I gave an invited talk this week about “advanced” treatment of anxiety disorders. i started by asking: How are a fighter pilot and an anxiety client alike? I described a scenario where the pilot of a F-35 (an “advanced” fighter still in development) hears the dreaded warning “missile launch,” meaning that an enemy missile is heading toward the fighter. The pilot is now 10-20 seconds from dying. He or she reacts with a strong emotion — fear. An anxiety client in a mall may react with the same emotion — at the same intensity — to being in a crowd of people. The emotional reactions of the two persons may be the same — the differences are what triggers the emotion and what the person does after experiencing the emotion. The pilot, with computer assistance operating faster than a human can, will start defensive actions immediately. The anxiety client will also start defensive actions immediately, some done automatically and very quickly. Here the unconscious mind operates, like the computer on the airplane. The anxiety client typically will eject, to use a pilot term, and flee the situation. This reaction greatly reduces anxiety in the short run and is thus powerfully reinforced, with the result that the person tends to flee or avoid crowds in the future — creating an anxiety disorder. The pilot, however, does not eject. She does what she is trained to do under the circumstances — release metal chaff or hot burners, depending on what type of sensors the missile is using; start jamming the electronics of the missile; try to insert in the missile computer code to shut down the missile engine; etc. The pilot knows what to do because of extensive training on simulators or on practice missions. Training is what the anxiety client needs — training in how to respond appropriately to perceived threats. The usual type of training we provide in psychotherapy includes educating the person about the importance of staying in the feared situation. Facing the feared stimulus is part of exposure treatment. The person may also learn calming methods such as taking a long, deep breath and may learn to look at catastrophizing thoughts (“I am going to die”) as thoughts — not reality. The person learns (at both conscious and unconscious levels) that he does not die and that the fear decreases as time passes. With a good deal of practice, the anxiety client functions more and more like a fighter pilot, using adaptive defenses and using them well.