PROB­LEM SHARED

Good Housekeeping (UK) - - Editor’s Letter - Pro­fes­sor Tanya By­ron

I am in my 50s and have a phobia of mo­tor­way driv­ing, which means I haven’t driven on one for some years. As my son grows up and we need to drive around more for his ac­tiv­i­ties, it’s essen­tial that I over­come it. I’ve been to many ther­a­pists but none seems to be able to fig­ure a way for­ward. One driv­ing in­struc­tor sug­gested that I may have hor­i­zon­tal ver­tigo, which might be the case as it’s not re­ally trav­el­ling at speed or other cars that worry me.

TANYA SAYS A phobia is ex­actly as you have de­scribed: an aver­sion to a sit­u­a­tion that’s caused by cat­a­strophic think­ing which doesn’t fit the re­al­ity of the risk. As you’ve dis­cov­ered, it can become en­trenched and re­strict ev­ery­day life.

When we feel highly anx­ious, we go into sur­vival mode and our in­stinct is ei­ther to fight or run away to avoid the risk. By avoid­ing driv­ing on mo­tor­ways, you’ve em­bed­ded the be­lief you’re in dan­ger. You have an ir­ra­tional per­cep­tion of risk as you have no ev­i­dence to chal­lenge it. To

You need to build your con­fi­dence and break down the fear

over­come this, you may need cog­ni­tive be­havioural ther­apy (CBT) to help com­bat neg­a­tive thoughts.

It’s im­por­tant to un­der­stand what un­der­pins anx­i­ety. Some­times, a bad ex­pe­ri­ence can cause an aver­sion to a spe­cific sit­u­a­tion because each time we’re ex­posed to that sit­u­a­tion our anx­i­ety is trig­gered. How­ever, your driv­ing in­struc­tor has sug­gested an­other pos­si­ble cause, which sounds like be­nign parox­ys­mal po­si­tional ver­tigo (BPPV). This is a com­mon cause of ver­tigo and symp­toms in­clude dizzi­ness, ab­nor­mal rhyth­mic eye move­ments and nau­sea. It can arise from a prob­lem in the in­ner ear and would need to be as­sessed and treated by a doc­tor.

What­ever the un­der­ly­ing cause, anx­i­ety has af­fected your driv­ing con­fi­dence to such a de­gree that it’s re­strict­ing your life and pos­si­bly your son’s if you can’t take him to ac­tiv­i­ties. Ad­di­tion­ally, if left un­treated, anx­i­ety can spread into other ar­eas of life.

Con­fronting your phobia with an ex­pe­ri­enced driv­ing in­struc­tor will en­able you to chal­lenge it one step at a time, build your con­fi­dence and break down ir­ra­tional fears.

For this to work, you need to ad­dress how to man­age es­ca­lat­ing lev­els of anx­i­ety and learn to keep calm, because if you white-knuckle each small driv­ing step, your anx­i­ety lev­els will only re­in­force your be­lief that you can’t cope. To man­age this, I’d sug­gest learn­ing psy­cho­log­i­cal and be­havioural skills first.

Cog­ni­tive be­havioural ther­apy is an ev­i­dence-based ap­proach for the treat­ment of anx­i­ety dis­or­ders. The phys­i­o­log­i­cal symp­toms of anx­i­ety are mas­tered by learn­ing ways to calm your body through breath­ing and re­lax­ation tech­niques. Apps, such as Headspace and Calm, might help you prac­tice this through mind­ful­ness.

Mas­ter­ing anx­ious thoughts that crowd your mind as you at­tempt mo­tor­way driv­ing re­quires the abil­ity to recog­nise them as ir­ra­tional when they come to you. Us­ing your ra­tio­nal brain, you can learn to block the thoughts, dis­tract your­self from them and chal­lenge them by talk­ing back to them. You can also prac­tise mind and body tech­niques while watch­ing on­line videos of this from the driver’s per­spec­tive.

If you are see­ing a GP to dis­cuss ver­tigo, ask for a re­fer­ral for CBT. Al­ter­na­tively, you can find a pri­vate prac­ti­tioner at bps.org.uk or cb­treg­is­teruk.com. See also: anx­i­ety­care. org.uk/pho­bias/driv­ing-phobia/.

Pro­fes­sor By­ron is a char­tered clin­i­cal psy­chol­o­gist. Each month, she coun­sels a reader go­ing through an emo­tional cri­sis

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