When anxiety runs sky-high

For most of Cris Mack’s adult life, the mere sight of an airplane in flight could trigger a panic attack.

“I’d feel like I was having a heart attack,” said Mack, 62, a Foster City, Calif., accountant and the wife of a former Navy pilot. “My hands would get clammy, my heart would palpitate, I’d hyperventilate. I got the kind of feeling in my stomach that if you don’t have a phobia you really don’t understand. I just knew something really bad was going to happen.”

Mack suffered from aviophobia, commonly known as a fear of flying. In its grip, she avoided even looking at airplanes much less boarding one. The fear hurt her business career as she reflexively turned down all work assignments that required air travel. “I didn’t take a whole bunch of jobs I could have,” recalled Mack. “I just couldn’t do it.”

Her inability to fly cost her precious time with family as well. Both her children went to college in Los Angeles, and her mother resided in the area too. With a concurrent fear of driving, her only route from the Bay Area to Los Angeles was by train, meaning that a round trip to attend an afternoon function at her daughter’s UCLA sorority would require a couple of days of traveling.

About one in eight Americans, or almost 25 million people, are afraid to fly. The often complex reasons behind the fear can vary greatly -- from a single turbulent flight to an inability to surrender control. Aviophobics usually fall into one of three categories: They won’t fly under any circumstances; they will fly, but only when absolutely necessary, such as to attend a wedding or a funeral; or they’ll fly begrudgingly, experiencing considerable preflight anxiety that gets worse during the actual flight.

The terrorism of Sept. 11 and subsequent terror alerts have heightened these fears in some and awakened them in others, say aviation industry officials, who have seen ridership decline sharply since the attacks. The threat has complicated treatment because unlike concerns over aviation safety, terrorism can’t be as easily dismissed as largely irrational.

“We try to separate the what ifs from the what is,” said Steven Hutchison, director of the Fear of Flying Clinic in Seattle. “Unfortunately, terrorism is a realistic fear.”

Even with terrorist incidents included, commercial aviation in the United States has a strong safety record over the last decade. Between 1992 and 2001, nearly 1,200 deaths occurred in accidents involving major U.S. air carriers domestically -- including the more than 200 passengers who died in the Sept. 11 terrorist attacks.

By comparison, approximately 40,000 Americans die each year in automobile accidents.

As Mack can attest, phobias aren’t conquered by statistics. “I knew intellectually the planes were safe,” she said. “But it was the emotional part I couldn’t deal with.”

Mack wasn’t always afraid to fly. She fondly remembers her first flight as a teenager as a wondrous trip into the clouds. But those feelings slowly gave way to a growing sense of dread when boarding prop and jet planes during the next decade or so. Then, at age 32, after what she described as a routine flight from the East Coast to California, she got off the plane and declared: “I’m never doing that again.” And she didn’t for 19 years.

Hutchison said Mack’s aversion to flying is common. Many people between ages 25 and 40 who’ve never had a scary moment in a plane suddenly are seized by an overwhelming fear at the thought of air travel. For women, it often occurs after giving birth -- as it did with Mack who had two young children when she swore off flying.

For men, the fear can surface after promotions, particularly those that include responsibility for other employees. “They realize things do happen and that they’re not immortal,” said Hutchison, who also has been a pilot at Alaska Airlines for 24 years. “They want to keep safe and avoid some things they used to do.”

Incentives to travel

Mack’s turning point came about a decade ago when her son took an internship in Washington, D.C., and a friend’s child was going to be married in New Orleans. She wanted to go to both places, but a train was out of the question this time. She’d had a pamphlet for the Fear of Flying Clinic on her refrigerator for almost two years, and now she decided to enroll.

The Fear of Flying Clinic, a nonprofit organization based at San Francisco International Airport with a branch in Seattle, claims a 90% success rate. Dozens of other clinics, seminars and individual psychotherapists who treat the phobia say they can provide similar results. Almost all the treatments diffuse fears in the same way, using some combination of relaxation therapy, behavioral modification, aviation education and a test flight.

The Fear of Flying Clinic’s eight-week program usually begins with people talking directly to pilots, air-traffic controllers, security police, flight attendants and maintenance personnel to understand how aviation actually works.

“We try to build a base of trust,” Hutchison said. “So they can give control over to the people who are operating the airport and the airplane.”

Her ‘aha!’ moments

It was during her 24 hours of class instruction that Mack experienced what she calls two “ ‘aha!’ magic moments.” The first came when a pilot explained more about turbulence, something that completely unnerved her. “I kept thinking the airplane was flying on nothing, but we learned air isn’t nothing. They compared it to a boat on water. So every time I hit turbulence, I kept repeating, ‘water, water, water.’ ”

She also discovered her anxiety attacks could be eased by controlled breathing techniques. Breathing more slowly meant less adrenaline was getting into her bloodstream -- something necessary for the anxiety attack to progress -- and it took her mind off her fears. “I used it all the time at first,” said Mack, who flew five times the first year of the course, including to New Orleans for the wedding.

Today, she has grown so comfortable with flying that she serves as a volunteer at the clinic, helping others to conquer the fear that kept her grounded for nearly two decades. The clinic holds its graduation ceremonies on a plane.

Fears over terrorism has caused her to cancel two recent trips, one to Europe shortly after Sept. 11, and one to Hawaii weeks before the war in Iraq began. But otherwise, she flies regularly -- and without fear.

“My fear of flying had nothing to do with terrorism,” said Mack. “I’m really free now. I love to fly.”