I am a patient of some psychological issues specially anxiety and thought related ocd. I developed fear of riding train, buses etc because I think the speed is going to kill me. I overcome the fear of riding bus by thinking that if I have any panic attack I can ask the conductor to stop the bus and can get rid of it. But incase of train it is not possible. I feel out of control. My current psychiatrist told me to take alprax 0.25 before 1 hour of riding the train. But I don't have any courage. I want to know is this medicine helpful and how or are there other options? I am now taking half of esta plus three times, 1/4 of alprax 0.25 three times and 1 clonil 10 at night every day prescribed by my psychiatrist.

Dr. Saul PereiraPsychologist49yrs exp

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Meet with a counselor. Please take your parents with you to determine the possible developmental issues that may have contributed to this condition. This is a fear-based condition and for some reason you have not been dealing with this childhood fear which has now developed into these repetitive adaptations to seem to need it for normal functioning: both anxiety and ocd are fear based. The behavior will then become based on magical thinking and certain rituals will become necessary to do normal things making you believe that either the frequency or the ritual is important to its success. This of course is a fallacy but there will come a time that even if told the truth, your belief will defy any logic and you will continue behaving like that even if it cripples you in your daily routines. It only appears as though some other force is behind these behaviors and that you are compelled to act in this fashion. That is obviously not true but no one can convince you of anything different. The obsession is a repeating thought pattern with no meaningful outcome; and the compulsiveness is the need to act on those obsessions also in a repeated behavior pattern as though you just cannot help yourself. This is all driven by fear and when you are frustrated with it, you will escalate anger over it. Doubt, insecurity, uncertainty, and lack of firm memory will all plague you and increase stress. There are certain behavioral techniques to be implemented and if they work you may get out of this condition rather easily. If that does not work as desired, then medication has to be introduced, and in combination with counseling much work can be achieved. The fear of travelling by train can be resolved by desensitization i.e. You need to travel with a companion you trust several times and get over the fear itself. After such journeys you could note down the different reactions and decipher the facts from the fictions. In time you will get over it for sure.  

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