FLIGHT PATHOLOGY FOR PASSENGERS WITH A FEAR OF AIR TRAVEL, THERE IS RELIEF.

Byline: Evan Henerson Staff Writer

About one out of every six Americans gets nervous or anxious on an airplane, data suggest. Relatively few are in therapy for the condition known as aviaphobia. Most fearful fliers get through airborne hours with varying degrees of ease, occasionally relying on alcohol, medication, an engrossing book or a chatty flight partner.

Flight coping strategies haven't changed even with people more reluctant to take to the air. Post-Sept. 11, psychiatrist and fear-of-flying expert Dr. R. Reid Wilson said the calls streaming into his practice did not come from aviaphobics, but from newspaper reporters wanting to know just how safe planes are. Patient-wise, he said, business was rather slow.

``It's common that we have a significant drop-off of referrals after an incident like this,'' said Wilson, the North Carolina-based co-author of ``Achieving Comfortable Flight,'' a self-help package for the fearful flier. ``People's belief systems are reinforced that the world is more dangerous up in the sky.''

Administrators of several fear-of-flying treatment centers and clinics around the country reported a similar trend. People already in treatment for aviaphobia were more likely to continue their therapy, reasoning the terrorist attacks were the acts of desperate people rather than proof man was not meant to soar at 30,000 feet inside a motorized metal tube.

At the other extreme, those who couldn't set foot on an airplane before Sept. 11 were even less likely to seek treatment following the terrorist attacks. As Wilson noted, the attacks and the subsequent crash of American Airlines Flight 587 in Queens, N.Y., on Nov. 12 confirmed their fears and increased their resolve to stay on the ground.

There are no accidents

Aviaphobics are often suffering from another related anxiety disorder such as claustrophobia, fear of crowds or separation anxiety, according to psychiatrists and clinicians. Others are reluctant to place themselves in situations where they are not in control.

Ronald Doctor, a professor of psychology at California State University, Northridge, says fear of flying falls into several categories, none of which suggest a mental illness. Through his Woodland Hills-based practice, Doctor works with patients both individually and - less frequently - in groups. He has also developed a computerized version of his own fear-of-flying program.

Himself a former fearful flier, Doctor's ability to conquer the anxiety led to his desire to help others through similar issues.

``It's not a great clinical practice by any means, but I got more and more interested in it,'' said Doctor. ``I found fear of flying to be analogous to so many situations in life, situations where our own thoughts affect our functioning. Once you can deal with fear of flying, you can feel alive.''

People convinced a plane flight will result in death are facing some long odds. According to Wilson's calculations, since an individual has a 1-in-10-million chance of dying in a plane crash, even a person flying every day of his life would probably need 26,000 years before ending up on a plane that goes down.

Safety statistics, probability ratios (the average person is much more likely to perish in a car crash or of a heart attack) are useful tools, say counselors. So is education. During her seminars at the 25-year-old Fear of Flying Clinic, conducted at the San Francisco International Airport, Jeanne McElhatton brings in mechanics, pilots and flight crew members who give her clients a primer on aviation, from aerodynamics to weather. She also uses a behavioral therapist.

Meet your crew

Fearful fliers are often encouraged to get acquainted with the flight crew and, whenever possible, meet the pilot to help personalize the experience and dispel an ingrained belief that somehow the plane flies itself. Heightened security measures since Sept. 11 have made reaching out more challenging, as cautious flight crews are less likely to engage in conversation.

The clinic boasts a 90 percent success rate. Those who complete seminars usually finish with a ``graduation flight'' from San Francisco to Portland, Ore., or Seattle and back on the same day. McElhatton encourages her graduates to get back on a plane soon after completing the course.

``We don't call it a cure,'' said McElhatton, a licensed pilot who developed the Fear of Flying Clinic as a means of getting her partner's flight-fearful husband to take a trip to Australia. ``We hope they'll be able to fly comfortably from point A to point B without panic attacks, without adrenalin shooting clear off the ceiling.''

Panic or the accompanying embarrassment a panic attack might cause is enough to keep many fearful fliers from traveling by air. Wilson advises his patients not to fight their feelings: It's better to accept that you're nervous or afraid and convince yourself you can get through it.

The most recent data on aviaphobia - commissioned by Boeing - are more than 20 years old. Psychiatrists speculate the airline industry doesn't want to spend money on research, which could potentially damage the industry. A flight attendant working on a master's degree while volunteering for McElhatton's clinic put several of the clients through some standardized psychological testing only to conclude there is no concrete profile of a fearful flier.

``Everybody's concerns are so individual,'' says McElhatton, ``and for a variety of reasons.''

Cristina Mack, an accountant in San Mateo, hated flying even before she took a flight to bring her mother-in-law to the West Coast following a death in the family. The flight itself was smooth, but Mack said she got off that plane and swore off air travel. She didn't fly again for 19 years.

``It was just the most miserable personal circumstance I could imagine at the time. Then it became a whole lot of other things,'' says Mack. ``Usually this the case. We find with a lot of people, (there is) something else that's happening in their life. Flying is the easy thing to pin it on.''

After going through McElhatton's clinic, Mack had a couple of key ``aha!'' moments. Learning about the physics of aerodynamics helped put things in perspective. So did controlled breathing and the realization a panic attack is actually a chemical reaction.

``My major problem was panic,'' Mack said.

Not only does Mack now love to fly, she accompanies Fear of Flying Clinic clients on their graduation flights and seeks out nervous fliers on routine flights. A bad experience on a flight - whether a bumpy ride or flying for an unpleasant reason - can kick a nervous flier into full-scale aviaphobia.

The condition, psychiatrists say, usually develops in adulthood. Dr. Alan Chroman, a Beverly Hills psychiatrist who works with Century City Hospital, advises his nervous fliers to think back to pleasant flight experiences, like those during which nothing happened.

Again, easier said than done when your mind focuses instead on images of planes smashing into the World Trade Center towers.

Powerful images

``Sept. 11 was so powerful, so visually ingrained that it tends to overwhelm a lot of people's most recent thought about flying,'' says Chroman.

Most fear-of-flying instructors and counselors say ignoring the concept of flight risk is unwise. Yes, airplanes fall out of the sky and people do die. ``If flying were a perfect system, nobody would be afraid of it,'' says psychologist and pilot Michael P. Tomaro.

During the last 15 minutes of his class, before his ``Flying in the Comfort Zone'' students take their graduation flight from Milwaukee's Gen. Mitchell International Airport to Chicago, Tomaro talks about the concept of risk vs. reward.

``I don't say we're not going to die today. I say our chances of dying today are 10-million-to-1, and that it's worth it even if we do die today,'' says Tomaro. ``We risk 5,000-to-1 odds just to get to the airport. We should risk 10 million odds to do something that benefits our lives.''

Conquering high anxiety

So you have to board the metal bird, but you'd rather not. You're hardly alone. The following is a list of steps you can take to make that flight a little more comfortable for yourself. They come from Dr. R. Reid Wilson, associate professor of clinical psychiatry at the University of North Carolina, Chapel Hill, and are adapted from his self-help manual, ``Achieving Comfortable Flight: Taking the Anxiety out of Airline Travel.''

1. Trust the airline industry - Airplane travel is the safest mode of modern transportation, but if you don't believe the statistics, seek out information about air travel including pilot training, aircraft construction and maintenance, the air traffic control system, the monitoring of weather systems and all the normal sights, sounds and sensations while you're on a flight.

2. Accept your feelings - If you struggle against anxious feelings, you will cause an increase in the feelings you're trying to reduce. Instead, tell yourself ``It's OK that I'm feeling this way. I expect to be nervous right now. I can handle this.'' Then work on believing those thoughts, not just repeating the words.

3. Handle your worries - Actively try to stop negative ``what if ...'' scenarios such as ``What if I have a panic attack?'' or ``What if something goes wrong?'' Reassure yourself with supportive statements like ``Turbulence may feel uncomfortable, but it's not dangerous'' or ``These negative thoughts aren't helping me right now. I can let them go.''

4. Breathe - Use straightforward and simple breathing exercises to relieve your body's stresses and quiet your mind. Wilson recommends the ``calming breath'': Completely exhale, then take a long deep breath. Hold your breath to the count of three. Exhale very slowly, saying the word ``relax'' under your breath. Rest for about 15 seconds. Let your muscles go limp and warm, loosen your face and jaw muscles and quiet your thoughts. Repeat the process two more times.

5. Relax - Research shows that if you can loosen your muscles, your anxieties will fall away automatically. Wilson recommends the ``10-second grip'': Grip the arm rests of your seat tightly while you contract your upper and lower arms, stomach and leg muscles. Hold the grip for 10 seconds as you continue to breathe. Let go and take a long calming breath. Repeat the process two more times. Shift around in your seat, shaking loose your arms, shoulders and legs. Gently roll our head a few times. Close your eyes and focus on gentle breathing.

6. Take supportive actions - Reduce your caffeine and sugar intake the day before or day of your flight. Refrain from drinking alcohol before or during your flight. Pack a bag of pastimes for your flight such as a book, crossword puzzles, favorite music and snacks. Get to the airport early; don't rush. Watch planes take off for a while to get an idea of the motions you might expect. As you board the plane, if permissible, greet the captain and look in the cockpit. Consider mentioning to the crew and flight attendants that you sometimes get afraid on flights. During the flight, ask flight attendants about any sensations that bother you.

- Evan Henerson

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) Fearful fliers

Counseling, knowledge can help people overcome anxieties that were intensified by Sept. 11 attacks

John Lazar/Staff Photographer

(2 -- 3) Landing in an airliner, above, is the least of the worries of some of those who fear flying, like John Lithgow's character, below, in ``Twilight Zone - The Movie.''

Box:

Conquering high anxiety (see text)