Therapy on the go

Several weeks ago, Sally Murray took an incredible trip, and like any adventurous traveler couldn't wait to talk about it.

"I went home and told my daughter, 'Do you know what I just did?!'"


She had ridden all the way to the top of the escalator at Bethesda Metro station. By herself.

For mountain climbers, skydivers and other serious daredevils, that doesn't sound like much. But for Murray, who had gotten so skittish about escalators she hadn't been on one in six years, scaling Mount Metro was an inportant step forward in conquering more stubborn fears.


"That's a very steep escalator," says Jean Ratner, offering her congratulations. "I often use that with people who have a fear of heights."

It's a rainy Monday night and the two women are chatting inside Ratner's Honda Accord, which is parked, engine running, in the lot of Bradley Hills Presbyterian Church in Bethesda.

Ratner, a 61-year-old clinical social worker in private practice, has the wheel. Murray, a 56-year-old education specialist at the National Institutes of Health, is in the back seat, hands clasped loosely in her lap, as if ready to spring into full prayer position.

Escalators make Murray uneasy. But that's small-potato turmoil. She and Ratner are about to go for a spin in the Honda to confront her biggest, most nerve-wracking nemesis: amaxophobia.

Fear of driving.

Sally Murray makes her way in the world's most mobile society with difficulty, heavily dependent upon public transportation and lifts she can wangle from her daughter, Olivia, and sympathetic friends.

While most Americans look forward to being on the move during summer-vacation season, for millions of men and women, this is the time of year they have to work even harder to avoid anxiety-producing encounters with cars, planes, trains, buses, bridges, tunnels and highway overpasses.

"It does turn up the anxiety flame," Carl Robbins, a counselor at the Anxiety and Stress Disorders Institute (ASDI) in Towson, says of the summer travel season.


Approximately 10 percent of Americans have some type of phobia. "Some people call them the common cold of psychiatry," says William Eaton, chairman of the department of mental health at Johns Hopkins' Bloomberg School of Public Health.

Nobody keeps specific tabs on people saddled with travel phobias, but about half of Jean Ratner's patients fall into that category, which is why she and a nurse-therapist partner operate what they call the Center for Travel Anxiety.

A handful of other therapists in the Baltimore-Washington area focus at least part of their practices on travel phobias.

In this region, the Chesapeake Bay Bridge looms large among the travel-anxious. According to Maryland Transportation Authority spokeswoman Teri Moss, in 1997 Bay Bridge police and road crews served as "driveover" chaperones for 2,151 motorists who were too rattled to venture across the 4.3-mile span. Last year, the MTA came to the rescue of 3,374 drivers; an average of almost 10 per day. Moss attributes that 50 percent jump to the overall increase in bridge traffic over the years.

For those with travel-related phobias, a particular incident can trigger avoidance behavior. Having a loved one killed in an automobile or airplane crash, for example, might understandably turn somebody into an armchair traveler.

Usually, however, the roots of the disorder are in an underlying condition such as claustrophobia or something more amorphous: a kind of creeping, Doomsday-scenario angst that manifests itself in the extreme as a knee-knocking, heart-pounding panic attack.


"Anxieties are very much what we call a 'what-if' disease," says Harold Steinitz, co-director of ASDI. "It's an illness of catastrophic thinking."

The phobic response can be narrowly defined (one of Ratner's patients has all but given up driving because she has a crippling fear of making left turns) or broader in scope. Some 30 years ago, Sally Murray was cruising down a highway in Massachusetts in her car when she got blindsided by a panic attack. Afterward, she decided to drive highways only in an emergency, then eventually began ducking them all together. Over time, every road became a torture chamber.

Controlled by fear

"It has come to the point," Murray says, "I don't like having the fear control me."

Donna Dodson, a 42-year-old paralegal, had a similar experience compressed into a much shorter period of time. She was driving to a convention in Ocean City last September when she suddenly got hit with a panic attack midway across the Bay Bridge.

The ride home to Baltimore took six hours as Dodson searched in vain for a bridge-free route. Within a couple of months she was becoming unglued driving past construction sites. Elevated stretches of the Jones Falls Expressway seemed fraught with danger.


"It was just ruining my life," says Dodson, who turned to ASDI for help.

Anxieties often are inherited, although it's uncertain whether genes are purely responsible. Felicia Powers, a book store manager from Bowie, had a mother who was spooked by escalators and father who was claustrophobic. She started getting panic attacks in her teens that morphed into fear of flying in her adulthood.

Gradually, that fear became "associated with other transportation," Powers says. She found herself wrestling with an equal-opportunity anguish that extended to subways, elevators, escalators and bridges. The world was a noose tightening around her.

"It's kind of like a little circle you can't get out of," explains Powers, who found her way to Ratner's Center for Travel Anxiety. "It's kind of like the fear scares you."

Brought to your knees by a bridge? You'd rather crawl to Los Angeles than fly? It sounds ridiculous, if not mildly amusing, to the phobic-free.

Little sympathy


"Most people generally aren't sympathetic," says Michael Pensiero, a scientist at the NIH's National Institute of Allergies and Infectious Diseases who developed a debilitating fear of flying in his late 30s. "Most people will say 'Have a drink and get over it.'"

Pensiero used to drive to business meetings in California, chewing up vacation days getting out and back. His flying phobia was a mysterious storm cloud that lingered six years, finally lifting after he had a series of sessions with Ratner.

Thomas Bellis, a 68-year-old minister from York, Pa., has been seeing Ratner for two years. Long plagued by periodic panic attacks, he couldn't bring himself to step onto an airplane. "You preach faith in God and yet I didn't have that faith to go and do it," says Bellis. "That really tore me apart."

Last month, Ratner accompanied him on a trial flight to Norfolk. It went well, and Bellis and his wife plan to go to Europe this fall. The embarrassment that was gnawing at him is a common cross to bear.

"People usually will not tell their friends and often don't tell their family members," says Ratner. "They make excuses because they feel so foolish that they can't do something other people can do. This is a major issue with treating any of the phobias."

That treatment can take the form of individual counseling, group counseling, anxiety-controlling medication or, the latest therapeutic wrinkle, virtual reality simulation.


Barbara Rothbaum, an associate professor of psychiatry at Emory University School of Medicine in Atlanta, helped design a "virtual airplane" that uses high-tech goggles and computer-generated images of a passenger cabin to give one a sense of being in flight. Unfortunately, the virtual highway her team hopes to use with phobic drivers has hit some potholes: So far, they've yet to create a prototype, Rothbaum says, "that didn't make people nauseous."

The most common treatment regimen combines stress-reducing tools (deep-breathing exercises, relaxation tapes, visualization techniques) with incremental exposure to the fearful situation - what Ratner describes as a "gradual desensitization program."

Pam Leiter, a 47-year-old housewife from Great Falls, Va., was terrified about flying. During the course of nearly four years of therapy with Ratner she took bumpy rides in the car to replicate air turbulence, sat for a few minutes inside an empty plane at Dulles Airport, listened to relaxation tapes for months, learned to mentally transport herself to a quiet beach whenever her anxiety level shot up, ate dinner at the airport with her husband, watched planes taking off over and over.

In April 2001, Leiter and Ratner flew together to Boston. The flight went so smoothly Leiter visited the pilot in the cockpit after touchdown.

"I was totally fascinated to see the world from above like that," recalls Leiter. "I'd never seen it before. The clouds were so pretty."

Ready to ride


"What's your anxiety level? How are you breathing?" asks Jean Ratner.

Strapped safely in the back seat of the Honda Accord, Sally Murray reports that her anxiety is about 2 on a scale of 10. Her breathing is slow and steady. Ready for takeoff.

Ratner noses the Honda out of the church parking lot and turns left, heading toward downtown Bethesda.

"It's hard for me to put myself in your place," Murray says, meaning the driver's seat.

Ratner knows all about that lack of confidence. She used to be afraid of flying and of big dogs. She knows the importance of focusing on something other than bad thoughts.

"Look at the road in front of us," she advises Murray, "and kind of pick the midpoint."


If that doesn't work, well, try counting trees ... or making up words from the license-plate letters on the car up ahead: "The point is, you want to do things that are 'grounding' to you."

The odds are good that Murray will overcome her phobia. She openly discusses it with family and friends. She conquered the Bethesda Metro escalator. She and Ratner drive an eight-mile loop without a hitch.

Next time, Murray will take the wheel of her own car and Ratner will sit in the back seat. Then Murray will drive solo and Ratner will follow along in the Honda. And with luck someday soon ... they will drive separately and meet at a Bethesda restaurant for lunch.

"I'll take you out to celebrate," says Ratner, "because you'll feel very free."

That's if all goes according to the desensitization plan. That's assuming, of course, that Sally Murray doesn't develop a surprise case of eleutherophobia: fear of freedom.

Here's help


Here are some resources for those who suffer from travel phobias:

Center for Travel Anxiety, 10400 Connecticut Ave., Suite 201, Kensington 20895; 301-469-8542; Jean Ratner and Judith Willging offer individual ($120 initial consultation; $90 per session) and group ($45 per session) therapy. Fear of Flying support group meets Saturday mornings.

Anxiety and Stress Disorders Institute, 6525 N. Charles St., Towson 21204; 410-938-8453; www. Staff provides individual ($50-$130) and group ($25-$35) therapy. Fear of Flying support group meets first Thursday of the month.

Anxiety Disorders Association of America, 8730 Georgia Ave., Silver Spring 20910; 240-485-1001; www. Clearinghouse for anxiety disorder information, plus nationwide database list of therapists.

NeuroSciences Inc., 5612 Spruce Tree Ave. Bethesda 20814; 301-571-730; email: Offers virtual reality exposure therapy for fear of flying, heights, public speaking, thunderstorms and bridges.

-- Tom Dunkel