Volume 77
Number 4

Health for All

Fear of Flying

Flying II: High Anxiety

Virtual Vietnam

Uncovering the Past

Wired New World

Enigma: Physics Band

Emory University

Association of Emory Alumni

Current News and Events

Emory Report



Sports Updates





















































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.”

First person: Associate Editor Paige Parvin faces her fear of flying.

For more information on virtual reality exposure therapy, call Virtually Better at 404-634-3400 or visit www.virtuallybetter.com.

A related story is also available at:





© 2002 Emory University