Carlos was afraid to ride on elevators. He had been known to climb 24 flights of stairs in an office building to avoid riding the elevator. Carlos’s own insurance office had plans for moving the company to a high-rise building soon, with offices on the 32nd floor. Carlos sought assistance from a therapist for help to treat this fear. He was taught to achieve a sense of calmness and well-being by using a combination of mental imagery and progressive relaxation techniques. In the relaxed state, Carlos was initially instructed to imagine the entry level of his office building, with a clear image of the bank of elevators. In subsequent sessions, and always in the relaxed state, Carlos progressed to images of walking onto an elevator, having the elevator door close after he had entered, riding the elevator to the 32nd floor, and emerging from the elevator once the doors were opened. The progression included being accompanied in the activities by the therapist and eventually accomplishing them alone.

Therapy for Carlos also included in vivo sessions in which he was exposed to the phobic stimulus in real-life situations (always after achieving a state of relaxation). This technique, combining imagined and in vivo procedures, proved successful for Carlos, and his employment in the high-rise complex was no longer in jeopardy because of his fear of elevators.