BEFORE
LAST SEPTEMBER, most Americans thought as little
about stepping on a plane as they did about hopping in a car
to go out for pizza. In terms of safety, their odds were better
flying: studies show you are nineteen times safer in a plane
than a car.
But
in the wake of the terrorist attacks on New York and Washington,
D.C., many people continue to grapple with a host of unfamiliar
fears, including a new trepidation when it comes to air travel.
The swift blow to the airline industry marked the beginning
of a lingering trend that has made itself felt across the country,
a wave of anxiety that is financially hobbling the nation’s
airlines (in November, air travel was still 30 percent below
average) and psychologically chilling the millions who rely
on them.
An
Emory psychiatry professor who developed a new, cutting-edge
therapy for fear of flying and other phobias is concerned about
what this surge of terror could mean for future flyers. In most
cases, virtual reality exposure (VRE) therapy, formulated in
part by Associate Professor of Psychiatry and Behavioral Sciences
Barbara O. Rothbaum, can go a long way toward helping fearful
fliers get back in the air.
Prior
to the September 11 attacks, when terrorists commandeered four
domestic flights for suicide missions that ultimately resulted
in the deaths of 266 passengers and crew members and some five
thousand on the ground, about twenty-five million Americans
were reportedly afraid to fly. There is no way to know just
how steeply that number has risen since the tragedy, but according
to Rothbaum, the shock to the nation’s psyche was significant
enough to trigger collective grief and anxiety on a spectacular
scale.
“Obviously,
we have heard about a lot of fear of flying, even in people
who weren’t scared to begin with,” says Rothbaum,
director of the Emory medical school’s trauma and anxiety
recovery program. “People are very wary about flying right
now. I think it’s different from the kind of fear we saw
previously, when most of our clients were scared of crashing
or having a panic attack. Most people did not think in terms
of this [terrorist] kind of activity.
“Now
the images are seared in everyone’s brain, especially of
that second plane crashing into the World Trade Center–it’s
really an awful, awful image for flying.”
Although
the attacks lend a new urgency to the fear of flying and its
treatment, this relatively common phobia is nothing new to Rothbaum.
She has worked with dozens of patients who struggle with a dread
of air travel and made a considerable mark in her field when
she helped create a revolutionary new element of treatment using
virtual reality technology.
The
most effective way to conquer this type of fear, according to
most psychiatry professionals, is through exposure–facing
up to the source of the fear in order to shout it down to a
more reasonable size. The commonly accepted method of treatment
for phobias, defined as “exaggerated and often disabling
fear,” is therapy that includes counseling, education,
and myriad relaxation techniques, culminating in repeated exposure
to the source of fear.
Flying
phobia, Rothbaum says, has always been frustrating to treat
because the exposure element–going to the airport, getting
on a plane–is inconvenient, time-consuming, and costly.
So she devised a plan to bring the exposure to the patient.
In 1993, funded by a joint biomedical technology grant from
the National Institute of Mental Health, Rothbaum and Larry
F. Hodges, a computer scientist at the Georgia Institute of
Technology, began to develop virtual reality-based therapy for
fear of heights. Using computer technology, they created “virtual”
high places, such as the view from the top of a skyscraper,
inside a headset to help conquer acrophobia. When the project
showed promise, Rothbaum and Hodges went on to make a virtual
airplane incorporating sound, visuals, and vibration.
“We
did a controlled study and found virtual reality exposure worked
just as well as standard exposure,” Anderson says. “People
did get scared, and then they got less scared. It worked and
it translated to the real world.”
A
series of controlled studies conducted at Virtually Better,
the Emory-Georgia Tech startup that has exclusive license to
the virtual reality software, are among the first of their kind.
So far, more than a hundred fearful flyers have participated
in the studies, with hopeful results: VRE appears to be keeping
pace with standard exposure methods. A year after treatment,
93 percent of those treated with VRE continued to fly, a significant
measure of success.
Treatment
at Virtually Better and other licensed clinics is now available
to virtually anyone. Clients seeking help for fear of flying
attend an average of eight one-hour sessions: four in one-on-one
counseling and four undergoing VRE. The number of sessions,
at $150 each, can vary according to the client’s needs.
During
the exposure portion of the therapy, subjects wear an elaborate
head-mounted display that creates a virtual world of digital
images and recordings, and the platform below them trembles
to give the illusion of engine vibration and turbulence. The
therapist also can communicate through the headphones to guide
the client through the experience. VRE allows the therapist
to focus on specific areas of difficulty, such as takeoff and
landing, and clients can experience several therapeutic exposure
situations per session–impossible in standard therapy.
The
treatment sparked a flurry of interest in both the psychiatry
community and the popular media, with dozens of articles in
the likes of Newsweek and USA Today as well as professional
journals. And more than a dozen clinics have signed on to use
the VRE software, including clinical partners in Australia and
Argentina.
Virtually
Better is also studying the use of VRE therapy to treat fear
of public speaking, bridges, storms, and elevators–all
common phobias–as well as pain management in sick children.
Rothbaum and Hodges have even developed a virtual Vietnam to
help veterans with post-traumatic stress syndrome.
“Most
people who are phobic know in their hearts that they have to
face their fear, but it is so overwhelming for them,” said
Page Anderson, a therapist at Virtually Better and one of the
first to conduct this type of therapy. “But here they are
able to tell themselves, ‘I can do this in the virtual
world.’ Virtual reality provides enough clues that their
minds fill in the blanks. Then most of the time it will generalize
to the real world. It’s a manageable first step.”
Since
the terrorist attacks, Rothbaum says, the fears sparked by these
events are being addressed regularly in individual therapy situations
at the Virtually Better clinic. “The attack on September
11 was significant for everyone, and it is something we must
take into account,” she says. “Clinically, everyone
needs to deal with September 11.”
But
with time, Rothbaum says, most people’s fear will fade,
and appropriately so. “I really think that as time goes
on and there are no more incidents, they will fly again and
see that it’s fine.”
Despite
its recent rise, at its heart, the fear of flying is the same
as it has been since the first plane took flight nearly a century
ago. The basic structure of the treatment Rothbaum developed
will not be altered to acknowledge potential terrorist attacks,
she says, and the virtual reality element won’t change
at all.
“We’re
not going to expose people to crashing,” she says. “That’s
just not something that is realistic.”
