Reality Testing And Risk Assessment
There was a dramatic increase in deaths when people switched from flying to driving in the three months following 9/11:
- ‘. . . from October through December 2001 there were 1,000 more highway fatalities than in the same period the year before, . . . . ‘It was called the 9/11 effect. It produced a third again as many fatalities as the terrorist attacks,’ says David Ropeik, an independent risk consultant and a former professor at the Harvard School of Public Health.
The article closes with this quote:
- ‘The residual parts of our primitive brains may not give us any choice beyond fighting or fleeing. But the higher reasoning we’ve developed over millions of years gives us far greater–and far more nuanced–options.’
These quotes are from a Time Magazine article at: http://www.time.com/time/magazine/article/0,9171,1562978-1,00.html.
There another Time article which is well worth reading: The Science of Anxiety. See: http://www.time.com/time/magazine/article/0,9171,1002605-1,00.html.
The contents of ‘The Science of Anxiety’ will be very familiar to readers of the newsletter, and to clients who have purchased ‘The Psychology Of Flight Anxiety’ DVDs. For example, this quote about what happens when a threat is presented to the mind; the information is passed both to the amygdala and to the cortex:
- ‘One of these pathways is a relatively long, circuitous route through the cortex, where the brain does its most elaborate and accurate processing of information. The other route is a kind of emergency shortcut that quickly reaches an almond-shaped cluster of cells called the amygdala.’
What we teach in SOAR (in ‘Control of Anxiety’) is how to stop the amygdala from reacting when you fly, because by the time your cortex has considered what is going on, the adrenalin has already been released into your brain and body. Dealing with flight anxiety cognitively can help with mastering the problem in the long run, but to attempt to deal with flight anxiety only by cognitive means dooms your efforts to be ‘a day late and a dollar short’.
The following essay deals with some of the questions posed in the Time articles.
Faulty Reality Testing And Risk Assessment
Much of what people suffer from when flying has to do with faulty reality testing. We all know our senses can play tricks on us if we rely on only one of our senses. That is why we ‘cross-check’ and compare the information provided by one sensory mode with that of other sensory modes. We compare what the shape of what we see with the shape our hands trace when we touch an object. We compare how something tastes with how it looks. For example, if someone says, ‘Close you eyes and open your mouth,’ you may not be comfortable just relying on what taste — alone — tells you; you want to see it, too.
So, the point I’m heading toward is this: we don’t believe it when we simply feel, or simply see, or simply taste. We want confirmation of a second sensory opinion before we feel sure.
This leads to the second point: if we get the same information from two senses, we are usually satisfied that we have it right.
But here is the kicker: is the information from the two senses all coming from outside? Or, is the information from outside coming into one of our senses actually causing (or influencing) what the other sense is telling us?
I used to use this story, and maybe it still is a good one. If you walked into a big camera store and told the sales person, ‘Look, I want to buy the best SLR camera available; I don’t care about the price; I just want the best. What should I buy?’
And the sales person says, ‘Hey, no question about it; you should get the Cannon XYZ-2000! It’s the best.’
But you know how it is dealing with sales people, so you want a second opinion. So you say, ‘OK, I may be back’. And you leave.
You walk out of the store and turn right. You go to the corner and walk down the block, and you see a sign ‘Cameras’ so you figure, here is your chance to get a second opinion, so you go in and ask the same question, and you get the same answer. So you figure, OK, I got a second opinion from a second store. Maybe the first store was overstocked and they recommended the camera because they want to unload them. But, now, with a second independent opinion, I feel confident to buy it.
The thing you don’t realize is, you are in the same camera store. I used to fly trips to Tokyo, and near the hotel, there was a camera store that took up an entire city block. So, if you walked out, turned right, went to the corner, turned right and walked down the block and saw a sign ‘Cameras’ and went in, you would be in the same store.
See, you are not getting a real second opinion. Maybe the store is trying to unload a clunker.
Here is where that leads us wrong when it comes to flying. When we picture a disaster, it really is not coming from outside. It is NOT coming from reality. If we could simply remember we are imagining, we could hang onto the fact that this is not reality, but simply imagination.
But, when we imagine vividly, it triggers stress hormones, the same hormones we feel when in actual danger. By association, these hormones change our mood to one of apprehension. But it doesn’t stop there. We are picturing disaster (imagination, of course), and the picturing can trigger enough stress hormones that we can feel the disaster.
Here is where we go wrong. If you are at Disney and you see a person standing in a room, it may be a real person, or it may be a hologram. Or, if you go to the Whitney Museum in New York, you can see a person sitting in a chair that looks absolutely real. In both cases, if you touch the thing you see, you will find out it isn’t real. Your hand would go right through the hologram at Disney. Your hand would find the temperature wrong with the wax figure at the Whitney.
When you picture disaster, and get a feeling which is associated with disaster, reality testing can be satisfied. If you don’t recognize that the feelings were caused by imagination, you get stuck with the belief that the disaster you have in mind is real, or that it is an omen. (It isn’t; no one knows the future; I have that on the best authority: a famous Indian fortune teller, Ramakrisha Sarathy).
Reality testing can be faulty when we fail to maintain a balance between left brain reasoning and right brain feeling. Anxiety can keep us from a balanced assessment. If we did not develop an early ability to maintain a sense of calm, we may not be able to calmly assess situations. This can lead us to be ’spring-loaded’ toward snap judgments based on feeling.
We have TWO sides of the brain for a reason. If you use only one side, you need to get some help to develop the ability to use both sides in a balanced way.
This is a more serious problem than merely dealing with flying. If we deal with day-to-day living based wholly — or even primarily — oriented to feeling, we are NOT living or making decisions in a balanced and mature way.
To Do Good Reality Testing, We Need To Be Able To Sustain Feelings Of Anxiety And Conflict
We don’t like conflict. It makes us feel uncomfortable. We want to get rid of it and feel ‘unified’ and ’single-minded’. It is easy to think avoiding conflict is a good goal. It isn’t. Our goal should be developing an ability to tolerate conflict within our mental processes for extended periods of time.
Adult and mature functioning requires ability to embrace conflict. Why? So that, while considering both the rational orientation and the emotional orientation, we can do good reality testing and then, when we are sure what we are dealing with, make a judgment based on a balance between reason and emotion, which often are in conflict.
One of the best things I ever learned was from reading an essay by Charles Brenner, M.D., who has long been considered one of the top theorists in psychology.
Brenner says psychological treatment is not supposed to get rid of internal conflict, but to help us develop the ability to embrace conflict and use it to our advantage.
Brenner states ‘. . . mental conflict is a characteristic of normal mental functioning . . . .’ He wrote, ‘Mental functioning is regulated by the pleasure-unpleasure principle. People seek pleasure and avoid unpleasure. Their efforts to achieve both these aims are what result in mental conflict . . . .’ He goes on to say that what determines healthy from unhealthy mental efforts is whether or not they are able to involve a balance of ones needs and desires.
He also writes that what is unpleasant about conflict is that it throws us into unwanted awareness of calamities in our own (usually childhood) relationships with the most important people in our lives.
He states, about developing a mental balance, ‘. . . a regard for logic and coherence is not, in fact, an innate characteristic of the mind, . . . It is the result of a long and painful development over the course of millennia, a development that must be transmitted anew to each new member of society. A regard for logic is . . . not something that is inborn, . . .’
What this suggests to me is that there is no instant way to develop the maturity needed to balance feeling with emotion, but that it has to be learned.
What we do with the Strengthening Exercise is to help repair some of the stress connected with conflict, and to help calm us when we are doing what is in our best interest, when that means flying.Part Three
Inability To Tolerate Anxiety Leads To An Obsession To Be In Control
When we were kids, we could not deal with uncertainty realistically. Some of us pretended to be super heros with omnipotent power. That helped us to fantasize that we — too — had control. When parents are sometimes threatening or abusive, we can’t stand the idea that it is just a roll of the dice today whether mom or dad will hurt us. So what do we do? We blame ourselves. It is better to blame ourselves and feel guilty than to recognize our parents are out of control and feel anxiety. It’s better to believe that what happened to us is because of us. To believe our being abused or beaten was due to a bad mood would cause too much anxiety. If we simply believe we are beaten or abused because we are bad, that gives us hope; if we can just learn to control our ourselves better, it won’t happen again.
When there is an anxiety issue, when we feel insecure, we try to control everything as the means to feel secure. Thus, control seeps in through every crack, and — instead of being able to recognize that in some ways our survival is just a roll of the dice — we try to attach meaning where there is none, and attach causality where there is none. We need to believe the world is controlled. Anxiety issues lead to faulty beliefs such as, ‘nothing happens by accident’. In a world we believe is controlled by God, we believe things don’t work out because we are bad.
Actually, some things don’t work out because of chance. Some things don’t work out because we abrogate our ability to cause them to work out and leave it to chance. Some things don’t work out because we are conflicted and cannot commit to a steady course. Some things don’t work out because as soon as we start doing what is in our best interest, we feel terribly alone, and get rid of the anxiety by sabotage of what we started out to do. Some things don’t work out because we are too busy dealing with imagination-based anxiety to pay attention to what we could have been learning had we been paying attention to reality (what is) instead of what if.
When I was in grad school, another statistics major and I were working on a research project Fordham was getting paid a lot of money to do. She and I ran into a problem. We became alarmed that maybe we had taken the data treatment A and entered it into the statistics program as treatment B. We couldn’t be sure. So, maybe we had ruined months of work, if not the whole research program. We went up to our professor and told him it was possible that we had ruined everything. He was not in the least upset. He said, ‘Well, let’s see what you are doing.
He took it step by step by step by step, from the most elemental point and led us through every basic step, covered every base, considered every explanation. It took hours. The other student and I started out with alarm, and then we got bored, and still our profession was just going point by point by point by point, etc. And finally, he found where we were right and where we were wrong, and it got fixed. But it only happened because he did not get even the slightest bit upset.
The other student and I had jumped to a conclusion: we had created a disaster. And because we were upset, we wanted a quick answer; we didn’t have the calm to take it from the very beginning and check every step, step by step to find out what the reality was. We were so anxious about disaster, we couldn’t engage reality step by step.
Now, let’s go back to the premise that when there is not enough soothing, we turn to control to get rid of anxiety. But, in order to achieve effective control, calm is essential.Part Four
Calm Is Essential For Real Control
This means calm is the real basis for real control. When anxious, we look to control. But we may very well be too anxious to be able to engage in either good reality testing or in effective control.
The basis for sorting out whether what we have in mind is a ‘what is’ or a ‘what if’ is finding enough calm to engage in effective, clear and leisurely analysis. It is essential that, even if the face of disaster, we don’t get alarmed.
Generals know all too well that their decisions would always result in disaster (death of soldiers). They want to limit deaths while achieving the objective. They certainly know they could make a mistake and disaster might result. They certainly are aware that not everything can be known, and in spite of their best efforts, luck can make the difference in success versus disaster.
Since we cannot ever be sure of avoiding disaster, we need to recognize that, and then — in spite of anxiety — make a clear and cool assessment in order to determine a course of action.
If we know we did our best, even when luck defeats us, even when luck brings disaster, we can still know we have done the best we could with the information we had at the time a decision needed to be made.
The Strengthening Exercise can help. The 5-4-3-2-1 can help. Understand that good reality testing comes only in a calm state. We need to make a commitment to accept anxiety in the midst of the battle so that reality (’what is’ versus ‘what if’) has time to make it through our thought processes. We are in far too much of a hurry to get rid of anxiety. Mature thinking is available only when we are able to tolerate internal conflict and internal anxiety.
Adrenalin And Memory
Research now shows that when adrenalin is present, it causes the event to be captured and ‘carved in stone’ in our memory.
If we remembered every thing and every moment, our brains would be so full of data that it would be impossible to sort through all of it. So, to protect the brain from too much remembering, one of two conditions has to be satisfied for memorization to take place.
- Multiple Episode Learning
- If you need to memorize something for school, going over it once will not make it stick. You have to present the thing you want to remember to the mind several times. Finally, the brain gets the message, ‘Oh, you keep telling me this again and again and again and again; I guess you want me to retain it; OK. I’ll do that for you.
- Single Episode Learning
- Single episode learning is necessary for us to survive. If we had to be exposed to a certain life-threatening situation again and again and again to memorize it, we might not last through them long enough to learn. So, when there is adrenalin present, one episode learning takes place.
When it comes to flight anxiety, single episode learning is important. If you become frightened on a plane, even when there is no danger, adrenalin causes a vivid memory of the event to be ‘carved in stone’ in your mind. It causes there to be a vivid and strong association between your belief that you were in danger, the feelings of rapid breathing, rapid heartbeat, tension in the body, etc., to be memorized in association with the airplane. Images of being in the plane, and feeling trapped in the plane so as to be unable to escape from the ‘danger’ is part of the memory.
When I was about eight years old, as I was playing in the yard, I turned over a stone. A black-widow spider was there on the stone near my hand. I ran all the way to the front of the house. Rationally, that wasn’t necessary; the spider wasn’t going to chase me, and if it did, I could have walked faster than it could have pursued me. But it felt good to run. The running felt like surfing a wave; it was effortless and invigorating.
What Bessel Van Der Kolk has discovered is, when we can take action — any action — when presented with an emergency, PTSD does not develop. If we cannot take action, the memory of that situation is recorded in the brain in a different area, an area where it does not fade. Such memories are so vivid, due to adrenalin and due to being recorded in a different way, that they can ‘flash back’ into awareness at any time. And when they do, the original situation is relived as vividly as when it occurred.
Since there was adrenalin produced when I saw the spider, the memory is carved in stone in my mind. But since I could take action — in this case, run — when I saw the spider, no PTSD developed. I can remember the vivid image. But it doesn’t cause a ‘flash back’.
But on an airplane where you cannot take action, being afraid — even when there really is no danger at all — produces a different reality, a reality that, because of the constellation of feeling, there must have been danger!
And even thinking about it causes anxiety. This is the kind of memory which needs to be treated with the ‘Erasure’ exercise. This exercise, developed by Bandler and Grinder, is highly effective in changing how flying feels when there has been a traumatic flight.
Recent research suggests that for one episode learning to take place, the adrenalin needs to be present for a few hours. Research in France at the University of Lille Medical School and at the University of California have experimented with prompt treatment with propanolol (brand name Inderal) to block the effect of adrenalin following a situation which might lead to PTSD. See: http://pub.ucsf.edu/today/news.php?news_id=2003102312.