Automatic Regulation—Its Discovery
In 1982, SOAR introduced flight-anxiety control strategies based on Cognitive Behavioral Therapy (CBT). CBT employs high-level thinking—called Executive Function—to replace impressions that produce anxiety with well-examined thoughts. Some clients were helped by these techniques, but there were two major limitations. First, some anxiety-producing thoughts (being up high, not in control, and no means of escape) are factual. Second, high levels of stress hormones caused by a rapid series of noises or motions can overwhelm the high-level thinking CBT depends upon. For example, during takeoff, there is one unfamiliar noise after another. In turbulence, there is one unexpected movement after another. Each noise and each motion triggers a release of stress hormones. Executive Function, hard-pressed to keep up, may be unable to prevent its own collapse. As a result, the CBT-based techniques failed some clients just when they needed them most.
For CBT-based techniques to remain viable during takeoff and when in turbulence, cognitive processes must be protected from stress hormone overload. What can prevent stress hormone release?
Systematic Desensitization trains the amygdalae to become accustomed to a situation they react to as non-routine. Treatment begins with exposure too mild to trigger a reaction. As treatment continues, the exposure is progressively increased, but so slightly that the amygdalae do not notice the difference. Finally, if treatment is successful, full exposure does not trigger an amygdalae response.
Though Systematic Desensitization can train the amygdalae to regard some situations as routine, it is not a practical treatment for flight phobia. A phobic flier could be exposed to slowly increased periods of time on a parked airliner, then to slowly increased periods of time of taxiing on the ground. The problem is that at some point, the next incremental increase in exposure would require a takeoff, a few seconds in the air, and a landing. This increase in exposure would be too great for the amygdalae to ignore and would ruin the treatment. Practicality aside, months of incrementally increased exposure to an airliner would be prohibitively expensive.
Simulated Flight
Exposure to simulated flight, using computer-generated images, is easily adjusted. Since the images are unmistakably artificial, and since exposure takes place in an office, there is no desensitization to the aspects of flight that anxious fliers find challenging: the risk of disaster, the loss of control, and the inability to escape. Despite elaborate claims of success, anxious fliers exposed to simulated flight were—according to research—no better able to fly than those exposed to a parked airliner. A number of SOAR clients had previously tried simulated flight and found it both expensive and unhelpful:
I just have to write and say thank you again for helping me to enjoy flying. It’s been two years since I took your course and I haven’t stopped flying. Just returned from a cross-country flight from Atlanta to San Francisco. I now can say I do enjoy it. I’ve even had some people say that I must have not really had a fear. Ha! I had gone twenty-five years without flying. Really became fearful when I was in college. It grew progressively worse and I just stopped. I went through Virtual Reality Exposure Therapy here in Georgia. Very expensive and did nothing for my fear. I then decided that I was going to do SOAR and just try it. I have to say I didn’t think it would work. How could something that didn’t cost a lot, not face-to-face with someone, work? But it did. I now look at flying as my time. It’s a time when I can’t get a phone call or do anything else. I’ve enjoyed using this time to catch up on my reading and to get excited about the places I am going!
Thought Stopping
Phobia therapist Jerilyn Ross promoted a technique called “thought stopping.” Clients were instructed to wear a rubber band on their wrist, and upon first awareness of an anxiety-producing thought, to snap the rubber band. By being associated with pain, it was believed troublesome thoughts would be inhibited. This method helped some clients control thoughts that led to anticipatory anxiety, but the rubber band technique did not reduce anxiety during flight.
Relaxation Exercises
Similarly, relaxation exercises may reduce anxiety on the days leading up to a flight, but not anxiety during the flight. Though a relaxed state can reduce anxiety-producing thoughts, relaxation cannot keep the amygdalae from performing their duty. The amygdalae have a job to do. They protect us by alerting us to anything that is non-routine. Whether the person is relaxed or not, the amygdalae will release stress hormones whenever they sense anything non-routine.
The Breakthrough—Systematic Inhibition
Finally, a breakthrough occurred. An attempt was made to reduce stress hormone release by redirecting anxiety-producing thoughts. The plan was to establish a habit pattern that would draw the mind from anxiety-producing thoughts toward recall of a powerful positive memory. The first experiment was with a marathon runner. She was asked to first imagine a flight scene and then quickly focus on her marathon experience. This was repeated with one flight image after another. After she reported reduced in-flight anxiety, thought redirection was tried with other clients.
The results were widely varied. Surprisingly, effectiveness depended on the type—not on the intensity—of the experience toward which thoughts were redirected. An equestrian who linked images of flight to competitive riding received no relief at all. Clients who chose sunning at a beach, peaceful moments of solitude, religious experiences, or meditation reported only slight improvement.
But a father who linked flying to the face of his son running toward him when returning home from work reported complete relief from anxiety when flying. The same was true for another man who imagined the face of his bride coming down the aisle. Another client used her loved one’s face at the moment they became engaged; it was profoundly effective. Time after time, when the face of a loved one was comprehensively linked to flight, clients reported in-flight anxiety as greatly reduced or eliminated, and no panic at all.
When a client decided to link flying to the memory of nursing her newborn child, I was concerned that the association might cause her to think, while aloft, that she might never see her child again. One by one, she linked various moments of flight, imagined as photographs in a magazine, to a memory of nursing her child. To my surprise, she reported complete freedom from anxiety on her flight. Because of her success, I started encouraging women who had nursed a child to link moments of flight to that memory. Time after time, women who linked flight to nursing gained complete relief. What could explain the protection provided by these links?
The Role of Oxytocin
It has been known for some time that the level of the hormone oxytocin is exceptionally high when a mother nurses an infant. Research by Kerstin Uvnäs-Moberg and Carol Sue Carter has helped us understand the anti-anxiety benefits of this hormone. Oxytocin, they found, plays a central role in the action of the parasympathetic nervous system, which Uvnäs-Moberg calls the “calm and connection system.” According to their research, the release of oxytocin inhibits the amygdalae, “conveying the sense that there is less to be afraid of.” It has been shown that when women are nursing, their blood pressure decreases and the level of the stress hormone cortisol in the blood drops.
Oxytocin is also produced during romantic moments, sexual foreplay, marriage proposals, and wedding vows. In such moments, the release of oxytocin inhibits the amygdalae, and prevents it from releasing stress hormones. In the absence of stress hormones, the Mobilization System produces no urge to escape.
Empathic Attunement—Connecting with a Loved One
In addition to reproduction-related situations that produce the anti-anxiety hormone oxytocin, calming can also be provided in a non-hormonal way. According to researcher Stephen Porges, the Social Engagement System responds to moments of empathic attunement with a neurological action that lowers the heart rate. This lowering of the heart rate produces a calming effect throughout the parasympathetic nervous system.
The success of the clients who have linked flight to a profound face-to-face moment has made it clear that something more than thought redirection is at work. Now, experience with thousands of SOAR clients has proven that linking challenging moments of flight to the memory of a beloved face can moderate or eliminate flight anxiety, claustrophobia, and panic. Once appropriate links have been established, the face of a loved one can neutralize anxiety-producing thoughts and strip in-flight noises and motions of their power to release stress hormones.
Ancient Greek mythology told us a face could launch a thousand ships. We have now learned an empathically attuned face can quell a thousand fears. This breakthrough, now called Systematic Inhibition, taps into our genetically encoded ability to be calmed by empathic attunement.
A single release of stress hormones does not cause distress. It activates Executive Function, causing whatever is non-routine to be examined. It is one stress hormone release on top of another, and then another, that causes high anxiety, claustrophobia, or panic. A series of stress hormone releases can cause Executive Function, which plays an important role in the regulation of anxiety, to be overwhelmed. Thus Systematic Inhibition can relieve distress by inhibiting stress hormone release, and by protecting your inner ability (what I call your inner CEO) to use Executive Function to regulate anxiety.