Panic Disorder: Fear Of Flying

Published: December 9, 2003

On May 15, 1930, a 12-passenger plane took off from Cheyenne, Wyo., with a new crew member, a 24-year-old nurse from Iowa named Ellen Church. Ms. Church earned a place in history as the first airline stewardess. But when Boeing Air Transport hired her, it was to solve a problem: fear.

The passengers, Ms. Church told an interviewer in 1960, were "really scared."

"Most of them had two or three stiff drinks before getting on," she said, "and nobody traveled by plane for pleasure."

Ms. Church and the other young women who joined her not only served coffee and cookies but also soothed passengers and held their heads when they were sick.

Seventy-three years later, stewardesses have evolved into flight attendants and are no longer required to have nursing degrees. But for an estimated 10 million Americans, the anxiety aroused by flying has never fully subsided.

Phobias are by definition irrational fears, and airline executives are fond of quoting statistics to demonstrate just how irrational it is to be afraid of flying. The chances of being killed in a car accident, or by a bolt of lightning, are far greater than dying in an airplane crash.

Such statistics "are what get you on the plane to begin with," said Dr. Michael R. Liebowitz, a professor for clinical psychiatry at Columbia University and the director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute in Manhattan.

Yet for most people, traveling high above the earth in a metal tube will never seem as benign as pulling out of the driveway in the family car. The sky, Dr. Liebowitz said, "is not a place that we inherently belong."

People who seek help, researchers say, usually fall into one of two groups, those whose fears are specific — a crash or a hijacking — and those who suffer from panic disorder, a fear of losing control of one's emotions in a place where escape is impossible.

A 35-year-old salesman in Georgia, who requested anonymity to protect his privacy, falls in the second category. For many years, he enjoyed flying. He had even jumped out of airplanes as an Army paratrooper.

But three years ago, as the door was closing on a flight for Las Vegas, he was overcome by a feeling that something was wrong. He had trouble breathing. He felt like he was having a heart attack. "I was thinking, `I've got to get off the plane,' " he said, and he promptly did so.

It is not uncommon, experts say, for anxiety to come on suddenly, and like the salesman, some people report first experiencing fear after the birth of their first child. But unlike many people who accept their anxiety as a reason to forgo air travel, the salesman decided that he needed to overcome his fear.

Many programs offer treatment, but Dr. David H. Barlow, the director of the Center for Anxiety and Related Disorders at Boston University, said the only method supported by scientific evidence involved gradual exposure to a feared situation.

In exposure treatments, Dr. Barlow said, patients, "with their full cooperation," are given a chance to experience their emotions in tolerable doses, so that they can begin to exert more control over their response.

The Georgia salesman sought help at a clinic in Decatur that uses a virtual reality simulation. Wearing a helmet equipped with two TV screens, he experienced taking off, flying through turbulence and landing without getting on an airplane.

Dr. Barbara O. Rothbaum, the director of the Trauma and Anxiety Disorders Recovery Program at Emory University and a developer of the virtual reality program called Virtually Better, said, "I want people to learn that they can feel anxious and that that's O.K., that they don't need to try to avoid it."

As for the salesman, he eventually took a short flight to Tallahassee, Fla., and has flown four times since then.

Occasionally, he said, the rush of fear he came to expect when the engines fired up has even turned into exhilaration. "That's one of my favorite parts," he said. "You feel the speed and the power."