Patient Story: Virtual Reality Therapy for Fear of Flying

Fright or Flight – A personal story of how one patient used Virtual Reality Therapy to treat his fear of flying.

In an attempt to cope with my fear of flying, I’ve done some ridiculous things. I’ve clutched good-luck charms, swallowed tranquilizers and prayed to the patron saint of air travelers, whoever that is. When I’ve been too anxious to even book a flight, I’ve passed up weekend jaunts to London, endured 16-hour Greyhound rides and traveled from New York to San Francisco by train—round-trip, four days each way. Over the years, my phobia has become a bad joke (though fodder for some good ones among my friends) and a crippling disability.

And so it is that I found myself sitting on a beige La-Z-Boy recliner in a psychologist’s office on the Upper East Side, wearing a virtual-reality helmet, with various wires attached to me monitoring my heart rate, the electrical impulses in my fingers and my breathing. I looked absurd, but I didn’t care. Robert Reiner, Ph.D., founder of Behavioral Associates, a private psychological practice with 20 therapists, told me that this innovative combination of virtual reality and biofeedback—his office is the only one in the Northeast that offers it—could eliminate my terror of hurtling through the air in a metal tube at 500 miles per hour. Good-bye, Port Authority, hello Heathrow!

During my first session, Reiner—an easygoing, confident guy —asked me questions about the origins and development of my fear. (Let’s see, there was that failed journey on a 747 going from Frankfurt to New York, when the engines backfired, the plane dipped wildly to one side, and the pilot announced, “I don’t want to go across the Atlantic on this one.” Not to mention the time I was flying on a ten-seater to Maine through a storm, and we aborted the landing at the last minute because the air-traffic controller was shouting over the radio, “Don’t land! Don’t land! There’s ice on the runway!”) We discussed my counterproductive strategy of “risk avoidance”—I hadn’t flown in three years—and my obsession with the details of major airline disasters (like the Japan Airlines crash, the one where the people on board knew they were going down far enough ahead of time that they wrote their loved ones notes, which were later found in the wreckage).

Reiner didn’t start in on me with safety statistics, which is good, because as far as I’m concerned, they’re meaningless. I am perfectly well aware, thank you, that flying is a million times or whatever less dangerous than driving or taking the train or crossing Fifth Avenue at noon. I know that turbulence is the airborne equivalent of going over a pothole in the road, that pilots are trained professionals and that planes can fly on one engine if the other fails (oh, God). It doesn’t matter. Fear is not rational.

Happily, Reiner didn’t expect me to be rational. “This is not about reasoning and facts,” he reassured me. “This is about a physical reaction to anxiety.” He explained his methodology, which he’s developed over the past year and has used to treat about 100 people, 90 percent of whom have subsequently flown without terror successfully: First, he would take me on a virtual flight to gauge what aspects of it produced the most anxiety; then, with the help of the biofeedback data, I would learn a breathing technique that would synchronize my respiration and heartbeat to produce something called sinus arrhythmia. This technique is what would get me through future sky voyages in one piece, so to speak.

The term sinus arrhythmia practically set off my panic button. But Reiner assured me that being in this (perfectly safe) state makes it “impossible to feel anxiety.” By combining the virtual flight with the breathing over the course of between 5 and 20 therapy sessions (50-minute hours, as with most therapies), he told me that I would condition myself to be able to fly without fear.

For my first simulated flight, Reiner put me in a chair and strapped me into monitoring devices (the same ones used in polygraph tests). Then he put the virtual-reality headgear on me; it was kind of like wearing a motorcycle helmet with a video screen inside. Soon I found myself looking out the window of a plane parked at a gate and awaiting takeoff. The quality of the image was more virtual than reality, similar to a high-end video game. Reiner had already told me that for the therapy to work, I would have to try to convince myself that I was actually flying. So when the engines fired up on the soundtrack (playing inside the helmet), the La-Z-Boy started vibrating, and the captain announced, “Flight attendants, prepare for departure,” I tried to get into the spirit of the thing.<

My suspension of disbelief worked. As we sailed up into the virtual sky over a virtual city, then went through a virtual thunderstorm, I felt the familiar signs of panic: tight chest, sweaty palms, leaping heart. When I took the helmet off after landing, Reiner showed me on a large flat-screen monitor what had happened to my vital signs over the course of the flight. Every time something changed—when the engines revved for takeoff, when the pilot announced we were about to enter a storm, when the lightning flashed, when the landing gear descended—my pulse and breathing spiked. No wonder Gary Condit didn’t want to take a bona fide lie-detector test.

In the next session, Reiner worked with me to regulate my breathing, so that I could self-induce this sinus arrhythmia. By taking slow, deep, yogalike breaths, I was able to get my heart line and my respiration line to rise and fall in concert. I have to admit, this produced a very pleasant sensation. I was definitely not fit to operate heavy machinery.

After about eight visits to Reiner’s office, the doc announced that I was ready to fly. This caused a crisis. I had been very proud of my prowess in the sinus arrhythmia department, but on some level, it hadn’t occurred to me that I would actually have to get on a plane. My journalistic principles, however, demanded that I take a nonvirtual flight. The cheapest I could find was a round-trip excursion to Pittsburgh; imagine my delight when I realized I’d be flying AirTran, formerly known as ValuJet (remember that little mishap in the Everglades?).

The morning of truth dawned calm and sunny. I had run out of excuses; there wasn’t even any traffic on the way to the airport. I had nowhere to go but up. And up I went, on a Boeing 717 (good thing I somehow forgot this was the model with the broken jackscrew that caused the Alaska Airlines crash). It was the first time I had flown without chemical support in I don’t know how many years. I breathed slowly and regularly, but quietly, so as not to alarm my fellow passengers.

And then, nothing happened, which was precisely the point. Sure, I had a few little twinges when the plane hit some light turbulence, when the sound of the engines changed and when the pilot made a bit of a hot-dog landing into La Guardia (“Sorry about the aircraft-carrier touchdown, folks. Old habits die hard,” he said with an annoyingly jovial chuckle). But basically, I remained calm and was able to avoid obsessing about my imminent doom. Both the to- and fro-Pittsburgh flights were, as they say, uneventful.

(Originally appeared in Time Out Magazine | Thursday, August 02, 2001)

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