Getting Over It

By Jennifer Huget
Special to The Washington Post
Tuesday, August 14, 2007

Let's be clear: Even the most debilitating phobia pales in comparison with the horror and suffering people experienced when the Interstate 35W bridge collapsed in Minneapolis on Aug. 1.

Still, for those who suffer travel-related fears, that event may have added an unwelcome wrinkle to their vacation plans. The dread of driving over bridges (or through tunnels or of flying) suddenly took a detour from irrational to grimly reasonable.

Whether the Minnesota bridge collapse revived your latent fear or sparked new apprehension, you might need help dragging yourself through your next trip.

Here are some tips for overcoming your travel anxieties from Jean Ratner, co-director of the Center for Travel Anxiety in Bethesda, and Jerilyn Ross, head of the Ross Center for Anxiety & Related Disorders in the District. Many require advance practice, so get started soon.

1. Avoid media overload. Ross says, "It's important to recognize that part of what makes this so awful is the dramatic nature of what happened" and the subsequent deluge of graphic images and frightening descriptions of the bridge collapse by survivors. "That sensory overload leads to anxiety," she says.

2. Control your breathing. Ratner says that a typical behavior during an anxiety attack is to stop breathing or to breathe too rapidly, either of which can make you feel weak, clammy and panicky. Before you travel, she suggests, "work out a specific breathing pattern, and practice it so it becomes an automatic reflex." Concentrating on the rhythm of your breath, she says, allows the mind to be fully occupied by something other than fear. "It's really doable," she says.

3. Stop your thoughts."You can teach your brain not to run off with a frightening thought," Ratner says. Practicing "thought-stopping" before you leave home allows you to "shift away from scary thoughts, stop the irrational, scary thought."

Ratner has patients develop a "definite thought pattern that you're definitely going to think" while crossing a bridge or taking off from the runway. "It can be as simple as counting to 8, repetitively, over and over again," she says. Other thought-stoppers: playing music, tapping out a rhythm on the steering wheel and, better yet, singing along with music. Added benefit: "It keeps you breathing," Ratner notes.

4. Keep your eyes on the road. People afraid of driving across bridges might have an easier time crossing if they "keep their eyes right ahead, on the road, instead of looking way up or way out," Ratner offers. "Just think of it as a road," she says.

5. Hang in there till we know more."Right now it feels like Russian roulette, with apparently thousands of bridges in the same condition" as the one that collapsed, Ross says. In the near future, she says, we should benefit from a clear explanation from engineers of what went wrong and assurances from the government that similar problems elsewhere are being swiftly addressed. "People's fears are usually allayed when they feel like they have some control," Ross adds. "Information gives people a sense of control of their destiny."

6. Take your own advice. People with phobias are typically well-read, bright and creative, Ratner says. So, when faced with a scary situation, she suggests they ask themselves, "What would I tell a friend who has this fear or difficulty?"

The answer is usually pretty useful, she says.

7. Take action. Ross notes that in the face of fear, "people want to feel they can do something." In this case, she suggests, there's plenty to do: "Write members of Congress, speak out about transportation system safety and the allocation of funds." Doing so, she says, may give you "some sense of control."

8. Weigh the odds. Ross observes that, tragic as the bridge catastrophe was, it was an isolated instance. "More people die driving to and from bridges every day than have died in bridge collapses in our entire history," she notes. "When we talk about anxiety, we talk about possibility versus probability," she explains. In anticipating another bridge collapse, she figures, "yes, it could happen, but it's highly unlikely."

9. Get on with your life."Unless you want to be a total recluse, you have to look at the odds, put it in perspective, and do what you can to get on with your life," Ross suggests.

Ross and Ratner emphasize that people with severe phobias won't benefit from a list of tips in the newspaper. A therapist can coach a true travel-phobe through his fears, using techniques such as gradual desensitization (exposing the patient to the thing feared a little bit at a time so he builds tolerance) and teaching self-calming and controlled breathing skills.

Some with severe cases may need medication, specifically benzodiazapines such as Klonopin and Ativan, Ratner says. But a doctor has to help establish the right dose, she notes, "enough to help, but not enough to sedate" if the patient's going to be driving.

Ratner doesn't expect a huge influx of new patients -- at least, not yet. In fact, now might be a good time for travel-phobia therapists to take a vacation of their own.

"I won't hear from people badly frightened by this bridge collapse until early next spring," Ratner says. "When there's a touch of that reality, people say, 'I'm not going to work on this [fear]. I'm going to get where I need to by another means.' But when people are hurt enough by avoiding, and they get the reassurance that no more bridges have collapsed, they may decide they need to work on it." But that, Ratner predicts, won't happen for several months. ยท

Jennifer Huget is a regular contributor to the Health section.

© 2007 The Washington Post Company