T:	at least how you doing today
C:	I'm doing well thank you
T:	doing well what's going on
C:	I have family coming into town and I have to go to the airport to pick them up
T:	so you have family flying in
C:	yes I get very anxious about having to cross the bridge I have to cross the Ben Franklin Bridge and then get over the bridge that goes to the airport by the stadium I think that's a Gerrard Point Bridge don't wanna yeah that's two levels there I have to do that both ways and then call you in coming
T:	both ways you have to do it across four times
C:	yes
T:	so what kind of feeling is just bringing up for you
C:	I get very anxious even or thinking about it right now
T:	so you're anxious right here with me
C:	yes yeah
T:	so I want to try to scale this we talked about this before with cognitive therapy so let's say that 10 is really the most anxious you're felt about crossing bridges right and one is no anxiety where would you be right now right now
C:	probably an 8 it's worse when I'm at that point of that day but right now I think just knowing that I have to do that yes
T:	and what's it on that day
C:	yes
T:	all right so but even now how far away is the until they
C:	oh it's a week there's we coming yet
T:	so even now a week out loses it's Nate this is really hurt
C:	No
T:	so for your job and local travel you don't really have to cross any
C:	ten minutes to work everyday and bang so 20 minutes I went shopping centers and everything that's just within the vicinity I don't have to cross any bridges
T:	right so no snow bridges yeah thanks probably planned it that way it's good I don't know
C:	it worked out well okay all right coming up pick up the family you will be crossing so let's look at this in each stage okay so I mean you're clearly anxious now as you mentioned let's go to trying to move forward a week to the day that they'll be fine at what time they find it
T:	it's gonna be a four o'clock flight
C:	so about what time would you have to leave -
T:	I would have to leave probably at 3 o'clock because it's only about 20 minutes to the airport really
C:	really
T:	but I would like to leave earlier they're probably taking up time by the time they land and to go through you know they're getting their luggages they probably won't even come out till maybe 4:30 but I'd like to make sure I'm there at around 3:30 4 o'clock
C:	all right so let's go to the best day it's good that day and said that afternoon
T:	okay
C:	so you're still at home and let's say we're about 15 minutes before you have to get in the car what are you thinking then
T:	I have to do this to to get up and go they need me to be there this this week it's my parents coming in and they're elderly so I don't want them to be stuck at the airport there's no one else that actually can go pick them up so I have to get up and go and pick them up so
C:	that's going here
T:	that is what's going through my mind that you know there's nobody else that can do this I mean it's cheaper than there's nothing I can't probably can't even afford to get a taxi for them because you'd have to cross that's from Philly to into New Jersey so that's gonna be very expensive I can't afford that when all I'd have to do is pay $5.00 for the tow and maybe gas up my car for $10 or something but hey I'll be thinking about it I have to do this and I'm not really doing it you know it's something that I can save money that way and I don't want to leave them stranded definitely someone else can I mean baby lost they're not familiar with there but in Philly the airport is crazy to me
C:	it's a big place a lot going on so so you're sitting at home in 15 minutes before you eat in the car and you're thinking I have to do this but your reasons are positive like you to save money and protect your parents from having to be there alone so ones things I do come in
T:	um just the thought of the bridge there it's just I could drive off the bridge you know they can fall off usually what I do is try to stay in the middle lane I can't do more miles an hour and I just I'm shaking I have the radio on and windows down because I can't swim so for any reason I'm to fall off I mean that's it for me I even have a little metal one of those so I think it's an instrument that you used in the house for I don't know pliers or something is something real hard that I can hit the glass with it sits right there on my door so I'm all ready I planned and I have that I planned ahead of time I know what I'm gonna do as soon as I approach the patient but I still feel anxious
C:	you're anxious before you leave and you're and you're starting to think about the bridge at that point we already think about it
T:	yes
C:	how about when you get your car you start driving toward the bridge say a prayer I'm still anxious I turn on the radio the closer I get to especially the toll points and I know it's at me and you see those lights flashing last exit before you know
T:	you know you're going over one
C:	yeah I have no there's no turning back there's no turning back
T:	so before that when you can still exit what's your anxiety level
C:	before when I can still Excel yeah it's probably still high it's about the other than the high nor so it's still high but
T:	it's not maxed out yet but every lap
C:	it's gonna be
T:	yeah I think it's pretty bad at that point
C:	and how about when you cross through the that's an inside the tendon okay
T:	yes yes
C:	so your specific fear as you start to cross this is the bed Frank want to be the first bridge right you can do across is that your car will go off the bridge
T:	yes
C:	and when does that so that's a 10th anxiety when does that anxiety start to go away
T:	as soon as that getting close to getting off the bridge and now leaving that little sigh of relief there's a little release there and I know that I've been able to manage those two three minutes of cross that into how many minutes it takes actually of crossing crossing the bridge and I start feeling a little bit of relief but then again I know I have to do my back exit and there's another one coming by that so starts all over again all
C:	right Sonia crossed the second bridge the drug point fridge you go to the airport as your anxiety dropping those points
T:	Oh as soon as this I'm descending from the Gerrard Point Bridge there's less you know it's almost reduced I'm not coming you know really low it's almost going yes it's not Muskaan
C:	yes
T:	and when you start thinking about that you're gonna have to cross them again
C:	as soon as I'm exit I'm getting back on 95 going north and I know here we go again and cars that zooming by and you know
T:	as you're not going to really
C:	know I'm that person into the middle lane doing 40 miles an hour yes
T:	all right so you're you're doing everything you can to keep your car on the bridge but you're still feeling anxiety like you're gonna go off the bridge
C:	yes the whole the whole time until you start really descending
T:	exactly
C:	and then you feel like you've made it
T:	yes especially when there are those big trucks tractor trailers coming
C:	does the air
T:	yes yes if it's also in bad weather or at night it's worse because on the bridge especially the top one you kind of see the sky and there's nothing else you see so it's like you're gonna fall off yes
C:	so in the lower level it's not as bad
T:	all the lower level coming back it's not as bad because you're kind of like protected here and there so it's not as bad but going is definitely worse yes
C:	are you aware of any time a car will gone off the bridge
T:	I hear all the news once in a while you'll hear something happen or sometimes in movies you see things happen I think it's possible
C:	it's possible do you think it's a high risk
T:	no maybe none of that um Girard bridge because I I noticed I was checking it the other day I had to go to the airport and I was trying to measure the distance between the metal poles just to see if a car could fit there really and I think a car could fit there but you know it just depends on the angle you were hit or something or if you flipped so yeah done some thinking she's
C:	done some calculations geometry right and you've concluded that it's not really likely but it could all right so but either way your anxiety is maxed out on each bridge now when you get home I mean get your parents back to you take them back to your house
T:	yes
C:	and you feel them
T:	I don't even recall all the anxiety know why it was such a big deal anyway I don't think about it at all
C:	all right so you when you arrived home you're down to one
T:	yes yes
C:	all right so going back to the the first stage like when you're getting ready you're thinking that you have to go
T:	yes
C:	and it would save your parents money
T:	it would save me money how it can be the one calling the can but if people want to pick them up and save them from being stranded at the airport than being in a land that they they're not familiar with an area they're not familiar with so make sure that they're safe
C:	how important is their safety to you know very important yes
T:	so it clearly it sounds like you picked them up before
C:	yes
T:	so picking them up is it's worth all the anxiety
C:	it's worth but yes it's
T:	tough
C:	it's still something that bothers me that I have to do yeah it's worth the inside
T:	that's worth it but you wish that you could do it without anxiety
C:	yes I wish there was another route that I could take any bridges at all that's not known yet defined yeah
T:	and how long have you had that anxiety we try to approach it
C:	as long as I can remember that I know maybe even that when I was younger but perhaps as a mother and you know someone as I got that life was important I mean prior to maybe marriage and kids
T:	all right developed along the way somewhere it's been with you ever since
C:	yes
T:	so I'd like to do what kind of therapy we call a refrain and actually you've kind of already done it but I want to make it a little clearer so you suffer things I D and you suffer it to protect mostly protector your parents
C:	yes
T:	so as you're going over the bridge you're thinking about the automatic thought we talked about these before right the thought that kind of pops in your mind is I'm gonna fly off the bridge
C:	yes
T:	so that seems pretty unlikely all right that's not something that maybe as you talk about geometrically maybe there's some way your car could find the bridge with physics now maybe could happen but it seems like it would be do you fairly like
C:	yeah
T:	so you could challenge that and this isn't the refrain part but you could challenge that on that thought which with a statement and adapt a response like it's pretty unlikely I think it's going to happen alright that might help a bit to keep applying then the chances are vastly in your favor I could sing how many cars you cross that bridge I'm a fly off the bridge alright heard of plan out for those bridges but the other you know the refrain part is that you're you're doing this you're willing to take on the bridges and have this anxiety for the betterment of your parents for their safety
C:	yes
T:	so in this whole equation of crossing bridges and anxiety and you're really really the good guy in this you're you're willing to you're willing to suffer and overcome a fear to make sure your parents are saying yeah I mean and you've thought about before like before you leave you think I only have to pick a month but you've never really connected it to want to be in the good guy here
C:	well yeah
T:	okay does that make sense
C:	yes it does it does yes like here go my guess my family size my brothers and sisters appreciate that yes
T:	yeah you've overcome it before to pick them up and when you pick up again you'll you'll overcome it again and you'll suffer but I the difference here is that that reframe I want you to apply that reframe when you're feeling that anxiety issue get ready to leave and as you're trapped with the bridge that you're really you know you're doing what you feel is right for the good of your family
C:	yes
T:	all right so the automatic thought that's gonna come in in is you're gonna fly off the bridge okay that's what that's what the exoti is about Miss Spears and the reframe in this case the reframe adapter response is I'm doing I'm doing this for my family and the probabilities preloaded like the bridge that's a separate thing but the reframe is I'm no I'm the hero of this I think that's a great way to look at here to hear of this situation
C:	so think of that terms at the beginning of that day or they went up to hold
T:	the whole day yeah yeah just kind of go over that should rather than like something you must do because really you don't have to do it strictly speaking right I know you feel you have to do it but you're willing to do it you're willing to sacrifice and suffer to do it
C:	okay
T:	and I'd rather that be the theme that you're getting is a positive thing that you're that you're willing to do it has to be done it's uncomfortable you'll survive it it's uncomfortable I focus on that kind of reframe then focusing on the very low probability that you're the risk that you're going to fly off the bridge so it's very low low risk
C:	okay look uh make
T:	sense and
C:	make sense and make sense
T:	so it's not so much being forced to do it me forced into an extra situation you're voluntarily in brave and I know it's hard it's hard for you didn't use your say it's a 10 on the anxiety to get that's that's the highest score right so it's hard for you but the way to look at it maybe would be you're doing has to be done you to flee go your family they need you have you ever had any close calls on a bridge or anything
C:	um when it there was that day when there was a lot of thunderstorm and there was wind so I could literally feel the car shaking on the bridge and there was a day I think I was coming into Delaware I had to stop and call those they say if you need help crossing the bridge and I stopped and call them but they talked me before they talk to me for about half an hour or so and then they told me that it would take another hour for someone to literally be able to come and get me and this was like that I was leaving here it was self probably around 10:00 10:30 class was over I was on the bridge and it was late at night raining and I just I couldn't do it but after a while I think I calmed down with their conversation and I was able to just take it easy in that middle lane she always managed to overcome
T:	yeah and that might be another a good automatic thought or adaptive response to that on that thought is that I've always managed overcome this and it hurts but managed overcome it
C:	yes
T:	I kind of taken charge like that and being assertive that might help reduce that automatically
C:	ok
T:	you think if you try that this time is you
C:	that's thinking in that positive way I've done this before and then that can do it again
T:	yeah
C:	all right all right
T:	so I'll see you again in two weeks which will give an opportunity
C:	to pick them up from me you're quite a bit
T:	and then we'll see how things start with that and we'll move from there
C:	okay
T:	all right thanks sweetie
C:	thank you very much