In response to my article on automatic control, Ganesh said automatic control is nothing more than distraction. But as every anxious flier knows, distraction isn't enough. It works only if the flight is smooth. Even then, an anxious flier may obsess that the flight may not remain smooth.
I agree with Ganesh that there is a role for distraction when dealing with phobia — not a leading role, but a supporting role.
First, stress hormones are released when the amygdala notices something unexpected or non-routine. That is its job. It is important to understand that neither focus, nor distraction, nor even relaxation can stop the amygdala from doing its job, which is to get a person's attention when something happens that they may need to attend to. We need the amygdala because we can get distracted — or intensely focused — on something and fail to notice a threat that has developed.
Second, when stress hormones are released, they activate both the primitive Mobilization System (which urges escape) and the cognition-based regulation system, Executive Function. Whatever a person is focused on disappears, and is replaced by what the amygdala has noticed. In other words, stress hormones hijack the mind — for a purpose.
If you are walking in the woods, and unknowingly approaching a snake, it takes one-tenth of a second for the snake's image in the retina of the eye to show up in the brain. It might take another tenth of a second to cognitively assess that what one sees is dangerous. And, it might take yet another tenth of a second to realize you need to stop. But, the amygdala has already taken care of that. Amygdala reaction times as quick as seventeen thousandths of a second have been recorded. So before the image of the snake has even arrived consciously in the mind, the amygdala has released stress hormones that made you freeze in your tracks. After freezing, you either congratulate yourself for avoiding the snake, or you chastize yourself for being frightened by a stick you mistook for a snake. Either way, your conscious mind had nothing to do with it.
Third, Executive Function (if not impaired) overrides the urge to escape. It is as if Executive Function says, "Hey, wait. I'm not going to run off like a chicken with my head cut off. Why? Because I HAVE a head — this huge cortex — and I'm going to use it. I'm going to assess the situation, and if it needs action, I'm going to decide what action to take. Then I'm going to take it. And if it is to run, it is because I say so. Not some little cluster of brain cells the size of a nut!"
When Executive Function (EF) commits to action, it signals the amygdala to stop releasing stress hormones. Problem over.
But if EF is unable to complete the process and reach the step (commitment) at which it resets the amygdala, stress hormones continue. So long as stress hormones continue, they continue hijacking the mind; they keep it focused on the problem. And, focus on the problem may lead to imagination of disaster, which in turn causes more stress hormones. And here is where distraction can be useful: we can use it to break this cycle in which stress hormones cause a focus on the problem which cause stress hormones, which cause a focus on the problem, etc.
Distraction could be, in a sophisticated form, a CBT technique that replaces a hormone-releasing thought with a thought that doesn't trigger hormones. But my clients seem to prefer something simple that they can use when stress hormones make the cognition needed for CBT hard to come by. They like the 5-4-3-2-1 exercise. And, unlike CBT techniques that have to be learned and rehearsed, the 5-4-3-2-1 only takes a couple of minutes to learn. There is a video on it at www.fearofflying.com/free-video/5-4-3-2-1-exercise.shtml
The exercise gives a person two minutes of distraction from the stress hormone-producing thoughts and images. That is enough time for the stress hormones that are already present and are trying to hijack the mind to burn off. Then, once the hormones are not in control of the person's focus, there is a window of opportunity; they again have the ability to focus on what they choose to. It is important, of course, to not shoot oneself in the foot by returning to hormone-producing thoughts.
The fourth point is that if we use yet another emotional regulation system, the Social Engagement System, none of this happens. Why? We don't get stress hormones in the first place. We link various moments of flight to the memory of a moment in which a person's face caused oxytocin to be produced. Then, as the flight unfolds, oxytocin is produced which keeps the amygdala from producing stress hormones. No stress hormones? No problem. So, the leading role is oxytocin, not distraction. Distraction, as any anxious flier knows, is no match for turbulence. When turbulence starts, there is nothing powerful enough to keep the anxious flier distracted from those intrusive movements.
To deal with turbulence, every phrase, every thought, every image, and every physical sensation that comes when the plane is in turbulence needs to be linked to a moment that produces oxytocin.
We are doing nothing more sophisticated than Pavlovian psychology. It is just that, instead of a bell that causes dogs to salivate, we are using the various stimuli of flight to cause anxious fliers to produce oxytocin.
The supporting role the 5-4-3-2-1 can play is as a backup. We use it when something takes place during a flight that the client did not include in their linking exercise prior to the flight. If something does trigger a stress hormones release, it is a good idea to write down what it is, so it can be added to the linking exercise prior to the next flight. Then, after writing it down, turn to the 5-4-3-2-1 to burn off the stress hormones.
Here is an example. A client was sitting in the boarding area, thinking how pleased she was to be so calm. Then, there was an announcement: "Passengers for flight 123, please proceed to Gate 16; there has been a gate change." Immediately, she got a shot of stress hormones. This was not routine. Nor was it something we thought of to include in the linking exercise. Had we included it, the announcement would not have triggered the release of stress hormones. She began to feel panic, but was able to employ her Executive Function. She quickly made an assessment, "How dangerous is it for me to walk a hundred yards?" With the realization that a gate change is insignificant, she was able to stop the stress hormones.
If she had not been able to, she could have turned to the 5-4-3-2-1.