Of elevators and exposure

An old joke describes someone who gets stuck in an elevator, and the emergency phone rings a long-changed number that is now a therapist's office. At first the therapist tries to explain that he can't help him, to which the person exclaims, "Can't you do anything for me?" After a long pause, the therapist replies, "How do you feel about being stuck in the elevator?"

There is some truth in jest to this joke for me. I am a psychotherapist who specializes in treating anxiety disorders, and decades ago I recovered from some severe and crippling phobias myself with the aid of good therapy. Nowadays I am a pretty happy guy who experiences very little anxiety on a day-to-day basis. But one issue I've never really bothered to deal with is that I am claustrophobic and don't like to ride in elevators. And yes, I have been stuck in them before.

In a way, I am almost glad to have one piddling fear left, to observe and work with what I prescribe for others. For one thing, it isn't very life-limiting. When I go to Manhattan and have a meeting on the 38th floor somewhere, up the elevator I go. But if I am at a five-story hotel, I will ask for a lower-floor room and take the stairs. Either way there is very little motivation for me to work on this fear, so I just put up with it or accommodate it.

But what if I suddenly needed to be taking elevators a lot? Here are some of the things I would do if I were treating myself for this problem:

1) Examine my thinking. My fear is ultimately caused - and sustained - by a great deal of self-talk, most of which is false. "If we get stuck between floors, no one will know and we'll die like rats." "I'll yell and scream and make a fool of myself." "I am taking a big risk."

All of these statements are rich in what we call cognitive distortions, or errors in thinking. Elevators have alarms, emergency phones, and even the sound of my voice to people on a nearby floor. My cell phone will often work from inside the elevator. I can count the number of times I've actually been stuck on the fingers of half a hand or so, and in each of those cases I was out again within minutes. So changing my self-talk to be more accurate and rational can help the way I feel.

2) Create a gradual exposure hierarchy. I generally prescribe approaching a fear in small steps, and learning to be fully present at each step. But how can you gradually expose yourself to an elevator? After all, once the door shuts you're in, right?

In reality, there are all sorts of steps you can take with an elevator fear. Do you feel anxious just standing near an elevator, or watching people get on and off? You can start there! Then try going in and right back out of the elevator, or perhaps just go up one floor. And there are different kinds of elevators: fast, slow, glass-enclosed, and the like. Taking a small step and learning to lower its anxiety will strengthen you for every other step you take.

For example, when I did my psychotherapy internship at a large super-regional hospital in Pennsylvania, its 10-story hospital wing had slow, creaky elevators that I hated. But its attached five-story clinic had brightly-lit high-speed elevators that were always full of people - and in time, I actually learned to ride comfortably on these elevators.

3) Practice, practice, practice. Which leads to my last point: practice, even at low levels, will inevitably chip away at your fears and create progress.

During my internship, for example, I got a chuckle out of one of my fellow interns as I described how we were going to get to a meeting on the eighth floor of the hospital: walk over to the clinic, take the high-speed elevator to the fifth floor, walk back to the hospital, and go up three flights of stairs. But there I was on an elevator - and eventually I took this elevator regularly with much less fear.

Will I get over my fear of elevators someday? Stay tuned. In the meantime, there are evidence-based tools I can use if I ever need them. And I can keep them in mind even as I make my way up and down the stairs.