Virtual Plane Calms Flying Fears

Medically Reviewed by Jacqueline Brooks, MBBCH, MRCPsych

Aug. 4, 2000 (Washington) -- Afraid to fly? Why not face those fears with a flight on the "virtual" plane built by Larry Hodges and Barbara Rothbaum? It taxies down a runway, reaches cruising altitude, even encounters a little turbulence before safely landing. The trip takes five minutes, and you never have to abandon the comfort of the therapist's office.

Virtual reality has left the land of video games and entered the realm of medical science. Using special effects from movie studio libraries and computer-generated images and graphics, the two constructed a 3-D software program that they and other psychologists say works just as well at combating fears about flying as does traditional "exposure" therapy.

In exposure therapy -- used to treat people's fears or phobias -- the person is gradually exposed to increasingly worse scenarios of the type they fear. For example, if you have a fear of riding in an elevator, you would first be asked to picture yourself in one, then you would stand in one with the door open and gradually you would learn to push the button and go for a ride.

The logic behind this type of therapy is that we learn -- over time and with experience -- that the things we fear happening, such the elevator falling, are very unlikely to happen.

"We know that standard exposure therapy works, but it has a lot of disadvantages," says Rothbaum, including the cost of plane tickets and extended counseling sessions, if the therapist goes to the airport, which is one component of exposure therapy. "We can do things with virtual reality that we simply can't do in real life. We can't do repeated takeoffs and repeated landings." Rothbaum is a professor of psychiatry at Emory University School of Medicine in Atlanta.

Hodges adds that because facing one's fears can be very painful, virtual reality programs may encourage people to seek treatment for their phobias. "We have people asking for it because it is not reality, but [the benefits] carry over into reality," he says.

The company founded by Hodges, Virtually Better of Atlanta, also makes programs to help people overcome their fear of heights and public speaking. There's even one featuring jungles, helicopters, and combat sounds that is being used to help Vietnam War veterans suffering from post-traumatic stress disorder. Programs to address thunderstorms and spiders are also on the list for new programs, as is one that simulates a mall to assist people whose agoraphobia keeps them locked indoors.

Hodges, Rothbaum, and others from Virtually Better demonstrated the program for flying fears at a meeting of the American Psychological Association meeting here this week.

A person is strapped into a seat -- just like on a plane -- and dons a large headset that covers his or her eyes and ears. The person sees images to simulate sitting in a window seat over the wing; the image changes as you turn your head. Noises simulate the sound of the plane's engines, while a flight attendant announces that take-off is coming up. Then the person feels as if the seat and floor are rumbling as the plane speeds down the runway, with the tarmac rushing by outside the window.

A pilot's voice comes on as the cruising altitude is reached and later when the plane is preparing to land. The program can be altered to create turbulence, with the blue-sky window view turning dark and stormy.

People who use the program quickly forget the images are computer generated and begin to feel just as scared and anxious as when they actually fly or think about flying, say those who have used the software. During the program, the person and the therapist can talk to one another, and the therapist can make certain parts of the flight longer or shorter to better address the person's particular fears.

So far, one study involving 45 people was done to test the effectiveness of this program in addressing flying fears. First, all of the people completed four sessions with a therapist to learn ways of controlling their anxiety. Then, one-third of the group got standard exposure therapy and one-third used the virtual reality program, with each group having eight sessions over a six-week period. The final third did not receive further treatment.

All 45 were asked to take a plane flight following the therapy, and an average of nine people from each of the virtual reality and standard therapy groups was able to make the flight. Yet only one person in the group of 15 who received no follow-up session was able to fly. Even a year later, the people in the two treatment groups continued flying.

The programs are available only in a few locations, although many therapists are becoming more interested in them, Hodges says

For the therapist "the main obstacle right now is price," Rothbaum tells WebMD. "But the cost has come way down."

For patients, there is greater convenience, with the therapy costing about the same as traditional treatment for phobias. Rothbaum predicts that someday these programs will be sold directly to patients who need them.

Jerilyn Ross, president of the Anxiety Disorders Association of America, tells WebMD virtual reality programs could be a good way to help people combat their fears one step at a time "while having the safety net" under them of the therapist's office. "It could be a terrific way for people to get started. It could be a good tool as part of a comprehensive program," in which the person is not only taught to be less afraid, but is also taught relaxation techniques and strategies to control their thoughts about flying, says Ross.