Does this sound like you?

Years ago I was driving the 5 hours to my in-laws in NY for a Christmas break with the family in our van, heading west on the Mass Pike. I started feeling shaky and tight so I slowed my speed, stayed in the "slow" lane, and pulled off at the next rest area that was thankfully just a few miles away. I headed to the men's room and sat in a stall, head in my hands, wondering what was going on. Did I need new glasses? Was I coming down with something?  Vertigo? I asked my wife to finish the drive. 

I needed to be back in MA the day after Christmas for work, so for the next few days I was constantly wondering whether that feeling would return. To my surprise, I already had that  feeling whenever I would think about the return trip. (I learned later this is called "anticipatory anxiety". ) I drove home on Christmas day using my father-in-law's car and sure enough the feeling returned while I was driving. It remained with me all the way home, and so did my white knuckles on the steering wheel. To try and make the feeling less intense, I tailed tractor trailers  most of the way eastbound on the Mass Pike. I can't say if it that strategy was effective, but it gave me something to focus on. To top off this night, I realized that since I drove my father-in-law's car with his keys, I didn't have my house keys so I could not get into my house. After that nerve wracking drive. On Christmas night. Needless to say, the locksmith I called made quite a Christmas bonus.

I happened to work only a few miles away from home and the commute was on side roads. So I went to bed that night hoping that when I woke up the next morning I would be back in a familiar and comfortable routine.  But when I woke up I didn't feel any better. Now the side roads felt as uncomfortable as the highways did yesterday. During the work day my mind would drift to an unexpected question: How would I get home tonight?  The answer was a return to white knuckles on the steering wheel. 

So at this point the logical thing to do would be to reach out for help. But because each day saw  some minor reduction of anxiety I figured whatever this was would eventually wear off. 

Looking back, that decision was a mistake that cost me valuable time.

Lesson Learned: I should have started to get help sooner.

For the next several years I avoided highways.  My wife would drive if we traveled as a family. And if I had to drive, I would research the route for alternatives to the highway. There's an obvious price to pay here - the extra time needed when taking side roads. But there is a higher cost paid - a loss of self-esteem. It is degrading to be so limited.

In the end, being limited to side roads will impact family life and work life. The stress of living with this kind of secret also takes a toll. Ultimately, something has to give.

Avoidance is a real effect.  It made me feel better in the moment to avoid getting on, or exit the highway. Because there was relief, the mind believed that the source of the discomfort must have been real. The relief had the opposite effect, reinforcing a false belief and likely only encouraging the anxiety the next time.

Lesson Learned: I needed to avoid Avoidance whenever possible.

I found a therapist that was near where I worked, so that I could take late appointments. That way I could minimize excuses to coworkers when leaving work for therapy. This therapist had an Eastern treatment focus, addressing anxiety through stress management. He introduced me to breathing techniques to calm the mind, and meditation to be mindful and "in the moment". Stress is absolutely a contributor to anxiety. In my opinion, stress created a similar environment as the original cause of the anxiety. These stress relief concepts were helpful then, and continue to be helpful.

After spending time thinking about the start of my driving anxiety, I was pretty sure that I knew the origin. There was a tense moment a few years previous on an interstate bridge spanning the Hudson River. It was under construction, with only one lane open, and a tractor trailer was riding on my bumper. This origin story made sense to me, and I applied the new techniques with this origin in mind.  

The biggest surprise for me was the therapist's offer to drive with me on the 4-lane highway near his office. With him calmly sitting in the passenger seat, coaxing me along, I drove the two miles to the next exit. The car hugged the breakdown lane the entire way, and I felt a tremendous relief to reach the exit, but that was the first time I had been on a highway since that long Christmas night drive home. And I had some hope.   

Lesson I should have learned: I should have made a habit of practicing stress relief techniques.

Although I would make subsequent attempts at one-exit highway runs, I was not seeing the progress that I needed to make a confident return to the highway. 

Then I decided to apply for a different job, which as fate would have it, was a 35-minute drive on a series of 6- and 8-lane highways.  

Fortunately, the new job would not start for a couple of months. I needed that time to somehow get back on the highway. 

After searching the internet, I found a resource that was specific to my phobia: the Driving Fear Help website. There is a cost for the program and materials, but what I took away from the materials was 

• the physiology of anxiety - what happens to the mind and body leading up to and during a "panic attack". 
• techniques to apply when I felt the discomfort beginning to rise

Using this new information I started challenging myself to get on and off the highway as part of my daily commute to my current job, extending the drive to the next highway exit every week or two. It felt good to make progress but I knew it wasn't enough to get me to the new job.

Boston University has a great resource, the "Center for Anxiety & Related Disorders". Not only do they offer personal and group therapy sessions, but they also offer a one-week "Intensive program for Panic, Agoraphobia, & Specific Phobias."

I signed up for the one-week program with less than a month to go before the new job started. The course materials explained the physical and mental aspects of anxiety, their approach to its treatment, and included useful exercises. The therapy sessions at BU were customized to my issues, were interactive, and followed the exposure method. The beginning of the week included exercises to elicit anxious responses, e.g., breathing through a straw, to get me used to the anxious feeling and to learn that the feeling would not escalate. By the end of the week my therapist rode with me while I drove from Boston to the Maine border. Like my first therapist, she was a calming presence. It was still a "white knuckle" drive for me, but I drove the whole way.

After learning the materials, and witnessing the progress that I made in a short time, I came to believe in exposure therapy. What I also learned was that it takes time for the therapy to work.

I didn't connect the term neuroplasticity to this process yet. That realization would come later.

Now, I was able to drive to the new job. I was uncomfortable, but I could push through it.

Lesson Learned: Exposure therapy (Cognitive Behavioral Therapy) is effective.

As time went on I was driving on the highway, but I never progressed to truly being comfortable. I found a professional hypnotist who listened to my description of the issue and what I felt was its origin. We had a couple of sessions, and they made a CD for me to listen to while falling asleep for several weeks between sessions. The focus of these listening sessions was positive visualization and relaxation.  I drove most of the way home on the highway after the last session and I felt pretty good for the first half of the drive, probably on adrenalin and good vibes. But for the 2nd half of the drive I was back to being uncomfortable. In the end, I don't think I am susceptible to hypnosis.

Lesson Learned: Positive thoughts are useful. The buildup of anticipatory anxiety is real, and positive visualization seemed to help a bit with that.  I found it helpful to recall good memories of driving, and to celebrate the successes of exposure therapy when they were reached..

I found that I could have a nerve-wracking drive in to work in the morning, and yet have a pretty good drive home. Maybe it was because there were traffic jams in the evening commute that slowed the traffic? The point is, there was no consistency for me, which was frustrating. Since I had tried a therapist already, I sought out a neurologist to see if there was maybe something wrong with me. The neurologist performed some cognitive tests and concluded there was nothing wrong. And to prove that life imitates art, my neurologist literally gave me the same useless advice as Bob Newhart in this skit:   https://www.youtube.com/watch?v=jvujypVVBAY

Lesson Learned: Give a therapist time to be effective, but ultimately make a change if you aren't making progress. 

My anxiety continued to increase and I found myself having intense fear responses just  approaching highway entrances. So I again avoided highways for months. 

I was determined to get back on the highway again, so I tried multiple approaches at the same time:

1. Appointment with my medical doctor, who prescribed me with Paxil. Paxil is an antidepressant, and an SSRI (Selective Seratonin Reupdate Inhibitor). As I understand it, this drug kept me from feeling too high and too low. My goal was to slow the physical onset of anxiety, and I think it did that.
2. A new therapist. I heard a podcast by a therapist/counselor who had trouble earlier in life driving on the highway. I was interested to work with someone who had the same problem and overcame it. I reached out and he took me on as a client. 
3. Acupuncture. I don't know if acupuncture helped with my driving issue, but I did find it to be a calming experience. So I received acupuncture therapy on a monthly basis.
4. Use the exposure therapy approach to start with small stretches of highway driving. I would "practice" at night looping back and forth between exits on the highway.  

I felt fortunate to be taken on as a client by a therapist who would know what I was experiencing, and who had overcome this issue. We spent significant time in these remote sessions talking about how anxiety affected the body, methods of coping while driving, and of course extending the highway driving (exposure therapy.) The origin of the fear was not considered important.  Progress was slow but eventually I was back on the highway, even if I was uncomfortable.

I stayed on "Vitamin P" (Paxil) for a year and then weaned off of it. I reached a point where I felt the therapy had reached the end of its usefulness, so I stopped the sessions. The highway driving was sufficient to get me to work, but not comfortable. I even drove to upstate NY once or twice, even if I was uncomfortable and did not look forward to it. 

After a few years, I found my discomfort worsening again. I was hugging the breakdown lane, driving just at the speed limit, tightly gripping the steering wheel, and feeling intense relief when exiting the highway. Rather than pushing through it this time, I thought that I should take some time off and not create more bad experiences driving. Maybe pushing was causing more stress. Maybe after some time off I would feel me more relaxed and ready to try again. 

Lesson Learned: Staying off the highway was a mistake. It reinforced Avoidance. I was back to avoiding the highway. Now what?

Since the effect of the previous therapies didn't "stick", and I was sure this was a mental issue, I wanted to try some other treatment method.

Eye Movement Desensitization and Reprocessing (EMDR) is a guided therapy using specific patterns of rapid eye movements, to reveal and eliminate the effects of traumatic experiences. It is based on how memories are stored in the brain. I was focusing on my driving origin story (NY bridge). Despite multiple sessions, there was no improvement.

I believe that treatment is unique to a person and the treatment provider, and what may work for someone else may not work for me, and vice versa.  But EMDR did not work for me.

In order to avoid medicating and possible masking the source of the issue, I wanted an alternative to Paxil. I worked with a homeopath, who listened to my story and provided me with  natural substances intended to address my anxiety. As I understood the homeopathic approach, small doses of a substance can help stimulate the body's healing force. The World Health Organization cites homeopathy as the second most widely used form of healing in the world. However, despite trying a series of substances, I did not feel an improvement. 

I sought a new therapist because I still believed therapy would ultimately be successful.  The approach this therapist used was one I had not heard of before: "Internal Family Systems". 

According to the IFS Institute (https://ifs-institute.com), “the mind is not a singular entity or self, but is multiple, composed of parts". I was introduced to the idea that the mind can be considered  to be made up of different "parts". It is possible that one "part" was stunted earlier in life in an effort to protect the other parts, perhaps in response to a traumatic experience. In the present, that "part" continues to perform the role of a protector. The patient is encouraged to address the misbehaving "part", and life, with 4 C's: Compassion, Curiosity, Courage and Connection.

At first this idea of "parts" did not resonate with me. However, the idea that the origin of my issue may be from very early in life was appealing, even if illogical to me. I had been confident that the issue was caused by driving, but none of the treatments "stuck". Maybe it wasn't the episode on the bridge that was the start of my issue. Maybe it was a result of not feeling safe in the car as a boy. 

Lesson Learned: Approach life with curiosity.

I returned to using Paxil, with the idea that the other therapies, like exposure therapy, would be more effective if the anxiety was muted.

I was recommended the book "The Body Keeps the Score", and it pulled the other aspects of anxiety I had learned over the years into place. It described the biological aspects of anxiety and the how the brain processes fear triggers. Most importantly, it described how trauma shapes the mental and physical development and functioning of the brain, and that the degree of the effects of trauma can be different from person to person. I realized that the origin of my anxiety was trauma experienced in childhood. Although I had experiences as a child in the car where situations seemed out of control, most of the trauma was unrelated to being in a car. It was actually from the trauma of growing up in an alcoholic household. The anxiety I experienced later in life in the car was real but for the wrong reasons (driving). The fear triggers are linked to the fear felt as a child, and the mind reaches for something plausible to tie the fear response to (driving).

With this new perspective, I continued to challenge my driving behavior (exposure therapy). I had learned the mind can, and will, physically make new ways of processing experiences that override old ways (neuroplasticity). Since I felt that I finally understood the cause of my issue, I felt more positive (and "curious") about approaching formerly apprehensive driving situations. I forced myself to get back on the highway after negative experiences ("courage"), after short breaks, allowing for relapses ("compassion"). The positive experiences continued to build on each other, and I would then add a new challenge (different route, longer time, etc.)

Lesson Learned:  Be open to the idea that there will be good surprises even during difficult times.

My wife and I had the opportunity to drive a family member's truck out to Las Vegas. Years ago this would be have been unthinkable for me. But given the recent positive experiences, I finally felt that it was possible for me to actually do this. I wanted so much to get back to enjoying driving.  So I planned the drive on Furkot.com and tried visualizing myself enjoying the drive. My wife and I split the driving. (See the map.) To my surprise, as one drives west the speed limits in each state increase from 65 mph to 70 mph to 75 mph and then to 80 mph. (I'm glad I didn't know that when I started the trip.) I kept up with traffic and focused on enjoying the drive. After 8 days we arrived in Las Vegas.  I was so happy to have done something that everyone else does without thinking (driving), but it was for me something that I had almost given up on. Mostly, I was very grateful for this milestone. Grateful to

• God
• My wife and family
• The therapists who treated me
• The authors of the books and websites that educated me

My recovery was a long process. I believe it was longer than it needed to be. During these years I alternated between hope and discouragement, advances and setbacks, I told myself that if I ever "got back on the highway" I would share my experience in the hope that it may be of use to someone else. So, here we are. 

Looking back, I believe these were the major sources of recovery:

1. Faith that I would be given strength to keep trying and to ultimately be blessed with success. My family had experience with recovery through Alcoholics Anonymous. An important component of AA is acknowledging the need for a Higher Power. My higher power is Jesus Christ.
2. Knowledge about physical aspects of anxiety.  How does the brain and body enter and exit a state of anxiety and panic? How does stress make anxiety more likely? Understanding these physical and mental responses helped me to remove the mystery of these feelings and to stay removed from them "in the moment".
3. Knowledge about childhood trauma and how it preconditions the mind to be susceptible to, and more easily trigger, anxiety. 
4. Strategies to manage anxiety "in the moment", and methods like CBT to minimize the opportunity for anxiety to occur.
5. Medication, at least for a limited period of time, to give the mind and body the chance for these strategies to take effect. 
6. Persistence: Never give up. The human spirit is incredibly resilient.

The Resources section of this site has a list of web sites and books for learning about anxiety. Therapists guided me in strategies to address anxiety. My doctor guided me in medication to help the strategies to be successful.

If you are going through something similar to me, I hope this information is helpful to you. I honestly believe that if I was able to move beyond this issue, anyone else can find a way, too.