It's 20 minutes before Alaska Airlines Flight 626 takes off from San Francisco International Airport for Seattle. Colette Vance closes her eyes and calms herself with rosary beads, hoping that her claustrophobia doesn't trigger a panic attack.
It happened the year prior, when she was flying back to North Carolina for college. She had intense anxiety and felt as if she was about to die.
"If I'm in a car, I can pull over, open my door and get some relief," she says. "But when I'm in a plane, there's no out."
After graduation, she avoided flying and drove home to California. The inconvenience of a cross-country road trip inspired her to confront her fear of flying.
Which is how she wound up on this commercial flight with a group of other anxious passengers. They're all on board for the final step in a training called the Fear of Flying Clinic, hosted at the San Francisco International Airport.
Fear of flying affects about 25 million Americans, and many psychologists say that the way to get over a fear is to gradually face it. But that's often hard to do with air travel if you're on your own, in public, surrounded by strangers. That's where the Fear of Flying Clinic comes in: over four days, participants are able to get slow exposure to the flying experience, as well as training and support from mental health and aviation professionals.
More information from insiders goes a long way
Fran Grant and Jeanne McElhatton, both licensed pilots, founded the clinic in 1976. They created an educational program to help Grant's husband overcome his anxiety about turbulence so that he could travel with them.
Today, volunteers put on the workshop — many of whom have gone through the clinic themselves. It's one of a handful of programs like it in the country.
Participants are afraid of flying for various reasons: recent aircraft accidents and air traffic controller shortages, traumatic experiences that flying reminds them of (like living through an earthquake), or a fear of heights.
The first part of the training is designed to give nervous flyers more information about flight safety. Working pilots, air traffic controllers, flight attendants and aircraft maintenance technicians present to the group and answer their questions — on everything from advancements in aircraft technology to safety protocols for pilots during thunderstorms.
Rewiring the fear response
The second big part of the training uses cognitive behavioral therapy (CBT) to help participants work on changing distorted thinking patterns that equate the presence of adrenaline with the presence of a real threat.
Using what's known as the "ABC model," volunteer psychotherapist Paula Zimmerman writes the letter "A" on a large sheet of paper at the front of the room. "A" stands for an "activating event" — the thing that triggers fear — like, for example, turbulence.
Then she adds "B," for belief — let's say someone believes that any time they experience turbulence, it means the plane is going to crash.
Finally, she writes "C," the consequence of that belief, which could be something like a panic attack.
If you believe turbulence means the plane is going to crash, it makes sense you'd be terrified. However, turbulence is a normal part of flying and doesn't necessarily mean anything is wrong.
Zimmerman spells all this out so that when flyers get scared on a real flight, they can work through this process on their own and try to correct their faulty thinking. With the example of turbulence, she offers a reframing tool: instead of saying "turbulence scares me," she suggests people tell themselves: "I upset myself when there's turbulence."
Face to face with a 787
The other big technique the clinic relies on is slowly exposing participants to the sights and sounds of planes.
On the second day of the training, participants visit a maintenance hangar and gather beneath the tail of a 787.
Just seeing the outline of the emergency exit door triggers a sense of dread for Vance, who practices Zimmerman's reframing.
"It's just an airplane," she tells herself. "Airplanes don't harm anybody."
One by one, participants climb inside. Vance sits in a window seat, which is more likely to trigger her claustrophobia. She starts to feel sick and rests her head on her mother's shoulder. But after some deep breathing, and processing with her mom and Zimmerman, she feels better. Eventually, she's well enough to tour the cockpit.
This lower level of exposure is a dress rehearsal for what comes next — the commercial flight to Seattle.
Graduation in the sky
Vance and other participants meet at the airport early on a Sunday. Vance goes through security, boards and sits in a window seat. Three other volunteers from the clinic — including a retired pilot and psychotherapist — are also there to support the anxious flyers.
The flight starts off a little rocky for Vance, but she focuses on her breathing and rides out the wave of anxiety. She says the support of everyone around her makes it easier.
" I'm feeling really safe on this flight," she says, "I'm really hopeful that I'm gonna do way more of this."
When the wheels hit the runway in Seattle, the clinic group erupts with cheers and congratulations.
On the flight back later that day, Vance opens the fortune cookie she received with her lunch at the airport.
"You will travel to many exotic places in the next few years," it says.
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