New Therapy Treats Fearful Fliers With Dose of Virtual Reality

It may be true that driving to the airport is a greater risk, but for millions of people the mere thought of getting on an airplane is a terrifying experience.

“Many people avoid flying completely,” even if that means turning down a lucrative job offer or traveling to Europe by ship, according to Barbara O. Rothbaum, associate professor of psychiatry and behavioral sciences at the Emory University School of Medicine in Atlanta.

Rothbaum is the principal investigator in a new research effort to see if high tech might help alleviate an anxiety that literally grounds people who are desperately afraid to fly. The program, supported by the National Institute of Mental Health, is designed to see if a strong dose of virtual reality might help people deal with their fears.

Rothbaum estimates that more than 25 million people in the United States are afraid to fly. That number includes some who are “fearful fliers”--those who tough out their anxiety because they have no choice but to fly--but it also includes a sizable number who simply cannot bring themselves to get aboard an aircraft.

Traditional treatment involves teaching the patient how to cope with fear, followed by flight time aboard an aircraft accompanied by a therapist. That is expensive, and it is impractical to take the patient repeatedly through the areas that may cause the greatest anxiety, such as takeoffs, landings and stormy weather.

“You can’t tell the pilot of a commercial airliner to stop and take off again,” said Samantha Smith, a clinical psychologist at Emory who will be running the trial program. “The advantage of virtual reality is we can have our virtual airplane take off and land as many times as we need.”

Participants in the study, which consists of three six-week sessions involving up to 60 patients, will sit in a “thunder seat” wired for sound to reproduce all the noises a traveler normally hears aboard an airliner.

Each patient will wear a virtual reality helmet that projects a three-dimensional image onto two tiny screens in front of the eyes.

“You have a window seat, and if you turn your head to the left, you can see the Atlanta skyline out of your window,” Smith said. “If you turn to the front, you see the back of the passenger seat in front of you. If you turn to the right you see empty seats and you can see out the right window. It feels quite realistic.”

So much so that during an earlier trial run, patients exhibited all the symptoms of being aboard a real aircraft--dry mouth, tense muscles, racing heartbeat, sweaty palms.

Rothbaum and her colleagues have set up a company, Virtually Better Inc. (https://www.virtually better.com), to develop the system and offer it to other anxiety-treatment centers across the country. They are still looking for participants, but volunteers must be in the Atlanta area for one of three six-week sessions.

Each “wave” of participants will be divided randomly into two groups, Smith said. One will receive traditional therapy, including time aboard commercial flights. The other will undergo virtual reality treatment, concluding in one trip aboard a commercial airliner.

Both groups will receive similar training for dealing with their anxiety.

“That will involve helping them learn how to relax, and how to breathe properly, and about such techniques as thought stopping,” Smith said.

“Thought stopping,” she added, “involves a lot of self-monitoring.” The aim is to help patients deal with their thoughts before they race out of control.

“When you notice yourself starting to go over something over and over again, and it just keeps spiraling out of control, getting faster and faster, you have to consciously stop and ask yourself if you want to worry about that right now. If you don’t, you literally scream in your mind to stop. Not out loud, hopefully, but in your mind you’re screaming to stop.”

A sudden noise, a little air turbulence, even the absence of the pilot’s voice on the intercom can trigger such runaway thoughts, she said.

One technique not recommended by therapists is self-medication with prodigious quantities of alcohol or tranquilizers. While that may ease anxiety during one flight, it may make the next one worse.

“Self-medication probably does have an [anxiety-reducing] effect, but people may then feel they couldn’t fly without some ‘help,’ which would make future flights more feared,” Rothbaum said.

What is absolutely essential, both Smith and Rothbaum said, is to confront the phobia head on.

“When you have a fear or a phobia, the tendency is to want to avoid the thing that you are afraid of,” Smith said. “But that only makes it worse. Avoidance does not make the fear go away. It only adds to the fear, and the next time you confront whatever you are afraid of, it’s worse.

“The way to get over a fear that is not quite rational is to expose yourself to what you are afraid of. But do it in an atmosphere that has minimal anxiety attached to it, and do it where you have support, encouragement, and some techniques to help you deal with the anxieties that come up.”

It is not entirely clear why some people are so afraid to fly. Smith said some can point to a single incident, such as a terrifying flight through a thunderstorm, as triggering their phobia. But others haven’t a clue as to the origin of the phobia.

Interestingly, only about half of the people who are afraid to fly are consumed with fears of a crash, Rothbaum said. The others are afraid of having a panic attack while enclosed in the airliner.

Some, apparently, are simply afraid of fear.

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Lee Dye can be reached via e-mail at leedye@compuserve.com.