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White Knuckle Combat: How to Conquer the Fear of Flying, Part I: Identifying Aviophobia

Sascha Segan explains how to identify the symptoms of aviophobia in the first in a series on understanding and overcoming a fear of flying.

Even in 2001, air travel was by far the safest form of transportation in the United States.

People who fear flying may feel that the events of September 11 have confirmed their decision never to set foot on a plane. The death of 266 air passengers was televised live that awful morning, part of a greater national catastrophe. But let us not overlook the widespread reality that more than 40,000 people die in highway accidents every year. While those deaths are rarely witnessed on such a global scale, the damage done is every bit as real.

Fear of flying, also known as aviophobia, is the second-most common fear in the United States, according to the National Institutes of Mental Health. Two out of every ten Americans are "afraid" of flying, according to a January 2002 CBS News poll--and another three are "bothered slightly."

But you're far more at risk when you hop in your car to fetch a stick of butter from the supermarket. Most people don't think twice about settling into their cars, betting on the fact that they will be transported safely from point A to point B. Yet car accidents account for more than 90% of transportation fatalities and are the leading cause of death for people aged 6 to 27, according to the U.S. Department of Transportation.

Planes are safer than cars mile by mile, passenger by passenger, or any other way you want to analyze it. During the year ending September 2001 (and taking into account the September attacks), 0.05 people died on planes per 100 million paid passenger miles. On America's highways in 1999 (the most recent year for which data is available), 1.6 passengers and drivers were killed per 100 million vehicle miles.

Profile of an Aviophobe

If you suffer from aviophobia, take consolation in the fact that you're in good company. Despite the fact that Stanley Kubrick's most brilliant pictures feature obsessively recurrent flight imagery--the fighter plane in Dr. Strangelove, the space ship in 2001: A Space Odyssey--the late director was deathly afraid to fly. Aretha Franklin turns down concerts that require air travel. The notoriously phobic Danish director Lars Von Trier is so acutely fearful of flying that he refused to travel to Cannes when his 1996 film Breaking the Waves was nominated for the Palm D'Or.

According to statistics from the National Institute of Mental Health, aviophobes tend to be successful, perfectionist, and intelligent--certainly smart enough to know that flying is safer than driving, but nonetheless unable to conquer the irrational fear. Some frequent fliers spend half their lives on planes for years on end and suddenly find themselves overcome with aviophobia, out of the blue, so to speak.

What Causes the Fear

Fear of flying may stem from a variety of influences. Some aviophobes--perhaps the most justified of all--suffer from post-traumatic stress disorder when they set foot on an aircraft because they actually survived a plane crash. Other aviophobes fear flying as an extension of phobic disorders such as claustrophobia (fear of enclosed spaces), acrophobia (fear of heights), the fear of losing control, panic attacks--even guilt. The tendency to suffer from these fears is often inherited.

Fear of flying may also stem from a general distrust of people in life. Victims of childhood violence or sexual abuse often distrust others, understandably, and may extend their apprehension toward pilots, airplane mechanics, and other strangers responsible for their safety in the air.

People who suffer from severe phobias unconsciously use their fear as a sieve for perceiving information. Aviophobes believe so firmly that they will die by setting foot on a plane that they are far more likely to remember information that supports their belief and discard information that refutes it--namely, say, the well-known fact that air travel is safe in comparison to other forms of modern transportation.

Many aviophobes who tremble at the mere thought of airplanes are fearless in the face of bigger threats to their health and safety. For instance, many people who refuse to set foot on a plane don't hesitate to drive in treacherous, icy conditions, with no more fear than the healthy amount that inspires caution. Many an aviophobe puts his life at risk by smoking two packs of cigarettes a day, without giving more than passing thought to the certifiably lethal threat of lung cancer.

Symptoms of Aviophobia

As you probably know, when you perceive danger, the brain responds by signaling the hypothalamus gland to prepare for action, to kick into the "fight-or-flight" response and allow you to escape from the perceived threat. This instinctive defense mechanism may be fueled by a real fear--say, a stranger in the window with a gun and a stocking over his head--or an imagined danger.

Fear of air travel is not entirely imagined; no form of travel is 100% safe. But nervous flying becomes aviophobia when rational thought gives way to irrational reflex, and no list of statistics or comforting argument can sate the beast of fear within your chest.

Once a severe phobia develops, physical reactions make the fear harder to beat. The fight-or-flight response releases hormones into the bloodstream that inspire a range of physiological symptoms, many of which serve to magnify the fear.

In aviophobes, the response to air travel--even the very idea of flying on a plane--ranges from sweaty palms to severe hysteria. Mild aviophobes can sometimes manage to psych themselves through a plane ride with nothing more than a case of hives, but in severe cases aviophobes must either refrain from air travel or undergo therapy.

As with any irrational fear, aviophobia usually manifests first as a siege of racing, irrational thoughts regarding the fear. The mere mention of air travel can unleash a parade of worst-case scenarios to fly past the mind's eye. In response to the perceived danger, brain activity actually shifts from the cerebrum, the center of conscious thought, to the brain stem, a very primitive part of the brain that hosts mental activity when a person is in "survival mode." Consequently, your access to information stored in the cerebrum may be cut off entirely. Memory is severely impaired. Concentration may become next to impossible. Dizziness may set in and make it difficult to walk or even speak.

The victim's heart will also respond to the fear. In the face of a threat, a person's heart rate escalates from 72 beats per minute, the average resting pace, to more than 140 beats per minute. The heartbeat may become irregular, and palpitations may occur. Blood vessels constrict, and blood pressure skyrockets. Sensing danger, the body responds by releasing blood sugars into the bloodstream. This usually serves to intensify fear and convinces many victims that they are having a heart attack.

In the face of fear, the body also requires more oxygen in order to escape from the perceived danger. Normally a person takes 6 to 15 breaths per minute, but when someone is intensely scared, that rate may increase to 20 or 30 or more breaths per minute.

A frightened person will also breathe from the thorax, the upper part of the chest, which allows the body to consume oxygen and dispel carbon dioxide much more quickly than when breathing from the diaphragm--the healthy, relaxed way to breathe, which fills the lungs to capacity from the bottom up. When a person breathes too much oxygen, the pupils may dilate and cause vision to blur. Dizziness may set in from the shortage of carbon dioxide. If someone gasps for shallow breath from the upper part of the chest for a long enough time, that person may start to feel a sort of choking sensation and eventually will pass out. This is how the body manages to overcome fear and ensure that a healthy level of carbon dioxide is restored to the respiratory system.

The stomach also responds to fear by secreting more acid. Someone who is very scared may also draw more than the normal level of oxygen into the stomach. These two effects, solo or combined, may cause stomach upset or diarrhea or both.

Fear of flying usually also makes for sweaty palms. The victim's lips, hands, and feet tingle and go cold. The face flushes. Hands may tremble and make it impossible to hold a glass.

Muscles tense up in response to flight fright, especially in the lower jaw, shoulders, lower back, calves, and legs. If leg muscles tense for an extended period of time, the legs may begin to tremble conspicuously or even give out. A person may have trouble standing up if the fear is severe enough. In the worst instances, aviophobes experience such great muscle tension that they may feel the urge to attack a flight attendant or fling open the emergency exit doors--which, by the way, is impossible while the plane is in flight.

Taking Things to an Extreme

Fear can make people do bizarre things. Dr. Rob Reiner, who treats fear-of-flying cases, recounted one story of a high-powered New York attorney who was in control of herself until she boarded a plane. While flying one day, she saw two obese women snacking in front of her and imagined that their bulk was tilting the plane to the side. (On a commercial airliner, that's utterly impossible.)

She tried to contain her worry, but eventually her fear got the better of her. Against her better judgment, she walked up the aisle and told the two women that they were clearly too fat and were tilting the plane. Could they move to opposite sides of the aisle? Needless to say, they were offended and refused to move. So the normally cool attorney became hysterical and flight attendants had to restrain her.

There's a happy ending: after several sessions with Dr. Reiner, she now flies regularly for business--and keeps her opinions of the other passengers to herself.

Afraid of Terrorism?

September 11 sent many aviophobes into new paroxysms of fear. Fear-of-flying therapists saw their caseloads diminish throughout September and October, as terrified patients stayed away, not willing to fly under any circumstances. Dr. Duane Brown, who counsels fearful fliers in Chapel Hill, NC, suspended his small practice entirely.

Fliers afraid of terrorism, Dr. Brown says, should focus on the good news--and there's a lot of it. Every day brings new news stories about stepped-up airline and airport security. Fearful fliers should get a friend to clip those stories and start a file on how U.S. airlines aren't just getting safer, they're the safest they've ever been. (This isn't just reassuring--it's also true.)

Fearful fliers should also go gently on their fear, Dr. Brown said. If they wish to avoid nonstop, cross-country flights, or work with smaller airlines with perfect safety records such as Southwest and JetBlue (both of which have never had a fatal crash, and which have lower international profiles than major airlines), there's nothing wrong with that.

The fear engendered by September 11 seems to be dying down, as of press time. Comparing a November 1999 ABC News poll to a January 2002 CBS poll, only 6% more Americans are "afraid" of flying than they were in '99--and only 2% more than in 1999 fit into the next category, "bothered."