Flight fright
By Dave Demerjian
Business Traveler, July/August 2007

For business travelers who struggle to cope with a fear of flying, the stakes can be especially high. Career advancement often depends on a willingness to travel long distances on short notice to meet clients, co-workers, and suppliers. In a global economy, where air travel is increasingly a part of doing business, what are the options available for business travelers who are afraid to fly?

Fear vs. Phobia
There's no "typical" nervous flyer, according to Jerilyn Ross, president and CEO of the Anxiety Disorders Association of America, and director of the Ross Center for Anxiety & Related Disorders. "Everyone's anxiety is different," she says. For some passengers, takeoff or landing causes the most anxiety, for others it's turbulence that puts them over the brink. Passengers can also react differently depending on the length of the flight or whether they're seated at a window or an aisle.

Ross says flight anxiety manifests itself in a number of different ways, but most flyers experience typical panic attack symptoms. "I had tunnel vision, pounding heart, and sweaty palms," says Barb Powell, a project manager whose job requires her to fly on a monthly basis, of her first in-flight panic attack. "It was like a bad dream that I couldn't wake up from."

For Jennifer Forbes, a public-relations manager, the symptoms also included racing thoughts, dry mouth, and dizziness. And film director Steve Addair would sometimes begin panicking before his flight even boarded. "I'd get all the way to the airport and realize that I just couldn't get on the plane," he remembers. For her part, Forbes could sometimes trigger her symptoms by simply booking a flight.

Aviaphobia can develop suddenly, even for those who have flown without incident for decades. "It often results from years of cumulative stress," says Tom Bunn, a former pilot and licensed therapist who runs a fear-of-flying program called SOAR. "We all have the ability to ignore a certain amount of stress. But we're also accumulating information about crashes and other scary scenarios that can eventually become too much. "Ross says major life events can also trigger fear of flying. "Get married or have a baby, and suddenly it's not just about you anymore."

For many, September 11 brought fear of flying into clear focus. "When airplanes crash into skyscrapers, and the nation watches it on TV, suddenly it's harder to ignore your fear," says Dr. Roy Welker, director of the travel clinic at Brigham & Women's Hospital in Boston.

Addair was unable to board a plane for nearly a year after 9/11, and fears about terrorism also triggered Barb Powell's first in-flight panic attack. "Sitting on the plane, I started imagining the 9/11 hijackers. I thought about those poor people, and the next thing I knew I was having a full-blown anxiety attack."

Understand the Causes
Ross says that treating flight anxiety requires differentiating between fears and phobias. "People with a fear of flying can usually provide a tangible, concrete reason for being anxious," she explains. "But phobias are by definition irrational fears, and need to be treated differently." She says that some fear of flight is actually triggered by claustrophobia or agoraphobia. "When I hear people say things like, 'I panic when I get on the plane, and I have no idea why,' it indicates to me that there may be an underlying phobia to deal with. Sometimes, the panic doesn't have much to do with flying at all."

Many of the people who are afraid to fly say their anxiety stems from the lack of control they feel onboard a plane. Ross says letting go of this need for control can be extremely freeing, but is often difficult for business travelers who thrive on controlling complex situations. "You've got bright, creative people who are constantly dealing with situations and putting out fires, but there is nothing they can do when their flight is bumpy," she says. "The loss of control is amplified." SOAR's Tom Bunn agrees. "A lot of my clients are lawyers," he says. "They're used to being in control, and then they board a plane and suddenly they're not."

Different Approaches
Several European airlines offer fear-of-flying programs that aim to calm jittery passengers by teaching them how planes work. Virgin Atlantic's Flying Without Fear program provides classroom sessions where airline captains explain aircraft operations, what causes turbulence, and the noises one might hear in flight, then send passengers on a 45-minute test flight. While U.S. airlines have cut these programs to save money, there are a variety of private programs available (see sidebar).

Ross says that "meet the pilot" type programs can be helpful for flyers whose anxiety is based on a concrete fear. Bunn agrees. "These programs are built around a belief that if you understand how everything works, you'll no longer be afraid. It works for some, but others will focus on the one-in-a-million chance that something might go wrong anyway," he says. "This is what causes the emotional reaction."

There are also programs designed to address the phobias that lead to fear of flying. Tom Bunn's SOAR program, which he began in 1982 after years of flying for Pan American Airways and working in their fear-of-flying program, provides passengers with DVDs, counseling, message boards, and phone consultations. "It deals with the underlying psychological issues that cause passengers to panic in the air," says Bunn. "We're helping people learn how to regulate their emotions when they're in the air." Through her Washington,D.C.-based Ross Center, Jerilyn Ross offers a variety of services to help people address fear-of-flying issues, including cognitive and behavioral therapies, some of which are conducted at airports and on airplanes.

Magic Pill
While it is generally agreed that a long-term, behavioral approach to addressing flight anxiety is ideal, for many busy business travelers, medication is the best option. "People come to me saying that they have an important trip coming up and are afraid to board the plane," says Brigham & Women's Roy Welker. "In situations where there's no time for behavioral treatment, I'll often prescribe something."

Welker says some passengers with mild anxiety who are concerned about getting sleep on longer flights can get by with prescription sleep aids like Sonata or Lunesta, or even over-the-counter remedies like melatonin. Some have also had success using betablocker medications (Lopressor and Toprol are two brands) to suppress the rapid heart rate and nervousness that often accompany flight panic. But Welker most commonly prescribes benzodiazepines like Ativan or Serax, which provide four to six hours of relief without leaving business travelers groggy when they land.

Welker says flyers taking drugs need to use caution. "If you are going from the plane directly to a big presentation, you need to consider how the medication might affect your performance," he says. And he points out that in today's security-conscious environment, airlines won't let passengers board if they're zonked out."Some of these pills kick in fast, so you need to take them immediately before the flight," he says.

Ross sometimes recommends benzodiazepines such as Xanax or Klonopin for anxiety, but warns that the effects of these medications are enhanced by alcohol."If you pop a pill before the flight, expect the impact of whatever you drink to be doubled." That means two Scotches with dinner could feel like four.

Both Welker and Ross suggest that managing flight anxiety with alcohol is unwise. "Many of the people who are afraid to fly talk about how difficult it is to feel out of control, "Ross says. "But knocking back four or five drinks doesn't give you more control – it ultimately gives you less. People need to remember that when they fly."

Progams for people dealing with flight anxiety:

CalmFlight
www.calmflight.com
tel. 914-381-3409

SOAR
www.fearofflying.com
tel. 877-332-7359

The Ross Center for Anxiety Disorders
www.rosscenter.com
tel. 202-363-1010

Fear of Flying Clinic
www.fofc.com
tel. 650-341-1595