Population studies indicated that OCD affects roughly 3 out of 100 people (likely underestimated) with typical age of onset spanning early childhood to late teens, although uncommon, in women, symptoms can start during menopause.

OCD is classified as a chronic condition with symptoms ranging from mild-moderate to severe and debilitating. Although, OCD is often life-long, there is now an innovative treatment, with roots in Cognitive and Behavioral Therapy known as Inference-Based Cognitive and Behavioral Therapy I-CBT that offers hope for significant remission where symptoms, when they do recur, can be easily managed

Exposure and Response prevention (ERP) and Cognitive and Behavioral therapy (CBT) have been the established treatments for OCD together with medication since the 1960s. Although ERP in particular is considered the gold standard of treatment, it has been shown to be less effective-and sometimes counter indicated for more complex forms of OCD such as obsessions involving sexual and harm themes.

Fortunately, an innovative and more effective Cognitive Therapy approach, Inference Based Cognitive and Behavioral Therapy (I-CBT), created 25 years ago initially by Dr. Kieron O'Connor, and further developed over the years by his associate, Dr. Frederick Aardema, has revolutionized the treatment of OCD.

I-CBT posits that obsessions are not just intrusions that are misinterpreted, rather they errors in reasoning, characterized by doubt-or discounting-of what is real or perceived in favor of what is imagined or extremely implausible. Locked doors might be unlocked, a clean surface might be contaminated, an organized shelf might cluttered or an unwanted image of doing harm might represent the intent to harm. Obsessional "thoughts" and/or images or "intrusions" are recurrent, unwanted and disturbing.

Agoraphobia with Panic is defined as fear and avoidance of places or activities where escape might be difficult if a panic attack occurred.This cycle of fear and avoidance lead to Agoraphobic avoidance in Panic disorder s very common, given the recurring and unexpected nature of episodes. Over time ,places and activities where panic has or could occur are increasing avoided, reinforcing the belief that these places are dangerous. Without treatment, the geography of "safety" shrinks, freedom of movement becomes more limited, undermining relationships, career, quality of life and in extreme cases, leading to disability

Travel Agoraphobia with Panic is intense fear and avoidance related to travel or forms of transport where escape is thought to be difficult and "help" not available. Common feared travel or transport situations are:

• Public Transport, such as buses, trains, undergrounds/metros, airplanes
• Driving or being driven in a car, particularly on motorways, at faster speeds and longer distances between exits, in traffic, going through" long" tunnels or over "long" bridges.
• Traveling "far" from home
• Crowded stations or other places typically encountered during travel
• Long cues anywhere during travel

Safety Behaviors are the many behaviors and actions that panickers believe will keep them safe from panic during travel.

• Only traveling with a "safe person"
• Carrying water, medication and a cell phone
• Calling a safe person
• Avoiding unfamiliar routes
• Connected short bus routes to go longer distances
• Sitting in a seat in a car or on transport that feels "safe"
• Refusing to drive in during weather or at night.
• Certain movements or habits such as fidgeting or tapping

Two Components of the treatment of Travel Agoraphobia with Panic:

• Panic Control Therapy a Cognitive and Behavioral approach tailored to treat panic attacks
• Progress Exposure to travel/transport situations avoided related to fear of panic

Panic Control Therapy
Panic Control Therapy (PCT) is a Cognitive and Behavioral approach adapted to treat Panic. Developed by American psychologist David Barlow more than 40 years ago, PCT remains the treatment of choice for Panic Disorder. The main components of Panic Control Therapy are:

1. Psychoeducation to help clients understand panic attacks and the causes of physical symptoms during a flight or flight response
2. Cognitive Restructuring (CR)- challenging and reframing catastrophic thoughts related to panic and travel fears, using standard CBT methods. In my practice, I incorporate a more recent Cognitive Therapy approach developed for the treatment of OCD, known as Inference-Based Cognitive and Behavioral Therapy ICBT.
3. Exposure to feared bodily sensations, where the person progressively desensitizes to sensations and symptoms experienced during these false alarms.
4. Progressive exposure to feared situations, activities and contexts associated with panic.
5. Dropping of safety behaviors panickers rely on to stave off a panic attack or 'Keep them safe" if one were to occur.

Transport-Travel Exposure Therapy Consists of progressive exposure to all feared transport situations. This component is the bridge back to recovering the lost geography of movement and travel. Clients are asked to create a ladder of difficulty or hierarchy of travel/transport feared and avoided, from the least challenging to the most difficult. Examples of the types avoided transport/travel situations I help clients recover through progressive exposure include:

• Riding in cars as a passenger, Ubers and taxis
• Driving agoraphobia related to fear of panic on roads, motorways and in traffic.
• Local and long distance bus travel, locally, regionally or internationally across Europe.
• Travel on local, regional, national high-speed rail to inter-European rail such as Eurostar and/or Eurorail

Phone screening at no cost I offer a free phone screening, to understand your specific needs and fit with my practice. I gather basic information about the condition and symptoms for which you are seeking treatment, why you have made this decision now, co-existing conditions as well as your motivation and commitment to change. I also briefly explain the CBT approaches I use, including Inference-Based Cognitive and Behavioral Therapy (I-CBT)

As a result, they have biased scanning for and memory of aviation accidents, reports of pilot error or irresponsible behavior. Aviation statistics mean nothing to them: 2.5 incidents per million aviation hours ? 8% of passengers in such accidents fatally injured ? “Someone has to go down, why not me”. “It is unnatural for this much metal to be in the air”. As with most phobias and obsessions, the perception of risk does not align with what is real or plausible and there is a broken relationship with possibility. Some examples of fears in Fear of Flying include:

In fear of flying, as with other anxiety disorders, the go to reaction is to avoidance. Those who do fly rely heavily on a combination of sedative medications and Safety Behaviors, which are responses or actions that allow them to feel safer or 'protected'. Examples of common safety behaviors used by fearful fliers include:

This form of air travel anxiety is experienced by those who suffer from panic disorder. It is important to understand that, generally, this group of travelers is not afraid of the plane crashing, rather, they fear having a panic attack while on the aircraft and experience the typical panic symptoms, fears and rely on classic safety behaviors when flying. Of course, context shapes specific safety behaviors used.

CBT is the treatment of choice for both fear of panic and fear of accident during air travel. The core fears of each is different, and, consequently, the focus of cognitive methods varies accordingly. Nonetheless, the fundamentals of CBT are applicable to the treatment of both. Briefly, steps in the approach I use, by category, are listed below: