One of my first jobs was as a school psychologist and there was young girl who was terrified of getting on the school bus. The first step was to teach her how to breathe deeply. Once this was accomplished, a task analysis/fear hierarchy was set up to get her to first see the bus from a distance (30 feet away) then, once comfortable, get closer and closer (5 foot increments) until she was able to board the bus and ride the bus home. Once the hierarchy was set up it was time to implement the plan. It was arranged with the girl's mother to drop off and pick the girl up from school during this process. After that, at the end of the school day, I would escort the girl to the bus loading area. We walked toward the bus until we were 30 feet away. The girl was then instructed to look at the bus and stay right where she was and breathe slowly until she felt calm. She was assured that she did not have to go any further, but had to stay where she was until she felt calm. The girl agreed and when she looked visibly calm (and stated so) we left the area and her mother took her home. The next day we walked up to 25 feet away and we continued at this rate until she got on the bus. After each session the girl was asked if anything bad had happened during the exposure. She always said no, but if it had we would have addressed her concern. Once she was able to get on the bus, I was prepared to ride the bus with her for support, but the girl wished to ride the bus alone (her mother was waiting for her at home). She reported being able to do the deep breathing while on the bus and made it home without fear. She continued to ride the bus home the rest of the year.
This happened to be a fairly easy case because her fear was directly about the bus itself and not worrying about something bad happening while on the bus like the bus breaking down or getting off at the wrong stop. In cases like that, in addition to the deep breathing, we would developed a coping thought to address the worry. For example if the client was an adult who was fearful of the getting off at the wrong stop, a coping statement could be "the bus driver will call out when the stop approaches, but if I did miss the stop I could get on another bus to take me to that stop." The other easy aspect of this case was that the feared item was accessible almost daily allowing for a 'real life' exposure that was well controlled. Exposure to other fears may be more complicated if the feared item is not consistently available or the fear is an imagined situation that may or not happen. Systematic Desensitization can be still be applied to these situations, but the exposure then needs to take place in the person's mind. I'll save that for my next post.
Steven C. Altabet, Ph.D.