Friday - February 27, 2009
Almost all fearful flyers who have done well will experience the odd return of fearful thoughts and feelings in the days before their next flight.
Here's one patient's story and my guidance for dealing with this challenge.
Many people who have worked hard to manage their fear of flying learn that the best way to keep their fears at bay is to keep flying, each time practising their learnt skills, behaviour and ideas.
Every so often, a patient will phone me a day or two before a scheduled flight for a brief chat, having noticed a sudden return of their anxious thoughts and feelings.
These calls come out of the blue for me, and I usually have to be quick with some reinforcing words and ideas before moving on with my own tasks for the day.
This happened today when a patient who has now enjoyed much progress rang me, with pre-flight jitters. Because I had flown with her on several occasions and had observed her progress directly, I felt confident in being able to spend a few minutes with her sorting through what needed to be done to prepare her for her next day flight.
In this case, the most important thing is to remind the patient of the normality of the thoughts and thus sensations she was experiencing. That is, because she was accessing memories of previous flights as part of her preparation, the "quick and dirty" part of the brain was also tuning in, and sharing experiences. This part short-circuits the slower thinking, decision-making parts of the brain (the pre-frontal lobes) and is responsible for "act now, ask questions later" behaviours and thoughts.
This meant my patient needed to slow things down, by going through her diaphragmatic breathing exercises (the patient in question has purchased from me a heart rate variability device which allowed her to see if her breathing was of the right kind). Once responding with calm energy, she was instructed to say out a aloud and write down her thoughts about how safe the flight would be, certainly compared to being at home (outer areas of Melbourne are still under bushfire threat) and driving to the airport.
These were well-rehearsed thoughts, practised before a number of previous flights, and she knew they worked for her.
So the message is: It's normal and OK for old ideas to leap in when you're about to do something with which you have "history". The task is to recognise that these ideas are "old brain" ones, designed to get you to act quickly without much thought, and increase arousal levels. Any patient's task is to bring the frontal lobes into the problem solving mix, by better emotional regulation through arousal control (breathing) and appropriate self-talk, focussing on dismissing catastrophic thinking, and rehearsing seeing oneself saying positive sentences approaching various scenes in the flight "envelope", ie. leaving for the airport, arrival, check-in, waiting at the Gate for the flight to be called, boarding, etc.
All these plans can be used to move further and move from being an "automatic" fearful flyer to one who sets achievable goals and moves steadily forward.
Friday - January 23, 2009
Thinking about the issue of safety - it's the most basic of shifts in behaving that produces the best results.
Ideas for you to ponder - and not just for fear of flying, but for most anxiety situations.
The more I work in the field of anxiety, the more I become convinced that the task of the therapist is to guide his or her clients to feel safe.
I embolden the two words "feel safe" because I am taking the term "feel" quite literally. To feel safe enables one to take risks. That is, to go into areas or scenarios which may contain elements of risk - that is, possible surprises or unknown elements - yet feel competent in being able to manage whatever novel or unexpected event may occur.
In other words, if you were to only go into situations where the statistics gathered by others or yourself inform you that there is 100% chance of nothing harmful happening, you would find extremely few places on earth to offer that guarantee.
Because of the necessity to go about a world where 100% guarantees don't happen, our brains have become very inventive over millenia to help us ignore risks when they are right under our noses (and in full view). The flip side of this capacity is that we are also inventive when we are able to see danger when statistically risk is very low, or certainly much lower than other things we do with demonstrably higher risks.
Just as us seeing the world is not a property of our eyes (they are just signal detectors) but of our brains - where we make sense of all the lights, and colours and movement and shapes our eyes detect - so do our brains make sense of what seems to be safe from what appears to be dangerous.
The task of fear of flying treatment, no matter what style or methods are undertaken, is to help the patient "feel" safer in the commercial aviation environment. For some that will be a return to previously held feelings of safety before some life changing event took place (which may or may not be aviation related).
For others, who have never felt safe in the aviation environment, a different set of procedures to inculcate a sense of safety needs to be developed. Again, a "one size fits all" treatment strategy disrespects the individual and his or her concerns.
Which is why you can hear very different outcomes from the same treatment program. For instance, at the recent 3rd World Congress on Fear of Flying in Montreal in June 2007 (where I presented too) I heard a number of airlines speak of their programs. Each used their own flight staff as well as psychologists for "relaxation training" and to provide some explanations about anxiety and fear.
Each claimed about the same outcome result: about 95% of people in the course did the graduation flight. What we don't know and I didn't learn was how many people took how many flights in the year after the graduation flight.
What each of the courses had in common was a great deal of information about flying - how planes do it - and the training of crew to make the experience a safe one.
Where most of these courses fall down is the abundance of accurate information about commercial aviation, but a relatively low priority placed on human physiology and psychology. For me, that's where the action is for most patients who come to see me.
When patients know that their bodily sensations are adaptations to certain sensory information such as turbulence, accelerations, changes in engine noise, then they can start the work of normalising these reactions and not having a secondary reaction to them, i.e, being scared of being scared. In other words, both the triggers and the resultant sensations are normal aspects of flying and do not constitute danger. Thus, the alarm bells or panic button can be switched back to standby mode (rather than off).
Many people learn to switch to standby (or low level monitoring mode) using medications or alcohol which can moderate the body's natural ability to reset the alarm bells. The ability is the province of what is called the Parasympathetic Nervous System (PNS), which is one half of the body's automatic response system, known as the Autonomic Nervous System or ANS.
The major nerve which innervates the PNS is the Vagus nerve which both sends and receives information from and to the brain and various parts of the body such as the heart and gut. It is known as the 10th cranial nerve. The other eleven mainly innervate the head, neck and face.
When our alarm bells go off - whether the danger is real or imagined - the PNS decreases its activity so that its opposite number, the Sympathetic Nervous System (or SNS) can recruit many muscles to do the job of acting upon the presence of danger. Think of the PNS and SNS as opposite sides of a see-saw or teeter-totter. As one goes, up the other goes down.
Both animals and humans have similar nervous systems in this respect, and for both, the SNS kicks up a notch in the presence of perceived danger or threat, and causes the animal to either flee or prepare to fight. Sometimes, the brain makes a very quick decision that neither option will promote survival, and so the SNS is outranked by the activity of the PNS which engages the body in a freeze reaction, causing immobilization. We sometimes refer to this as frozen with fear.
This has survival properties in the hope that a predator will not notice a non-moving, non-breathing animal which appears to be feigning death. But this can only be sustained for a minute or two at most, before the animal needs to breathe once more. (Some animals use the same mechanism to go deep diving for long periods of time).
It's similar to going to a horror movie and hearing the audience collectively inhale and hold its breath when a scary image or sound is noticed. It's quite automatic and built into us for survival purposes. Only when we feel safe from danger can we return to normal breathing patterns.
People who are chronically stressed have a disturbed balance between the relative strengths of the PNS and SNS. Usually, stressed out individuals have very low PNS tone as it's called and an overactive SNS which leaves them strung out, irritable and tired. It also makes logical thinking and planning more difficult, and creative thoughts are hard to come by. In other words, the see-saw or teeter-totter is seriously out of whack!
Such people need to be taught how to increase their Vagal tone, and this can be achieved through learning breathing techniques combined with emotional shifts, such as feeling what it's like to have achieved something, or having cared for someone in your life. While I have mentioned the survival mechanisms of flight, fight and freeze, we humans have a fourth and that is to flow, which usually means relying on our social bonds and community to get us through difficult times.
In essence, what one is trying to do is teach the brain/body better means via practice to increase the effectiveness of the PNS and decrease the reactivity of the SNS when it's not needed to kick into action. This can be assisted by also changing one's thinking style to better reflect the reality of the presence of danger or its absence.
Unfortunately, too many therapists put all their eggs in one basket and merely try and help people change their thinking ("turbulence might be uncomfortable, but not unsafe") without helping their patients actually feel safe, in the full meaning of the words.
The virtue of going on flights with patients, or using some virtual means, is that patients do get to experience their uncomfortable sensations while being guided in how to modulate their impact via physiological shifts (e.g, don't hold your breath and don't bring in tension by gripping the seats), and changes to thinking, such as "I know what to do... I have a plan to use my new ways of thinking and breathing".
When patients integrate these two modes of danger reduction, they feel safer, and thus more likely to better estimate their chances of surviving a commercial flight. In other words, they feel it's OK to take a "risk" they ordinarily would avoid, knowing they have tools to manage the risk.
This sounds simple, but requires practise, and the hope generated with the therapist that the practise will pay off in the long run.
Unfortunately, from my perspective, too many Google searches on treatments for fear of flying see the promises of fast, easy and guaranteed "cures" which undermines the time and effort required for enduring success.
I wish it were as easy as many of the websites promise, but in my experience many of these changes are short-lived, don't last beyond the next flight, and don't generalise to other feared situations other than flying.
Tuesday - December 25, 2007
Some thoughts about claustrophobia on board aircraft
For reasons not yet apparent, I am seeing an
increasing number of patients reporting claustrophobia as a source of fear of
flying. Mind you, they're not reporting it as their sole source of fear
responses, but an important aspect contributing to their either not
flying at all, or flying under extreme
duress.
If this sounds like you, this blog entry will be of interest. If it's not you, no matter, keep reading to help you understand your own fears and models for what to do about them.
DEFINITIONS
Let's start with definitions, since the term claustrophobia is quite often used in daily speech. From there, we'll look at how several patients have used the term and what we've down about it.
The American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV), published in 1997 with a revision due in 2012, classifies Claustrophobia as an Anxiety Disorder, specific phobia, situational type. It includes fear of restriction and fear of suffocation, and may share some characteristics with panic disorder and agoraphobia.
Beyond fear of flying, claustrophobia can have dramatic, life-changing impacts on those who live and work in high rise buildings and need to ride elevators, those who attend theatres and nightclubs (always noting first where the EXIT signs are), and those who need to seek diagnostic assessment in devices like MRI scans, where it's estimated that between 4-20% of patients fail to complete the 50 minute assessment, which requires the person to lie motionless in a large donut-shaped tunnel-like device. Given the expense of such treatments, it's not surprising an increasing amount of interest is being shown by hospital staff in claustrophobia treatment.
ETIOLOGY
Research has attempted to divide claustrophobic threats into different categories, such as fear of entrapment and inescapability (think of miners trapped in a small hole in the ground), fear of asphyxiation or suffocation, and fear of loss of control in a confined space.
Some people can track the origin of their fears back to childhood events which traumatised them, such as being locked in a cupboard, lost in a cave, buried in the sand, trapped down a manhole, or near-drowning experiences.
Each of these events can be accompanied by panic-based thoughts, feelings, and physiological signs such as changes in breathing and heart function, felt as frightening experiences in and of themselves.
These events can become life-long avoidance behaviours, with individuals seeking safety and assurance wherever they go, requiring time-consuming planning before commencing even short journeys.
Yet many fearful flyers who report claustrophobia as a major concern do not report any significant history of entrapment. Yes, a few report an episode of being trapped in an elevator, or travelling on a bridge with large semitrailers either side, or in tunnels where no natural light can be seen and the traffic's not moving. Each represents a "dangerous" situation, where no actions of one's own can get things moving or alleviate any perturbing thoughts or feelings.
Some report that not being able to escape impending or anticipated anxiety elevations or likely places to re-experience a panic attack with no safety zone, as being central to their experience.
Occasionally, the fear of suffocation on board is central, and some appropriate aviation knowledge about air circulation needs to be supplied. (Air gets in and out of aircraft a high volumes. In through the engines, filtered and brought to room temperature using airconditioning "packs", then funnelled out through exit valves which also control pressure within the aircraft, holding it to around 8,000 feet when cruising).
TYPICAL PRESENTATIONS
But for most people it's the thought, with accompanying sensations, of being trapped and not able to leave at will that presents itself for treatment.
It's for this reason that I usually show new patients a video I call "ON BOARD" soon into our assessment. The video is one I took in the west wing of the QANTAS domestic terminal at Melbourne Airport. It shows live scene of the gate area, then a ticket check sequence, and a walk down the jetway as we go from landside to airside, and then on board the aircraft.
I stop the video at various times, and ask patients to rate their arousal, what they are noticing in terms of feelings, sensations and immediate thoughts. The latter I explore, probing for typical catastrophic or doom-laden ideas, and seek to know with the patient how they know them to be true. I'm not interested in how they began, but what's keeping them going.
I don't try to dissuade patients of their beliefs at this point, preferring to perform some more assessment with other videos to get a fuller picture of what's going on. Sooner or later, one discovers, with the patient, a set of ideas about survival, safety, luck, personal control and escape fantasies.
Let's take the example of a claustrophobic patient whose principle thought is "Once I step on the plane, that's it! I'm stuck here for 12 hours. Anything could happen - I could have a panic attack, want to get off, run up the aisles like a crazy person, and so on.
Typical apprehensions of non-patient populations are also likely on board flights but it sounds more like this:
"How am I going to stop myself from getting bored for 12 hours; will we make our connection on arrival; will my luggage make it; will I get the seat allocation (or upgrade) I asked for; will I be seated alone or next to someone who'll (yack all night, smell, occupy my seat as well, walk over me all night to get to the restroom); and so on...
These are the typical qualms of everyday travellers, a long way from the exotic notion of air travel several decades ago.
While many can sympathise with these modern day travel dilemmas, many cannot understand the fears of the claustrophobic. For the non-sufferer, elevators are tools to get us from A to B without having to climb scores of stairs, and plane travel means man less hours than train, bus or ship travel.
TREATMENT OPTIONS
It's important to drill down and get some understanding of the thoughts, behaviours and sensations which accompany claustrophobic behaviours. The urge to escape must be understood, or more to the point, what is it in the physical context that generates a demand to escape? One needs to peel away layers of thinking to get closer and closer to deeply held schemas to understand what's driving the demand to escape. It's not good enough to accept "I need to get off to get in control again" as the sole response. One needs to ask what would happen if control couldn't be accomplished and deal with that response. Many patients have not thought through their catastrophic ideas, because each generates much physical sensations, which reinforce the "truth" of their initial belief. Each layer must be understood and challenged with factual, plausible information about self and the environment, and where possible physically acted upon as incontrovertible evidence. As forceful as it sounds, it can still be achieved in a charming and playful manner, if you can find the right therapist.
For some patients, a course in breathing strategies will go a long way, especially if they have taught themselves to alter their breathing when presented with a noxious thought. Often, this change goes unnoticed at the outset, but can lead to unpleasant sensations due to hyperventilation or holding breath. These have significant impacts on Heart rate variability, decreasing what's called Vagal Tone (the vagus nerve innervates both heart and diaphragm) and is the equivalent of putting your foot down in your car and accelerating down a narrow winding street - very scary!
Once breath control has been achieved (and you can monitor your success with various heart rate equipment) then it's time to shift gears with respect to your feelings and thoughts.
I'll expand on the following sentence in another blog entry soon, but it goes to the heart of anxiety:
If this sounds like you, this blog entry will be of interest. If it's not you, no matter, keep reading to help you understand your own fears and models for what to do about them.
DEFINITIONS
Let's start with definitions, since the term claustrophobia is quite often used in daily speech. From there, we'll look at how several patients have used the term and what we've down about it.
The American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV), published in 1997 with a revision due in 2012, classifies Claustrophobia as an Anxiety Disorder, specific phobia, situational type. It includes fear of restriction and fear of suffocation, and may share some characteristics with panic disorder and agoraphobia.
Beyond fear of flying, claustrophobia can have dramatic, life-changing impacts on those who live and work in high rise buildings and need to ride elevators, those who attend theatres and nightclubs (always noting first where the EXIT signs are), and those who need to seek diagnostic assessment in devices like MRI scans, where it's estimated that between 4-20% of patients fail to complete the 50 minute assessment, which requires the person to lie motionless in a large donut-shaped tunnel-like device. Given the expense of such treatments, it's not surprising an increasing amount of interest is being shown by hospital staff in claustrophobia treatment.
ETIOLOGY
Research has attempted to divide claustrophobic threats into different categories, such as fear of entrapment and inescapability (think of miners trapped in a small hole in the ground), fear of asphyxiation or suffocation, and fear of loss of control in a confined space.
Some people can track the origin of their fears back to childhood events which traumatised them, such as being locked in a cupboard, lost in a cave, buried in the sand, trapped down a manhole, or near-drowning experiences.
Each of these events can be accompanied by panic-based thoughts, feelings, and physiological signs such as changes in breathing and heart function, felt as frightening experiences in and of themselves.
These events can become life-long avoidance behaviours, with individuals seeking safety and assurance wherever they go, requiring time-consuming planning before commencing even short journeys.
Yet many fearful flyers who report claustrophobia as a major concern do not report any significant history of entrapment. Yes, a few report an episode of being trapped in an elevator, or travelling on a bridge with large semitrailers either side, or in tunnels where no natural light can be seen and the traffic's not moving. Each represents a "dangerous" situation, where no actions of one's own can get things moving or alleviate any perturbing thoughts or feelings.
Some report that not being able to escape impending or anticipated anxiety elevations or likely places to re-experience a panic attack with no safety zone, as being central to their experience.
Occasionally, the fear of suffocation on board is central, and some appropriate aviation knowledge about air circulation needs to be supplied. (Air gets in and out of aircraft a high volumes. In through the engines, filtered and brought to room temperature using airconditioning "packs", then funnelled out through exit valves which also control pressure within the aircraft, holding it to around 8,000 feet when cruising).
TYPICAL PRESENTATIONS
But for most people it's the thought, with accompanying sensations, of being trapped and not able to leave at will that presents itself for treatment.
It's for this reason that I usually show new patients a video I call "ON BOARD" soon into our assessment. The video is one I took in the west wing of the QANTAS domestic terminal at Melbourne Airport. It shows live scene of the gate area, then a ticket check sequence, and a walk down the jetway as we go from landside to airside, and then on board the aircraft.
I stop the video at various times, and ask patients to rate their arousal, what they are noticing in terms of feelings, sensations and immediate thoughts. The latter I explore, probing for typical catastrophic or doom-laden ideas, and seek to know with the patient how they know them to be true. I'm not interested in how they began, but what's keeping them going.
I don't try to dissuade patients of their beliefs at this point, preferring to perform some more assessment with other videos to get a fuller picture of what's going on. Sooner or later, one discovers, with the patient, a set of ideas about survival, safety, luck, personal control and escape fantasies.
Let's take the example of a claustrophobic patient whose principle thought is "Once I step on the plane, that's it! I'm stuck here for 12 hours. Anything could happen - I could have a panic attack, want to get off, run up the aisles like a crazy person, and so on.
Typical apprehensions of non-patient populations are also likely on board flights but it sounds more like this:
"How am I going to stop myself from getting bored for 12 hours; will we make our connection on arrival; will my luggage make it; will I get the seat allocation (or upgrade) I asked for; will I be seated alone or next to someone who'll (yack all night, smell, occupy my seat as well, walk over me all night to get to the restroom); and so on...
These are the typical qualms of everyday travellers, a long way from the exotic notion of air travel several decades ago.
While many can sympathise with these modern day travel dilemmas, many cannot understand the fears of the claustrophobic. For the non-sufferer, elevators are tools to get us from A to B without having to climb scores of stairs, and plane travel means man less hours than train, bus or ship travel.
TREATMENT OPTIONS
It's important to drill down and get some understanding of the thoughts, behaviours and sensations which accompany claustrophobic behaviours. The urge to escape must be understood, or more to the point, what is it in the physical context that generates a demand to escape? One needs to peel away layers of thinking to get closer and closer to deeply held schemas to understand what's driving the demand to escape. It's not good enough to accept "I need to get off to get in control again" as the sole response. One needs to ask what would happen if control couldn't be accomplished and deal with that response. Many patients have not thought through their catastrophic ideas, because each generates much physical sensations, which reinforce the "truth" of their initial belief. Each layer must be understood and challenged with factual, plausible information about self and the environment, and where possible physically acted upon as incontrovertible evidence. As forceful as it sounds, it can still be achieved in a charming and playful manner, if you can find the right therapist.
For some patients, a course in breathing strategies will go a long way, especially if they have taught themselves to alter their breathing when presented with a noxious thought. Often, this change goes unnoticed at the outset, but can lead to unpleasant sensations due to hyperventilation or holding breath. These have significant impacts on Heart rate variability, decreasing what's called Vagal Tone (the vagus nerve innervates both heart and diaphragm) and is the equivalent of putting your foot down in your car and accelerating down a narrow winding street - very scary!
Once breath control has been achieved (and you can monitor your success with various heart rate equipment) then it's time to shift gears with respect to your feelings and thoughts.
I'll expand on the following sentence in another blog entry soon, but it goes to the heart of anxiety:
"We are feeling
creatures, who think".
I can't recall where I first read or heard this, but
when I did it rang so true that I have used it in many subsequent patient
sessions. Essentially, from an evolutionary perspective, our thinking and
language abilities came last in our
development.
More and more researchers are looking once more at notions of "gut feelings" and intuition, where words do not immediately capture our experience. In other words, we can process what's happening around us through our sensations and emotions, upon which is ladled thoughts. These are both thoughts about what we're experiencing, but also about how we're experiencing.
The how incorporates our body's reactions - outside of our control most of the time - to events we perceive.
It's also a two-way street, so if we say to ourselves, "My G-d! The plane door has closed!", we invite our brain to engage the feeling/sensation components and off we go, creating huge and frightening physical reactions, such as heart rate increase, which we then perceive as itself frightening and confirming of our perception of danger. The noose tightens around us, our breathing is interfered with, and we actually bring on the sense of suffocation we fear will happen!
Let me put it bluntly: Anxiety loves you to think in future language. What will happen, how will you cope, what happens if...., etc. It feeds off future catastrophic thinking where you don't check out risks and likelihoods, but accept your body's feelings and expressions as evidence that you need to worry.
So two forms of thought change need to occur:
1. Your thinking needs to stay in "here and now" style, not what if... Rather than ask rhetorical questions, you need to starve anxiety by making statement about what you will do NOW and in the next moment.
2. Your thinking needs to shift from certainty about future catastrophic events, to a more testable "let's see how this strategy works, and if it doesn't I'll resort to Plan B."
Meaning, rather than preparing escape routes before embarking on a challenging task, better to prepare a series of strategies using actions you are going to take. These actions must be ones that keep you in your feared situation, rather than aid you to escape.
I can't emphasise this point enough.
The more you prepare escape routes, and then experience relief when you take them, the more you feed Anxiety and make it stronger.
I discuss with patients a variety of activities and strategies they can perform when the going gets tough, and their thoughts and feelings are on the prowl. Beside going into breathing mode (and increasing vagal tone by breathing diaphragmatically - not too deep that you get dizzy, and somewhere between 6 -10 breaths/minute), it requires both thinking and behavioural strategies.
You need to have - ready to launch - a memory of a most pleasant, satisfying accomplishment, which you will pair up with your calmness-derived breathing in the face of Anxiety screaming at you that you need to leave.
You need to tell Anxiety you are not about to die even though it insists you will, and it sends out even stronger unpleasant sensations just in case you forget. It's not a matter of ignoring Anxiety. It must be told where to get off, and when to appear, when and if needed.
The more you confront, then do other than Anxiety's bidding, the weaker it becomes and the more "bedded down" are alternative behaviours to anxious ones.
If need be, turn Anxiety into a person, and give him or her a name, and converse with it. Have a reasonable and logical discussion about who is correct with the facts of flying and being enclosed. You may need to write down some of these ideas you propose to "discuss" on a 3 x 5 library card, because it's not always easy to remember your best arguments when you're highly aroused. And it's when you're highly aroused that Anxiety becomes super-sneaky, throwing all manner of reasons to escape at you.
Then you need to do what you need to do - head into an increasingly difficult set of challenging situations to confront Anxiety and test your abilities to put Anxiety in its place. Do this in the weeks before your next flight. It can mean heading into lifts, giving speeches and presentations or going to the airport and heading to the gate area and standing in boarding queues, where security allows this to happen.
Take note of where the exit signs are if this is your usual behaviour. Tell yourself, "I know where you are, and I'll use you (the signs) if I absolutely have to, but otherwise, I'm going to venture into challenging situations at will."
If you are have PDA or some other device, set it to give an alarm about four times during the day. When it goes off, check yourself and note what you are feeling at the moment. You need to learn to develop a better relationship with your ability to know about your "here and now" feelings. When you can name them, reinforce it with a thought or picture of your pleasant, satisfying accomplishment.
These "pairings" need to occur on a regular basis, accompanied by your breathing exercises, to tell Anxiety you're taking charge and getting control of those bodily sensations, thoughts and feelings you've till now thought out of your control.
Showing patients how they can do this, and allowing them to see how they can control what they thought were scary uncontrollable functions like a racing heart (and reinforcing this using biofeedback equipment) is extremely helpful to therapeutic progress.
Accompanying patients to airports or feared situations like tunnels also is extremely helpful, as I can both model new behaviours, provide evidence that what I'm doing is not dangerous, and check, monitor and reinforce anti-anxiety patient behaviours.
Whatever means you're using to overcome claustrophobia, it needs to incorporate an action plan for the times both before and during a flight. You need conspicuous evidence that you have a set of tools or strategies that you can have confidence in, which you know work, and for which you have back up plans... just in case. Above all else, you won't die from these uncomfortable sensations. By meeting them head on, you will strengthen you own sense of control.
More and more researchers are looking once more at notions of "gut feelings" and intuition, where words do not immediately capture our experience. In other words, we can process what's happening around us through our sensations and emotions, upon which is ladled thoughts. These are both thoughts about what we're experiencing, but also about how we're experiencing.
The how incorporates our body's reactions - outside of our control most of the time - to events we perceive.
It's also a two-way street, so if we say to ourselves, "My G-d! The plane door has closed!", we invite our brain to engage the feeling/sensation components and off we go, creating huge and frightening physical reactions, such as heart rate increase, which we then perceive as itself frightening and confirming of our perception of danger. The noose tightens around us, our breathing is interfered with, and we actually bring on the sense of suffocation we fear will happen!
Let me put it bluntly: Anxiety loves you to think in future language. What will happen, how will you cope, what happens if...., etc. It feeds off future catastrophic thinking where you don't check out risks and likelihoods, but accept your body's feelings and expressions as evidence that you need to worry.
So two forms of thought change need to occur:
1. Your thinking needs to stay in "here and now" style, not what if... Rather than ask rhetorical questions, you need to starve anxiety by making statement about what you will do NOW and in the next moment.
2. Your thinking needs to shift from certainty about future catastrophic events, to a more testable "let's see how this strategy works, and if it doesn't I'll resort to Plan B."
Meaning, rather than preparing escape routes before embarking on a challenging task, better to prepare a series of strategies using actions you are going to take. These actions must be ones that keep you in your feared situation, rather than aid you to escape.
I can't emphasise this point enough.
The more you prepare escape routes, and then experience relief when you take them, the more you feed Anxiety and make it stronger.
I discuss with patients a variety of activities and strategies they can perform when the going gets tough, and their thoughts and feelings are on the prowl. Beside going into breathing mode (and increasing vagal tone by breathing diaphragmatically - not too deep that you get dizzy, and somewhere between 6 -10 breaths/minute), it requires both thinking and behavioural strategies.
You need to have - ready to launch - a memory of a most pleasant, satisfying accomplishment, which you will pair up with your calmness-derived breathing in the face of Anxiety screaming at you that you need to leave.
You need to tell Anxiety you are not about to die even though it insists you will, and it sends out even stronger unpleasant sensations just in case you forget. It's not a matter of ignoring Anxiety. It must be told where to get off, and when to appear, when and if needed.
The more you confront, then do other than Anxiety's bidding, the weaker it becomes and the more "bedded down" are alternative behaviours to anxious ones.
If need be, turn Anxiety into a person, and give him or her a name, and converse with it. Have a reasonable and logical discussion about who is correct with the facts of flying and being enclosed. You may need to write down some of these ideas you propose to "discuss" on a 3 x 5 library card, because it's not always easy to remember your best arguments when you're highly aroused. And it's when you're highly aroused that Anxiety becomes super-sneaky, throwing all manner of reasons to escape at you.
Then you need to do what you need to do - head into an increasingly difficult set of challenging situations to confront Anxiety and test your abilities to put Anxiety in its place. Do this in the weeks before your next flight. It can mean heading into lifts, giving speeches and presentations or going to the airport and heading to the gate area and standing in boarding queues, where security allows this to happen.
Take note of where the exit signs are if this is your usual behaviour. Tell yourself, "I know where you are, and I'll use you (the signs) if I absolutely have to, but otherwise, I'm going to venture into challenging situations at will."
If you are have PDA or some other device, set it to give an alarm about four times during the day. When it goes off, check yourself and note what you are feeling at the moment. You need to learn to develop a better relationship with your ability to know about your "here and now" feelings. When you can name them, reinforce it with a thought or picture of your pleasant, satisfying accomplishment.
These "pairings" need to occur on a regular basis, accompanied by your breathing exercises, to tell Anxiety you're taking charge and getting control of those bodily sensations, thoughts and feelings you've till now thought out of your control.
Showing patients how they can do this, and allowing them to see how they can control what they thought were scary uncontrollable functions like a racing heart (and reinforcing this using biofeedback equipment) is extremely helpful to therapeutic progress.
Accompanying patients to airports or feared situations like tunnels also is extremely helpful, as I can both model new behaviours, provide evidence that what I'm doing is not dangerous, and check, monitor and reinforce anti-anxiety patient behaviours.
Whatever means you're using to overcome claustrophobia, it needs to incorporate an action plan for the times both before and during a flight. You need conspicuous evidence that you have a set of tools or strategies that you can have confidence in, which you know work, and for which you have back up plans... just in case. Above all else, you won't die from these uncomfortable sensations. By meeting them head on, you will strengthen you own sense of control.
Tuesday - December 18, 2007
Trapped in an elevator falling 15 floors - or did it? A Melbourne news story showing how easily our senses can be fooled.
It's not unusual to see patients referred for
treatment of their fear of flying to mention in the first session (or by email
when they make contact via this blog) mention other
fears.
These aren't just apprehensions or concerns, but vivid and intrusive fears which they acknowledge have two things in common:
1. The fears are intrusive and don't just occur when placed in the situation or context they fear, but when they think about it, or see it portrayed in the media, hear others tell stories about their fears, or find themselves in similar but not the same feared situation.
and
2. They acknowledge their fears - and more importantly their reactions to those fears - are beyond what is reasonable in their own mind, and now appear as a cost to their quality of life.
So it's not surprising that when patients consult me, or another professional who claims specialisation in the treatment of anxiety and "excessive fears" that they'll be asked about other fears. Common ones asked about (because they so often appear concordant with fear of flying) are fears of:
• bridges, tunnels, cars, ships and other forms of transport
• heights or movement (such as skyscrapers, elevators, rollercoasters, ladders, etc)
• animals, such as dogs, snakes, spiders, birds, etc
• potential contexts of social humiliation such as public speaking
• uncomfortable threatening physical signs of anxiety such as panic attacks, loss of control etc
Last week in Melbourne, an elevator company, Kone, was fined in the Magistrates Court due to a faulty elevator in a Melbourne hotel. A chef in the restaurant on the 35th floor of the hotel was in it when it failed and fell trapping him for 90 minutes.
This is the Melbourne Age newspaper's report of the hearing:
The Melbourne Magistrates Court today heard that chef Glenn Rochester entered the service lift in the basement of the Sofitel Hotel on June 5 last year to go to work on the 35th floor.
About 15 seconds later the lift fell, throwing Mr Rochester to the floor, and after it came to a halt it took 90 minutes to free the frightened chef, the court heard.
Mr Rochester said he believed the lift had fallen about 15 floors, but the court was today told it fell just 7.8 centimetres.
I want you to notice the most curious last clause. The frightened chef, thrown to the floor and likely very scared about what was happening, "believed" the elevator fell 15 floors.
The court heard evidence (from whom we're not told) that it "fell" 7.8 centimetres, about 3 inches.
Now, it's hard to fathom how someone can confuse 3 inches with 15 floors, but in a moment of terror, in an accelerating elevator, a confused estimation might result.
What's the point of telling you this story?
Well, there are a few. First, while elevators and escalators remain the safest forms of mass transport currently known, commercial aviation comes next. (Makes me wonder what your chances of injury were if you were a flight attendant onboard Lockheed L-1011 widebody jets which had a built-in one floor elevator.)
One rarely hears of elevator malfunctions, so when they do malfunction, it makes news, especially when fines of $50,000 are imposed, as in this case!
But also, similar to the way most passengers misinterpret movement in turbulence as being measured in "thousands of feet", in actual fact very little distance is covered in turbulence (in a vertical sense) yet our motion control organs (the vestibular system) gets it wrong because we have no external reference point to compare it to, just like our "falling" elevator. We trust our sense organs but in reality they are only a part of our total system that lets us know where we are in space and how fast we're travelling.
Because a fear of falling is so innate it's very easy to overestimate the distance covered during a "fall", trusting our sense organs to interpret distance rather than our eyes. In the elevator case, the trapped fellow had no external reference point to compare his sensations with, and so his estimate was 15 floors.
When you encounter turbulence, bear in mind that your reactions, physical and emotional, will likely be well and truly out of proportion to what's really going on. There's nothing wrong with you, it's the way our sense systems work in the absence of complete and verifiable data. Some of seem more prone to exaggeration than others, especially when it comes to our physical sensations or thoughts.
Always remember, that while turbulence may be uncomfortable, it is not unsafe.
These aren't just apprehensions or concerns, but vivid and intrusive fears which they acknowledge have two things in common:
1. The fears are intrusive and don't just occur when placed in the situation or context they fear, but when they think about it, or see it portrayed in the media, hear others tell stories about their fears, or find themselves in similar but not the same feared situation.
and
2. They acknowledge their fears - and more importantly their reactions to those fears - are beyond what is reasonable in their own mind, and now appear as a cost to their quality of life.
So it's not surprising that when patients consult me, or another professional who claims specialisation in the treatment of anxiety and "excessive fears" that they'll be asked about other fears. Common ones asked about (because they so often appear concordant with fear of flying) are fears of:
• bridges, tunnels, cars, ships and other forms of transport
• heights or movement (such as skyscrapers, elevators, rollercoasters, ladders, etc)
• animals, such as dogs, snakes, spiders, birds, etc
• potential contexts of social humiliation such as public speaking
• uncomfortable threatening physical signs of anxiety such as panic attacks, loss of control etc
Last week in Melbourne, an elevator company, Kone, was fined in the Magistrates Court due to a faulty elevator in a Melbourne hotel. A chef in the restaurant on the 35th floor of the hotel was in it when it failed and fell trapping him for 90 minutes.
This is the Melbourne Age newspaper's report of the hearing:
The Melbourne Magistrates Court today heard that chef Glenn Rochester entered the service lift in the basement of the Sofitel Hotel on June 5 last year to go to work on the 35th floor.
About 15 seconds later the lift fell, throwing Mr Rochester to the floor, and after it came to a halt it took 90 minutes to free the frightened chef, the court heard.
Mr Rochester said he believed the lift had fallen about 15 floors, but the court was today told it fell just 7.8 centimetres.
I want you to notice the most curious last clause. The frightened chef, thrown to the floor and likely very scared about what was happening, "believed" the elevator fell 15 floors.
The court heard evidence (from whom we're not told) that it "fell" 7.8 centimetres, about 3 inches.
Now, it's hard to fathom how someone can confuse 3 inches with 15 floors, but in a moment of terror, in an accelerating elevator, a confused estimation might result.
What's the point of telling you this story?
Well, there are a few. First, while elevators and escalators remain the safest forms of mass transport currently known, commercial aviation comes next. (Makes me wonder what your chances of injury were if you were a flight attendant onboard Lockheed L-1011 widebody jets which had a built-in one floor elevator.)
One rarely hears of elevator malfunctions, so when they do malfunction, it makes news, especially when fines of $50,000 are imposed, as in this case!
But also, similar to the way most passengers misinterpret movement in turbulence as being measured in "thousands of feet", in actual fact very little distance is covered in turbulence (in a vertical sense) yet our motion control organs (the vestibular system) gets it wrong because we have no external reference point to compare it to, just like our "falling" elevator. We trust our sense organs but in reality they are only a part of our total system that lets us know where we are in space and how fast we're travelling.
Because a fear of falling is so innate it's very easy to overestimate the distance covered during a "fall", trusting our sense organs to interpret distance rather than our eyes. In the elevator case, the trapped fellow had no external reference point to compare his sensations with, and so his estimate was 15 floors.
When you encounter turbulence, bear in mind that your reactions, physical and emotional, will likely be well and truly out of proportion to what's really going on. There's nothing wrong with you, it's the way our sense systems work in the absence of complete and verifiable data. Some of seem more prone to exaggeration than others, especially when it comes to our physical sensations or thoughts.
Always remember, that while turbulence may be uncomfortable, it is not unsafe.
Monday - December 12, 2005
Short versus long flights - could shorter flights be more stressful after all?
Quite a few clients say they dread
long flights based on their experiences of short flights, but is it possible
that long flights might be less stressful?
I have been seeing quite a few people lately who
have come to see me when they know they are soon to take a long-distance flight.
Here in Australia, that usually means an international flight of many hours
duration, usually in excess of 8
hours.
Few Americans ever take single flights of that duration, and perhaps the same is true of Europeans. Firstly, Americans tend not to travel internationally as much as Europeans and Australians, preferring if travelling for leisure to fly within their own country. We know this because of the statistics of how many Americans hold passports, usually required to travel outside the North American mainland.
Phil Gyford's site has a discussion from 2003 looking at the issue of passport ownership around the world (see link here) and the consensus seems to be the figure for the US is around 20%. For Australia, it is possibly 50%. But be cautious about quoting those figures in any kind of official correspondence!
What it means is that for me, as someone working extensively with fear of flying clients, I need to be prepared for the issues clients bring to the session about international air travel, while my American colleagues would best concern themselves more with domestic travel. Knowing lots about both, and also what happens in other countries with respect to their local airlines, procedures, security, as well as local customs and conditions is a good thing.
The fact that I travel a lot, and often to place coincident with the places my clients visit, is advantageous in the sense that knowing about the destination allows my client to become more excited and enthusiastic about it, especially if my exuberance is catching!
That said, I do get a high proportion of clients who present with fears on short interstate flights of a couple of hours, who believe the entire experience will be multiplied 3 or 4 times over with a flight that is 8 hours long. For a small proportion who have never flown to the US where the minimum flight time is 12 hours with very good tailwinds, that time on board feels an impossible ask. Or as one client said, "Hell off earth!"
But I have been thinking that for my clients who have spent time with me and then taken an international flight successfully, they often return to speak with me of what a great achievement it was, and that what we discussed about long flight turns out to be true: that it isn't the equivalent of 5 short flights strung together, and that indeed, the longer they are on board the less intense is their fear as the flight proceeds. Even turbulence and changes in engine power to climb above or around weather cells mid-flight is handled better than they expected.
Of course, we have usually prepared for this eventuality (it would be rare for a trans-Pacific roundtrip flier not to get any of this on an Australian-US west coast adventure).
The principle at work here is the same one that works for so much behavioural work with anxiety: the longer you stay in the feared situation without an event occurring the more the fear response subsides of its own course. Add in helpful tools such as index cards which contain challenges to false assumptions about flying, breathing techniques and how to cocoon and self-soothe, and you have the chances that a long flight is more helpful over the course of one's fearful flying "career" than many short flights.
The problem with short flights is that things often happen so quickly that there is too little time to really feel the results of utilising the tools learnt in therapy. In the cruise the time one can practise leaving the relative safety of one's seat might only be 30 minutes. Moreover, on short flights, single aisle aircraft such as 737s and A320s are utilised meaning one is discouraged from leaving the seat so the meal service can proceed in the short time available. Even though the flight attendants try to be courteous, they are operating under pressure, especially on airlines offering full service, and so can come off as "professionally brusque". And it can be easy to take that personally, rather than see they have a job to do, and limited time.
The other issue is the return on investment factor I like to think about. Let's say you fly from Sydney to Melbourne, about the same distance from LA to San Francisco. In the old days of prop jets like the Lockheed Electra (I loved the sound of those huge Allison engine with those great square propeller blades) and Vickers Viscount, flight time was 55 mins. Now it's about an hour and 20 mins, even though we are flying jets which climb and descend faster, cruise higher and much more quickly, and are of course more reliable with fewer flight crew. It's just that things are so busy at airports that holding patterns near descent are not uncommon because of the density of air traffic.
So, it might take 45 minutes to drive to the airport, 10 minutes for parking, then being sure you're there at least 30 minutes before the flight, then negotiate all the security, and make your way to the gate having checked in. It's no wonder I advise clients to try and take handheld luggage whenever possible. So you can actually spend more time in pre-flight activity than in the air itself. And the cruise, where you get a chance to feel the aircraft under minimal stress (compared to takeoff and landing) is often quite short by comparison. If you choose to eat, then you might only get 15 minutes to really try relaxing, and usually sleep is out of the question.
On a long flight, you get lots of time to practise many of the tools to overcome fearful of flying. With many flights leaving the US west coast late at night to come to Australia, even usually "wired" fearful flyers will find they sleep. That's often a breakthrough too, since so many think they could never allow themselves to sleep, since they must be "vigilant for anything going wrong."
The other advantage of long-haul flights for fearful fliers is that there are more crew on board (both cabin and flight) and with more "spare time" between predictable inflight events (such as meal services) you are more likely to have a chance to speak at length with one, and learn more about their jobs, and get your questions answered. many are very pleased to have an opportunity to discuss their work, and especially be of help to someone who is fearful of something airline employees are passionate about. Of course, not all crew will always be responsive, so that needs to be factored in and again, not taken personally if the interaction is not satisfactory.
It's for this reasons, I often suggest clients speak with cabin crew on entering the aircraft, as long as it seems a rush to get away is not occurring.
My usual suggestion is to present the greeting cabin crew with your boarding pass, and say something like:
"Hi, I'm in 31A, and this is my first flight since doing some work on my fear of flying. I'm really excited about seeing how I do, but I know it would really help if a crew member might visit me when there's time after the meal service and see how I'm doing."
There is no need to say your name, as they'll note this looking at your boarding pass, and it's the seat number they really need to remember. The cabin manager will usually inform the flight attendant taking care of your area of you, and if he or she doesn't visit you themselves, will usually suggest to another crew member of your presence. Sometimes, they might tear off part of your boarding pass and stick it on their manifest of all passengers on board as a reminder.
On very busy international flights where 400 people are boarding through one door, I would usually suggest not to doing the introduction bit at the jetway, but get to your seat and stowe your luggage first. When things seem to calm down, it might be time to introduce yourself to the crew servicing your cabin area in the same way I mentioned above. (I usually raid the various magazine racks for my personal preferences).
For this reason, I sometimes suggest pre-ordering a special meal (allow 72 hours), which usually gets delivered before the main cabin service, and matches passenger name with seat number. This way the crew get to know you. Of course, in business and first class, food orders are taken very early in the flight or even during the pre-boarding, when the cabin crew walk about with a manifest copy, and ask of your preferences using your name.
Sounds like this: "Mr Posen (checking the seat number I am in against the manifest to make sure I haven't moved), will you be having the steak or the fish entree tonight?"
Pretty civilised, huh?
So the easiest way to approximate this, is to order a special meal where they match up seat number, with passenger name, and meal preference.
In this way, the more you get to interact with your crew, the better your chances of seeing them in action and reinforcing the normality of the flying experience. Things happen, they happen on schedule, and they happen according to procedures. The more you get to see these in action, rather than hiding yourself away staring straight ahead, or buried in a picture book, the more relaxed you'll come to be over time. But the more you practise doing a short flight on board a long flight, the less chance you give yourself of coming to terms with your fears.
Bottom line message: It's OK to think long flights are more troublesome than short flights if you already have a fear of flying. But the reality is that the reverse might in fact be true, and you are best not to turn down the opportunity to do a long flight for this reason alone. The usual truth is that when applying the right tools of understanding and action, a long haul flight can really accelerate your progress and allow you to practise things almost impossible to do on short flights. After all, they have lots in common but sufficient difference to allow you to observe your fears over the long haul and plenty of time to really practise reducing your anxiety.
Of course, there are horses for courses, and those suffering fear of flying with a strong claustrophobia/need to exit symptomatology will need a different preparation than someone whose principle fears revolve around takeoff or landing.
Few Americans ever take single flights of that duration, and perhaps the same is true of Europeans. Firstly, Americans tend not to travel internationally as much as Europeans and Australians, preferring if travelling for leisure to fly within their own country. We know this because of the statistics of how many Americans hold passports, usually required to travel outside the North American mainland.
Phil Gyford's site has a discussion from 2003 looking at the issue of passport ownership around the world (see link here) and the consensus seems to be the figure for the US is around 20%. For Australia, it is possibly 50%. But be cautious about quoting those figures in any kind of official correspondence!
What it means is that for me, as someone working extensively with fear of flying clients, I need to be prepared for the issues clients bring to the session about international air travel, while my American colleagues would best concern themselves more with domestic travel. Knowing lots about both, and also what happens in other countries with respect to their local airlines, procedures, security, as well as local customs and conditions is a good thing.
The fact that I travel a lot, and often to place coincident with the places my clients visit, is advantageous in the sense that knowing about the destination allows my client to become more excited and enthusiastic about it, especially if my exuberance is catching!
That said, I do get a high proportion of clients who present with fears on short interstate flights of a couple of hours, who believe the entire experience will be multiplied 3 or 4 times over with a flight that is 8 hours long. For a small proportion who have never flown to the US where the minimum flight time is 12 hours with very good tailwinds, that time on board feels an impossible ask. Or as one client said, "Hell off earth!"
But I have been thinking that for my clients who have spent time with me and then taken an international flight successfully, they often return to speak with me of what a great achievement it was, and that what we discussed about long flight turns out to be true: that it isn't the equivalent of 5 short flights strung together, and that indeed, the longer they are on board the less intense is their fear as the flight proceeds. Even turbulence and changes in engine power to climb above or around weather cells mid-flight is handled better than they expected.
Of course, we have usually prepared for this eventuality (it would be rare for a trans-Pacific roundtrip flier not to get any of this on an Australian-US west coast adventure).
The principle at work here is the same one that works for so much behavioural work with anxiety: the longer you stay in the feared situation without an event occurring the more the fear response subsides of its own course. Add in helpful tools such as index cards which contain challenges to false assumptions about flying, breathing techniques and how to cocoon and self-soothe, and you have the chances that a long flight is more helpful over the course of one's fearful flying "career" than many short flights.
The problem with short flights is that things often happen so quickly that there is too little time to really feel the results of utilising the tools learnt in therapy. In the cruise the time one can practise leaving the relative safety of one's seat might only be 30 minutes. Moreover, on short flights, single aisle aircraft such as 737s and A320s are utilised meaning one is discouraged from leaving the seat so the meal service can proceed in the short time available. Even though the flight attendants try to be courteous, they are operating under pressure, especially on airlines offering full service, and so can come off as "professionally brusque". And it can be easy to take that personally, rather than see they have a job to do, and limited time.
The other issue is the return on investment factor I like to think about. Let's say you fly from Sydney to Melbourne, about the same distance from LA to San Francisco. In the old days of prop jets like the Lockheed Electra (I loved the sound of those huge Allison engine with those great square propeller blades) and Vickers Viscount, flight time was 55 mins. Now it's about an hour and 20 mins, even though we are flying jets which climb and descend faster, cruise higher and much more quickly, and are of course more reliable with fewer flight crew. It's just that things are so busy at airports that holding patterns near descent are not uncommon because of the density of air traffic.
So, it might take 45 minutes to drive to the airport, 10 minutes for parking, then being sure you're there at least 30 minutes before the flight, then negotiate all the security, and make your way to the gate having checked in. It's no wonder I advise clients to try and take handheld luggage whenever possible. So you can actually spend more time in pre-flight activity than in the air itself. And the cruise, where you get a chance to feel the aircraft under minimal stress (compared to takeoff and landing) is often quite short by comparison. If you choose to eat, then you might only get 15 minutes to really try relaxing, and usually sleep is out of the question.
On a long flight, you get lots of time to practise many of the tools to overcome fearful of flying. With many flights leaving the US west coast late at night to come to Australia, even usually "wired" fearful flyers will find they sleep. That's often a breakthrough too, since so many think they could never allow themselves to sleep, since they must be "vigilant for anything going wrong."
The other advantage of long-haul flights for fearful fliers is that there are more crew on board (both cabin and flight) and with more "spare time" between predictable inflight events (such as meal services) you are more likely to have a chance to speak at length with one, and learn more about their jobs, and get your questions answered. many are very pleased to have an opportunity to discuss their work, and especially be of help to someone who is fearful of something airline employees are passionate about. Of course, not all crew will always be responsive, so that needs to be factored in and again, not taken personally if the interaction is not satisfactory.
It's for this reasons, I often suggest clients speak with cabin crew on entering the aircraft, as long as it seems a rush to get away is not occurring.
My usual suggestion is to present the greeting cabin crew with your boarding pass, and say something like:
"Hi, I'm in 31A, and this is my first flight since doing some work on my fear of flying. I'm really excited about seeing how I do, but I know it would really help if a crew member might visit me when there's time after the meal service and see how I'm doing."
There is no need to say your name, as they'll note this looking at your boarding pass, and it's the seat number they really need to remember. The cabin manager will usually inform the flight attendant taking care of your area of you, and if he or she doesn't visit you themselves, will usually suggest to another crew member of your presence. Sometimes, they might tear off part of your boarding pass and stick it on their manifest of all passengers on board as a reminder.
On very busy international flights where 400 people are boarding through one door, I would usually suggest not to doing the introduction bit at the jetway, but get to your seat and stowe your luggage first. When things seem to calm down, it might be time to introduce yourself to the crew servicing your cabin area in the same way I mentioned above. (I usually raid the various magazine racks for my personal preferences).
For this reason, I sometimes suggest pre-ordering a special meal (allow 72 hours), which usually gets delivered before the main cabin service, and matches passenger name with seat number. This way the crew get to know you. Of course, in business and first class, food orders are taken very early in the flight or even during the pre-boarding, when the cabin crew walk about with a manifest copy, and ask of your preferences using your name.
Sounds like this: "Mr Posen (checking the seat number I am in against the manifest to make sure I haven't moved), will you be having the steak or the fish entree tonight?"
Pretty civilised, huh?
So the easiest way to approximate this, is to order a special meal where they match up seat number, with passenger name, and meal preference.
In this way, the more you get to interact with your crew, the better your chances of seeing them in action and reinforcing the normality of the flying experience. Things happen, they happen on schedule, and they happen according to procedures. The more you get to see these in action, rather than hiding yourself away staring straight ahead, or buried in a picture book, the more relaxed you'll come to be over time. But the more you practise doing a short flight on board a long flight, the less chance you give yourself of coming to terms with your fears.
Bottom line message: It's OK to think long flights are more troublesome than short flights if you already have a fear of flying. But the reality is that the reverse might in fact be true, and you are best not to turn down the opportunity to do a long flight for this reason alone. The usual truth is that when applying the right tools of understanding and action, a long haul flight can really accelerate your progress and allow you to practise things almost impossible to do on short flights. After all, they have lots in common but sufficient difference to allow you to observe your fears over the long haul and plenty of time to really practise reducing your anxiety.
Of course, there are horses for courses, and those suffering fear of flying with a strong claustrophobia/need to exit symptomatology will need a different preparation than someone whose principle fears revolve around takeoff or landing.
Friday - March 11, 2005
Flight Attendants - more than "trolley dollies" and "old boilers"
"I'm much more than a pretty face - and don't you forget it! I might save your life one day."
How people come to consult me always feels like
the spin of the roulette wheel: Did they hear about me and my work through word
of mouth, a previous client, an airline, another psychologist, a travel agent,
the Yellow Pages or this blog?
New clients seem to come in "runs". A run of those one week where it's turbulence at the centre of their concerns. Another week, it will be panic attacks on board. Lately it's been about safety - clients focussing on the extreme unlikelihood of an incident but believing it's their luck that the next incident will involve their flight.
Up to a point, one can use the safety statistics to begin the process of chipping away at assumptions which can be shown to be false, yet never tested. Other times, I feel like I'm going down a rabbit hole which is narrowing and I'm getting nowhere. In which case, we put the discussions of safety to one side, and perhaps focus on another aspect of their flying concerns, such as the physiological aspects of their fears This follows my belief that once clients can see and experience a reduction in uncomfortable sensations (e.g, heart thumping, legs twitching, perspiring, etc.) which they experience just thinking about an upcoming flight, we can make some headway with the safety matters.
(At other time, I go into clinical psychologist/therapist mode where the "action" may be more to do with relationships and work concers).
Eventually, it comes down to discussing human error as a partial explanation for why incidents occur. It's at this point we often discuss who's crewing an aircraft and their primary responsibilities.
Most clients say that the responsibility of the flight crew is to fly the plane, without knowing any detail at all of how this is accomplished nor the training required.
When it comes to flight attendants, many are surprised when I inform them that their primary role is as cabin safety officers. Serving drinks and meals is very much a secondary aspect of their role, even though it's the most conspicuous.
Flight attendants' lives look pretty glamorous, and indeed there are many benefits unique to their working lives. But at the end of the day, it's work. Sometimes, it's fun and exciting if you get a great crew and you're away from home for a few days in an exotic location, sharing first class facilities.
Other times, it might be up and down the coast, say between Melbourne and Sydney, or LA and Seattle, in an all coach setting with very little time between flights.
Fearful flyers often look to flight attendants as their cues to whether they should worry or not. Smiling, pleasant flight attendants are reassuring and comforting, and help keep fearful thoughts at bay. Worried, hassled, scowling attendants have the opposite effect, although I am quick to let clients know that a worried look on a flight attendant's face is unlikely to be about the aircraft's safety but perhaps some personal matter, like paying the last gas bill on time, or leaving enough food out for the cat. Or whether their evening dinner date will be on time. Or it could be the passenger in 6B gropes her each time she walks by his seat...
Cabin attendants take their safety roles very seriously, and take offense at being referred primarily as glorified waiters. Most of the time you will only ever see them in a safety role during preparation for takeoff and landing, where their task is to ensure the cabin is ready for that critical flight phase.
So aisle and floor areas need to be checked for baggage that may interfere with a quick emergency exit; that seat and tray tables are in the "locked and upright" position, again for unobstructed fast exits. And of course safety belts are fastened, so as to restrain you in case the plane comes to a very quick stop.
Of late, that safety work has extended to making sure mobile and electronic devices are switched off during the critical flight phases, and safety messages are delivered professionally.
(Small aside: Here in Australia, footballers are treated as heroes. During one fearful flyer course I ran for the now defunct Ansett Australia, the Cabin Manager who was part of the staff, had a run in with a leading hero about his use of his mobile phone at a prohibited time of the flight. Asking him several times to switch it off, he threatened to report the matter to authorities when the "hero" didn't desist. To which he was duly labelled, "You'd be a hero, wouldn't you...."
It was interesting to see how the airline backed him up when the story was eventually leaked to the newspapers, especially since the football league contract was a lucrative one. But the airline did back him, given the level of threat to safety cavalier footballers can pose, because of their hero status.
The same footballer by the way was at one point charged with sexual assault in an unrelated incident near a nightclub, and also the centre of a major scandal when he admitted an affair with a team mate's wife, and stood down from his position of team captain.
A further coincidence is that I once flew seated next to the same footballer as a passenger from Melbourne to Sydney, and he seemed a tad apprehensive that the plane wasn't following his expected landing pattern. We actually skirted Sydney airport to the west, before turning south onto the 16R long runway into Botany Bay. Small world, huh?)
That said, every so often a client asks what happens in an emergency, and it's then we can discuss flight attendant training. However, today I came across a very good blog called The Unknown Aviator, and its current blog entry concerns itself with flight attendants. The author speaks about being part of an emergency drill, acting as a passenger, during a cabin emergency simulation.
Here's a little of what was written:
Unfortunately most people underestimate the importance of the (flight attendant) role and the skills required to perform their jobs effectively. The term "trolley dollies" is often used to describe them which I think is very unfair although it has a nice ring to it :)
Let me briefly describe an occassion where I found a whole new level of respect for the members of the above mentioned profession. Not too long ago I had the opportunity (or perhaps the misfortune) of being selected as a guinea pig along with few other victims in a mock aircraft cabin evacuation trial which was being used to train cabin crew. I was placed inside an aircraft cabin mockup along with the other victims and we were being looked after by the soft spoken cabin crew as if it was a normal flight.
The "captain" shortly announced that an emergency landing was about to take place and we had to assume the crash positions. At this point we were all happily sitting in our seats looking around with silly smiles and not taking it seriously at all. Shortly before "landing" the crew underwent a startling transformation which at the time reminded me of Bruce Banner and his alter ego. They rapidly moved from seat to seat to ensure we all assumed the brace position and our belts were fastened etc.
After the "landing" which was accompanied by very realistic crash noises from the surround speakers in the cabin and smoke being released into the cabin the crew made us unfasten our seat belts and shouted out instructions and literally pushed us out of the "plane" as fast as possible in as orderly a fashion as possible. Gone were the "welcome aboard", "thank you for flying with us" tones. They were replaced by "get the **** out of here before i kick you out" tone which no none dared question. It is difficult to describe the entire exercise in words but the professional and almost military like manner in which it was executed was most impressive.....
The one thing that really struck me was the drastic change in behaviour of the crew and the effective way in which they herded us out of the "burning wreck" and got us all out as soon as possible. You may think you can ignore the routine oxygen mask demo at the start of every flight but you certainly cant ignore them in the event of a real emergency. I almost felt that they would physically attack me if I didnt listen to them and did what they said after the emergency was declared. This I felt was exactly the kind of approach that should be taken as their advice is probably the only thing that will save your life in a real emergency.
Therefore in addition to serving coffee and tea these people are directly responsible for your lives in the event of a crash landing. It is their duty to stay calm and ensure the passengers are evacuated as swiftly and as safely as possible. If an aeroplane catches fire after landing then the first few minutes if not seconds are the most important. It is vital to evacuate the aeroplane before the fire takes over completely. It is the crews duty to ensure that panic and fear does not overcome the passengers. In a smoke filled aeroplane it will be the "trolly dollies" and their male counterparts who will have to ensure the emergency doors are opened and the passengers including the old and frail, the disabled, the kids are all safely evacuated before worrying about their own personal safety."
So next time you contemplate sneering at the work of a flight attendant, hold back and reconsider.
They are like icebergs. Almost certainly you will only ever see a small proportion of their training in action. The rest is stored a rehearsed knowledge actions, reviewed and refined for the unlikely time it will be needed to save lives. So while certain airlines seem to insist on flying across the Pacific with rather mature cabin staff, fearful flyers can take comfort in the many years of training and experience they have. It's that which will save your life, rather than a pretty smile or handsome bearing.
New clients seem to come in "runs". A run of those one week where it's turbulence at the centre of their concerns. Another week, it will be panic attacks on board. Lately it's been about safety - clients focussing on the extreme unlikelihood of an incident but believing it's their luck that the next incident will involve their flight.
Up to a point, one can use the safety statistics to begin the process of chipping away at assumptions which can be shown to be false, yet never tested. Other times, I feel like I'm going down a rabbit hole which is narrowing and I'm getting nowhere. In which case, we put the discussions of safety to one side, and perhaps focus on another aspect of their flying concerns, such as the physiological aspects of their fears This follows my belief that once clients can see and experience a reduction in uncomfortable sensations (e.g, heart thumping, legs twitching, perspiring, etc.) which they experience just thinking about an upcoming flight, we can make some headway with the safety matters.
(At other time, I go into clinical psychologist/therapist mode where the "action" may be more to do with relationships and work concers).
Eventually, it comes down to discussing human error as a partial explanation for why incidents occur. It's at this point we often discuss who's crewing an aircraft and their primary responsibilities.
Most clients say that the responsibility of the flight crew is to fly the plane, without knowing any detail at all of how this is accomplished nor the training required.
When it comes to flight attendants, many are surprised when I inform them that their primary role is as cabin safety officers. Serving drinks and meals is very much a secondary aspect of their role, even though it's the most conspicuous.
Flight attendants' lives look pretty glamorous, and indeed there are many benefits unique to their working lives. But at the end of the day, it's work. Sometimes, it's fun and exciting if you get a great crew and you're away from home for a few days in an exotic location, sharing first class facilities.
Other times, it might be up and down the coast, say between Melbourne and Sydney, or LA and Seattle, in an all coach setting with very little time between flights.
Fearful flyers often look to flight attendants as their cues to whether they should worry or not. Smiling, pleasant flight attendants are reassuring and comforting, and help keep fearful thoughts at bay. Worried, hassled, scowling attendants have the opposite effect, although I am quick to let clients know that a worried look on a flight attendant's face is unlikely to be about the aircraft's safety but perhaps some personal matter, like paying the last gas bill on time, or leaving enough food out for the cat. Or whether their evening dinner date will be on time. Or it could be the passenger in 6B gropes her each time she walks by his seat...
Cabin attendants take their safety roles very seriously, and take offense at being referred primarily as glorified waiters. Most of the time you will only ever see them in a safety role during preparation for takeoff and landing, where their task is to ensure the cabin is ready for that critical flight phase.
So aisle and floor areas need to be checked for baggage that may interfere with a quick emergency exit; that seat and tray tables are in the "locked and upright" position, again for unobstructed fast exits. And of course safety belts are fastened, so as to restrain you in case the plane comes to a very quick stop.
Of late, that safety work has extended to making sure mobile and electronic devices are switched off during the critical flight phases, and safety messages are delivered professionally.
(Small aside: Here in Australia, footballers are treated as heroes. During one fearful flyer course I ran for the now defunct Ansett Australia, the Cabin Manager who was part of the staff, had a run in with a leading hero about his use of his mobile phone at a prohibited time of the flight. Asking him several times to switch it off, he threatened to report the matter to authorities when the "hero" didn't desist. To which he was duly labelled, "You'd be a hero, wouldn't you...."
It was interesting to see how the airline backed him up when the story was eventually leaked to the newspapers, especially since the football league contract was a lucrative one. But the airline did back him, given the level of threat to safety cavalier footballers can pose, because of their hero status.
The same footballer by the way was at one point charged with sexual assault in an unrelated incident near a nightclub, and also the centre of a major scandal when he admitted an affair with a team mate's wife, and stood down from his position of team captain.
A further coincidence is that I once flew seated next to the same footballer as a passenger from Melbourne to Sydney, and he seemed a tad apprehensive that the plane wasn't following his expected landing pattern. We actually skirted Sydney airport to the west, before turning south onto the 16R long runway into Botany Bay. Small world, huh?)
That said, every so often a client asks what happens in an emergency, and it's then we can discuss flight attendant training. However, today I came across a very good blog called The Unknown Aviator, and its current blog entry concerns itself with flight attendants. The author speaks about being part of an emergency drill, acting as a passenger, during a cabin emergency simulation.
Here's a little of what was written:
Unfortunately most people underestimate the importance of the (flight attendant) role and the skills required to perform their jobs effectively. The term "trolley dollies" is often used to describe them which I think is very unfair although it has a nice ring to it :)
Let me briefly describe an occassion where I found a whole new level of respect for the members of the above mentioned profession. Not too long ago I had the opportunity (or perhaps the misfortune) of being selected as a guinea pig along with few other victims in a mock aircraft cabin evacuation trial which was being used to train cabin crew. I was placed inside an aircraft cabin mockup along with the other victims and we were being looked after by the soft spoken cabin crew as if it was a normal flight.
The "captain" shortly announced that an emergency landing was about to take place and we had to assume the crash positions. At this point we were all happily sitting in our seats looking around with silly smiles and not taking it seriously at all. Shortly before "landing" the crew underwent a startling transformation which at the time reminded me of Bruce Banner and his alter ego. They rapidly moved from seat to seat to ensure we all assumed the brace position and our belts were fastened etc.
After the "landing" which was accompanied by very realistic crash noises from the surround speakers in the cabin and smoke being released into the cabin the crew made us unfasten our seat belts and shouted out instructions and literally pushed us out of the "plane" as fast as possible in as orderly a fashion as possible. Gone were the "welcome aboard", "thank you for flying with us" tones. They were replaced by "get the **** out of here before i kick you out" tone which no none dared question. It is difficult to describe the entire exercise in words but the professional and almost military like manner in which it was executed was most impressive.....
The one thing that really struck me was the drastic change in behaviour of the crew and the effective way in which they herded us out of the "burning wreck" and got us all out as soon as possible. You may think you can ignore the routine oxygen mask demo at the start of every flight but you certainly cant ignore them in the event of a real emergency. I almost felt that they would physically attack me if I didnt listen to them and did what they said after the emergency was declared. This I felt was exactly the kind of approach that should be taken as their advice is probably the only thing that will save your life in a real emergency.
Therefore in addition to serving coffee and tea these people are directly responsible for your lives in the event of a crash landing. It is their duty to stay calm and ensure the passengers are evacuated as swiftly and as safely as possible. If an aeroplane catches fire after landing then the first few minutes if not seconds are the most important. It is vital to evacuate the aeroplane before the fire takes over completely. It is the crews duty to ensure that panic and fear does not overcome the passengers. In a smoke filled aeroplane it will be the "trolly dollies" and their male counterparts who will have to ensure the emergency doors are opened and the passengers including the old and frail, the disabled, the kids are all safely evacuated before worrying about their own personal safety."
So next time you contemplate sneering at the work of a flight attendant, hold back and reconsider.
They are like icebergs. Almost certainly you will only ever see a small proportion of their training in action. The rest is stored a rehearsed knowledge actions, reviewed and refined for the unlikely time it will be needed to save lives. So while certain airlines seem to insist on flying across the Pacific with rather mature cabin staff, fearful flyers can take comfort in the many years of training and experience they have. It's that which will save your life, rather than a pretty smile or handsome bearing.
Friday - February 11, 2005
United Airlines' "Channel 9" and its links to Microsoft and Robert Scoble - the scobleizer
Sometimes
you have to allow for some strange forms of synchronicity in this
world!
I usually take two or three trips to the US each
year, for conferences, talks, lectures and holidays - yep, vacations as
Americans are wont to say.
If I go to direct, rather than via Europe, it is always with United Airlines. My very first trip to the US in 1982 or so was with Pan Am - well, it was meant to be. When a fault in the plane couldn't be fixed in Melbourne, on a half empty flight, we were all transferred to QANTAS, which became a packed plane which made its way to Los Angeles (LAX) via Tahiti (PPT). PPT doesn't mean you get to see lots of Powerpoint presentations, but is the three letter code for Papeete, where the big planes land.
Our's was a 747-200 which then took us on to LAX, from where we took a Pan Am Lockheed L-1011 through the night into Miami (MIA). The return flight a few weeks later was just as eventful, except this time the same type aircraft took off west over Miami Beach, when I noticed we then turned left and headed west. To which I said, "we're heading back to the Airport!" which indeed we did!
Apparently, an oil supply problem to one of the three engines had occurred, requiring a return to base. A few hours later we were on our way again, landing in LAX too close to our return 747's departure to Sydney (via Honolulu, HNL).
We were told by Pan Am agents that they tried to hold our flight as long as possible, knowing a bunch of incoming pax were delayed in MIA, but we were too few in number to further delay the LAX-SYD flight. As we waited in the queue to be assigned another flight, we overhead the person in front being told they were up for their own overnight accommodation because their agent had not left enough time between connections. Looking at our own tickets, there was only 45" minutes between arrival in LAX and departure, so we thought our goose was cooked.
As it turned it, we did OK, being offered an outward flight on QANTAS the next morning, or out on Pan Am two days later, with Pan Am picking up hotel and all meal costs.
Since we were only scheduled to pass through LA we took the two days and were put up at the Sheraton LAX, which remains one of my favourite airport hotels at LAX, although the Westin edges it out for comfort. So the next day, after a breakfast of fluffy pancakes which I still remember to this day (few Australian eateries do good pancakes), off we went on our bus tour of the LA environs, including Farmers Market, Hollywood, and a few supposed movie stars' homes.
The return to Australia then went off without a hitch.
Later in the eighties, Pan Am sold its routes and aircraft to United Airlines, including its long distance 747SP aircraft (the little stubby 747s with the extra tall tails) which could do the long trans-Pacific flights before the longer range standard 747s were in service.
Since that time I have continued to fly United Ailrines, in the belief that its Frequent Flyer scheme, as part of the Star Alliance network, offers more value for frequent trips to the US than does the QANTAS/American Airlines combination. Flying into LAX or San Francisco (SFO) from Australia then moving on to other US cities is a more seamless experience with UA than QANTAS since it has its own customs area, so no buses to catch around the airport from the international to domestic terminals.
One of the things I like to do on UA flights is listen to Channel 9 on the in-flight audio entertainment system. This allows you to listen into communications (comms.) between the flight traffic and air traffic control (ATC). Having listened to such communications for many years over a scanner - a one-way receiver which allows you to monitor various frequencies which aircraft use - I have learnt much of the aviation terminology which sounds like double-dutch to most naive listeners. Additionally, in very busy areas such as the New York region, ATC speak very quickly and you need to have your wits about you even if you are proficient in airline speak.
I've always wondered what fearful flyers would make of listening to these broadcasts. Would it seem so foreign and strange that it would increase anxiety, or would the level of emotion - essentially zero - and very crisp efficient comms allay such fears?
Well over on The Economist's online site, is a story about Microsoft evangeliser Robert Scoble and how his weblog is changing the nature of public relations. You can listen to a recent talk of Robert's here, if you want to know more about weblogging in the business sector.
In the Economist article, we learn how he was poached from NEC's Silicon Valley operations where he was evangelising Tablet PCs, and invited to come to work for Microsoft in Washington. His boss was Lenn Pryor, who was then Microsoft's "Director of Platform Evangelism."
Let me allow the Economist's article take up the story so you can see the connection to a Fear of Flying weblog:
"Mr Scoble started blogging four years ago. At the time, he worked for NEC, a Japanese technology company, and was based in Silicon Valley, a place rife with loathing for Microsoft. Mr Scoble's area of expertise was tablet PCs—laptop computers that allow users to handwrite their notes, and that have been mostly a dud, both then and now. But Mr Scoble used his blog to converse with NEC's customers, giving tech support and listening to feedback, with such disarming honesty that his blog became a must-read for gadget lovers.
This caught the attention of Lenn Pryor, who is—really—Microsoft's “director of platform evangelism”. Until then, says Mr Pryor, Microsoft had been evangelising mostly one-on-one, “which doesn't scale well”. But Mr Pryor had a radical idea. Afraid of flying, he had met a pilot at United Airlines who told him to tune into channel nine from his plane seat, where he could listen in on the communications of the pilots. Mr Pryor did, and soon “the irrational nature of my fear started to fade”. It had something to do with hearing real people talking honestly. He realised that Microsoft, the target of similarly irrational fears, should have its own version of channel nine, and that public blogging by insiders should be an important part of it.
Mr Pryor figured that the straight-talking Mr Scoble would make a reassuring pilot or “a great evangelist”. So he hired him. Mr Scoble, for his part, simply kept doing what he was good at. His blog—which he has kept outside of Microsoft's computers, and to which he usually posts in the wee hours after midnight—reads like a stream of consciousness. A reader might discover, for instance, that Mr Scoble's new wife just became an American citizen, or how to win a cheese contest. “A good blog lets you see the mess; lets you see behind the scenes,” he writes in one entry."
So there you have it! An interesting story and link I think. If you want to visit Microsoft's Channel 9, here is the link.
If I go to direct, rather than via Europe, it is always with United Airlines. My very first trip to the US in 1982 or so was with Pan Am - well, it was meant to be. When a fault in the plane couldn't be fixed in Melbourne, on a half empty flight, we were all transferred to QANTAS, which became a packed plane which made its way to Los Angeles (LAX) via Tahiti (PPT). PPT doesn't mean you get to see lots of Powerpoint presentations, but is the three letter code for Papeete, where the big planes land.
Our's was a 747-200 which then took us on to LAX, from where we took a Pan Am Lockheed L-1011 through the night into Miami (MIA). The return flight a few weeks later was just as eventful, except this time the same type aircraft took off west over Miami Beach, when I noticed we then turned left and headed west. To which I said, "we're heading back to the Airport!" which indeed we did!
Apparently, an oil supply problem to one of the three engines had occurred, requiring a return to base. A few hours later we were on our way again, landing in LAX too close to our return 747's departure to Sydney (via Honolulu, HNL).
We were told by Pan Am agents that they tried to hold our flight as long as possible, knowing a bunch of incoming pax were delayed in MIA, but we were too few in number to further delay the LAX-SYD flight. As we waited in the queue to be assigned another flight, we overhead the person in front being told they were up for their own overnight accommodation because their agent had not left enough time between connections. Looking at our own tickets, there was only 45" minutes between arrival in LAX and departure, so we thought our goose was cooked.
As it turned it, we did OK, being offered an outward flight on QANTAS the next morning, or out on Pan Am two days later, with Pan Am picking up hotel and all meal costs.
Since we were only scheduled to pass through LA we took the two days and were put up at the Sheraton LAX, which remains one of my favourite airport hotels at LAX, although the Westin edges it out for comfort. So the next day, after a breakfast of fluffy pancakes which I still remember to this day (few Australian eateries do good pancakes), off we went on our bus tour of the LA environs, including Farmers Market, Hollywood, and a few supposed movie stars' homes.
The return to Australia then went off without a hitch.
Later in the eighties, Pan Am sold its routes and aircraft to United Airlines, including its long distance 747SP aircraft (the little stubby 747s with the extra tall tails) which could do the long trans-Pacific flights before the longer range standard 747s were in service.
Since that time I have continued to fly United Ailrines, in the belief that its Frequent Flyer scheme, as part of the Star Alliance network, offers more value for frequent trips to the US than does the QANTAS/American Airlines combination. Flying into LAX or San Francisco (SFO) from Australia then moving on to other US cities is a more seamless experience with UA than QANTAS since it has its own customs area, so no buses to catch around the airport from the international to domestic terminals.
One of the things I like to do on UA flights is listen to Channel 9 on the in-flight audio entertainment system. This allows you to listen into communications (comms.) between the flight traffic and air traffic control (ATC). Having listened to such communications for many years over a scanner - a one-way receiver which allows you to monitor various frequencies which aircraft use - I have learnt much of the aviation terminology which sounds like double-dutch to most naive listeners. Additionally, in very busy areas such as the New York region, ATC speak very quickly and you need to have your wits about you even if you are proficient in airline speak.
I've always wondered what fearful flyers would make of listening to these broadcasts. Would it seem so foreign and strange that it would increase anxiety, or would the level of emotion - essentially zero - and very crisp efficient comms allay such fears?
Well over on The Economist's online site, is a story about Microsoft evangeliser Robert Scoble and how his weblog is changing the nature of public relations. You can listen to a recent talk of Robert's here, if you want to know more about weblogging in the business sector.
In the Economist article, we learn how he was poached from NEC's Silicon Valley operations where he was evangelising Tablet PCs, and invited to come to work for Microsoft in Washington. His boss was Lenn Pryor, who was then Microsoft's "Director of Platform Evangelism."
Let me allow the Economist's article take up the story so you can see the connection to a Fear of Flying weblog:
"Mr Scoble started blogging four years ago. At the time, he worked for NEC, a Japanese technology company, and was based in Silicon Valley, a place rife with loathing for Microsoft. Mr Scoble's area of expertise was tablet PCs—laptop computers that allow users to handwrite their notes, and that have been mostly a dud, both then and now. But Mr Scoble used his blog to converse with NEC's customers, giving tech support and listening to feedback, with such disarming honesty that his blog became a must-read for gadget lovers.
This caught the attention of Lenn Pryor, who is—really—Microsoft's “director of platform evangelism”. Until then, says Mr Pryor, Microsoft had been evangelising mostly one-on-one, “which doesn't scale well”. But Mr Pryor had a radical idea. Afraid of flying, he had met a pilot at United Airlines who told him to tune into channel nine from his plane seat, where he could listen in on the communications of the pilots. Mr Pryor did, and soon “the irrational nature of my fear started to fade”. It had something to do with hearing real people talking honestly. He realised that Microsoft, the target of similarly irrational fears, should have its own version of channel nine, and that public blogging by insiders should be an important part of it.
Mr Pryor figured that the straight-talking Mr Scoble would make a reassuring pilot or “a great evangelist”. So he hired him. Mr Scoble, for his part, simply kept doing what he was good at. His blog—which he has kept outside of Microsoft's computers, and to which he usually posts in the wee hours after midnight—reads like a stream of consciousness. A reader might discover, for instance, that Mr Scoble's new wife just became an American citizen, or how to win a cheese contest. “A good blog lets you see the mess; lets you see behind the scenes,” he writes in one entry."
So there you have it! An interesting story and link I think. If you want to visit Microsoft's Channel 9, here is the link.
Wednesday - May 19, 2004
Safety and Swiss Cheese!
What's the connection?On SBS-TV last night here in Australia, viewers
were presented with a very interesting French documentary, entitled
"Why Planes
fall".
Here is what the programs notes said:
Cutting Edge: Why Planes Fall
Why Planes Fall looks at the reasons why modern air accidents occur. The majority of modern airline crashes are not caused by aircraft problems such as mechanical flaws or computer failure, but in 70% of cases, by human error. In the 1970s NASA pioneered the idea that in addition to acquiring training in how to fly, pilots needed to know how to handle stress and conflict on board planes. This documentary includes compelling re-enactments of what took place in the cockpit in the moments before a number of famous crashes. (From France, in French and English, English subtitles)
I always have reservations about recommending such programs to patients (especially with such titles) since any program which features incidents, no matter how rare, may be incorrectly interpreted. For the same reason, I always organised for Ansett Fear of Flying groups to visit the maintenance hangars late in the training program where the sight of a Boeing 767 in pieces undergoing a D check would be seen as reassuring (the thoroughness of maintenance) rather than dangerous ("there are so many pieces which could fail").
Fortunately, this French documentary which strongly featured psychological aspects of flight management, including Crew Resource Management (CRM) in Air France and United Airlines, managed to ultimately portray why commercial aviation is as safe as it is, far safer than most other modes of transporting people - elevators and escalators apparently being top of the pops for safely moving people.
One of the key people interviewed is a psychologist whose research has helped explain how a vastly safe system can be "tricked" so that incidents occur His name is Professor James Reason, a psychologist in Manchester, UK.
Reason has written extensively about how humans and organisations (not just aviation but nuclear plants and governments) commit errors and how such incidents can be prevented once their causes are understood. In particular, he has developed what he calls the "Swiss Cheese" model of incident occurrence.
Here is what it looks like applied in one area where vulnerabilities can have dire consequences, the hospital setting:
Here is what the programs notes said:
Cutting Edge: Why Planes Fall
Why Planes Fall looks at the reasons why modern air accidents occur. The majority of modern airline crashes are not caused by aircraft problems such as mechanical flaws or computer failure, but in 70% of cases, by human error. In the 1970s NASA pioneered the idea that in addition to acquiring training in how to fly, pilots needed to know how to handle stress and conflict on board planes. This documentary includes compelling re-enactments of what took place in the cockpit in the moments before a number of famous crashes. (From France, in French and English, English subtitles)
I always have reservations about recommending such programs to patients (especially with such titles) since any program which features incidents, no matter how rare, may be incorrectly interpreted. For the same reason, I always organised for Ansett Fear of Flying groups to visit the maintenance hangars late in the training program where the sight of a Boeing 767 in pieces undergoing a D check would be seen as reassuring (the thoroughness of maintenance) rather than dangerous ("there are so many pieces which could fail").
Fortunately, this French documentary which strongly featured psychological aspects of flight management, including Crew Resource Management (CRM) in Air France and United Airlines, managed to ultimately portray why commercial aviation is as safe as it is, far safer than most other modes of transporting people - elevators and escalators apparently being top of the pops for safely moving people.
One of the key people interviewed is a psychologist whose research has helped explain how a vastly safe system can be "tricked" so that incidents occur His name is Professor James Reason, a psychologist in Manchester, UK.
Reason has written extensively about how humans and organisations (not just aviation but nuclear plants and governments) commit errors and how such incidents can be prevented once their causes are understood. In particular, he has developed what he calls the "Swiss Cheese" model of incident occurrence.
Here is what it looks like applied in one area where vulnerabilities can have dire consequences, the hospital setting:
ARDS is Acute Respiratory Distress Syndrome which can result from a number of preventable circumstances. In the illustration above, each slice of cheese, starting from the right, represents an obstacle or defense to ARDS development in a patient admitted to the hospital. But the holes in the cheese slice represent something different - a latent error or system failure waiting to to happen. These could be human error, equipment failure, and so on.
Each of these can be handled and prevented by proper training, supervision, maintenance and so on. But when these methods break down, the likelihood of a serious event increases. We are talking here in probability terms, with each of them being independent of the other. Although it must be said that an organisation which allows one or two of these events to occur may well have systemic and cultural problems which might allow for more events to occur: that is, for the slices of swiss cheese to have more holes in them.
When the holes line up, meaning all the defenses fail and an organisation's latent vulnerabilities are exposed, then an incident occurs, as this illustration above shows.
The same reasoning has been applied in aviation too, where each slice might represent a different component of the aviation matrix: the airplane manufacturer, the airline, pilots and their training, air traffic control and so on.
Each acts in a defensive way to prevent incidents, yet each of these have vulnerabilities where things can go wrong. The more we know what can go wrong, the smaller the holes in the swiss cheese becomes, and the less chance the slices will spontaneously align for an incident to occur. This is one reason why aviation incidents, no matter how small, are thoroughly investigated by first-tier airlines, who also encourage an organisational culture of self-reporting to occur, without penalty for admission of error. In other words, it's one thing to have holes or vulnerabilities, it's another for them to line up at any one given time to allow an incident to "pass through". This is why aviation incidents are often described as occurring from a conspiracy of unlikely events occurring close together in time and space.
This is also why flying is as safe as it is... there are lots of slices (=redundancy systems, ie. three hydraulic systems, planes can climb out on one engine, etc), and efforts are constantly occurring to reduce hole size. There are few industries as self-reflective and examining as the commercial aviation industry.
To bring the message home, try and develop a model for your driving experience. How many slices of cheese exists to help you prevent an accident, or recover from it? How big are the holes, and how often do you refine your driving methods to improve the chances of not being in an accident, or surviving one?
Before I knew of Reason's Swiss Cheese theory of organisational vulnerability, I would discuss these matters (system redundancies, incident probabilities) with clients by referring to the wiremesh or chainlink fences surrounding the nearby Melbourne Airport (as well as many other secure places).
Here you can see wiremesh used to make fences, baskets, cages and whatever - it's to prevent things getting in, or things getting out!
The integrity of the mesh - its ability to do the job it was designed for - is determined by the strength of the individual components (the metal itself) and the design and quality control used to put the components together. Not to mention whatever maintenance is needed to reinforce its integrity in the face of wear and tear, weather, etc.
Should one of the links in the diagram be broken, then the integrity of the mesh is only very slightly affected - it can still do its basic job of protection. And if another link fails, but quite some distance from the first one, then the fence can still do its job without too much going wrong.
But if more and more links should fail, and they are in close proximity, then the fence may present less and less resistance to intruders or whatever it is containing. Eventually, with enough links broken, the fence or barrier will no longer function in the way it was meant, and danger can get in or out.
To me, that's how air safety works - there are multiple redundancies which must spontaneously conspire together to fail in location and time, in order for vulnerability to danger to become active. Every time you hear of some event which has resulted in a trusted piece of equipment or a person or an organisation failing, you can be sure the swiss cheese holes have lined up, or a number of wiremesh links have been broken for the vulnerability to be exposed.
Here's hoping this brief exploration of safety systems in complex organisations has been helpful.
Saturday - April 24, 2004
"I feel so much safer when I drive my car than when I fly"
I wish I had a dollar for each time I
was told this by a client.... it speaks of the "illusion of control" we possess
when we drive our cars.
I have no doubt that many people who say they
feel safer when they drive their car believe it to be
true.
Of course, believing it to be true doesn't make it so...that's a form of magical thinking developmental psychologists observe when they speak with adolescents about their lives. It's usually when thinking, or to use its psychological term, cognition, shifts from the style of a young child to one more resembling adult thinking.
So when I hear someone say they feel they are safer driving than flying, I don't argue - it's their feelings after all and I take them at their word.
Usually, I wait until clients bring up the "driving versus flying" dynamic, which happens at some point of treatment. I allude to it during the very first session, or even on the phone when I make the first appointment, and do a mini-assessment on the phone or by email. I also usually ask about other fears, like trains, ships, bridges, heights, enclosed spaces, open spaces and so on...(In another section, I'll explain a little more how I work, and why I take referrals myself, rather than though a secretary or receptionist.)
Often, I hear clients say that they are OK if they themselves do the driving, but become nervous passengers if someone else does the driving. This clues me in to issues of control, or more accurately, what it could mean for them to give up control. I make a mental note of it to consider as a hypothesis to assess more thoroughly later, when the time is right, and the client has "cued" me to do so during our conversation.
What I will do when the "car versus plane - driving versus flying" discussion arises is see it as a great opportunity. I get to assess how the client understands statistics (and where they obtain these figures), I get informed about some of their thinking or cognitive style, and it give me a potential entre to help do some effective cognitive and emotional change.
Now you might say, "Ok - please explain all that!" And now I will...
1. "Feel" statements, e.g. "I feel driving is safer than flying because I feel in control.
My response: When I hear this statement or a variation of it, I usually ask, with some curiosity, "Do you mean you feel it or you believe it?"
What I am doing here is inviting the client to separate feelings from thoughts, in the sense that the same thought can give rise to different feelings depending on context, new understandings, different emotional states, and a variety of situational cues. And it works in reverse, in that the same feeling can give rise to different thoughts in the same way.
In other words, thoughts don't give rise to the same feelings, and feelings to the same thoughts - other situational factors come into play.
So when I hear someone say I feel safer when I drive than when I fly, I ask (again with curiosity) if they really mean it to be a feeling or they have facts or evidence (either personally-derived or from some important source). Working with facts turns about to be easier in most cases than working with feelings.
My task then is to understand how clients see the difference - if they do - between feelings and thoughts (or beliefs). I may even ask for clarification: "Do you mean you feel safer, or that you know it is safer (to drive)?" By asking it this way - as an either/or - I am hoping to press home that feelings and thoughts, while connected, are not one and the same.
If thoughts or beliefs can change, then possibly feelings, and associated distressing physical symptoms and signs, can too. And if physical signs and symptoms can change, then feelings and thoughts can also change. That's the theory anyway!
2. In practice, clients who discuss the car vs plane comparison lead themselves down a certain path which can be unhelpful to overcoming their fears.
Because this comparison is very much rooted in issues of personal control, gently disabusing people of their cognitive bias must be done very carefully and painstakingly. I might, in an appropriate context, discuss how I had been at the airport recently and watched the rhythm of aircraft during a turnaround, the period when an arriving aircraft becomes a departing one. The aircraft sits there while all around a ballet of equipment and staff service and prepare her (aircraft, like ships, are usually referred to in feminine terms, perhaps because for so long their captains were male!)
I usually mention how I watch for one of the flight crew to descend down the jetway stairs, and begin their walkaround
, inspecting the aircraft with eyes and hands in a careful and consistent
routine they first learnt as novice flyers perhaps 40 years ago. (This is where
I might introduce the term "good airmanship" into the sessions, in preparation
for other safety-related discussions to
come).
Then I casually ask them when they last checked their car's tire pressure and condition, or engine oil, or brakes (other than driving to see me). And, if they remain in good humour (most do) if they will now check these things at the end of their session with me.
Of course, most say that aircraft are far more complicated than cars, and it's not the same thing. But I think that once the point is made - that they take the condition of their car for granted - it makes the next more challenging discussion easier to digest.
And that is that there are literally teams of mainly invisible people who take pride in making flying safe. Now this discussion can go in all sorts of directions - about engineering and design, flight testing, maintenance schedules, Minimum Equipment Lists, cabin crew training, and air traffic control (to mention but a few - and only a few!)
I might ask, to continue the client's desire to compare cars and planes (now you see why I don't usually bring up the conversation first), if the client has undertaken advanced training in defensive driving to handle tire blow-outs, dogs or children racing onto the road, or engine seizures, all rare but possible events in one's driving career. And then I might mention the frequency of pilots training in simulators every six months to maintain licensure (how would you like to be tested not just for competence but emergency handling of your car, every six months?).
I might even show the client a video of a simulator session, using the Airbus 320 video from ITVV.
Airbus320videofromITVV.
http://www.itvv.co.uk/sasa320sim.asp" target="NewWindow">
But I usually wait a few sessions before doing this, when I believe the client can better accommodate seeing pilots training to handle emergencies they will rarely if ever handle during their career. No use having clients believe they are training for daily events!
In some cases, when I detect a client is rather cavalier about safety, I may even let out a little whistle, and ask how they feel taking their kids in the car when it doesn't get a thorough "walkaround" each time - but that's something I will only rarely suggest, since it can so easily place people on the back foot (an Aussie cricketing expression for being defensive).
But I will say that even if they were to do a daily walkaround, and take a defensive driving course, the best they can do is maximise the chances they will not cause a collision or incident. Yet - what of other drivers who may be only a few feet from them each time they pass? At least in commercial airspace there is a good to excellent chance that all pilots are licensed and tested regularly in reliable aircraft, which are kept separate by professional air traffic controllers (I always talk of ATC
being about separation issues, which usually
gets a smile from clients who are also
therapists).
In other words, I am hoping to engage the client into thinking their belief they are safe by virtue of feeling in control of the car - ie., they are at the controls of the car - is open to being challenged. I may speak with reference to it being an illusion of safety and control, especially if they consider they share the road with all sorts of other drivers they can't control. Indeed, many nations around the world spend millions of dollars attempting to reduce road fatalities and injuries by researching this very illusion of control. One explicit aspect of these illusions people hold to be true is that bigger heavier cars are safer, especially SUVs, but the data doesn't support this belief. If you want some hard cold science on realistic fears head to this site of David Myers, who asks if we fear the right things.
3. Still not convinced? How about turning to page 8 at the Amazon.com site of Fieldings, "The World's Most Dangeous Places"
(Hint
- it's NOT an airplane - no, much closer to
home.)
The other issue of control that frequently is brought up (again, by clients not me) is what to do if they feel unwell or unsafe. I'm often told, "Well, if I feel like it, I can pull over to the side of the road, and in a plane you can't".
Yes, true - planes can't hover in mid-air. They need to keep in motion, air passing over the wings to keep them aloft. (This is where the situation might call for a discussion on fuel calculations, racetrack holding patterns, and the gliding ability of Boeing 767s.)
Most people seem to think if their tire blows out, they just pull over, but the truth is that this is quite a dangerous maneuver needing a fair amount of training to do well, and for which most drivers never train!
Of course, you may want to pull over to the side of the road because you're unwell, and that is fair enough too. In a plane, the pilots can't just drop you off until you feel better and ready to continue your journey. So if you do get ill frequently and need regular stops, maybe flying is not the best mode of transport. But if you are going more than a few hundred miles, better to get where you are going quickly than spend hours on the road, isn't it?
No, the issue here is often one of fearing becoming ill, possibly due to the fearful flying feelings, and having to endure discomfort for many hours. Sometimes psychologists will refer to that as discomfort anxiety. And it's not about the plane, but about what you say to yourself about the plane and yourself. Certainly, flying can trigger queasy feelings in very rough turbulence (I easily get airsick, although I have no fear of throwing up, and it's never happened. I know it's to do with G forces and occasional feelings of disorientation on board. I get worse if I am a passenger in the back of a car with limited ability to see around me.)
Sudden movements can be scary because of the effects of G forces when we expect to be stable. And they can reinforce our beliefs it is scary to be fly even when it is smooth. Bumps, and any resultant "butterflies" drives our feeling uncomfortable up a few notches. This reinforcement process I call a form of "emotional or gut reasoning" where our sensations inform us of our reality, and confirm our assumptions flying is dangerous: "See how bad I really feel when I fly - it must be dangerous!" This is otherwise known as The tail wagging the dog.
Of course, believing it to be true doesn't make it so...that's a form of magical thinking developmental psychologists observe when they speak with adolescents about their lives. It's usually when thinking, or to use its psychological term, cognition, shifts from the style of a young child to one more resembling adult thinking.
So when I hear someone say they feel they are safer driving than flying, I don't argue - it's their feelings after all and I take them at their word.
Usually, I wait until clients bring up the "driving versus flying" dynamic, which happens at some point of treatment. I allude to it during the very first session, or even on the phone when I make the first appointment, and do a mini-assessment on the phone or by email. I also usually ask about other fears, like trains, ships, bridges, heights, enclosed spaces, open spaces and so on...(In another section, I'll explain a little more how I work, and why I take referrals myself, rather than though a secretary or receptionist.)
Often, I hear clients say that they are OK if they themselves do the driving, but become nervous passengers if someone else does the driving. This clues me in to issues of control, or more accurately, what it could mean for them to give up control. I make a mental note of it to consider as a hypothesis to assess more thoroughly later, when the time is right, and the client has "cued" me to do so during our conversation.
What I will do when the "car versus plane - driving versus flying" discussion arises is see it as a great opportunity. I get to assess how the client understands statistics (and where they obtain these figures), I get informed about some of their thinking or cognitive style, and it give me a potential entre to help do some effective cognitive and emotional change.
Now you might say, "Ok - please explain all that!" And now I will...
1. "Feel" statements, e.g. "I feel driving is safer than flying because I feel in control.
My response: When I hear this statement or a variation of it, I usually ask, with some curiosity, "Do you mean you feel it or you believe it?"
What I am doing here is inviting the client to separate feelings from thoughts, in the sense that the same thought can give rise to different feelings depending on context, new understandings, different emotional states, and a variety of situational cues. And it works in reverse, in that the same feeling can give rise to different thoughts in the same way.
In other words, thoughts don't give rise to the same feelings, and feelings to the same thoughts - other situational factors come into play.
So when I hear someone say I feel safer when I drive than when I fly, I ask (again with curiosity) if they really mean it to be a feeling or they have facts or evidence (either personally-derived or from some important source). Working with facts turns about to be easier in most cases than working with feelings.
My task then is to understand how clients see the difference - if they do - between feelings and thoughts (or beliefs). I may even ask for clarification: "Do you mean you feel safer, or that you know it is safer (to drive)?" By asking it this way - as an either/or - I am hoping to press home that feelings and thoughts, while connected, are not one and the same.
If thoughts or beliefs can change, then possibly feelings, and associated distressing physical symptoms and signs, can too. And if physical signs and symptoms can change, then feelings and thoughts can also change. That's the theory anyway!
2. In practice, clients who discuss the car vs plane comparison lead themselves down a certain path which can be unhelpful to overcoming their fears.
Because this comparison is very much rooted in issues of personal control, gently disabusing people of their cognitive bias must be done very carefully and painstakingly. I might, in an appropriate context, discuss how I had been at the airport recently and watched the rhythm of aircraft during a turnaround, the period when an arriving aircraft becomes a departing one. The aircraft sits there while all around a ballet of equipment and staff service and prepare her (aircraft, like ships, are usually referred to in feminine terms, perhaps because for so long their captains were male!)
I usually mention how I watch for one of the flight crew to descend down the jetway stairs, and begin their walkaround
, inspecting the aircraft with eyes and hands in a careful and consistent
routine they first learnt as novice flyers perhaps 40 years ago. (This is where
I might introduce the term "good airmanship" into the sessions, in preparation
for other safety-related discussions to
come).Then I casually ask them when they last checked their car's tire pressure and condition, or engine oil, or brakes (other than driving to see me). And, if they remain in good humour (most do) if they will now check these things at the end of their session with me.
Of course, most say that aircraft are far more complicated than cars, and it's not the same thing. But I think that once the point is made - that they take the condition of their car for granted - it makes the next more challenging discussion easier to digest.
And that is that there are literally teams of mainly invisible people who take pride in making flying safe. Now this discussion can go in all sorts of directions - about engineering and design, flight testing, maintenance schedules, Minimum Equipment Lists, cabin crew training, and air traffic control (to mention but a few - and only a few!)
I might ask, to continue the client's desire to compare cars and planes (now you see why I don't usually bring up the conversation first), if the client has undertaken advanced training in defensive driving to handle tire blow-outs, dogs or children racing onto the road, or engine seizures, all rare but possible events in one's driving career. And then I might mention the frequency of pilots training in simulators every six months to maintain licensure (how would you like to be tested not just for competence but emergency handling of your car, every six months?).
I might even show the client a video of a simulator session, using the Airbus 320 video from ITVV.
Airbus320videofromITVV.
http://www.itvv.co.uk/sasa320sim.asp" target="NewWindow">
But I usually wait a few sessions before doing this, when I believe the client can better accommodate seeing pilots training to handle emergencies they will rarely if ever handle during their career. No use having clients believe they are training for daily events!
In some cases, when I detect a client is rather cavalier about safety, I may even let out a little whistle, and ask how they feel taking their kids in the car when it doesn't get a thorough "walkaround" each time - but that's something I will only rarely suggest, since it can so easily place people on the back foot (an Aussie cricketing expression for being defensive).
But I will say that even if they were to do a daily walkaround, and take a defensive driving course, the best they can do is maximise the chances they will not cause a collision or incident. Yet - what of other drivers who may be only a few feet from them each time they pass? At least in commercial airspace there is a good to excellent chance that all pilots are licensed and tested regularly in reliable aircraft, which are kept separate by professional air traffic controllers (I always talk of ATC
being about separation issues, which usually
gets a smile from clients who are also
therapists).In other words, I am hoping to engage the client into thinking their belief they are safe by virtue of feeling in control of the car - ie., they are at the controls of the car - is open to being challenged. I may speak with reference to it being an illusion of safety and control, especially if they consider they share the road with all sorts of other drivers they can't control. Indeed, many nations around the world spend millions of dollars attempting to reduce road fatalities and injuries by researching this very illusion of control. One explicit aspect of these illusions people hold to be true is that bigger heavier cars are safer, especially SUVs, but the data doesn't support this belief. If you want some hard cold science on realistic fears head to this site of David Myers, who asks if we fear the right things.
3. Still not convinced? How about turning to page 8 at the Amazon.com site of Fieldings, "The World's Most Dangeous Places"
(Hint
- it's NOT an airplane - no, much closer to
home.)The other issue of control that frequently is brought up (again, by clients not me) is what to do if they feel unwell or unsafe. I'm often told, "Well, if I feel like it, I can pull over to the side of the road, and in a plane you can't".
Yes, true - planes can't hover in mid-air. They need to keep in motion, air passing over the wings to keep them aloft. (This is where the situation might call for a discussion on fuel calculations, racetrack holding patterns, and the gliding ability of Boeing 767s.)
Most people seem to think if their tire blows out, they just pull over, but the truth is that this is quite a dangerous maneuver needing a fair amount of training to do well, and for which most drivers never train!
Of course, you may want to pull over to the side of the road because you're unwell, and that is fair enough too. In a plane, the pilots can't just drop you off until you feel better and ready to continue your journey. So if you do get ill frequently and need regular stops, maybe flying is not the best mode of transport. But if you are going more than a few hundred miles, better to get where you are going quickly than spend hours on the road, isn't it?
No, the issue here is often one of fearing becoming ill, possibly due to the fearful flying feelings, and having to endure discomfort for many hours. Sometimes psychologists will refer to that as discomfort anxiety. And it's not about the plane, but about what you say to yourself about the plane and yourself. Certainly, flying can trigger queasy feelings in very rough turbulence (I easily get airsick, although I have no fear of throwing up, and it's never happened. I know it's to do with G forces and occasional feelings of disorientation on board. I get worse if I am a passenger in the back of a car with limited ability to see around me.)
Sudden movements can be scary because of the effects of G forces when we expect to be stable. And they can reinforce our beliefs it is scary to be fly even when it is smooth. Bumps, and any resultant "butterflies" drives our feeling uncomfortable up a few notches. This reinforcement process I call a form of "emotional or gut reasoning" where our sensations inform us of our reality, and confirm our assumptions flying is dangerous: "See how bad I really feel when I fly - it must be dangerous!" This is otherwise known as The tail wagging the dog.
There is a time and place to
let our bodies and hearts rule our heads - but flying isn't one of
them.
Let me put it to you directly: If flying causes fearfulness, then all who fly should become fearful. That is clearly not the case. If we became fearful of truly dangerous places, against realistic standards of measurement (injuries, fatalities etc) then the most dangerous place on Earth for the average person is .... their kitchen at home.
If working with fears was where I wanted to make a small fortune, and I knew people only ever exclusively functioned in an actuarial fashion (purely on statistics), I should really be running "Fear of Kitchen" classes. (Although not like this person's) For another take on fear, I found this Dutch site intriguing....
Update (May 10, 2004): Travelling around the web produces lots of surprises and little gems along the way.
I located a UK site which looks at the mathematics of safety, comparing various modes of transport, as well as looking at how we go about assessing risk, not too different from what I have been writing. Here is it is.
Further update (May 14, 2004): I subscribe to the Health Behavior News Service, which exists for journalists to have infomation pushed to them from which they may develop stories for local publication. The latest version, dated for May 2004, looks at Driving and car safety.
Here is how Kristina Campbell introduced the full article:
"Proponents of air travel like to quote the statistic about how much more likely you are to die in an automobile accident than a plane crash. In part, that’s because we tend to travel much more frequently in cars than in airplanes — but there’s also truth to the fact that auto driver error is much more common than pilot error. Driving is so much a part of our lives that we tend to turn our attention elsewhere far too often while we’re behind the wheel, sometimes leading to disastrous consequences. This month’s issue of Facts of Life takes a close look at the issue of traffic safety and its health implications for everyone."
I have blogged the full article in my "In the News" category since it's a long article. If this interests you, you can go here to see it.
Yet another update (June 15, 2004): In my usual fashion to surf around to locate articles and links of use, I have located the following article from the Sciencentral.com website (free registration) which looks at how US driving habits changed after the 9-11 World Trade Centre attacks. It's called Real Worries.
There is a video to watch which features a fearful flyer undergoing therapy with a colleague, Rob Reiner, Ph.D.
in New York City,
as well as the afore mentioned David
Meyers.
The article features a report from a Germany-based psychologist, Gerd Gigerenzer, which showed that in the three months after 9-11 there were 353 more traffic deaths than average for those months in the previous five years., presumably because people chose to drive over flying.
The article states, "The April 2004 issue of Psychological Science contains a commentary by Gerd Gigerenzer, who calls those excess traffic deaths "the price Americans paid for trying to avoid the risk of flying," noting that the number of extra traffic deaths exceeded the number of people inside the four planes hijacked on 9/11.Gigerenzer, director of the Center for Adaptive Behavior and Cognition at the Max Planck Institute for Human Development in Germany, says this stems from our natural avoidance of "dread risks, that is, low-probability, high-consequence events."
Meyers also suggests there are a number of factors that increase our beliefs in low risk behaviours will occur more often than high risk one, when statistically, it's the other way round.
Here you can
see four factors that help to skew or bias our reasoning, and how each one can
apply to fear of flying. In other words they tap into basic fears we carry with
us as part of the human experience. When it comes to fear, it's often a case of
"Act and feel now, think
later".More to come about fears soon...