For Fear of Flying, Therapy Takes to the Skies

By TIM MURPHY
For most of the 100 or so sleepy-eyed people boarding the U.S. Airways shuttle to Logan Airport in Boston from La Guardia in New York on a recent hazy Saturday morning, the 35-minute flight could not have been a bigger nonevent. But that was not the case for about 20 passengers clustered nervously near the gate. Many clutched puzzle books and bags of sour candy as though they held talismans. Some made nervous jokes, others sobbed quietly.
“I have pills with me just in case of an emergency,” said a teenage girl who planned to distract herself on the flight with celebrity magazines.
Mariasol Flouty, a 44-year-old software developer from White Plains, held fast to her Sudoku book. “I had plane-crash nightmares,” she confessed. “I woke up very tense.”
No one was more terrified than Beth Brenner, a 45-year-old mother of two teenagers from Somers, N. Y. “I was hysterical last night,” she said, “but my son said, ‘You’re going to be O.K.’ ” Ms. Brenner was crying quietly on the shoulder of a counselor and staying close to her designated seatmate, Richard Bracken, a retired pilot who had flown for American Airlines for 30 years. “I’m trying to be a father figure here,” Mr. Bracken said.
Several studies have found that up to 40 percent of people have some degree of anxiety about flying, said Dr. Lucas van Gerwen, an aviation psychologist and professional pilot in the Netherlands and an organizer of an international fear-of-flying conference, sponsored by the International Civil Aviation Organization, that took place in early June in Montreal.
According to the National Institute of Mental Health, the percentage of Americans who have a fear of flying so intense that it qualifies as a phobia or anxiety disorder and keeps them off airplanes is closer to 6.5 percent. Those most paralyzed by their flying fear — called aviophobia — sometimes turn to programs like the one at Westchester County Airport in New York, run for 10 years by the Anxiety and Phobia Treatment Center at White Plains Hospital. The program culminates with the graduation flight to Logan from La Guardia.
“We have people who haven’t flown for 5, 10, 15 years,” said Dr. Martin Seif, a psychologist in Greenwich, Conn., who created the program, called Freedom to Fly. He himself used to be so scared of flying, he said, that he once arrived late at a conference in Atlanta because he insisted on taking a train, which got stuck in the snow.
People who suffer from phobias inhabit a world apart. “Anxiety is an altered state of consciousness,” Dr. Seif said.
An anxiety or panic attack is often acutely physical, marked by sweating, numbness in the hands and feet, and a pounding heart, leading sufferers to think they are having a heart attack. In such an episode, “the images in your mind feel like they can really happen,” Dr. Seif said.
Exposure-therapy programs like Dr. Seif’s, in which participants face their fear in small doses by meeting at an airport and boarding a stationary plane several times before taking an actual flight, have declined since the World Trade Center attacks of Sept. 11, 2001, as airport security has tightened, said several fear-of-flying experts.
As a result, virtual-reality programs — high-tech simulations of the flight experience involving a helmet with built-in audiovisual components — have replaced many more traditional treatment programs like Dr. Seif’s.
According to Dr. Barbara Rothbaum of Emory University in Atlanta, who has studied virtual-reality treatments for fear of flying, the success rate is comparable. Dr. Seif said his program’s success rate, defined as those who take the flight to Boston and back, was at least 90 percent. That is comparable to the success rate for similar programs, according to Jerilyn Ross, president and chief executive of the Anxiety Disorders Association of America.
The Sept. 11 attacks also shifted the equation for aviophobes in more subtle ways. With polls immediately after the attacks showing a spike in people who said they were anxious about or unwilling to fly, true aviophobes “grabbed that as a reason for not flying anymore at all,” Dr. van Gerwen said.
In fact, when prodded by Dr. Seif during the program’s first session in mid-April, many participants conceded that their phobia was driven not by a rational fear of crashing but by their own anxiety, easily whipped into a frenzy by factors like a plane’s height, its enclosed atmosphere and wind turbulence, which can feel hazardous even to hardy fliers.
Together, Dr. Seif said, they would learn to “stay in the situation and out-bluff anxiety.”
For the next five Mondays, group members practiced just that. They passed through airport security and met in one of the staff classrooms, where the program began with an outpouring of personal stories.
One man, a tall, broad-shouldered 37-year-old finance executive for an airline, divulged that he had not flown in 20 years, since having had a panic attack on board a flight after the death of his grandmother.
He was among several in the group to link the onset of their phobia to a major life change. That factor, Dr. Seif said, along with a genetic predisposition to anxiety disorders, appears to be a major contributor to a fear of flying.
Twice, the group was visited by Mr. Bracken, the veteran pilot, who patiently dispelled a wild array of fears. “When I’m up there, I feel like the wings and tail are going to rip off,” one man said.
Mr. Bracken detailed the protections woven into building, maintaining and inspecting aircraft. He explained that turbulence was what occurred when, say, a plane hit a ripple of air left in the wake of another jet, and assured his listeners that radar kept planes miles away from truly dangerous weather.
Most group members found the explanations calming. Not Ms. Brenner. Told that the chance of a multiple engine failure was next to none, she insisted, “But what would you do if they did?”
Dr. Seif replied, “That’s like asking what if you’re driving down the highway and your brakes go, your airbag’s not working and you’re approaching a big brick wall.”
The last half-hour of every session was spent aboard a stationary jet. The first time, many group members said their anxiety levels were high, raised by the enclosed space and the smell of the cabin. “I feel like I’m going to throw up,” Ms. Brenner said.
But by the week before the actual flight, when airport staff members added another layer of reality by starting the plane’s engine, even she was relatively at ease.
That changed the next Saturday when the group members took their seats in the front of the plane to Boston. Tension filled the cabin. One young woman bolted from her seat, unpersuaded by entreaties to stay from Dr. Seif and others.
Once the flight was in the air, most participants coped well, as Dr. Seif had predicted they would, busying themselves with their magazines and puzzles or organizing an e-mail list so the group could stay in touch.
Ms. Brenner did not fare as well. She was nearly catatonic throughout the flight, clutching Mr. Bracken’s arm on one side and on the other, that of Cecilia Gschwind, 39, a homemaker from Harrison, N.Y.
“Why does it feel like we’re not going up?” Ms. Brenner asked as the plane made its unmistakable ascent. Halfway to Boston, when asked how she was doing, she said, “I’m having a hard time focusing.”
Dr. Seif demanded that she talk with him to distract herself. He was only half-successful.
At Logan, with an hour or so to kill before the flight home, the participants were giddy and celebratory. Many spoke of their plans to fly again within the next few months. One woman, who had not flown in 10 years, said she was finally ready to take her children to Disney World. She lamented the places she had not flown in her 20s but said, “I think my 30s will be good.”
Ms. Brenner, however, slipped away from the group and took a train back to New York, calling Dr. Seif to let him know.
“O.K., goodbye, see you Monday,” he said curtly into a cellphone.
He was softer, though, when the group reconvened Monday for a final session, and he told Ms. Brenner she did the right thing. “It was such a trauma that you needed time to heal,” he said. For her part, Ms. Brenner said she was not ashamed of herself for running — just frustrated. “I thought I was going to feel this huge rush of relief and accomplishment after the flight,” she said. “But I didn’t. I thought, ‘This is not helping.’ I was so unhappy.”
Ms. Brenner is not making any immediate plans to fly again. “I’m going to try to figure out why it’s as bad as it is for me,” she said. “I don’t think it’s about the planes.”