Nerves in Flight

Karsten Kramarczik, a magazine art director from Schriesheim, Germany, never liked to fly. Even as a child, he found that the prospect of enclosing himself in a long metal tube and hurtling through the ether at nearly the speed of sound made him shiver. Nevertheless, for much of his life Kramarczik forced himself to get on airplanes. Then, four years ago, doubt mysteriously turned into full-blown panic on a trip to Barcelona. He has not flown since.

According to a 2006 USA Today/CNN/Gallup poll, 27 percent of American adults are at least somewhat afraid to take to the skies; 9 percent are “very afraid.” These statistics suggest a recovery since the September 11, 2001, attacks, shortly after which a Gallup poll indicated that 43 percent were wary about getting on an airplane, including 17 percent who were “very afraid.”

A fear of flying, termed aviatophobia or aviophobia, refers to a level of anxiety so great that a person refuses to travel by air or finds doing so extremely distressing. Experts estimate that at least 10 percent of Americans have such a phobia. These people worry obsessively that they will crash or even die of their own fear. In extreme cases, an individual suffers a full-blown panic attack, a sudden feeling of intense anxiety that is often accompanied by shortness of breath, chest pain, nausea and dizziness. Some may vomit at the mere sight or mention of an airplane.

Such intense fear can be debilitating. It may prevent a person from traveling to distant destinations on vacation or to see family or friends. It can also cripple the careers of those who must travel for their jobs.

Fortunately, fear of flying usually yields to treatments such as do-it-yourself DVDs, hypnosis and virtual reality. Perhaps the most effective technique, however, involves forcing a patient to face what he or she fears—by flying in a plane. The goal of such exposure therapy is habituation, a form of learning in which a response to a stimulus diminishes with repeated contact. Kramarczik has chosen a program that combines exposure with relaxation exercises and information about both flying and fear that puts the dangers in perspective.

The prognosis is promising. According to one German study, exposure therapy can eliminate or significantly ameliorate severe anxiety associated with flying in more than 90 percent of aviophobes. “People who look their fear in the eye have already taken the first step,” explains psychologist Marc-Roman Trautmann, training facilitator at the German Flight Anxiety Center (GFAC) in Nieder-Wiesen, Germany.

Diffusing Dread
Kramarczik, along with three like-minded souls named Melanie, Stefan and Sven, took that first step in a seminar room in Raunheim, Germany, the meeting place for one of Trautmann’s courses. Trautmann uses cognitive-behavior therapy, a type of psychotherapy that diminishes destructive emotions by correcting distorted cognitions and encouraging more adaptive behaviors. In this two-day program, the training facilitator would instruct participants about air travel as a way of calming overblown estimations of its dangers. He would also coach them to relax and, on day two, would accompany them on a flight to Vienna.

All the participants were determined to become fearless fliers. Melanie’s husband and two children had acquiesced to her phobia for years, one time driving 11 hours to the coast of Spain on vacation. Now they want to fly, but Melanie is afraid of having an embarrassing panic attack. Stefan, who has not flown in eight years, wants to set a good example for his children. And Sven is an export manager who must fly for his job but has had no faith in the safety of air travel since 9/11.

Although Sven can pinpoint the origin of his fear, not every aviophobe can. When Trautmann asks Kramarczik to recount the details of his nightmarish trip from Frankfurt to Barcelona, no obvious trigger emerges. His fear of flying seems to have grown over time with the accumulation of negative experiences in the air such as turbulence, storms and a prior takeoff from Cuba that occurred during a hurricane warning.

Kramarczik’s fear also stems in part from his fear of heights, or acrophobia. Terror of tight spaces, or claustrophobia, as well as a feeling of not being in control can similarly exacerbate a fear of flying in some people. But the risk of breaking out in panic during a flight is often a function of a person’s overall level of stress, Trautmann says. A person who feels pressure from various sources may lose control during a flight, whereas one who is under less tension will be better able to tolerate flying on any given day.

Whatever the causes of their angst, many aviophobes unwittingly aggravate their apprehension by focusing on it, and their anxiety spirals out of control. To interrupt that cycle, Trautmann tells the group that although their fright and its physical symptoms may seem significant, both are in fact a maladaptive distortion of a response that evolved for a different purpose.

Much of our anxiety stems from something called the fight-or-flight, or acute stress, response, which protects animals in the presence of real, immediate threats. When faced with possible danger, an animal or person releases a cocktail of hormones such as adrenaline and noradrenaline that produce a heightened state of alertness and facilitate a variety of physical changes, including a racing heartbeat, faster breathing, and blood vessel shrinkage and dilation. These bodily adjustments help prepare the muscles to act—to fight, perhaps, or freeze or flee. Once the threat is gone, the body returns to equilibrium, and the stress symptoms—tension, sweating and a quickened pulse—diminish.

Even though no acute danger exists, aviophobes perceive peril whenever they step onboard an aircraft. “I feel like I’m going to die,” Melanie says. Trautmann counters: “No one dies of fear.” It feels that way, he explains, only because the stress response surfaces inappropriately—and then refuses to dissipate. “The body cannot tell whether our fear is well founded or not,” he says. It thus spews out stress hormones in reaction to imagined threats as well as real ones.

Flying is not the only example of a modern make-believe menace; an upcoming sports competition, math test or stage performance can also provoke an irrational stress response. In such situations, Trautmann advises, try to push past your unreasonable anxiety so that it does not stop you from doing something that is important to you, especially because avoidance only intensifies the fear.

Facts of Flight
Next Trautmann escorts the participants to a Condor hangar in which Boeing airplanes get routine maintenance and checks. There they will learn facts about air travel. According to Trautmann, a lack of information is a main cause of aviophobia, and thus a dose of the hard facts can help cure it.

Several jumbo jets are standing in a row in the huge hangar, some of them with exposed
innards. Mechanics and engineers are methodically going down their checklists; a co-worker double-checks each step. The process relies on redundancy: engineers design all the important systems with backups that automatically take over their functions in the event of a failure. Still, an aircraft never even gets to the runway unless everything is working to specifications. The captain and first officer must also check off all systems before takeoff.

“What happens if an airplane banks too steeply when taking a turn?” Kramarczik wants to know. “More than once, it has occurred to me that it wouldn’t take much more to tip us over.” A technician explains that what he is seeing is an optical illusion. Although it may look to a passenger like the horizon is perpendicular to the aircraft, in actuality the airplane takes the curve at barely 25 degrees from horizontal, he says. And airplanes are built to take curves safely at 60 degrees, the technician maintains.

Many people also falsely assume that a failure of all engines will cause a plane to nose-dive. In reality, all airliners can glide without engines, although they will start to descend. A safe landing is possible if the plane is near a runway or suitable landing area. This scenario occurred with a flight from Canada to Portugal in 2004. There were no deaths among the 293 passengers and 13 crew members onboard.

Sven has another worry: “But what would happen if some nut gets control of the airplane, as happened at the World Trade Center?” Trautmann says that a high-security door now protects airplane cockpits and that even the flight attendants have to ring if they want to enter. The crew also monitors the cabin through a video camera and unlocks the door only when they are satisfied that all is clear.

What is more, the overall risk of flying is very low. “Statistically, a passenger would have to fly 2.4 billion miles before experiencing an accident. That is about the same as 14 round-trips to the sun,” reads a passage from the cockpit flight manual of the German airline Lufthansa, parroted in Trautmann’s course. “The most dangerous part of the trip remains the drive to the airport.”

But information alone does not always squelch fear, so Trautmann tries to attack it physically as well. He introduces the group to progressive muscle relaxation (PMR), a series of stress-reducing exercises developed by Edmund Jacobson, a physiologist formerly at the Laboratory for Clinical Physiology in Chicago.

“Think about your favorite place and let your thoughts take you there,” Trautmann instructs the group. “Make a tight fist with your right hand, hold it, and then relax your hand and place it on your knee. Now do the same with both hands.” He repeats the exercise with other parts of the body, including the arms, legs, stomach, shoulders and neck. After several times through the exercise, each person experiences a release of physical tension. But will these techniques work for tomorrow’s flight?

Prepare for Takeoff
The next morning Trautmann urges the four reluctant fliers to replace any horrific images in their minds with positive thoughts. In a secluded corner of the departures hall, he guides them through more relaxation exercises; then they board a bus to the plane.

The enclosed gangway unnerves Kramarczik, but he, Sven and Stefan board the plane uneventfully. Melanie hesitates; her eyes tear up, and she is close to turning back. But just then the pilot—who turns out to be Austrian car-racing legend and aviator Andreas Niklaus “Niki” Lauda—introduces himself and offers to show Melanie the cockpit. Melanie momentarily forgets her fear as the pilot guides her into the cockpit, and he lets her remain there during takeoff.

Kramarczik, Stefan and Sven sit down in the cabin, their faces betraying tension as they discuss what they learned the day before. As the plane begins to taxi, they pause to identify the noises and movements of the aircraft. The turbines accelerate; the nose of the plane lifts off. Everyone is pressed softly against the backrest, and in a few minutes they are at cruising altitude.

They all drink a toast and then are allowed to visit the cockpit. When Lauda asks Kramarczik why he is afraid of flying, he admits that his lifelong displeasure with being in an airplane turned to fear after a very turbulent flight. The pilot reassures him that turbulence has never caused an airplane to break up or otherwise malfunction. Turbulence is mostly uncomfortable for the passengers, he says, like driving on a bumpy road.

Lauda and his co-pilot seem completely calm and in control, and Kramarczik is starting to relax, too. He blanches slightly during landing but is otherwise feeling fine. Seeing the flight from a pilot’s perspective has helped him give up control and unwind onboard.

After the flight of 90 minutes, all the class participants disembark much less anxious about flying. “Waiting in the airport was much worse than the flight itself,” Melanie says. “I was so tense. Now I’m feeling much better. My family will be proud of me!” Stefan remarks: “Now I know that there was no reason for my extreme reaction. When the thrust stopped after takeoff, I thought, uh-oh, we’re going down! But nothing happened.”

Trautmann is also pleased with the progress of his charges. “You now have the hardest step behind you,” he says, “but don’t forget: you have to fly back!”