Panic attacks on NYC subways and anxiety treatment

Anyone who has taken the train during rush hour in NYC, knows this message too well: "delayed because of train traffic ahead of us, please be patient".

Today I was stuck for about fifteen minutes underground, on a crowded subway and a passenger next to me, had a panic attack. Someone quickly got up and offered their seat as she struggled with guilt, embarrassment and panic.

Panic attacks often times come with a trigger which could be enclosed, tight, hot spaces where exit isn't probable (cluster phobia). Panic attacks on the subway is something so common that I would say 98 percent of calls I get are specifically for this issue.

How can cognitive behavioral therapy and specifically exposure therapy help decrease panic attacks on the subway (and in general)? Cognitive behavioral therapy examines the relationship between our thought pattern, behavior and feelings. Often times, those with anxiety disorders engage in avoidant patterns: avoiding subways altogether, avoiding subways during rush hour, avoiding crowded streets, avoiding people, places and things which make anxiety and panic worst. Sound familiar?

When you avoid or escape, you are reinforcing the fear and making it worst. The "I can't do this", "I am going to go crazy", "this is dangerous", "must avoid" is pushing avoiding behavior which results in lots of anxiety and panic and phobias. In a nutshell, treatment teaches individuals to think and perceive and behavior differently.

Treatment also teaches valuable muscle relaxation and mindfulness strategies. Lastly (and very importantly!), treatment exposes to the feared stimulus. I have rode subways with my clients and supported electronically or by phone, subway rides and car rides and trips to malls. Treatment for anxiety is short term because it works quickly.

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