Terror at 30,000 feet

Richard Klein had a patient who was afraid to fly. She was the vice president of a company that often required travel, and her phobia was becoming increasingly hard to hide.

“She was fearful of having a panic attack when they closed the door of the aircraft,” says Klein, a clinical psychologist and director of The Phobia Center, a Beachwood-based clinic. “Flying had become progressively more difficult.”

One month before a scheduled make-or-break business trip the woman sought help.

“She wasn’t sure if she would be able to handle the feelings any longer,” says Klein. “She was also concerned about the damage it would do with her company and the relationship with the client.”

It’s not as uncommon a scenario as you might think. More than 25 million people in the United States suffer from a fear of flying.

Compounding the problem is that phobias are often secretive, the type of thing people don’t talk about with their co-workers or bosses. “In the long run it may hold back someone’s success,” says Klein, “especially if you consider the lack of productivity. What happens is that people who need to travel for business may try to do a lot of the work over the phone or through e-mail. Some people will even drive eight hours instead of taking a half-hour flight. They’ll put off flying at all costs.”

The phobia typically falls into two categories-a fear that the plane will crash and a fear of having a panic attack.

“Universally, everyone talks about feelings of powerlessness,” says Klein. “A person may know, statistically, that flying is safer than driving, and understand that they can get into a car accident much easier. But they don’t rationalize it that way.”

For those dreading panic attacks, the phobia is associated with the fear of being confined in an enclosed place without the ability to get out. “Think about it,” says Klein. “If you have a panic attack at 30,000 feet, what can you do?”

Not much. But it’s possible to treat the phobia by reducing the anxiety associated with it. That, says Klein, is best done through exposure therapy-exposing the patient to whatever stimuli causes the anxiety, a little at a time, until the fear is controllable. For a fear of flying, that usually means working in stages, starting by having the patient sit in the airport and watch planes take off and land. Once a person is comfortable there, the next step would be putting them on a plane and sitting on the tarmac. After that, taxiing down the runway, followed by taking a real flight.

Unfortunately, Continental doesn’t have any programs that accommodate individual stages like that-it’s either fly or be left behind. Instead, Klein’s treatment process uses virtual reality.

“We can take them through the same steps,” explains Klein. “We immerse the person in the experience through a sense of presence. Little by little, we desensitize them to the phobia.”

That’s what happened with the executive. She undertook a series of virtual reality sessions at The Phobia Center. “The goal was to get her on that airplane,” says Klein.

Normally, the session runs once weekly for between eight and 12 weeks. But because of the tight time constraints, Klein and the woman met twice weekly for four weeks for intensive sessions.

Each session typically begins with a 15-to-20 minutes discussion about outside homework-such as going to the airport and watching planes or calling an airline to ask about flight schedules. “You can’t believe how hard that is for some people,” says Klein. “They are so afraid of flying that even talking about it with the airlines causes them anxiety.”

After that comes the virtual reality session. The patient sits in a chair and straps a large headset over his or her eyes and ears. The headset is connected to a PC-which runs the virtual flight simulator-and stereo speakers-which project sounds like those you’d hear while sitting in an airplane. Beneath the chair is a subwoofer speaker that causes the chair to reverberate, mimicking what passengers feel on a real airplane.

While the virtual reality graphics don’t quite match what you’d see on the big screen, they are equally impressive. It takes a few moments to become acclimated to the virtual airplane. The images move as quickly as you move your head-tracking your vision using computer-aided telemetry and redrawing new images at between 30 and 60 frames a second. Simply put, as you look around you can see everything you’d see on a real plane-minus the passengers.

Then Klein begins the VR session-which varies according to the progress of the client. Some people simply spend the 25-minute VR session sitting on the plane and looking around-including out the window at the tarmac. Others simulate take-offs and landings. Those further along in the treatment add thunderstorms and turbulence to simulate a rougher flight.

During the sessions, Klein gauges the patient’s discomfort level every five minutes. On a scale from zero to one hundred-zero being no anxiety, one hundred meaning panic-Klein asks the patient how they feel. “The concept is to keep the discomfort level low,” he says. “We work step by step to increase the hierarchy of the flight. If it gets to intense, we land the plane or, in extreme cases, remove the head gear.”

As for the vice president, when the time came for her business trip, she was able to get on the real plane and accompany her client on the flight. “She still had apprehension,” says Klein. “But she was able to do it. She made her flight successfully.”

Klein says the executive’s success isn’t a fluke. Of the nearly 20 patients he’s seen in the past year, only one didn’t complete the program. The rest have faced their fear of flying and taken real flights.

Next on tap for Klein and the Phobia Center are other virtual reality-based treatments, such as fear of driving, fear of heights and fear of public speaking. And in case you were wondering, the last one doesn’t include a virtual crowd in its underwear.