This is the third session of treatment for Karen in trying to overcome her fear of flying. Karen has been great in practicing her breathing and reports that she feels very relaxed after just two or three minutes of breathing. I gave Karen a relaxation CD today and asked her to practice progressive muscle relaxation at least one time per day by following the directions on the CD.
The remainder of the session today focused on introducing Karen to cognitive therapy. One of the assumptions of cognitive therapy is that it is not the situation that creates a negative feeling, but your interpretation of the situation. A great example of this principle very often occurs in the flying situation. You can have two people sitting next to each other, on the same flight, going to the same place, experiencing the same sounds and physical sensations of flying. However, one person can be calm and relaxed and the other person could be extremely anxious. If you ask each person what they are thinking one person may be say: "I can't wait to get to Hawaii and relax on the beach." The other person may be thinking: "The plane is going to crash. I am going to die. I am never going to see my family again." Cognitive therapy involves having the patient identify the thoughts, figure out what is wrong with the thoughts and then replace the irrational thoughts with new realistic thoughts. In Karen's case she did believe that flying was not safe and that planes frequently crashed. Karen continually overestimated the risk of flying. It was very important for me to educate her about the real odds of planes crashing. I also find it important to get patients to realize they are already taking higher risks in many everyday activities. For example, driving is a much more risky activity.
Karen also had a fear that she would have a panic attack on the plane and go crazy. Karen learned to restructure this thought by telling herself: If I start to panic I can do the breathing and relaxation exercises I learned. I have had panic attacks before and never gone crazy." Karen was also encouraged to keep track of any other thoughts that she might have about the flight or the time before the flight. All of her irrational thoughts and restructured thoughts were written out and kept in a small diary so that she could refer back to them at any time.
Karen was instructed to continue practicing her breathing and relaxation skills during the week. She was told that the next session would involve the use of the virtual reality therapy equipment so that she could practice using her new skills during a simulated flight.
Published On: September 26, 2008