Obsessive compulsive disorder - OCD treatment and therapy from NOCD
What is OCDOCD SubtypesI’m afraid of using public transportation. Could therapy help?

I’m afraid of using public transportation. Could therapy help?

9 min read
Jessica Migala

By Jessica Migala

Reviewed by April Kilduff, MA, LCPC

Sep 18, 2023

Possibly related to:

With news stories of all the bad things that happen on public transport—assaults and robberies, not to mention its reputation as a hotbed of germs—it’s no wonder you might be nervous about stepping onto a bus, train, or subway. 

Buses, subways, and trains are tremendously useful, often necessary resources, but if you fear public transportation or are actively trying to avoid it, you’re not alone. In a YouGov poll in 2023, 39% of U.S. adults say that public transit is “very or somewhat dangerous.” Of course, there are other concerns beyond crime that can strike up fear, such as a desire to avoid the grime of dirty stations and subway cars or buses, or fear that a horrible accident may take place. That last point became paramount during the COVID-19 pandemic, when we were told that riding crowded public transportation could actually be dangerous for our health.

Especially if you need public transportation for work, school, or to maintain a social life, anxiety related to using public transportation might have a significant impact on your life—even if you truly want to conquer your fear. In this article, you’ll learn more about what may be causing your fear of public transportation, why that may be doing you a disservice (or could even be harmful to your mental health), and how you can seek help.

Fear of public transportation: An overview

There a couple potential underlying issues going on if you find you’re too frozen to ride the subway:

In the following sections, we’ll dive into what you need to know about each. 

What are Agoraphobia and Claustrophobia, and how can they cause fear of public transportation?

One reason why your fear of public transit might be especially strong is due to agoraphobia. This is a mental health condition characterized by intense fear of being in a public or crowded place where you can’t readily escape or access help, according to StatPearls. “If you look at the definition of agoraphobia, fear of public transportation is actually something that’s specifically mentioned,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. Additionally, you may have fears of being in crowds, lines, or wide open spaces, he notes. 

Most often—but certainly not all of the time—a fear of public transportation will be based in agoraphobia, says Dr. McGrath. And it’s especially likely if, in addition to the fear of public places like public transport, you’re actively avoiding these spaces, and (this is important) there’s not an active threat that causes this fear. According to the American Psychiatric Association, 1 to 1.7% of adolescents and adults worldwide have agoraphobia. 

Claustrophobia might be a term you’re more familiar with. It’s the fear of what can happen when confined in an enclosed space, per StatPearls. For instance, says Dr. McGrath, when you’re in the subway, the door closes, you’re locked basically in a tube—what if the subway tunnel collapses? You’re essentially trapped. Even if you don’t worry about that particular outcome per se, these places can be crowded—with not much room to move around—which can trigger claustrophobia in general.

Like agoraphobia, a claustrophobic fear must be irrational, says the American Psychological Association. Of course, to people who suffer from either condition, these worries may feel entirely valid, but the real risk of your fears coming to fruition is not significant, and you feel an outsized anxiety about them.

Some also experience panic attacks due to fear of their phobia. A panic attack is an episode of symptoms, such as chest pain, dizziness, shortness of breath, sweating or chills, and shaking, among other symptoms, according to Penn Medicine. Panic attacks, though not dangerous to have, can make you feel terrible—though they are simply a false alarm sounded by our instincts for survival. And so, people who have panic disorder will go out of their way to avoid places and situations where they might have another one.

Could I be avoiding public transportation because of OCD?

OCD is a mental health disorder that involves two primary types of symptoms: obsessions (recurring, distressing thoughts, images, feelings, sensations or urges) and compulsions (physical or mental behaviors performed to neutralize those anxiety-provoking thoughts or avoid an unwanted outcome). 

The disorder can manifest in a variety of ways—there are many, many subtypes of OCD. And while a fear of public transportation can show up in OCD, having that fear alone doesn’t suggest you have OCD. It’s what you do in response to being around public transport that will provide some clues about whether your fear could be a sign of OCD. 

“OCD loves to attach itself to anything,” says Dr. McGrath. For example: 

  • If you’re concerned about safety (maybe you recently heard about an incident on a news story), then OCD obsessions may tell you that the only way to have a safe ride is to touch the door three times as you board. (Or say two prayers. Or count to a certain number.) If you don’t, then something terrible could happen. 
  • There are many germs on buses, trains, and subways, and this can easily be the subject of obsessions in Contamination OCD. Fears might range from contracting a disease from touching the handrails, sitting on the seats, or breathing the same air as strangers, to concerns about contaminating someone else with something deadly. COVID still exists, and you can worry that you’re bringing COVID on the train that will eventually be spread to a child who dies of the illness. “If your obsession is that you might spread COVID on the subway, for example, your compulsion will probably be to avoid taking the subway—even if driving will take twice as long. You’d feel as if you were better for humanity by taking a car,” Dr. McGrath explains. 
  • Harm OCD can also show up in this fear of public transport. Here’s an example of Harm OCD: What if you suddenly snapped and pushed a fellow commuter onto the train tracks where they were killed? Having that type of intrusive thought can trigger extreme fear. “I’ve had a client with harm OCD who was so fearful she’d push someone into an upcoming train that she stopped taking the train. It was the only way she could get to school, so she couldn’t go anymore,” says Dr. McGrath. 
  • On the other hand, maybe you take a train that children regularly ride. Having Pedophilia OCD (POCD) may mean that you’re afraid that you could molest them while being trapped in the train—even though that’s the last thing you’d ever do. As a consequence, you will go out of your way to avoid situations in which you could be around children, or ruminate at length about whether it’s possible that you acted inappropriately around children. This is an excellent example of how OCD often latches onto things that are particularly important to you (such as the safety of children).

The ramifications of fears in OCD or a phobia can be extremely detrimental. “We’ve had people lose scholarships, jobs, and enter into serious depression because their fears were controlling their lives,” says Dr. McGrath. “They were living their lives based on their fear—and not what they wanted out of life,” he adds. 

How to get help

The source of your fear matters, but both phobias and OCD can be treated with a type of cognitive behavioral therapy called Exposure and Response Prevention therapy, or ERP

ERP is a type of therapy where you confront the things that trigger your obsessions, according to the International OCD Foundation. Naturally, when your obsessions are triggered, you will want to perform a compulsion to chase away the anxiety and discomfort. But in ERP, with the help of a trained therapist, you will make a conscious choice to resist performing a compulsion. That’s how you begin to regain control over your life, rather than being guided by fear. 

“My goal is for you to get to the point where you can live the life you want to live—and not just the life OCD or a phobia wants you to live,” Dr. McGrath says. 

When beginning ERP, you wouldn’t necessarily work on the public transportation aspect of the fear. Rather, you’d work on the subtype of OCD you have. Let’s say you have Contamination OCD—you’d confront your fears about germs first, says Dr. McGrath. “It’s likely you’re avoiding other places with germs, so we’d create a hierarchy of all the places you’re avoiding, ranking them from least to most scary,” he says. You could work through each stage systematically. 

When you get to your fears about public transportation, you may be asked to simply look at pictures or videos of public transportation (known as imaginal exposures), then eventually get on the bus or subway—perhaps wearing a mask and gloves—for just one stop at first. Then, two stops. And you’d extend your ride until you became more comfortable on it. Perhaps you’d work your way up to removing the gloves for part of the trip, leading up to whatever point allows you to live with the freedom you want. “This system allows you to face your fears gradually, rather than all at once,” says Dr. McGrath.

Now, if an anxiety disorder like agoraphobia or claustrophobia is what’s behind your fear of public transit, you can also use ERP for treatment. Dr. McGrath says that similar exercises, like those outlined above, would be used to confront these phobias.

In addition, if you have panic attacks that are a source of distress and are limiting your life, then you’ll probably need to confront those, too. Some people with OCD may have a panic attack if they don’t perform a compulsion, says Dr. McGrath. In that instance, purposeful exposure to panic symptoms can help you overcome them—these are known as interoceptive exposures. 

Here’s what that might look like: Your therapist may ask you to do physical activities that will induce panic-like symptoms, such as running in place (to become breathless), spinning in a chair (to become dizzy), or breathing through a straw (to mimic difficulty breathing). You wouldn’t be asked to do all of these at once, but just one at a time. “This teaches people that they don’t need to be afraid of panic attacks or the sensation of a panic attack. If they can create it on their own and not be harmed, then they learn that a panic attack that appears out of the blue isn’t harmful to them either. They can handle it,” Dr. McGrath explains. When you know that you no longer have to fear a panic attack, it actually makes it less likely that one will happen, and you can feel far more comfortable entering the situations you may have been avoiding.

NOCD Therapists specialize in treating OCD

View all therapists
Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Want to work with one of our therapists?
Schedule a free call to learn more.

Use insurance to access world-class
treatment with an OCD specialist