Comparing airline crews' approach to fearful patients taking a flight, accompanied by their psychologist

Every so often you get a chance to see how two airlines competing in the same market place for the same customers, truly compare. I did this on the weekend, accompanying a patient to Sydney and return as part of her fear of flying treatment with me. Let's say at the outset that ordinarily, when psychologists write publicly about patients, they usually try to obscure the patient's details so they cannot be identified. Some even go to the extent of writing in a way that the patient themselves cannot identify they are the subject of the story. One can do this by taking an amalgam of patient experiences and conjuring up one story, true in its elements, but not true to it being the sole experience of one person. It's quite an old literary technique to preserve confidentialities and protects informants and useful sources of information.

One of the problems with fear of flying, when using an exposure based model - that is, actually getting on board aircraft with patients - is that there is always a breach of confidentiality when introducing onself and one's patients to crew. For most patients, this is seen as the cost of doing the business of behaviour change. For myself, it's also a part of doing continued business, so that where possible and with the acknowledgement of the patient, I'll let the airline know ahead of time that we are flying with them soon.

I have regularly done this with QANTAS in Melbourne, contacting Duty Managers by phone or fax, especially when I have spoken to staff recently about getting patients on board stationary aircraft as part of the exposure program. (Not all patients need this, but some are clearly advantaged by this in vivo treatment).

I expect nothing from QANTAS - no special service, no upgrades, no special attention. But there have been times in recent months when my good relationship with QANTAS staff at Melbourne has been especially useful in unexpected situations, and so I find it best to maintain good professional relationships where I can.

I have tried in the past to do the same with VirginBlue, based in Brisbane, but have been consistently rebuffed or my emails have gone unanswered. Bear in mind that these dealings have been with VirginBlue management, and not with crew.

This past Sunday, my patient followed my guidance and booked flights to Sydney on QANTAS and return on VirginBlue. This was no accident, as I had suggested that our first flight together, following several sessions using Virtual Reality and elevators (to help work with the claustrophobic aspects of her presentation), would best be served on the largest aircraft we could fly on as inexpensively as possible.

This turned out to be QF73, a 747-400 from Melbourne's International terminal into Sydney's International terminal. This service then continues on to San Francisco, so is a great way for patients to experience international check-in, customs, and the excitement of people travelling overseas. And it's the same price, and often cheaper, than the usual domestic flight. For some it's more of a hassle, since you cannot use the automated check-in facilities and must get to the airport earlier, but for therapeutic purposes, it's very beneficial.

Also, depending on the time of year, the flight can often be half-full, giving the claustrophobic patient a better opportunity to deal with being in "a large tin can" which is not too crowded. You still can't get off, but there is a greater sense of abundance of air to breathe and room to move.

After clearing customs and security, we spent some time in the international waiting area near Gate 8 contemplating the best time to board: wait until most people had boarded, or get on early and wait on board for the flight to commence. Given that anticipation of feeling uncomfortable was a primary concern, it was agreed to board early and spend more time on the plane, dealing with any urges to get off (escape) into "freedom". Which is what we did, with plenty of time before the scheduled departure.

Once we got our seats (we'd been moved from the back of the plane where the computer had put us to just behind business class by the check-in staff who didn't know of our purpose for flying that day), we settled in and I asked about her boarding experience. My patient thought about it and admitted to a mild case of "jelly legs" on boarding, a sign of physiological arousal. So, I suggested she deplane and do it again, and use some of the training we'd done to reduce her arousal and board without the jelly legs. This she did, and reported improvement. But she also reported some quizzical looks and questions from the cabin crew stationed at the door, who didn't know our purpose for being on board. In fact, while the patient had been heading back out, I had located the cabin crew member servicing our area and explained our purpose for flying, and reassured him, together with my business card, that it ought to be smooth sailing, and we needed no special attention.

On her return, he greeted her and explained that if there was any assistance she required, she should let him know.

When I asked her mid-flight about the experience, she said that the cabin crew seemed more apprehensive than she felt! But overall, the impression left was one of professionalism and courtesy.

During the flight, we were checked on once more, and done so quite discreetly.

Disembarking after a rather uneventful flight which took us to the west of Sydney, then landing to the north on the main runway, RW34L (over lots of water of Botany Bay), my patient was able to experience a roll-out where the 747's weight allowed it to roll past RW25 (the east-west runway) towards the terminal without the need for energy using reverse thrust, and with just a dab of brakes, the giant plane was brought off the active runway onto taxiway then tarmac. From there, we disembarked (I left behind my boarding pass which was required to clear Sydney customs, so had to go back and retrieve it) then we caught a bus over to the domestic terminal for the VirginBlue flight to Melbourne in 90 minutes.