Fear of traveling in New York City Subways and trains can be particularly troublesome. The clients we work with have a persistent fear of panic symptoms while traveling, often leading them to avoid it altogether. Panic symptoms like dizziness and feeling faint are particularly harrowing when experienced in the subway. The expense and inconvenience of getting around town adds a further stress to an already high-stress city. Sometimes people with a fear of subways and trains pass up great social and career opportunities because it is difficult to get around.

An important part of our work involves actually riding the trains with clients. There we teach them to manage and often eliminate panic symptoms, allowing them to move smoothly throughout the five boroughs and make New York City a more accessible and enjoyable place to live.

Contact us if you’d like to know more about how to get past your fear of riding the subways and trains.

Raphael D. Rose· Michelle A. Blackmore· Michelle G. Craske

WHAT IS SPECIFIC PHOBIA?

Specific phobias (also known as simple phobias) refer to excessive fears and avoidance of a wide range of circumscribed situations or objects (American Psychiatric Association, 1994). In contrast to more commonly occurring fears, phobias are severe enough to cause significant interference in life functioning and/or cause significant distress (Craske, 2003). Individuals who meet DSM-IV criteria for specific phobia rec-ognize that their fear is excessive or more than what would be expected. Unlike adults, children are not required to acknowledge that their fears are unreasonable or exces-sive, and in order to prevent the overdiagnosis of transitory developmental fears, per-sistence of symptoms is required for at least six months. Historically, the various specific phobias (e.g., animals, heights, blood, flying) were grouped together, but recent research suggests marked differences across the various phobias (Himle, McPhee, Cameron, & Curtis, 1989; Ost, 1987), including age of onset (Curtis, Hill, & Lewis, 1998; Ost, 1987), rates of cooccurring disorders (Himle et aI., 1989), response profiles (Craske, Zarate, Burton, & Barlow, 1993), familial aggregations data (Himle et al., 1989), and genetic variance data (Kendler, Neale, Kessler, Heath, & Eaves, 1993). Hence, while phobias vary greatly in terms of the particular feared stimulus and other factors mentioned above, typically individuals with specific phobias fall into the fol-lowing four subtypes: animal fears (e.g., snakes, insects), natural environment fears (e.g., storms, heights), blood injection-injury fears (e.g., receiving or observing nee-dle injections or blood injuries), and situational fears (e.g., flying or enclosed spaces).

When individuals with specific phobias are not exposed to their feared object or situation, they experience the least severe and impairing anxiety disorder (Barlow et al., 1985). However, when encountering feared objects or situations, individuals with phobias tend to experience severe discomfort and may attempt to escape the situa-tion or else endure it with great distress. This distress is often accompanied by physi-cal symptoms such as palpitations, sweating, blushing, and trembling, which may take the form of a situationally bound panic attack. Individuals may also experience simi-lar distress in advance or anticipation of exposure to a feared situation or object (e.g., before a scheduled flight, prior to a medical appointment). As a result, feared situa-tions are often avoided. Such fear and avoidance may significantly interfere with the individual’s functioning, often resulting in a change in normal routines, a decline in occupational opportunities, negative impact on social relationships, or changes in regular health

BASIC FACTS ABOUT SPECIFIC PHOBIAS

Mild fears of specific situations and objects are quite common in the general pop-ulation (King et al., 1989); however, specific phobias (that cause clinically signifi-cant interference and/or distress) are among the most common of the anxiety

disorders. The National Comorbidity Survey found lifetime prevalence rates for specific phobias, using DSM-IV criteria, to be 12.5% (Kessler, Berglund, Demler, Jin, & Walters, 2005). Fredrikson, Annas, Fischer, and Wik (1966) found slightly higher prevalence rates (16.3%) among their Swedish sample of 704 adults.
Women (15.7%) are more likely than men (6.7%) to receive a specific phobia diagnosis (Kessler et aI., 1994). Overall, 75-90% of individuals with animal, natural environment, or situational specific phobia are female, with slightly lower rates (55-70%) for individuals with phobias of heights or blood-injection (Himle et al., 1989).

Age of onset, course, and demographic characteristics

The majority of individuals with animal and blood-injection specific phobia report an onset of difficulties by childhood (ages 7-9), whereas situational and natural environment subtypes exhibit a bimodal distribution of onset, in early childhood and early adulthood (Himle et al., 1989), with situational subtypes more commonly developing in young adulthood (Ost & Treffers, 2001). Additionally, for those pho-bias occurring during childhood, elevations are often seen between 10 and 13 years of age (Strauss & Last, 1993).

Untreated specific phobias tend to be chronic or recurrent (Yonkers, Dyck, &, Keller, 2001), with a remission rate over a seven-year period as low as 16% (Wittchen, 1988). Interestingly, despite the relatively high prevalence and chronic-ity of specific phobias, individuals rarely seek treatment, perhaps because most peo-ple with specific phobias are able to function despite strong fears and phobias. Individuals with higher levels of functional impairment, multiple phobias, panic symptoms in the phobic situation, and surprisingly, absence of blood phobias, injury or medical procedures were all related to higher help-seeking (Chapman, Fyer, Mannuzza, & Klein, 1993). As a result of the generally circumscribed nature of spe-cific phobias, they are associated with less distress overall in comparison to other anxiety disorders (Craske, 2003).

This article is for any parent with children in competitive sports; for any parent who is closely involved with their child’s world of sports; for any parent who has the best interest and future of their child in mind. The article focuses on the adolescent age range of 11-19.

Being frequently approached by parents who seek advice about their child, I tried to deliver here the gist of the most important things about child psychology in the context of competitive sports.

I will begin with the commonality between most parents who are closely involved in their child’s world of sports. In the beginning, when the child becomes involved with sports at a young age, the parents’ involvement mostly ends with driving the child to practice or paying the sports club. Later, their involvement gradually deepens. As the child grows older and perseveres in their sports field, the parent finds themselves involved in additional subjects, such as: the position of their child in the team, the attitude of the coach and the management towards the child, victories and defeats, wins and losses, the influence of sports on schooling, social life, and so on.

Since the parent’s involvement is a gradually deepening process over the years, the parent unwittingly takes on the additional roles of coach, manager, psychologist, doctor, and more. The parent in fact becomes an “expert” in a wide range of subjects.

This taking of responsibility by the parents in such a large number of roles is not always in the child’s best interest. Indeed, there are famous athletes whose family’s limitless involvement helped them reach the highest levels (the Williams sisters, or Omri Kaspi in basketball). Still, there is a greater number of athletes who managed to make those achievements with less intense family support, and there is an even higher number of athletes who suffered at this exaggerated involvement and struggled to fulfill their true potential as a result.

Successful athletes are mostly characterized by their will to succeed in their field – regardless of their environment. Parents can be a promoting and assistive factor, but cannot replace the “fire” that has to burn inside the child. As soon as the child loses their authentic internal will to succeed and advance in sports, if the will to succeed in their field is no longer burning in their bones, then no support, no pushing and no sincere and informed explanations may help.

Then what can parents do in order to preserve the child’s love for the sport they practice?

It is very important to create, as much as possible, a separation between the child’s life in sports and their life at home. In sports – the child is exposed to perpetual criticism, pressures, and a competitive atmosphere. Therefore, the home must be a place of refuge for them from tension and criticism. The child has to feel that the home and their parents are a safe and supportive place, and not someone else at the club who criticizes and analyzes their abilities after practice or a game. A child who knows that following a weak performance they have somewhere to derive power and mental peace, will develop better mental immunity and stamina, and will become emotionally available to get better at sports. Love that only depends on the level of their performance will encourage a sense of tension and disquiet in the child that will accompany them always.

Losing concentration, restlessness, violence and anger are examples of common behaviors from young players during a game. In most cases those behaviors are expressions of tensions and mental stress that stems from the fear of the imminent criticism after the game (especially if it is a bad game). A young player who knows that among family members they will not have to deal with questions and defend, regardless of the game’s score, will be able to display better calm and concentration in a game, and perform better.

Following are several principles that may be incorporated in daily life:

1. Feedback and game analysis – after a match, adrenaline is high, passion is at a peak and therefore things are not always spoken with consideration. It is recommended to wait for at least half a day before discussing the game. No matter what the outcome was, after a game you need to rest, eat and indulge.

2. Respecting the system – a parent who communicates to their child that they respect the system (coach, management, professional team) will enforce the child’s self-confidence since the child is supported by this same system. This behavior also covertly teaches the child that even though the system may not be perfect, problems can be solved in an appropriate and acceptable way that will not harm their personal progress.

3. Nurturing a sense of responsibility – be supportive, but let your child deal with the consequences of their actions. Responsibility is ultimately with the child. A player who from a young age learns to take responsibility for their actions (without those around them hurrying to solve their problems for them) will develop an independent and mature personality, which is necessary both in and outside of sports.

4. Developing a varied personality – it is recommended to treat the child as a complex and varied person, and not just a player. Sometimes people forget that the child is much more beyond just a player, with wants, difficulties and other interests that do not necessarily relate to sports.

5. Finally, it is their life – if the child made any decision that is unacceptable to you such as switching teams, a conversation is a good and important tool you can use to express your opinion and to try and convince them, yet there is no room to feel hurt or guilty even if you had already invested many hours in their current path. This is their life and their wishes, and whatever they learn in sports they will be able to apply in the future in a variety of other fields. Success has many varied faces.

The group therapy format is an important mode of treatment for social anxiety because it provides opportunities to meet new people, develop conversation skills, practice public speaking in front of an audience, and get feedback on your performance. It is a valuable adjunct to individual treatment. Our social anxiety group meets on Thursday evenings. The sessions have a graduated structure, which helps clients to slowly challenge their social fears and build confidence speaking in public. The following topics are addressed in the therapy group:

If you are interested in participating in our public speaking phobia and social anxiety group please contact Behavior Therapy of New York.

• Psychoeducation about social anxiety, from a cognitive behavioral perspective
• Behavioral techniques to help you manage your anxiety
• Identifying thought patterns that maintain fears and developing cognitive strategies to challenge them
• Social introductions
• Small talk and casual conversations
• Informal speeches (such as giving a toast or speaking briefly at a business meeting)
• Formal presentations (that might be typical for you in your work setting)
• Incorporating audience feedback

Months of physical training to prepare for the rigors of running 26.2 miles have made your body stronger and faster than ever. Mental training can bring your mind up to speed with your well-tuned body and turn a good ING New York City Marathon experience into a great one. Here are some psychological tools that you can use before and during your race to maximize performance and enjoyment.

Pre-Race Strategies

Rational thinking. Pre-race thoughts are often filled with worry over things you can’t control. Try to recognize such irrational thinking patterns as “I didn’t train enough,” and “I must break four hours to be happy.” These thoughts are irrational because there is probably no evidence that they are true, and even if they are, there is nothing you can do about them in the days before the race. All they can do is eat away at your mental and physical energy. Replacing these thoughts with rational thinking can help your mind become clear and relaxed. Try to shift to thoughts such as “I would have preferred to train more, but I put in all the effort I could,” and “One of my goals is to break four hours, but I have other important goals as well.”

Thought watching. Sometimes thoughts erode our mental edge because we imbue them with negative energy. A better strategy is to view these thoughts objectively, as neither good not bad. Take a few minutes each day to allow worry thoughts, such as “It might be hot and I won’t finish,” to flash across your mind like words on a movie screen. Regard them with calm detachment, and you may be surprised by how clearheaded you feel. Thought watching is also a great method to use during your race.

Visualizing. Visualizing is a helpful technique because it increases the likely occurrence of -visualized behaviors. MRE studies have shown that visualizing an activity-such as running with good form-activates similar parts of the brain that are activated when performing the activity. Think of visualizing as priming your mind and body for success. For example, you can visualize running with restrained strength along Fourth Avenue in Brooklyn, steadily ascending the Queensboro Bridge, controlling your exuberance on First Avenue in Manhattan, and bearing down for the final tough miles in the Bronx, Harlem, and Central Park. To visualize successfully, sit in a comfortable chair, minimize distractions, and try to make your visions of success as vivid and detailed as possible. You’ll have a mental edge when they happen on race day.

Race-Day Strategies

Focus internally. One way to decrease race-day anxiety and maintain concentration is to focus inward. By concentrating on relaxing and maintaining good form-running tall, keeping a quick cadence, swinging your arms easily at your sides-you can simplify your thoughts, reduce distractions, and even feel sharper and faster.

Accept the challenge. When the going gets tough, recognize that the marathon is difficult and sometimes painful, and know that you have the ability to deal with the challenges. As you persevere through the tough miles, let yourself be surprised by feeling renewed strength after particularly hard patches.

Focus externally. Tuning in to cheering spectators and other runners can boost your mental energy and take the focus off your discomfort. Try some mental imagery, such as throwing an imaginary lasso around a runner 10 feet in front of you, tying the other end to your waist, and letting that runner pull you along.

Experienced runners use a variety of tools to gain the mental edge they need. Find what works best for you, and stay flexible in your approach, both in training and on marathon day. Good luck!

Rob Udewitz has worked with athletes in many sports some of which include golf, tennis, squash and track and field. When working with athletes, a multi-modal approach is individually tailored from a complete psycho-physiological assessment. The assessment provides data to identify areas of strength and weakness in the athlete’s ability to manage performance stress. When combined with other sport-specific measures a game plan is developed. Dr. Udewitz integrates technologies like biofeedback and virtual reality along with more traditional sport psychology techniques (i.e. mental imagery, relaxation training and self-talk strategies). These techniques sharpen athletic performance and help athletes find a consistent and reliable process oriented approach.

Jason writes about his mental preparation work with Rob

As a psychology major in college, I am keenly aware of the mind-body connection. I felt strongly that if I was going to succeed beyond my result in the Olympic Games in Athens (25th place individual, 4th place team), it was essential that I be more proactive about cultivating the type of strong mental foundation that “peak performance” comes from.
After having moved to New York City one year before the Beijing Games, I was lucky to forge a bond with Rob, who help me too fast track my mental training program and achieve the goals that I set to accomplish during that very important year. We delved deeply into a program that included innovative techniques such as, Biofeedback, Neurofeedback and Structured Visualization to create that type of base that is so important when dealing with the stress of elite level athletics. Rob was there coaching me through every step of the process, from the beginning of the qualification to end when it got really tough.

Before the last 2 qualifying tournaments for the Games, I had fallen to 6th place in the rankings after a string of disappointing results. Knowing that I needed to be in the top 3 by the end of those 2 tournaments, I felt the pressure mounting. However, unlike previous times, I was ready for this pressure and viewed it as an opportunity to test myself and all the techniques that Rob and I had been working on.

In our last international competition, I won two very critical bouts propelling me to a very much needed 12th place finish. Three weeks later in our Olympic trials, I was still out of the top 3 but felt confident about my ability to make the result that I needed to qualify for my second Olympic team. The competition started out a bit rocky, but in the end thanks to my mental training, I was able to prevail in a critical match between me and the only person left could take that last Olympic spot, thereby securing my qualification.

From there I continued to gain momentum with our program. We worked diligently leading up to the Olympics during which Rob never ceased to challenge my own limits and boundaries, while at the same time putting me at ease during such a stressful time. In Beijing, despite a rough day in the individual competition (28th place individual), I was able to stay tough and focus on the team event. Thanks to my hard earned mental resilience and focus, I helped our team win a silver medal, which was the best performance for the US team in the history of our event. Rob will forever have my gratitude for playing such an integral part in this tremendous result. Thanks so much Rob, and I look forward to keeping the momentum going!

This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with “straying” to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the I-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent­to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with ‘straying’ to CBT for comorbid disorders. (more…)

Q. I get so nervous before races that I regret signing up. But I’m always glad when I’m done. How can I get over this?

A. Your jitters show you’re invested in the outcome. A few simple strategies can turn your nervousness into helpful energy to create a positive experience.

Take slow, quiet, and deep breaths. Clear your head of anxiety-producing expectations such as, “I should run a personal record or all my training will be a waster.” Instead think, “I’ve done my training, so we’ll see what happens.” Using past race experiences, close your eyes and “see” yourself before, during, and after your race. See yourself weathering difficult moments and finishing strong. The day before your race, dream up worst-case scenarios that include the ridiculous. For example, “If I don’t run well tomorrow, I’ll be the biggest loser ever.” This creates a paradoxical effect-it gives you perspective on how foolish those feelings are.

Lastly, remember: PRs aren’t everything. The camaraderie of your running friends and the pride you’ll feel after your effort are benefits worth racing for.