Claudia W.: What you're about to hear are the key parts of a one-time unscripted session with a real person. Names have been changed for confidentiality. Please note that this episode contains some emotional discussion around road fatalities and driving phobias. 
Eva: I don't know how you ever get over something like that. That will always be there..
Claudia W.: This is how did we get here with me, Claudia Winkleman and my excellent friend, clinical psychologist, professor Tanya Byron. In this podcast, we address some of the challenges people are facing day to day. Tanya talks to our guests in a one-to-one session, and I listen in asking questions at the start in the break and at the end. There may be some audio lagging and background noise from time to time because we're all recording remotely from our homes. We hope that it's not too much of a distraction. This time we meet Eva, who's married with two children. Around eight years ago Eva felt faint whilst driving on the motorway with her children and husband, and has been too scared to drive on fast roads ever since. Eva wonders whether that instant was triggered by a fatal road accident that her close friend had when she was a teenager. 
Eva: I just remember screaming at the top of my voice. Like screaming. Just I'd never felt anything like it. 
Claudia W.: Let's go and meet Eva.
Eva, thank you so, so much for coming on the podcast. We're incredibly grateful. Uh, tell me, why are you here? 
Eva: Few years ago when I was, well, it's more than a few years now, and I was driving with my children. I had a complete kind of panic moment and I basically felt light-headed and had to pull off the motorway. And ever since then, I've just not been able to drive on any kind of fast roads and it's getting worse. So I'd really like to be able to get back to driving normally and deal with whatever it is that's kind of causing me to feel like that. 
Claudia W.: Have you ever had that feeling of having to get off the road, metaphorically if you like, about anything else?
Eva: Never. And actually when it first happened, I assumed it was a physical thing. I'd had a can of Coke, I was tired, it was night time, my kids were really young, I was breastfeeding. I just thought, oh, I'm knackered 
Claudia W.: Yeah.
Eva:  And I had no idea whatsoever at the time, and not until years later that actually, it might be something psychological.
Claudia W.: How are you in a car? Can somebody else drive you? 
Eva: Yes, but if I don't trust them, then I get quite panicky about it. 
Claudia W.: How old are your children now?
Eva: They are 10 and 11. 
Claudia W.: Would you let them boil a kettle or, you know, make toast? 
Eva: Yes, I do. 
Claudia W.: Everything is fine. 
Eva: Yeah. 
Claudia W.: It is just a car. Can you watch a car chase or does it make your heart go a bit fast?
Eva: I like watching police programs and things like that, if I saw that, I'd be okay with it. 
Claudia W.: How does this impact your daily life. 
Eva: It doesn't really impact my daily life because I live in sort of outer skirts of London really. So, I can avoid it a lot of the time, which is part of the problem. And then it just, I can pretend it's not there, but then if we come to go away anywhere, or I drive out to see friends that live out of London, then it comes back and then I'm panicking thinking, right, can I get the train there and how do I manage it? And I never want to tell anyone about it. So, I'm always trying to find a way around it. 
Claudia W.: Before this happened, did you take pride in driving? Lots of people love driving. They like freedom. 
Eva: I love driving. I couldn't wait till I eventually passed my test and I was 17 and couldn't wait to get in the car. So it's never, ever been a thing for me, that being scared. 
Claudia W.: For those people you have told, do they say, don't worry about it, we'll drive you. Or do they go we have to fix this. 
Eva: No, they're completely fine about it. It's, I want to do it for me and I haven't told my kids because I wouldn't want to, give, put that onto them. 
Claudia W.: Yeah. Yeah. If I can take you back there to the moment where you actually had to pull off, talk to me about what was going on in your head, your gut, what happened? 
Eva: So it was, it was a response to seeing an accident which wasn't gory, I didn't see any, you know, anything terrible, but obviously there was an accident on the side of the road and that was it. I'm now scared of being in that situation and feeling that feeling again and not being able to manage it. That then becomes the trap. 
Claudia W.: Ok, well thank you again for coming in and Tanya will come and join you now, but Eva, thank you. Thank you. 
Eva: Thank you.
Tanya B.: Have you understood that, that this is a phobia, you have a phobia to sort of motorway or dual carriageway driving. Would you identify with that idea? 
Eva: Yeah. 
Tanya B.: And you don't have any other sort of phobias in your life. 
Eva: Did I have any of that before? No, I didn't. I love roller coasters. I love, I used to love driving fast. Yeah. There's nothing that ever scared me before. 
Tanya B.: This, may feel like something that it's like, oh, well, you know, so what big deal she can just drive her kids to school and her husband can drive everybody when they're on holiday sort of thing. 
Eva: Exactly. 
Tanya B.: But actually it is a big deal, because, it is very sort of disabling in a way, isn't it? Because it's already shrinking your life in the sense of what you want to be able to do. Describe to me how it disables your life? 
Eva: There's this weakness, it's this kind of chink in my armor that makes me feel really inadequate. And it does feel really trivial, especially in the time of a pandemic, but it's that fear that it will either permeate more into other areas if I don't get a grip on it. And the last thing I want is to not be able to see friends or my kids not to have opportunities because I've got an issue that I've not dealt with. 
Tanya B.: You said, I feel inadequate. This is a weakness. It has quite a corrosive impact on your own self-esteem talk me through that a little bit. Let me, let me hear a bit more about that.
Eva: In one way it's not rational, but on another way I can rationalize it, and I can say to myself well it is, dangerous driving on the motorway and, you know, people say, well, just get in the car and drive. But when I do. I feel more panicky again and it reinforces it. 
Tanya B.: Well, fear feeds, fear, doesn't it. And also you describe anticipatory anxiety. You think about it, you feel afraid before you even begin. it. So it, I mean, it is very common. You know, a lot of people will struggle with a very specific phobia, but aren't actually people who generally in their life are anxious. It creates its own reality, even though it is irrational, and that's where confidence starts to get eroded because you think I'm an idiot. Why? You know. But you're not. 
Eva: I think the irony is that my fear of driving on fast means I start to literally physically take my foot off the accelerator, which is actually extremely dangerous to do on the motorway. So, like, you say, I almost create my own reality, which is either make myself at risk.
Tanya B.: There are two other areas I really want to think about with you before we get to a plan. One is I'm curious to know whether you've had any help for this before, and then the second thing is, is there a backstory? So let's start with, what have you tried before to try and deal with this problem? 
Eva: So I went and got some counseling, some CBT. And the main thrust of it seemed to be, let's just get in the car and start small, you know, go and do one junction on a dual carriage way, just conquer it. By doing that, I felt panicky and fearful. And then it just really convinced that I shouldn't be doing it. 
Tanya B.: What you're describing is exposure therapy. So the idea is, is that you expose yourself incrementally in small steps to what it is you're afraid of in order to show yourself that you are able to manage it. And then you just build up to bigger and bigger steps until you just kind of one day punch the air with joy and go, I've nailed it, I've cracked it. So that's exposure therapy. Another approach would be flooding where we put you in a car in rush hour on a, on the M1 or something and say, drive. However exposure therapy cannot work unless you are also given the tools to manage the anxiety that you are going to experience when you put your foot on the first rung of that ladder. So with the CBT, what were you taught in terms of anxiety management? 
Eva: There wasn't a lot of discussion about how you'd manage your anxiety there. I think he was, I remember him saying to me, well, you can always just pull over. And I remember attempting a drive in a, uh, to a shopping center out of town on a dual carriage way and having to pull over at one point. But I now sat on the side of the road feeling entirely panicked thinking I've got to pull back onto that road. It didn't feel very comforting. 
Tanya B.: What seems very clear to me is that your anxiety response is, is very, very physiological. 
Eva: And that's what shocked me the first time, I didn't, I thought I had a physical issue because I had, I just couldn't recognize it as a, as a mental thing, it, to me, it just felt, I felt it all in my body. 
Tanya B.: And describe to me what you felt really, really take yourself back there, close your eyes if you want, but just try and describe every physiological shift you felt in that moment. 
Eva: Lightheadedness just came on so quickly. I just instantly felt, I'm going to pass out and I've never passed out in my life, so I don't actually know what that feels like, but I just instantly felt like the oxygen drain from my head. And I thought, oh my goodness, I've got stop driving, this is dangerous. Definitely heart racing, you know, sweaty palms. Almost just a physical weakness. I just feel really stressed. 
Tanya B.: Do you feel any little flutter of anxiety just as we're recalling it and discussing.
Eva: I did have EMDR therapy at one time, who, as we came towards the end of that, she said, right, picture yourself going onto the motorway. And if I really, really put myself on that slip road, that would happen, I would recreate all those physical feelings. 
Tanya B.: And as you're describing now, your speech rate has gone up slightly, and it felt like you, you slightly breath hold. I could see a little tiny shift in you as you were describing it, would you agree with that? 
Eva: Absolutely, and that's, I think that's absolutely right. It's more of a breath hold than a, I'm not gasping for air. I probably hold my breath more. 
Tanya B.: You said you also, I think you said, just, just correct me if I'm wrong you said you had EMDR, which is eye movement, desensitization and reprocessing. So that's a psychotherapy that also deals with people who feel anxious, but, who are anxious because of trauma. And so it gets people to relive by describing the trauma, like when you were in the car and driving and the lightheadedness and the kids were in the back and it was dark and blah, blah, blah. But, as you're doing it, you are either tapping or your eyes are following something. Yeah. You're nodding, so. 
Eva: It was the eye movement. 
Tanya B.: And that then enables the brain to, to process the trauma in quite a specific way, because you're also doing a physical movement at the same time. But also, your practitioner would be sort of saying, right, we're just gonna leave the memory, I want you to study your breath. So there also the sort of reprocessing is you're, you're getting the trauma to be retold and retold with anxiety management happening at the same time. So you keep retelling the story, but you bring your anxiety down and down and down. So you fundamentally disconnect the anxiety from the experience.
Eva: Yes. 
Tanya B.: Why did the EMDR not work for you? What happened?
Eva: So, it worked to a point, but then my mum got very unwell, and it was just at the point we were sort of moving it to the next stage. And I didn't feel, I suppose, after I came out of all of that cycle, my mum was ill for quite long time and then she died and then I didn't feel that I'd have made enough progress in it to merit going back to it? I guess that's really the honest answer. 
Tanya B.: How long ago was that? 
Eva: About two years? 
Tanya B.: I'm really sorry, you're getting tearful. So you miss her. 
Eva: Yeah, she was one of my best friends. 
Tanya B.: I mean, that is trauma. And, two years is nothing. When you lose your mother who you're also deeply, deeply close to. 
Eva: Yeah. And for that year, I just watched her suffer.
Tanya B.: It sounds like to me as if you were in the process of a therapy that I think probably would have worked for you, but completely understandably you, you couldn't continue it. You needed to throw everything you had within yourself to be with your mom. And then the result of that is you lose your mum and the death of someone you love is quite fundamentally the core of this phobia.
Eva: Yeah. 
Tanya B.: You know, people go, well, what's the worst thing that could happen, and, and then two years ago, well, the worst thing did happen right? 
Eva: Yeah. Absolutely. 
Tanya B.: What if I drive badly and there's an accident and I die, the kids die, whatever. It's kind of entrenched it even more in a way I can't afford to lose anyone else. I am not going to put my children, myself, my family at risk. I therefore cannot drive. I mean, it's irrational in some ways, because obviously they're very different events, but there is a real rationality to it. So I totally understand. Just tell me a little bit now when you're crying, how that sits for you? 
Eva: You know, losing my mom, is kind of reinforcing all of those fears around what is the worst that can happen. And I also, when I was at school, when I was 16 and one of my really good friends was run over and killed by a car on a dual carriageway, 
Tanya B.: Oh no..
Eva: And you know, I always thought, you know, maybe that was kind of coming back to kind of bite me. And so, I don't know, I don't know if they're connected or if I'm just conflating it all, whether it's just emotion that I buried, because when that happened, you know, back in the nineties, there was no support or discussion about it. All our school cared about was that we weren't going to fail our GCSE's. And, you know, all our parents just wanted us to kind of keep us on track. I think with my mum dying, I have really sat with emotions a bit, like I'm not scared to cry about it, I'm not scared to cry infront of my children about it. I think that's really important. Um, so I have tried to kind of face it down a bit more than perhaps I would have done in the past. 
Tanya B.: Tell me about your friend, I mean, gosh. So you are how old? 15, 16? 
Eva: I was 16. Yeah, she was 15. 
Tanya B.: And she was a really close friend? 
Eva: Yeah, we were all going on our first girls holiday that summer to Spain to celebrate the end of our exams and, we were a really kind of close group, and in fact, the group of girls I was at school with, then we're all still friends now. 
Tanya B.: And what happened if you don't mind me asking?  
Eva: Sure, she went on holiday with one of our friends' families. Um, and they went to Spain and she just walked over across the road, looked the wrong way and, was hit by a car. That's all I know. 
Tanya B.: That's absolutely tragic. So you don't know whether she died instantly, whether she died. 
Eva: I think she did, because my friend's brother found her, you know, just lying on the road. 
Tanya B.: And how were you told? 
Eva: A friend rang me at home. It was Easter holidays. My parents were at work and, I was supposed to be going on, um, a study course that afternoon with a friend of mine. And I just picked up the phone and I can't even remember which friend it was just said, Kate's been killed. 
Tanya B.: And even now, as you remember it, it brings tears to your eyes. 
Eva: Yeah. I just remember screaming at the top of my voice. Like screaming just I'd never felt anything like it, just that sort of guttural instinctive response to just that news. I just couldn't believe it. Just a massive, massive shock. 
Tanya B.: At your age, then, that stuff doesn't really happen. You're young. You don't, you're not thinking about mortality, your own mortality. I mean that, must've just been like someone hitting you from behind over the head with a breeze block. Stunned you, shocked you. 
Eva: Yeah, it was massive.
Tanya B.: And what happened afterwards? 
Eva: We would all get together as a group of friends at other people's houses to kind of support each other. But what I always found really weird was we'd go there and then no one would talk about it. And I think I just felt like I needed to talk about it. 
Tanya B.: But you, what you needed to talk about it, but no one talked about it.
Eva: Not really. You know, my mum and dad would try and be helpful and supportive, but I guess when you talk about it, you seem upset and, from that generation, they didn't want to upset you. So they would probably steer around it. 
Tanya B.: But that's where you're a good mom, right? I just want to reiterate this to you that, here you are now two years after the death of your mum, and you are able to be open about your grief in front of your children, because you understand that not upsetting children when they are obviously deeply upset, is really a ridiculous way of supporting, you know, pretending a feeling isn't there and business as usual, come on, pick yourself up, get back to your revision, you know. I mean, that is ridiculous. Back in the day when you were younger, so you're saying this was the nineties, yeah. Obviously your parents were loving and kind, I'm not suggesting they weren't, but there wasn't a real sense that they need to be enabled to grieve openly. They need to be given permission to do that. It's part of a process of saying goodbye to someone they loved very, very much and thought that they would be friends with forever. That wasn't done. 
Eva: Absolutely not. One of my mantras when I would be growing up from my dad, if I was upset about anything, I can remember him pleading with me, don't, please don't cry, please, don't cry. You know, it just, it, I could see how much it affected him emotionally if I was upset. And that's why, like you say, I feel really strongly that my kids need to see that, you know, you shouldn't be scared of your emotions.
Tanya B.: It's really interesting isn't it because, you've wanted to change that narrative with your own children. You're not saying to your kids, please don't cry. You're saying, if you need to have a cry, cry. This is how we do feelings. This is what emotional processing is. So you've changed that narrative. But interestingly with yourself, you haven't. 
Eva: I know.
Tanya B.: When it comes to this fear, which has landed itself on the driving. It does seem to have a link doesn't it, to your, your sweet friend, Kate who sadly lost her life when she was so young on a dual carriageway. Dual carriageways, you can't do them. I mean, it can't just be a coincidence, right? There is something there. It's really interesting that you are completely afraid of, of your feelings there. What do you do? You hold your breath. You start to sweat. You go into a major physiological response to panic, and panic is the fight, flight or freeze response. And you freeze, you take your foot off the accelerator and then you stop. You then engage with flight. Flight, being runaway, being avoidance. 
Eva: Yeah. 
Tanya B.: You avoid going onto the motorway, going onto the dual carriageway. So of course the more we avoid something we're irrationally afraid of the more we reinforce the belief there's something to be afraid of. 
Eva: Exactly. That's why it seems ridiculous to me. Like all my other friends are functioning and coping so.
Tanya B.: You're saying to me, why did that sort of trauma manifest itself years later in my phobia and it hasn't done with my friends, because they're merrily driving on dual carriageways. Have you heard of individual differences? You know, I mean, look who knows how it's affected them. Maybe, some of your friends are super over protective of their kids in a way that Claud assessed very well, that you're not. 
Trauma can impact people in different ways. And there's no guarantees. It would have impacted you like this, but we have to go back to the night when you can see that it first happened. You are driving. You're a young mum, you've got two little kids in the back of the car. I think you said you were breastfeeding. So you're knackered. 
Eva: Yeah.
Tanya B.:  I think it was nighttime.
Eva: Yeah. 
Tanya B.: So it's dark. 
Eva: I drunk a can of Coke to try and kind of, give myself a bit of a boost before I got in the car. Just thinking, well, that will just kind of, you know, the sugar and the caffeine will keep me going, oh, you've got a couple of hours to go. So it's definitely in that tired mind space. 
Tanya B.: That's quite dangerous actually, because what you're doing is you're whacking in a lot of sugar and caffeine, so it will ping you up for a while and then you crash down. So it sounds to me that you suddenly, your blood sugar levels shifted and you got light headed. So, the initial reason for that lightheadedness was physiological. 
Eva: I don't even drink tea or coffee. So for me, any caffeine is unusual and I don't drink Coke regularly either. So it was, it was definitely a, I thought, oh, how stupid it's because I drank that can of Coke. That's how I rationalized it for ages. And it was only then when I tried to go back to driving that it happened again, that I realized it was more than that. 
Tanya B.: Absolutely. So that's then where the backstory comes in. So, that single event was a physiological response. You went light headed and then you panicked. 
Eva: Yeah. 
Tanya B.: And you're saying, okay, Tanya, I get that, it was physiological, but then why did it embed itself and become a phobia? You tell me, we've just had the conversation. What happens on dual carriageways? 
Eva: In my head they're dangerous.
Tanya B.: You're laughing, but you're crying. 
Eva: I don't know how you ever get over something like that. I remember when one of my counseling sessions, they said, do you know, do you think you've got over the death? And I said, I don't think you'd ever get over something like that. It would always, that would always be there.
Tanya B.: Absolutely. Right. And in a way, you know, I'm really pleased for Kate that you keep her alive. She's still important. But, getting over it is an interesting phrase because fundamentally what happened with you on that night, that was terrifying, you suddenly felt you were going to faint you're out of control. Which then became conditioned to the underlying reality for you that dual carriageways equals death. So you understand this idea of classical conditioning. We pair two unrelated things, and we give them a relationship. Classical conditioning is best described by the experiments of Pavlov, who was a Russian scientist who basically took a load of dogs. And every time he gave them food, he rang a bell. Food bell, Food bell. What was interesting is then eventually, and very quickly, all he had to do was ring a bell and they would salivate, there was no food in sight, but the bell was connected to eating. Therefore the physiological response was salivation. So what he showed is that we can, we can knit together two completely unrelated stimuli, and they then become related through the repeated exposure. And your repeated exposure has been, I felt faint on a dual carriageway with my children. Dual carriageways kill people. They killed my friend Kate. You go back to that panic of the day that you were called to say she was dead. And then you've got a Pavlovian conditioned response. All you have to do is think about a dual carriageway and your kids in the car and you're panicking. 
Claudia W.: Tan, can I just ask a question? I love the Pavlov dog story. In all our years, working together. I've never heard you use it in one-on-one conversation with somebody. But, it was fascinating by how it relates to either. 
Tanya B.: The Pavlovian classical conditioning description is really important because the link between lightheaded and feeling sick in that moment, and dual carriageway, and losing Kate, is really, really helpful. This happens, you know, if you can do it with dogs, with food, with bells, you can do it with an exhausted breastfeeding mother on a dual carriageway at 10 o'clock at night, having a post can of Coke come down, who becomes light-headed. And PS, her friend died 10 or 15 years earlier on a dual carriageway. 
Claudia W.: Okay. Back to the chat. 
Eva: What I find strange though, is that losing my mum is one of the worst things that could happen. And yet that hasn't derailed me in the way that I thought it would derail me. Whereas something so historical potentially does? 
Tanya B.: You were 16 years old when you found out that Kate had died, and nothing was really settled on to help you process that. Losing your mom, you're older. You prepared yourself for it. You are properly grieving, but you're grieving in a very healthy way. And you continue to have support from people when you need it. Just to remember your mom and have a cry. None of that happened before. So the event when you were 16, when Kate died, is the one that's derailed you. Contextually it's the Kate event that then does what Pavlov found with those dogs, it conditions, fear to dual carriageway driving. But we're still left with, so what do you do about it? Do you need to do a bit of narrative work to say goodbye to Kate? Do you want to write to her, do you want to write to yourself? 16 years old, trying to get your head around it. What do you think would be helpful next? 
Eva: I feel like writing to my 16 year old self would be the most helpful thing. 
Tanya B.: You could do that. Can you just lay out what you think you now see in terms of physiology and psychology. We're going to have to think about the way in which you can set that up more systematically and learn how to manage your physiological and psychological anxiety in the run-up to your little drive that you've planned for that day. And also during it. 
Eva: So just, uh, you're asking me to explain how I felt physiologically and how I feel psychologically. Is that, is that what you're asking to do? 
Tanya B.: Let me just explain it. The reason we become anxious is because our body goes into fight, flight or freeze response. In other words, if you and I are sitting having a coffee and someone comes running in screaming and shouting, and it looks like they've got a weapon in their hand or something, we're not going to sit there and still carry on chatting, we're going to feel a complete change in our physiology. So we jump up and we run. Flight. Or we throw chairs at that person. Fight. But we have to shift psychologically and physically in order to protect ourselves from threat. So our breathing changes because we need to get more oxygen into our lungs, to oxygenate our blood, our heart races, to pump oxygenated blood to the areas of the body we need, if we feel threatened, which will be our muscles. We need our muscles to run and to punch. And as all of this is happening, physically, the part of the brain that then gets less oxygenated blood because it's the least important part of us at that time, is where? Our rational brain. You and I, in that cafe with someone running and looking like they've got a weapon, we don't need to sit there going, oh, she could be really rude if we, um, you know, if we just kind of got up and walked out? Oh, oh, I don't know, you know, the part of us that's about social skills and thoughtfulness, and deliberation, and behavioral self-management, no, no, no, no. We don't need to manage our behavior. We need to act, we need to act now. Our limbic brain our, the anxious areas of our brain, crank up because now we have to survive. You know, it all sorts of interesting things happen. Why do people want to go to the toilet more when they're anxious? Do you know that? 
Eva: No. 
Tanya B.: If you and I were running away from threat and we'd just been and bought loads of fantastic stuff, we'd gone on a great shopping expedition, and we had lots of heavy bags in our hands and we were running away from threat, what would we do with the bags? 
Eva: Just drop them. 
Tanya B.: Right. Because? 
Eva: They're heavy and they're gonna slow you down, put you at risk. 
Tanya B.: Right. Think of a bladder full of urine, a bowel full of feces, a stomach full of, you know, food that's being digested. What does our body do when we're anxious? We throw up. And you said earlier, when I'm in that situation, I feel sick. So what we can see is you are going straight into the anxiety, and so you are going to take your foot off the accelerator. You are going to feel sick. You are going to hold your breath because you are going into a panic response. That is how physiology and psychology are linked because when we are in a state of threat based anxiety, we focus specifically on the threat because if we don't, it could jeopardize our survival. The problem is this isn't a threat, in the way that you have now got to the point of thinking it is, but you've got this narrative sitting behind it, so the whole thing has just become, I literally can't think of a better word, so forgive me, but you seem like quite a chilled woman, it's just become a total shit show in your head.
Eva: [laughs]
Tanya B.: Do you now get that? 
Eva: Yeah, I do. 
Tanya B.: If you shift the area of the brain that's taking over, you shift the way your body is reacting and your brain is thinking. 
Eva: So it's about listing out the physiological check responses and the psychological responses. And then, yeah. 
Tanya B.: And then we can work out what to do. 
Eva: Ok.
Claudia W.: There'll be lots of people listening, who, I mean, I hate spiders, as you know, is there always a narrative behind it? 
Tanya B.: No, not always. Sometimes it can simply be something at that time that is predisposing you to feel extreme fear in the face of a particular event or a particular whatever you're experiencing, which then becomes so embedded you ruminate on it a lot. It isn't unusual with people who have a very specific phobia, that there is some narrative somewhere. It may just be that at the time in their life, when that particular event occurred, and they felt that extreme level of panic other stuff was going on and they were particularly vulnerable or there was, everybody is different right, and so, fundamentally the important thing is for her to be able to say it is a, it is a simple phobia. It's not a complex phobia, it's very specific and she's not an anxious person in her life generally, but this has just a collision of factors in a specific moment that has left her terrified. And of course, if you have a strong physiological response, that is really scary as well. That terror, all of that just keeps impacting, impacting, impacting, and so the layers build, and then the narrative is I can't do this and I have to avoid it because if I do it, I am absolutely going to freak out and put myself and other people in danger. I can't wait for her to come back. Yeah, me too.
Eva: So what I've done and this might not be right, is I wrote down physiology and then I wrote down what I was feeling. And then I wrote down psychology and I wrote down things that were coming to my head at that time. 
Tanya B.: Perfect. 
Eva: Okay. So on the physiology, I just wrote lightheaded, hold breath, heart racing, tense muscles, sweaty palms. And then on the psychology I wrote, got to get out of here. Stop it's dangerous and you're putting your kids at risk. If you panic, you won't be able to drive home and you'll have to call someone to come and get the car. If you panic, your kids will see and you'll make them get a phobia. There's no where to stop you're trapped. People behind wanting to drive faster and you're in their way. 
Tanya B.: If we want to find a way to reconfigure your response. What you need to do really is learn how to manage the physiological feelings. What then should your response be to, to those physiological symptoms when you spot them as early as possible? What do you need to then do? 
Eva: Just note it and try and counter them. 
Tanya B.: Yes. Noting is a great word. So, you note them, uh, with interest, not with panic, you go, oh, I know what this is. And let's just go through your physiological responses. If you know your breath holding, what would you then want to be doing to counteract that? 
Eva: Lots of deep breaths?
Tanya B.: It's yes. Yeah. Steady breathing. So you want to breathe in through your nose and out through your mouth and you make the outward breath slightly longer than the inward breath. So it's.[Breathing sounds] If your heart is racing obviously, if you manage your breaths, you know, eventually you can cut, you know, your heart rate and your breath rate will start to kind of sync up, but sometimes just counting your, your heartbeats, even if it's very fast, it's really interesting, but by counting them and steadying your breathing at the same time, you actually, as you count them, you can feel the rate come down and with your sweaty palms, you know, you just wipe them on your leggings and  you keep going but, fundamentally, and I know this sounds really weird, but welcome the anxiety in a, in the way that if one of your kids walked into the room crying, you'd be very distressed, but you'd welcome them into your arms, and you'd say, I've got this, this doesn't feel nice for you or me, but I've got this and you would have a tone of voice and a way of just being solid and containing that would calm them down, and then you'd say, so what's going on? And so you know what i mean? That's what you need to do for yourself. So I would like you to do an awful lot of progressive muscle relaxation exercises every day and breathing exercises every day. I want you to block time out in your day, maybe, sort of 10 minutes in the morning with a breathing exercise and 20 minutes at night before you go to sleep. There are some fantastic apps. Headspace is a great one. You go in there, there's a huge amount of content and it, and there are things for anxious when driving anxious when this, so you can actually find content to suit you, but you know, you need to learn how to click that physiological anxiety management technique straight in. 
Eva: Totally understand that. 
Tanya B.: Right. So I prescribe that for you. 
Eva: Great. 
Tanya B.: It will come, but it'll take a bit of time right. 
Eva: Yeah, for sure. 
Tanya B.: The thinking bit, then obviously your thoughts are linked to the perception of your physiological change. What is your internal chat? How do you talk back to your anxiety? 
Eva: Just you'll be fine, like you say, you've got this, you've done it before, what's the worst that can happen. Preparation as well as just being kind to yourself. 
Tanya B.: Absolutely. Basically with cognitive anxiety management, you've got the option to either engage with some positive self-talk, which is what you've just said. So one is positive. Self-talk another one would be, you can distract yourself. So let's say you have decided that tomorrow you're going to go for a one junction dual carriageway drive just to start on the bottom rung of your exposure therapy ladder. You every time you can feel those intrusive thoughts going, oh my God, it's tomorrow, oh my God, it's gonna be terrible, oh no, do I have to write goodbye letters to the children? You know, all that sort of [gasps in] you go, think of that thought as a sort of unwelcome guest at a party, you know, what would you do if you had a gate crasher at the party? You'd open the door, you'd say, sorry, you're not welcome and you'd shut the door in their face, I mean. Some things, you know, you can just block and then you can distract yourself. You can say, I'm not going to think about this. I'm going to put on a YouTube workout, I'm going to call a friend, I'm going to, you know, you can see these thoughts as toxic. See these thoughts as the bully that lives inside you, and often, what do we say to children when someone's being mean to them? Ignore them. Because if you ignore them, they'll eventually go away because it's not going to have an impact on you, so they're not getting what they want. 
Eva: Yeah. 
Tanya B.: You might need some coaching on this, so it may be worth it, now that you understand it better, having some CBT to help you with it again, um, there are some online CBT courses as well that you could do yourself, or you could find a CBT practitioner who could do it with you and you could sort of every week or two weeks you could plot forward and get that support with really practicing the anxiety management, really practicing the cognitive management. I think you're more than halfway there. I think now that we've clicked, the narrative into place and now, you know why it's happened and what you can do about it. You're the kind of women, I think when you've got a solution, you can bear the pain. What do you think? Do you agree with me or.. 
Eva: I completely agree. I think it's worth it. I think before I could never get over the physiological responses. I just couldn't see a way to to manage that, so I completely understand that you've, I've got to have those so well practiced and so well at my fingertips and disposal that I can click them in quicker because if I don't, I'm already panicked and then I'm, it's too late.
Tanya B.: Some people I work with where they have a very, very intense, specific phobia, which causes such an intense, physiological reaction that cognitive management, maybe some people visualize, you know, you visualize, I can drive this, you know, you don't keep worrying about the person behind you. Fine. They're fine. They can be behind me. You know, all that stuff. If that doesn't quite cut it, there are medications called beta blockers, which not everyone can take, cause obviously it depends, whether, you know, you've got other conditions, but it just takes the, the edge off the physiological anxiety and you can take them, they don't cross the blood brain barrier. It's not going to distort the way you think, but it just, it just kind of settles the physiological response, just. And some people take them in the early days of exposure therapy because it just helps them build their confidence. I'm not suggesting that is something you should, but if you felt it could be helpful, you could talk to your GP and you could explain, you know, exactly why this is something you wanted to talk to them about. Or you could, you know, just before you go for a drive, just settle yourself, you know, have a camomile tea or whatever it is that you do that helps you just relax and take a breath and just get yourself into that head space and say, I've got this. And so you go to the first rung of the ladder. So you do one little junction, dual carriageway you're familiar with in good conditions when there's not a lot of traffic and you rate your anxiety from zero to 10 and obviously 10 is a full-blown panic attack. And you keep doing that junction maybe every day until you're down below five. In terms of the anxiety rating and then, you know, you're ready to go to the next level.
Eva: Yeah. That's a really good way to look at it, yeah. Because otherwise I seem to do it to me, you do that once and then you should be able to go two junctions and, you know, just kind of ratchet it up from there, but I like the idea of getting comfortable with that one part before you can move on. 
Tanya B.: There's no should in this, it's all about you feeling, I mean, excuse the pun, but you're in the driving seat of how you manage. 
Eva: Yeah. 
Tanya B.: This anxiety. You absolutely run this, and if you look online there's, um, some really good PDF's, there's one called um, Mood Juice, M O O D J U I C E. They do a PDF around anxiety and they've got a really good description of everything I'm talking about and a hierarchy and exposure therapy and managing physiology, managing psychology. Have a look at that PDF. 
Eva: Great. That's really helpful. Thank you. 
Tanya B.: Do you think you can do it? 
Eva: I want to do it, so I think I can. 
Tanya B.: You're definitely going to do this. I know you are. Um, and you might be able to do it on your own. Although I think if it feels, it just a bit of a challenge to think all this through and do it, just get yourself a running mate, find yourself an online CBT therapist, clinical psychologist like me, or do it with a friend, just get your friend to really understand what you're doing and they can be your coach. And the key to exposure therapies is a little every day. Yeah. The other part of this of course then is the, I suppose the conditioned response that comes from the underlying trauma and you wanted to write to yourself, do you feel comfortable sharing that? 
Eva: Yeah of course. It's quite short, but I said, um, the day you got that phone call, you were in the prime of your life. Everything changed. Life would never be the same. Again. You learned that the world is a cruel and incomprehensible place at times, but it's taught you to value life and live without regret as life is very short. The pain you saw her family go through was unbearable. Nothing can be worse than the loss of a child. Her parents were so generous to you and to all your friends and tried to make you all feel better by showing their strength and compassion. You will miss her forever. And you still wish she was here with you all growing older and laughing together. She was always the life and soul of the party and the world is a less fun place without her.
Tanya B.: Do you miss her?
Eva:  Yeah, a lot. 
Tanya B.: You said you learned the world was a cruel and incomprehensible place. And when people talk about an anxiety, an irrational anxiety. One of the sort of stock phrases that people will come back with will be, yeah, but what's the worst that could happen. You know, what the worst that could happen is. So you've internalized this sense of the worst can happen and it did happen. So it's very hard for you to counter the 'what if-ness' of anxiety with some kind of rational grounded, yeah but what is the worst thing that could happen? 
Eva: That is absolutely, nail on the head, how I feel about it. 
Tanya B.: Did you ever feel you had a chance to say goodbye to Kate? 
Eva: Well, obviously we had her funeral, but as a person, no, because no one was expecting that, you know, we went on holiday for the Easter holidays that'd be the last time that you might see her. 
Tanya B.: Well, what, what do you think you need to say to her? 
Eva: All the things that you'd like to say before someone goes, how much you liked them, how brilliant they were, how much you'd missed them, if you didn't see them again, just all those things you would like to say to someone if they, if you knew and never going to see them again.
Tanya B.: And as you say this to me, you get tearful again. 
Eva: Mmm.. 
Tanya B.: Maybe you need to write a letter to her and maybe you need to put it somewhere. Maybe you just need to say goodbye, not as in, you're going to forget about her, but as in the trauma aspect of your relationship with her is something that you can say goodbye to. So that you further untangle it from this phobia that you have had for so many years.
Eva: Yeah, I'm definitely prepared to do that. Anything I can do to, to try and process some of this stuff is, is definitely, I'm open to it. 
Tanya B.: Good. You've been amazing to work with. 
Eva: Aww, you've been amazing. Thank you so much. I'm so grateful. 
Tanya B.: Oh, it's an absolute pleasure. You need to tell us how you do. 
Eva: I will.
Claudia W.: If you were phoning a girlfriend now going, I can't believe what I've just done. How would you describe it? 
Eva: I think I've, I've just got away out of, what's been a trap really, and that just feels amazing. 
Claudia W.: At some point, imagine in the future, if you go, kids, just jump in the car, I'm taking you to, there's an extraordinary swimming bath with a wave machine or whatever. They might not want to do that. 
Eva: They'd love it. I feel like now it's worth the effort, with the doing of breathing exercise and stuff. Like, when people say, oh, meditate, and I think, well, I lie down, I try, it doesn't work for me. It's boring. With a kind of goal in mind, I'm so goal-orientated anyway, it'll feel, I'll do it. Do you know what I mean? 
Claudia W.: You know there's something at the end, and I've also, somebody said you'd like meditation, I lasted 30 seconds, I was like, well, I don't like humming, number one. But if it's going to get you somewhere, and I bet I think you might start to quite liking it because we've spent a year inside. You have two children close in age. It might be quite nice just have 20 minutes by yourself. 
Eva: There's a lot to be said for that. 
Claudia W.: There's a lot to be said for that. I'm making up ironing. I never thought I'd do that. But mom, I think it's done. I need 15 minutes to stand against the wall alone and you will have this now. And, I hope you enjoy it and you've got an aim. 
Eva: Absolutely. Absolutely. No, it's, it's been brilliant. Really good. 
Claudia W.: Well Eva, thank you so much for coming in. Thank you. 
Eva: Thank you.
Claudia W.: I think lots of people will be listening will have a phobia about something and just maybe phobia is too strong, but, a great dislike. 
Tanya B.: Yeah, and with things like spiders and mice and things like that, it's about how quickly they run and how they suddenly move, and, for some people that can be really, really scary, and then it becomes, you know, a phobia. That's normal. You know, we can all have a phobia to something. Yeah, if you can keep yourself managing your anxiety as you expose yourself to the thing that makes you more anxious than you should be around it. And you expose yourself to that regularly, and some people like with arachnophobia like you or mice or whatever, rats, whatever, it may be, I, you know, some people can't even say the word. Some people can't say tarantula. Some people can't say mouse. Some people can't even look at a picture of it. Can't, can't even look at a cartoon of it. So the exposure therapy can start at a very basic level, but everybody gets there in the end. 
Claudia W.: You are extraordinary. And that's the end. Take the compliment. I don't want a word from you back. Don't speak. Don't look, look at the way you're looking me, but you are, and thank you so much to Eva for coming in. On Zoom, not in. On. Thank you.
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