Planning and Starting Your Flight
Just planning a flight can cause anxiety. The amygdalae respond whenever anything non-routine comes to mind. Since you don’t routinely fly, each planning issue you consider properly triggers the release of stress hormones. You may prefer to keep planning out of mind. It seems that the more attention you pay to planning, the more anxious you become. That may be true—but only up to a point. There is an anxiety peak. After that, you start gliding downhill. Each time you, as the CEO, decide what to do about an issue and commit to a plan of action, your assistant Amy is signaled to get her fingers off the intercom and leave you alone, at least about that issue. Once you start making decisions and commitments, you are over the hump. It gets easier. When your planning is done, you will feel better. You know what you are doing, and what to expect.
Choosing an Airline
Not all airlines are the same. When choosing an airline, there are several factors to consider, the fare being just one. Though all airlines must comply with government regulations, these are minimum standards. Some regulations are archaic and do not adequately protect the public. New airlines and low-fare airlines rarely exceed these minimum standards. Established airlines generally have higher standards. Ask yourself these questions:
Look at www.airsafe.com for accident rate statistics. Compare the statistics. If the airline is not listed, it has not flown enough flights to produce meaningful statistics.
Some anxious fliers feel more confident when they’ve done due diligence by executing this research. Most, though, find it unsettling to consider safety issues at all. If this is so for you, just know that any airline you pick is far safer than travel by automobile. Spending a day flying is safer than spending a day following your usual routine, if your routine involves driving. How can you be sure of that? Research by Michael Sivak and Michael J. Flannagan, both from the University of Michigan Transportation Research Institute, has shown that driving just 10.8 miles on an interstate highway, or approximately five miles of urban driving, has the same risk of fatality as taking a flight all the way across the country or even to another continent.
About Business Aviation
Though the safety record of business aviation does not match that of the airlines, travel on a private jet is far safer than driving. That said, there are ways to avoid the problems that have led to the higher accident rate. If you are the person in charge when flying on a business jet, leave the decision about whether to delay or cancel the flight completely up to the pilots. The pilots know what they should do. But executives with important business to negotiate have been known to throw a pilot’s judgment off balance, without knowing they are doing so. The pilots are in a difficult position. If they take a stand, you may move your business elsewhere, and the pilot could be in trouble with his company for losing your business. So my recommendation is that you say not one word to the pilots about how important the flight is. If the pilots say they may need to delay or cancel the flight, the next words from you—even if you are the CEO of a major corporation—should be, “You’re the boss.”
If you are not the person in charge, keep an eye on the person who is. If you sense he or she is influencing the pilots, talk to the pilots privately.
Thinking, Fast and Slow
Nobel Prize winner Daniel Kahneman has written a book titled Thinking, Fast and Slow. There are an amazing number of insights in the book about how the mind works. He reveals that there are two different mental systems: One is quick, and one is slow. They both are useful. For example, we need intuition (thinking fast). In some cases it is accurate; in others, it is way off base. How good fast thinking is depends upon experience and training. He writes, “We have all heard such stories of expert intuition: the chess master who walks past a street game and announces, ‘White mates in three’ without stopping, or the physician who makes a complex diagnosis after a single glance at a patient.” Most of us, he says—excluding chess masters and brilliant physicians—have to work at thinking; we have to use slow deliberate thinking to obtain the right answers.
I think this applies to fear of flying. Most people have limited experience about how flying works. But they have a lot of experience reading about crashes or seeing what claim to be documentaries about crashes on television (most documentaries are grossly misleading). Unless one is a frequent flier, most of our experience with flying comes from the media, and most of that is about crashing. This means our fast thinking—based on our television-viewing experience—tells us flying is quite dangerous. But the fast thinking of pilots—based on real experience with flying—tells them that flying is remarkably safe.
Is there a way your fast thinking can accurately reflect flight safety? Imagine you are a reporter, and your job is to gather information on every flight that takes off and lands in the United States. You are going to spend one minute gathering information on each and every flight. Let’s figure you work a forty-hour week, fifty weeks a year, for forty years. You study sixty flights an hour, for eight hours a day; that’s 480 flights a day, 2,400 a week, and thus 120,000 flights a year. If you do that for forty years, you study 4,800,000 flights. At that point, you turn the job over to a new reporter who does the same thing for forty years. At the end of the second reporter’s career, there is still less than a 50/50 chance that either you or he gathered information on a crash. Both you and your successor, when using your fast thinking to answer the question, “Is flying safe?” would most likely say, “Yes, in my experience, it is absolutely safe.” Your experience in this case would overestimate safety. Only after a third reporter had spent forty years doing the same thing would the 50/50 mark be reached. There is a 50/50 chance the third reporter would answer, “Well, flying isn’t absolutely safe, but it is awfully safe because in all the time I reported on flying, there was just one crash.” But, since there is a 50/50 chance this third reporter would not run into a crash, he might still say, as the first two did, “Yes, in my experience, it is absolutely safe.” (By the way, these numbers are based on findings by MIT professor Arnold Barnett, who says that, based on airline flying in the United States from 2000 through 2008, the chance of fatality when boarding a random flight was one in twenty-three million.)
Your experience allows a more accurate assessment of driving. In the same way the reporter is aware of every flight (not just flights that crash), you are aware of every car trip you take. You know the result of each. And since you rarely have an accident, your fast thinking gives you the feeling that driving is—at least if you are in control—absolutely safe. Even so, if your slow thinking thoroughly studied road accidents, it would recognize driving—even with you in control—is not absolutely safe. What, then, happens when your fast thinking about driving and your slow thinking about driving collide? You think, “Yes, accidents can happen, but I’m a safe driver, and even if I have an accident, I will be able to walk away from it.” It is very hard indeed to accept that your own driving could result in your demise.
That, again, is a bias error. Why? Fast thinking—based on personal experience—contains a bias error because you have never been killed in an accident. Therefore, you fully expect, when you drive, to get to your destination just fine.
When you consider taking a flight, your fast thinking about flying based on media exposure (it’s dangerous) slams into your fast thinking about driving (it’s safe). What would it take to give up your fast thinking, which is, Kahneman says, lazy thinking, and dig into the matter? It’s not even necessary for you to do the work. Why? It’s been done for you.
Since 95 percent of airline accidents occur during takeoff and landing, risk of flying depends almost entirely on the number of flights involved in the trip. The length of the trip is not significant; a long flight has pretty much the same risk as a short flight. But with a car, as Sivak and Flannagan pointed out above, the risk of fatality depends upon how many miles are driven.
In terms of time, at fifty-five mph, eleven minutes forty-seven seconds of driving equals the risk of taking a flight. Since the average airline trip is 694 miles and takes about an hour and a half, eleven minutes forty-seven seconds of driving has the same risk of fatality as the average airline flight. But it also means that eleven minutes forty-seven seconds of driving equals flying eight hours to Europe or flying fourteen hours to Asia.
If stats don’t reassure, my personal experience may help. I flew with the airlines for thirty-one years at a time when planes were not nearly as good as they are today. I know literally hundreds of pilots and hundreds of flight attendants who flew year in and year out, all over the world. Each spent an entire career in the air. And yet, I do not know one single pilot or one single flight attendant who was ever harmed in an accident.
Preboarding Strategy: Meeting Your Captain
The only thing that was an absolute must for me was meeting the pilots. It helped tremendously. I worried at first that they wouldn’t understand, or would think I was weird. Just the opposite; they always were very understanding. Most said they had family members who didn’t like to fly. But, the pilots are always great. When they pulled out photos of their kids, that did it. Knowing they were going to make sure they made it back home to their children was all it took for me. Having met them on so many flights, I don’t feel like I need to do that anymore. I just settle back in my belief/knowledge/experience that they know what they are doing and do it extremely well.
To facilitate meeting the captain, prepare two letters (see samples in Appendix B). One is for the passenger service agent in the boarding area. It asks that you be allowed to board early. The other is for the captain, explaining you are an anxious flier and are working on overcoming difficulty with flying. It asks that you be allowed to visit the cockpit when you board. While the plane is on the ground and sitting at the terminal, this shouldn’t pose a problem and is still allowed. You have to board early so the flight attendants have time to run the letter up to the cockpit or tell you there isn’t time for you to meet the captain.
Get to the boarding area early. Present the first note, or simply tell the gate agent that you are an anxious flier, you’re working on overcoming flight anxiety, and you’ve been told it makes a big difference if you can meet the captain, and you need to board early so there’s time once onboard to do that. Don’t expect the gate agent to give you permission to meet the captain. That can come only from the captain. What you need from the gate agent is permission to board early. If the gate agent agrees to board you early, ask if you should stay close by or stand by the entry point. If the gate agent is not cooperative, just go and stand as close to the entry point as possible. Listen for the first boarding announcement. It usually goes like this: “We would like to invite our first-class passengers (or passengers in a certain zone) to board at this time.” This is followed by “people with children, and anyone who needs extra time.” Extra time? That’s you. It doesn’t matter where your seat assignment is, if you qualify as needing additional time, you can board ahead of your row number. But don’t wait to hear that. As soon as you recognize the beginning of the boarding announcement, get on the plane. Don’t wait for the announcement to end. Boarding early is important. The flight attendants take your letter up to the captain only if you are on the plane at the beginning of the boarding process.
From a chat room discussion at www.fearofflying.com:
Captain Tom: Jennifer, once you meet the captain, you will get a good feeling about him or her. All captains have to go through the same training. If they can get through a check ride in the simulator and a check ride with a flight check captain in the plane, they’re fine.
Captain Steve: Hi, Jennifer. That’s right. That’s why I ride as a passenger with no worries whatsoever.
Captain Tom: No simulator instructor or flight check captain is going to turn someone loose with an airplane that they do not have 100 percent confidence in.
Jennifer: Thanks! That is reassuring!
If You Can’t Meet the Captain
On some foreign airlines, flight crew members don’t know about fear-of-flying courses. If you receive a blank look when you ask them to let you meet the captain, that may be the reason. When the plane is under way, you will be all right even if you don’t meet the captain. Though it would help you feel better about letting go of control. A client posted the following on the SOAR message board:
Letting go of control doesn’t mean you’re at one with the universe. Letting go doesn’t mean you are prepared for the inevitable doom that is chasing you down and will only catch you on that damn plane. Letting go just means that you realize you’re going to be just fine and that worrying, fretting, or being anxious won’t affect the reality of the situation.
So, whether you meet the captain or not, once the plane has departed, that is a closed issue. You will stop worrying about your decision. The Strengthening Exercise will “kick in” and take care of you.
Onboard Strategy
A flight attendant will ask for your boarding pass and point you toward your seat. Instead of going to your seat, find a flight attendant who is not tied up at that moment. A good place to look is in the galley. Ask the flight attendant to take the note to the captain while you wait. Say, “I’m an anxious flier, and I’m working on it with someone, and he says it’s really important for me to meet the captain. I understand about security so I don’t want to go up to the cockpit unannounced. Please take this letter up to the captain for me.” Place the letter in the flight attendant’s hand like you are serving a summons. Then say, “I’ll wait right here while you check with the captain.”
Two things can go wrong, so be prepared:
Do not approach the cockpit on your own; just have the letter carried there. If the captain receives the letter, he or she will likely meet with you. Approach the cockpit only if accompanied by a flight attendant. If the captain or flight attendant signals from inside the cockpit to come up, don’t. A sky marshal might not be able to see the signal. Wait to be accompanied. Captains are usually more than happy to help anxious fliers. Don’t worry about interrupting anything. The pilots finish their initial checks before passengers board. Ask the captain about expected turbulence and the destination weather. Let the captain know it will help if he or she makes extra announcements about what’s going on. Also, about twenty to thirty seconds after leaving the runway, the noise-abatement procedure calls for engine power to be reduced and the nose lowered (which causes a feeling of light-headedness). The noise-abatement procedure is more noticeable on some takeoffs than on others. Ask the captain if the change will be significant enough for you to notice it.
Why Does Meeting the Captain Help So Much?
If you could fly in the cockpit, you would have a great flight. Instead of imagining what might be going on, you could see competent pilots in complete control. Since you can’t do that, the next best thing is meeting the pilots who are going to be in control.
When you take your seat, picture the cockpit. Picture the pilots in complete control. Picture them in control of takeoff. Picture them in control during cruise. Picture them in control during landing. If you hear a noise or feel some unexpected motion, picture the captain’s confident face, realizing that he or she knows how to deal with anything that could possibly happen. Each year, he or she practices everything that could go wrong in the simulator.
Everyone knows about Captain Sullenberger’s landing in the Hudson River. And, most probably, if you knew you were flying with him, much of your concern about your flight would vanish. Your confidence would come from knowing he was severely tested and that he passed the test. You should also know that what every airline pilot goes through yearly in the flight simulator is far more of a test. What Captain Sullenberger did is what every airline pilot can do. The pilots you will be flying with could do what he did just as well as he did.
Medication
I am a former extremely fearful flier. I flew and loved it until I was twenty-five. My dad was an airline pilot, so I flew a lot. Then—out of the blue—I developed a big fear. I flew anyway, hating every second of it for the next ten years, using diazepam, booze, you name it. The shakes, the anticipation, the terror, it all increased until I just stopped. I couldn’t do it anymore. Even thinking about it had me in a cold sweat. The drugs don’t work. I started on one 5 mg diazepam—and felt more relaxed BUT then needed two, until I was popping five 10 mg pills per flight to try to stop myself from feeling the fear. They are no match for the fear. They mask it, make it worse, and stop you from getting rid of it. I understand why my doctor prescribed the diazepam, but he was lazy and ill-informed to do it. It prolonged my fear and stopped me from looking into real, long-term solutions. By taking a pill you are telling yourself you can’t cope. Every time you take a pill you are acknowledging the fear—setting off down a superfast highway of faulty thinking—and letting it win! By taking a pill you are saying this is a lifelong condition about which I can do nothing, over which I have no control. And it’s not true. I have flown nine times in the last year and I can tell you I now enjoy it. No drugs. No booze. I have stopped feeding the fear. I now trust myself and my brain to calm me.
If you’ve been using, or are considering using medication for flight anxiety, in light of research that shows serious drawbacks, you should reevaluate the decision with your physician. Anti-anxiety medications entail significant risks in flight, and they provide little if any benefit. In fact, they stand in the way of desensitization; by increasing the anxious flier’s sensitivity to flying, they complicate future treatment.
The World Health Organization has warned that sedatives should not be used for flight anxiety due to risk of venous thromboembolism (VTE). When sedated in a seated position, as is the case except in business class or first class, blood stagnates in the legs; that can cause clots that may travel to the lungs. Symptoms of VTE are chest pain and breathing difficulty. Death can result if not treated. Among healthy individuals, four hours of seated immobility doubles the risk of VTE, to one in six thousand.* The same risk may apply to sleeping medications as well.
* See WHO Research Into Global Hazards of Travel (WRIGHT) project on air tavel and venous thromboembolismat http://www.who.int/cardiovascular_diseases/wright_project/en/
Though benzodiazepines such as alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium) may reduce anxiety prior to flight, these medications can cause sharply increased difficulty if used during the flight itself. Control of panic depends upon the ability to distinguish imagination from reality. During flight, when mental acuity is needed, the use of such medications reduces reflective function and opens the door to psychic equivalence and terror. The same is true of alcohol.
In addition, use of anti-anxiety medication has been shown in research by F. H. Wilhelm and W. T. Roth at the Stanford University School of Medicine to cause two additional problems:
The medical research involved two flights. On the first flight, half of the anxious fliers were given alprazolam and half were given a placebo. On the second flight, no medication was administered. Results:
* The Stamford University School of Medicine research report is available at http://www.ncbi.nlm.nih.gov/pubmed/9299803
Since medication makes it increasingly more difficult to fly, the amount needed to control anxiety increases. When the medication loses its effectiveness, some passengers become desperate and, in a state of panic, may imbibe alcoholic beverages, even though they know the combination is dangerous. When taken together, benzodiazepine and alcohol reduce the breathing rate, possibly to unacceptably low levels, and can cause unconsciousness or death.
By reducing reflective function, anti-anxiety medication can cause the person to believe what they most fear is actually taking place. For example, in routine turbulence, the medicated passenger can believe the plane is plunging out of the sky. After the flight, instead of recognizing the problem was imagination, they continue to believe the plane fell thousands of feet. They credit medication for making it possible for them to endure the near-death experience. Further medicated flying causes additional experiences of terror, until the person can no longer fly at all.
The same is true of alcohol, depending upon how much alcohol is used. Anti-depressant medications that have a mild anti-anxiety effect on the ground are, anecdotally, ineffective in flight. Natural tranquilizers, such as valerian root or chamomile, except for a placebo effect that can be significant when a person believes in a product, offer little if any relief.
In the short term, the effectiveness of medication in reducing either anxiety or panic varies from individual to individual. In the long term, benzodiazepines appear to cause the person’s ability to fly to deteriorate. Most anti-anxiety medications expose the user to several serious risks, including that of dependence. Even the occasional use of alprazolam at the recommended dosage has been known to cause seizure. When anti-anxiety medications do successfully sedate the fearful flier, they increase the VTE risk. Because it’s so problematic, some psychiatrists will not prescribe benzodiazepines under any circumstances. Therefore, the use of anti-anxiety medication for flight anxiety can rarely be justified.
The toughest part of your flight—now that you have learned and practiced the Strengthening Exercise—is in the boarding area. Once you meet the captain, anticipatory anxiety falls away. Anticipatory anxiety is mostly about giving up control. Once you meet the pilots, it feels right for them to be in control. They care about themselves. They care about their families. And now they care about you. At this point, all your tools and skills and practice will kick in. But until you meet the captain, use the 5-4-3-2-1 Exercise whenever you notice anxiety.