When traveling down, would turning around and facing the other direction help?
It might also allow you to start a short conversation with the traveler above you, eg. "I have vertigo which makes going down escalators tough"... would that sort of distraction be helpful or not?
I've violated that rule pretty much every time I've been on the tube and I never had anything but positive responses (and my head is still firmly attached).
I long ago made a decision that saves me enormous amounts of headache: if you say or do something I will interpret that in the simplest and most straightforward way possible without trying to second-guess ulterior motives or secondary (or further) layers.
Exceptions: poetry, music, jokes and other cultural expressions.
Before then I was always chasing my own tail with 'what do they mean?', which is pointless, if they meant something they could say that particular thing outright and get it over with.
This is symmetrical, so, I don't want to 'wash my hands', I would like to use the toilet. When I'm hungry I say so and when I say 'no problem' it really means that so we can move on.
All in all this made life a lot easier, though from time to time it can make for comedy.
Honestly, I don't know. The anxiety overtakes me to the point where I can barely communicate with the people I know, mush less those I don't. Also, once I'm on, I'm frozen. I've worked up all my nerve just to get on, so I couldn't see myself turning around.
As I say, I try to avoid the escalator, if nothing other than to be courteous. However, sometimes I use it out of courtesy as well, such as when I'm with a group of friends, and don't want them to have to wait on me. When I do need to use it, I've developed a pretty good system of keeping the anxiety in check - sort of a deer in the headlights approach, where my gaze is focused on my shoes.
It might also allow you to start a short conversation with the traveler above you, eg. "I have vertigo which makes going down escalators tough"... would that sort of distraction be helpful or not?