Dr. Duane Brown, who teaches counseling and counseling psychology at the University of North Carolina, Chapel Hill, and used to lead American Airlines' fear-of-flying program, offers a fairly simple, drug-free program for coping with the fear of flying. It attends to both the psychological and the physiological aspects of aviophobia. His book Flying Without Fear (New Harbinger Publications: Oakland, 1996) is very user-friendly and offers a host of techniques you can try on your own, without any formal workshop or seminar training.
The program teaches you how to curb the irrational, involuntary thoughts that make your heart pound and your teeth chatter. It also shows you how to curb these physiological symptoms of fear, which undeniably aggravate the phobia and make it harder to overcome. The program also emphasizes the importance of reeducation and offers a new information base about the safety of air travel. These facts are sometimes at odds with the media's terrifying treatment of airplane disasters. They also challenge the natural human fear of the unknown, which allows so many aviophobes to tremble in the sky yet feel entirely comfortable racing along the freeway at killer speeds.
Turning the Involuntary "Fight-or-Flight" Mechanism
To some extent, the fear of flying is an involuntary response. You cannot control the thoughts that enter your mind, and once the idea of a plane crash enters an aviophobe's head, a series of physiological responses is triggered, which usually serves only to intensify the fear. In Flying Without Fear, Dr. Brown suggests that you can actually curb your initial fear and reduce or eliminate the more advanced stages of flight fright.
The first step is to identify your fear and decide you don't want to live with it anymore. Brown recommends that you actually wear a thick rubber band over the palm of your hand on the day of your flight. The minute you have second thoughts about flying or you start to imagine a crash scene, a cabin fire, or your funeral, he recommends that you snap the rubber band. It will hurt, but not as greatly as the pain you'll experience if you panic and your imagination goes into overdrive. Next, he recommends that you actually command your fear to go away. You must not be hard on yourself as you command your fear to flee; keep your anger trained on the fear itself.
The shortness of breath and heart palpitations that usually accompany scary thoughts about air travel may set in within a fraction of a second after you first entertain the fear. This response is involuntary, so even if you snap the rubber band and try to quell your anxiety, your body will have already started secreting fight-or-flight hormones, your heart will have already started pounding in your chest, and your breathing will quicken and become shallow. You can take action, however, to retard these somewhat automatic responses even after they've set in.
Control Your Breathing
The minute after you snap your rubber band, you should focus on your breathing. Make an enormous effort to breathe slowly and deeply from your diaphragm. Place your hand on your stomach and take a deep breath. If your belly compresses when you inhale, you are breathing correctly, diaphragmatically. If not, you are probably breathing from the chest, which will intensify your response to the terror.
Keeping your hand on your belly, practice slow, deliberate inhalation, sucking your belly in as you fill your lungs with air. After several long, deep breaths, you will begin to perceive an overwhelming sense of calm. As you probably know, deep, diaphragmatic breathing is the cornerstone of ancient relaxation strategies like yoga. Think of your breath as an instrument of healing that will help to cure you of your fear.
If you still feel light-headed after breathing deeply, your chest muscles are probably too worked up to relax entirely. In this case, Dr. Brown recommends that you grab a plastic bag--
Control Your Heart Rate
You can also slow a pounding heart with a technique called the Valsalva Maneuver. Please be aware, however, that only people with healthy cardiovascular systems should try this exercise, as it can altogether stop the heart of someone who has suffered a heart attack or stroke. If you have even slight doubts about the healthiness of your cardiovascular system, consult a doctor before trying this procedure.
If you're convinced your ticker is strong and healthy, try the following steps the minute you can feel your heartbeat speed up and intensify. Sit up straight in your seat. Breathe slowly and deeply from your diaphragm. As you are filling your lungs, pull in your stomach. When your lungs feel full, hold your breath. Use your stomach muscles to push down on your lower intestines, as you would if you were suffering from constipation. As you are bearing down, count 5 seconds: one one-thousand, two one-thousand, and so on. Exhale and release the tension. Your heart rate should slacken by about 20 beats per minute. Repeat the process three or four times, until your heart is beating at a normal pace.
Now, focus all your attention on your breathing, drawing in long, deep breaths from the diaphragm and exhaling slowly. This will keep your heart beating at a normal, relaxed rate.
Relax Tense Muscles
You will also need to work on relaxing your muscles, focusing on those that are most susceptible to stress: the trapezius, which are the large shoulder muscles that support the neck; the jaw muscles; and the leg muscles.
To eliminate stress in the shoulders, try an exercise called the turtle. Sit up straight in your seat. Shrug your shoulders at the same time that you pull in your neck, as though you were a turtle. Aim to touch your ears with your shoulders. Hold the position and count out 5 seconds as you rotate your head to massage the muscles in your shoulders. At the count of five, release the tension. Let your shoulders relax completely, and then repeat this exercise three to five times.
To eliminate stress in the jaw, try the piranha. Stick out your lower jaw as far as you can. Try to extend it beyond the teeth in your upper jaw. Hold the position as you count out 5 seconds. Release and allow your jaw to slacken. Repeat three to five times.
To eliminate stress in the legs and prevent them from trembling, try the ballerina. Slide your feet as far under the seat in front of you as you can. (This exercise works best in coach, where you won't have much room for your legs.) Lift one foot off the floor, arch your foot, and point it toward the front of the plane. Count out 5 seconds. Then rotate your foot so your toe is pointing toward you. Try to point your foot toward your chin and count out 5 seconds. Drop your foot to the floor and relax. Repeat this exercise three to five times with each leg. You can also try walking to the back of the plane, where you'll have more room to stretch your legs. The walk will also do you good.
Other Ways to Treat Aviophobia
Dr. Brown's program may not work for severe aviophobes, or those who need a professional hand to hold while they work through their fears. The first step in most professional treatments is to help the patient discover the true root of his or her fear. Is it claustrophobia? Lack of control over the situation? Or fear of not knowing what's going on in the cockpit and in the workings of the plane?
Patients then learn relaxation techniques to calm the physiological symptoms of irrational fear, do homework assignments on the safety of air travel to build up rational defenses against fear, or attack the fear from both rational and physiological angles.
After a few sessions addressing the underlying psychological issues, therapists then put the patient on an airplane--in a real ("in vivo") or imaginary ("in vitro") context.
No U.S. airlines currently run fear-of-flying clinics; most are organized by independent therapists or ex-pilots. Clinics at the Seattle (tel. 206/772-1122; www.scn.org/health/fofc) and San Francisco (tel. 650/341-1595; www.fofc.com/) airports are run by an organization of female pilots and focus on spending time on airplanes.
Virtual Reality Therapy
One of the hottest approaches at press time was virtual reality therapy, in which patients don a 3-D headset and sit in a chair that vibrates to simulate takeoff, flight, turbulence, weather problems, and landing. Thirteen clinics in nine states currently use the VR system, which was developed by Virtually Better, Inc. (tel. 404/634-3400; www.virtuallybetter.com). Therapists like VR systems because they give the doctor complete control over the flying situation, so a session can focus on a particular facet of flying (such as takeoff or weather problems).
VR therapy is costly--think $65 to $300 per session, depending on where you're taking the treatment and how much you can afford to spend--but many medical plans cover it, especially if you can prove that flying is necessary to your job.
A 2000 study in the Journal of Consulting and Clinical Psychology, a respected peer-reviewed medical publication, found VR therapy to be as successful as exposure to a real-life plane--both VR and exposure therapies had a 93% success rate. (However, two of the researchers performing the study were being paid by the VR firm.)
But there are differences in approach even between clinics using Virtually Better.
Dr. Rob Reiner of Behavioral Associates in New York (tel. 212/860-8500; www.behavioralassociates.com) combines virtual reality therapy with biofeedback, where computers monitor a patient's vital signs to provide an objective measure of fear. He teaches a breathing technique called "respiratory sinus arrhythmia" which forces the body to calm down when anxious. Using the biofeedback monitor, patients can watch themselves calming down.
The exposure therapists at Boston University's Center for Anxiety and Related Disorders (tel. 617/353-9610; www.bu.edu/anxiety), however, view relaxation techniques as avoidance tactics that prevent patients from really grappling head-on with their fears. Dr. Curtis Hsia of the center says fliers should be as aware of their surroundings as possible so as to have a sense of control over their flying experience.
Flooding
Flooding, a more intensive variation on exposure therapy, is another popular treatment for fear of flying. Not for the faint of heart, flooding forces clients to face their fears all at once, in an airport or on an airplane. Clearly it's a faster way to deal with, and perhaps overcome, the fear of flying; in fact, the approach seems tailored to the kind of people who dive head-first into ice-cold water rather than wade in slowly. But while many clients do manage to confront their fears at first, existing data regarding the long-term benefits of flooding are still inconclusive.
Simple Remedies for Minor Aviophobia
If you're leaving on a jet plane tomorrow, or for some other reason don't have time to embark on an intensive treatment program, there are simple safeguards you can take to curb anxiety before you board a plane.
Eat a nutritious meal before boarding. If you go too long without food, your body will try to compensate for your low blood sugar level by releasing adrenaline. This chemical reaction will make you feel stressed and anxious.
Avoid refined sugars (candy bars and other junk foods), caffeine (a stimulant), and alcohol. While doctors sometimes prescribe one-time doses of anti-anxiety drugs like Xanax for aviophobia, the side effects can be a problem (drowsiness, withdrawal symptoms). Ultimately, it's a Band-Aid solution that doesn't get at the root cause of the phobia. Alcohol is an even worse idea, as it can spur irrational behavior and "air rage."
Try to get to the airport early. The last thing you want to be when you step on a plane is nervous and anxious.
Pay attention to good news, not bad. If you suffer from untended aviophobia, you will tend to seek out information that supports your fear. Avoid reading about the airline industry in the news and have friends clip stories about how security is improving.
Sit over a wing, rather than in back, for a smoother ride. While turbulence is for the most part harmless--provided that you're seated and wearing a safety belt at the time it occurs--it is jarring and can easily fuel your fear if you're not in full control of your phobia.
Splurge on a first-class or business-class ticket if your fear of flying stems from claustrophobia; it will guarantee you more space. If you must fly coach, try to book a bulkhead seat or check in early and reserve an emergency exit row seat. Or try to fly American Airlines, which offers an inch or 2 more legroom in coach than other major airlines do.
Fly at off-peak times such as midday and midweek. Emptier planes are less stressful, and staff are often friendlier because they have to deal with fewer passengers.
Avoid sitting in a window seat if your fear of flying stems from acrophobia (fear of heights), where you will be able to look down and see how high you're flying.
Finally, take charge of your situation. Make choices that give you a feeling of control. Some airlines have better safety records than others, and some countries have more rigorous safety enforcement procedures than others.