Fear of flying affects one of six Americans, according to R. Reid Wilson, a Chapel Hill, N.C., psychologist specializing in the treatment of anxiety disorders. And right now, some people may be more fretful than usual in the wake of the deadly TWA and ValuJet crashes.
Worldwide, about 2,500 passengers died in commercial aviation accidents in 1996, according to Airclaims Ltd., a London-based aviation insurance claim specialist.
Fortunately, there are more options than ever to help white-knucklers. Besides traditional programs that often include a visit to the airport and a graduation flight, other choices include home-study courses, take-along kits, one-on-one therapy sessions and an Internet group workshop. In working with fearful fliers over the years, the therapists and pilots who direct the programs say they have discovered a number of strategies that work for most people.
Fear of flying is not because of a single or simple cause, said Wilson, who has found in his research that the average age of fear onset is 27. Female fearful fliers outnumber males, 2 to 1.
About 50% of fearful fliers have panic disorder, a psychological problem marked by anxiety or panic attacks, according to Wilson, an associate clinical professor of psychiatry at the University of North Carolina School of Medicine. Others have claustrophobia or fear of losing control, fear of death or separation from loved ones, or fear of crowds. Some worry about the plane falling out of the sky or fear relinquishing control to the pilot. In fewer cases, fear of heights is the problem, according to Wilson.
"Often fearful fliers are high achievers," said T.W. Cummings, a retired Pan American Airways pilot who directs the Freedom from Fear of Flying program based in Coral Gables, Fla. Cummings also said that many of his clients have told him that fear of flying is their only phobia.
What many with flying phobia do have in common, Wilson and Cummings agree, is the tendency to ignore statistics. While 159 passengers in the U.S. died on scheduled airline flights in 1994, according to the National Safety Council, nearly 22,000 died in car, bus and train crashes that year, the latest year for which figures are available.
As impressive as those statistics might be to some, most fearful fliers find it difficult to calm their fears with numbers. So Wilson and other experts don't dwell on statistics.
Instead, Wilson begins sessions by writing in big red letters on a board the word risk.
Sure, he tells fearful fliers, there is always a possibility, however remote, of dying in an airplane crash. (Per airline flight, the death risk is one in 10 million, said Wilson, drawing on data from 1976 and 1991.)
"You can never close the loophole of the probability of the plane crashing," he tells clients. Once the potential risk is acknowledged, clients can move to the next step: desensitizing themselves to their fears and symptoms so they can board and get through a flight.
If claustrophobia is the underlying fear, for example, Wilson encourages clients to enter a crawl-space-size room in his office. He turns on the heater to make it as stuffy as some airplane cabins and closes the door, informing the client that the aim is to stay in the room for five minutes. The goal is to learn to tolerate the symptoms, to realize it's possible to cope with them.
Other programs desensitize participants by conducting classes at or near an airport and by taking people aboard planes and, finally, aboard a graduation flight. "What helps is exposure," Cummings said. He has workshop students board a plane and one by one tell others in the group which seat is the most uncomfortable for them. If it's a window seat, Cummings will ask the fearful flier, "Could you sit there for 10 seconds with the help of the group?" Usually, he said, it is possible.
Learning about how the plane operates can help ease fears too, and is a component of many programs. "The concept that knowledge dispels fear still holds," said Fran Grant, a pilot who co-founded the Fear of Flying Clinic at San Francisco International Airport (and in other cities by arrangement) and combines behavior modification with information.
Other techniques include "thought-stopping," in which fliers don't allow themselves to focus on "what ifs," as in "What if we crash?"
Wilson also advocates the "10-second grip" exercise. "Grab the arm rest. Squeeze. Hold for 10 seconds. Take a break for 30 seconds. Repeat three times."
Paying attention to good nutrition before a flight can help, said Glen Arnold, a Southern California psychologist and founder of one-day Thairapy, seminars offered in the Los Angeles area for fearful fliers. Minimize sugar, caffeine, alcohol and nicotine at least 12 hours before the flight, he advises.
"Be OK with being anxious," Wilson tells clients. "Don't feel like you have to be calm." What fearful fliers must learn is to "handle your worries," he said. "Or the worries will run everything."
About 90% of workshop participants make it to the graduation flight, says Cummings, but he advises graduates to fly again within a month to keep their skills sharp.
Among upcoming and ongoing programs for fearful fliers:
"Achieving Comfortable Flight," a self-help program developed by Cummings and Wilson. It includes educational booklets and audiotapes, some of which can be taken on the plane; $49.95 plus shipping and handling. (To order, call  394-2299.)
Freedom From Fear of Flying workshop, conducted by Cummings, in late January (date not yet confirmed) in the Los Angeles area; $400 plus air fare for the graduation flight. (For information, call  261-7042).
A group workshop on the Internet for $15 per session by Al Forgione, a psychologist who directs the Institute for the Psychology of Air Travel in Boston. He also offers phone consultations at $60 per hour and a home study course for $79.95 (For information, call  437-1811.)
A one-day Thairapy workshop, conducted by Arnold, is planned for February (date not yet confirmed) in the Santa Monica area; $149. Arnold also offers individual therapy for $100 per session, with positive results common after six sessions, he said. (For information, call  967-0772.)
The Fear of Flying Clinic, offered at San Francisco International Airport, can be arranged in other cities with a minimum of five people. (For information, call  341-1595.) Cost varies by location.
Seminars on Aeroanxiety Relief offers a course for $285 to $390, depending on components. The total package includes tapes and booklets, therapy sessions, telephone support and an airport meeting with Tom Bunn, a United Airlines pilot and psychotherapist who founded the program. (For information, call (800) 332-7359.)
The Healthy Traveler appears the second and fourth week of every month.