The first time I took the tube

Specialist CBT therapy for anxiety, OCD, depression and more in West London

The first time someone takes the tube again after a period of panic or avoidance may look ordinary to everyone else. It can involve standing outside the station for several minutes, noticing the sound of a train arriving, holding a ticket, taking one stop and leaving. Afterwards, there may be relief, exhaustion, disappointment that it did not feel triumphant, or a mixture of all three. That experience does not prove a diagnosis or tell us what someone should do next. Avoiding the tube can relate to panic, a difficult physical symptom, a health condition, mobility, trauma, grief, sensory overwhelm, a real safety concern, a previous frightening event or something else entirely. A reflection cannot determine that a person has agoraphobia or panic disorder, nor can it decide that travel is safe for them. For some people, the hardest part is not the journey itself but the anticipation. They may start scanning their body at home, worry about being trapped, map every exit, cancel plans or feel pressure to perform calmness for the people travelling with them. Others may avoid asking for help because they fear being seen as inconvenient. These experiences deserve more than a message to be brave. It can help to describe the pattern with care. What happens before the journey? What is the feared outcome? Are there physical symptoms that need medical assessment? What changes when the person leaves the station early or cancels? What would a more manageable week look like, even if the tube still feels difficult? These questions can create a starting point without assuming that the answer is exposure or that the person has failed by avoiding. New, changing or worrying physical symptoms should be discussed with an appropriate medical professional rather than automatically attributed to panic. Chest pain, fainting, breathlessness, dizziness, medication effects and other health concerns can need medical attention. If someone is in immediate danger, in crisis or unable to keep themselves safe, urgent appropriate help is needed. CBT may be considered after assessment if it is appropriate for the individual. Behavioural or exposure based work is not a self directed instruction from a blog to force a journey, remain in a place that feels unsafe or ignore symptoms. If such work is included in therapy, it is planned collaboratively with a qualified clinician, with consent, a clear rationale and attention to safety, health, access needs and the person’s pace. The aim is not to make every journey feel easy or to prescribe a fixed route back to travel. It may be to understand the relationship between fear, prediction, bodily sensations and avoidance, then decide what choices support the person’s wider life. Progress can be uneven. A difficult journey does not cancel the value of an earlier one, and a successful journey does not mean someone should take bigger risks without support. For related information, see <a href="/therapy/panic attacks/">support for panic attacks</a>, <a href="/guides/panic disorder agoraphobia west london/">the panic and agoraphobia guide</a> and <a href="/guides/how to break panic attack cycle/">understanding a panic cycle</a>. The Lyceum Clinic offers assessment led CBT online and in West London.