How to avoid a specific anxiety developing into a phobia

[siniang]

So, this isn't necessarily a PTSD question as I don't have PTSD surrounding this - so @mods if you think it belongs into the "other disorders" subforum, please move. But I wasn't completely sure where to put it and thought maybe some of you might have some experience with this regardless (just with PTSD triggers/stressors, or generally PTSD-unrelated as well).

I have pretty severe flight anxiety. I don't have aviophobia; I can (could?) board a plane and endure a flight - in what state is a different matter, but I don't get actual panic attacks (yet). I can think about flying just fine without getting distressed. But the flight anxiety has been persistent and it's been persistently bad and I do have persistent actual nightmares surrounding the topic, had for 10+ years.

My go-to "treatment" - and what probably most therapists would recommend - had been exposure therapy. With all my anxiety surrounding flying, I still "just did" it. The reason for flying was more important for me than to give in to the fear, so I just pushed myself to endure it no matter what. It helped somewhat. For over a decade, I was flying at least 2-3 times a year, during some times even significantly more frequently. But even then, the anxiety remained stable, didn't become less, even when I was on a plane for various short- and long-distance trips pretty much every month for stretches of times.

COVID has grounded me for well over a year, now, and will continue to keep me grounded for who knows how long. And I'm really worried that this lack of exposure with an accompanied general increase in hypervigilance (thanks, pandemic), will push my anxiety into a proper phobia.

Any helpful tips on how to prevent this from happening in lieu of actually being able to board a plane?

Statistics and "logic" don't help me with this. Anxiety doesn't care. It doesn't matter how often it didn't happen. All it needs for it to happen is once. Also didn't exactly help that we had two engine failures of major planes and an actual crash of a smaller plane into the ocean here in Hawaii literally within 7 days of each other.

Edit: I guess it is PTSD-related insofar that, while the flight anxiety itself is my GAD talking, my PTSD-brain "knows" I will meet an early demise and the two marry into "it'll happen during a plane crash if you fly". Kind of like statistically it remains always the same probablity of being struck by lightning, but your PTSD-brain doesn't care because it's convinced *you* specifically are more likely to hit than others. And if lightning keeps hitting around you and really close to you, while not actually hitting you just yet, you're obviously in a thunderstorm, which significantly increases the chance of being struck.

PTSD cognitive distortion/core belief stuff. I guess also avoidance territory (don't wanna get struck by lightning? Reduce the probability somewhat by moving out of the storm)

 

[Friday]

I have a fairly similar thing about cities.

What a I’ve found is that it matters very little how long I’ve been away from them -a few weeks holiday, to years- I’m going to have to spend some time building my tolerance back up, once I return.

IE The anxiety & panic attacks? Are unavoidable.

The massive meltdowns and total inability to handle cities, otoh, are totally avoidable. Meaning I have to be careful how I approach them. Whether it’s a hotel room, or an apt/flat, I need a place of sanctuary to retreat to & reset my baseline, as I overwhelm my system in small easy to manage (if a bitch to live through) doses. I cannot just arrive in town, after being away, and spend all day -much less day after day- out & about (whether normal life or tourist stuff) unless I want to be wracked with the migraine to end all migraines, toddler-like-self-control (you call that a temper tantrum? Pfft. Now THIS is a temper tantrum!), panic attacks, anxiety attacks, shakes/shits/pukes oh my. Hot f*cking disaster. Not gonna do it. Nope! Nope! Nope! (Unless I have no other choice).

I also never know whether the panic attacks and anxiety attacks as I ease myself back into city-life are going to sort themselves in days or weeks. That’s far more dependent, it seems, on other factors; not how long I’ve been gone, and not how careful I am with my emotional monitoring and regulation. Maybe someday I’ll find the common denominator, but as yet I haven’t.

But? My love-hate thing with cities has never gone so far as to develop into a specific phobia. (I’m emetiphobic, so there’s that). Instead my cities-thing lives sort of halfway between PTSD (stress & hypervig) & ADHD (sensory overload) and they feed off of each other until I can back them both down. Meaning there are components of each in play, more than I’ve mentioned here, but once I can downshift those overreactions I’ll be fine. Until the next time I leave, and have to build my tolerance back up, again.

Don’t know if any of this helps, at all... my airports & flying thing has some direct trauma-ties, so it seemed like the cities-thing is a closer match? But that doesn’t mean an exact match, or even close enough to be helpful.