone to panic attacks. Certainly no ordinary activity such as driving an automobile will be impaired significantly by anxiety. If you are afraid of a particular place because you think it is truly dangerous–such as the subway, even though two or three million people ride on it every day-then you should not go there. Do not ride the subway. But if you know very well that you avoid it because in that setting you feel trapped or anxious for any other irrational reason, then there is no alternative to riding the subway. You should ride it until it no longer matters to you whether you ride it or not. Then you can stop. At this late stage of treatment two or three rides are usually enough. A similar rule can be set down for every sort of phobia. Someone afraid of heights should not stop short of going into a tall building, indeed, the tallest building around. Someone afraid of traveling should not delay indefinitely making that single, prolonged trip he has always dreaded, whether it is to a relative in another state or to Europe. Of course it is always not possible to put everything aside to take a trip to Europe, but these final confrontations should be undertaken as soon as possible. They often prove to be anticlimactic. Having dealt with your anxious feelings over and over again. you may find yourself more or less calm during these ultimate trials. You may no longer be phobic. but until you go past the last obstacles, you cannot be sure. Is it necessary for someone afraid of heights to throw himself out of a plane skydiving or, short of that, climb a mountain? No. These are activities far removed from ordinary life. They are potentially dangerous or likely at least to become unpleasant for reasons having nothing to do with a phobia. Similarly, one need not drive on icy roads, walk through bad neighborhoods, hang out a window, hurtle up and down a roller coaster, handle poisonous snakes, juggle on television, or ride in a submarine. However, do not try to convince yourself that there is a danger looming in front of you when you really know there is none.(c) Fredric Neuman
“Ask Dr Neuman” Advice Column
