Dear Therapist:

I have a specific fear that I have a hard time with but it isn't something that I really have to face very frequently. Let's say it's flying. It's not something I do very often but when I need to it's really hard. I was prescribed a medication I can take from my doctor and I can use it before flying and I feel ok. Is this a good enough way to deal with it or would it be better to invest in therapy to get rid of the fear? Would therapy even be helpful considering that it's not something that's usually bothering me?

Response:

Your question is a common one, from both specific and general perspectives. Flying is a common fear, and people often wonder about whether to medicate or delve into the fear. Generally speaking, when someone faces a problem with multiple possible solutions, how do they choose the right solution? There are a few considerations that I will address.

The first consideration is something that you mentioned. From a practical point of view, how often does this problem crop up? Is it likely to occur more or less often in the future? How much consternation does it cause? Is this likely to change going forward?

You mentioned that you seldom fly. If this is likely to continue, and the medication you take reduces your anxiety without undie side effects, that seems like a compelling reason to continue this course of treatment.

However, you seem to be asking this question for a reason. If medication does the job and has no ill effects, what is it that makes you wonder about therapy. Does the knowledge that you have a “problem” bother you? Do you feel that requiring a substance equates to a loss of control? Or do you simply like the idea of understanding yourself and working through life’s difficulties.

Another thing to consider is whether you have other fears that are associated with your fear of flying. Is there an underlying fear or insecurity that causes you to be afraid of flying, and that also affects you in other ways? For example, if you always feel the need to be in control, flying could trigger a fear of losing control. If this is the case, you might find yourself being rigid and controlling within relationships and in other areas. The real problem, therefore, would be your need for control rather than your fear of flying. Reducing your fear of flying through medication would be addressing the symptom rather than the issue.

If you recognize that your fear of flying may be only a symptom of a more fundamental issue, this doesn’t necessarily mean that you should try to resolve your fear of flying in therapy. But it might mean that you want to address the larger issue so as to minimize its detrimental effect.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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