Tami Augen Rhodes needed to fly to Washington. An invitation to a black-tie event at the Supreme Court was an opportunity the 49-year-old lawyer in Tampa, Florida, did not want to miss. But Rhodes had not flown since she was 35, when an escalating dislike of flying grew into a firm phobia.
Desperate to get to Washington without resorting to a long train ride, Rhodes called into a weekly group-telephone chat run by Tom Bunn, a former Air Force and commercial airline pilot and licensed clinical social worker who runs a program for fearful fliers.
Bunn asked her what she was afraid of.
"I started crying," Rhodes recalled. She told the group what worried her. "I am afraid of dying."
Fear of flying, or aviophobia, is an anxiety disorder. About 40% of the general population reports some fear of flying, and 2.5% have what is classified as a clinical phobia, one in which a person avoids flying or does so with significant distress.
As with other situational phobias, the fear is disproportionate to the danger posed. Commercial air travel in the United States is extremely safe. A person who took a 500-mile flight every day for a year would have a fatality risk of 1 in 85,000, according to an analysis by Ian Savage, associate chair of the Economics Department at Northwestern University. In contrast, highway travel accounts for 94.4% of national transportation fatalities.
But for many, statistics are not enough to quell phobias.
The Anxiety and Depression Association of America suggests eight steps to help identify triggers and defuse them. Martin Seif, a clinical psychologist who wrote the steps, identifies the variety of conditions that may comprise the phobia - panic disorder, social anxiety disorder, obsessive compulsive disorder and panic disorder, among them.
For some, breathing exercises, anti-anxiety medication and cognitive behavioral therapy work. But the strategies do not work for everyone.
Bunn has worked with fearful fliers since 1980 after becoming curious about the psychological and physical components that produced anxiety and panic in situations that he as a pilot knew to be safe. He developed a set of mental exercises for fearful fliers. One, called the "strengthening exercise," links specific phases of air travel with a joyful personal memory, a visualization technique meant to trigger a sense of calm.
Rhodes had two months to prepare. She delved deeply into written exercises, videos, phone sessions. The day of her flight, she felt anxiety. But she was organized, equipped with magazines, memorized mental exercises and had an understanding of the expected noises and sensations of flight.
"The panic never came," she said, describing her flight. Since then, she has flown several more times, including a trip to Seattle to surprise her best friend.
Fear of flying, according to one overview, is far less studied than other conditions that can be detrimental to relationships and careers such as social anxiety, obsessive compulsive and post-traumatic stress disorders. Little is known about what keeps people afraid even after exposure to successful flights. And there are few experts in the field who are trained as both pilots and clinical social workers.
Stacey Chance, a pilot who flew with American Airlines for 30 years, runs a free online Fear of Flying Help Course, a one-hour overview of each aspect of flight. He includes video clips from therapists and pilots and printable checklists for managing anxiety. He was surprised to learn that many passengers fear they will "lose control and open a door in flight," a scenario he said is impossible.
The door is pressurized.
Tonya McDaniel, a licensed clinical social worker at the Center for Growth in Philadelphia, uses a virtual-reality program designed for psychologists: While patients navigate stages of air travel with an avatar - from packing, boarding, takeoff and even weather - McDaniel monitors their heart rates and self-assessed level of distress, measured as SUDS (subjective units of distress scale.)
The goal of the exposure therapy is to recalibrate a person's response, eventually teaching the body that the experiences are "not dangerous and this is OK," she said.
After patients complete the sessions, McDaniel encourages them to keep practicing, even if it is simply going to the airport to watch planes.
"Phobias breed on avoidance," she said.
Untreated, the phobia takes a toll. Rhodes did not go to her grandmother's funeral or her best friend's wedding.
Bunn trained as a fighter pilot, a vocation he chose because growing up in a small town in North Carolina after World War II, "the ones who got all the attention were ex-pilots," he said. He finished top of his class in flight school and got assigned to the F-100 Super Sabre, a supersonic fighter.
While based in Germany in the early 1960s, sitting around on "nuclear alert," he delved into books on psychology, an interest spurred by his mother's mental illness. Later, as a commercial pilot for Pan Am, he helped a fellow pilot with a graduation class for fearful fliers run by the airline.
"People were sitting on the plane doing breathing exercises, doing exactly what we told them, and they still had panic," he said. It was awful to be so helpless, he thought.
By 1982, Bunn started his own course, and eventually earned a master's degree in social work at Fordham University. He did shifts at a Veterans Affairs hospital, and in 1996 retired from flying to work full time as a licensed clinical social worker in Bridgeport, Connecticut.
His program for fearful fliers, SOAR, continued to grow until it became his sole focus. Clients, me among them, call him "Captain Tom."
He found that home study helped.
"[People] were in control," he said. "They didn't have to show up in an airport and fly in two days," Bunn said.
Lisa Hauptner, a former client, quit her job in the corporate world to help run the business. Her own fear began as many do, with work-related stress and a sense of impending change.
"There are usually stressors, good or bad, happening at the time," Hauptner said. "The average age of onset is 27. Think about what's going on when you are 27 years old. You may be getting married, or may be moving, or may be engaged or having a child."
Cognitive behavioral therapy, often used to treat anxiety and panic with measurable results, was helping people on the ground, they found, but left them vulnerable to feelings of panic in flight. Once panic starts, "cognitive ability is fried," Bunn said. Stress hormones and a fight or flight response take over.
Bunn said that people can "retune" their ability to calm themselves before panic escalates, relying on unconscious or procedural memory, the kind used to ride a bike. He offers exercises that are simple, but require practice, conditioning the body to respond to triggers (turbulence, for example) with less alarm.
He was influenced by the work of Stephen Porges, Distinguished University Scientist at Indiana University and Professor of Psychiatry at the University of North Carolina University, whose Polyvagal theory examines how our nervous system detects and responds to threat.
Porges described Bunn's exercises as using "visualization to help people deal with fear of flying, or deal with anxiety." The images send the body cues that it is safe and not in a state of defense.
At age 83, Bunn is busy. He responds to 30 to 40 emails a day from anxious fliers and conducts up to eight private phone sessions. His weekly email goes to more than 17,000 subscribers. Last April, he released a book, "Panic Free: The 10-Day Program to End Panic, Anxiety, and Claustrophobia," which uses the system developed for fearful fliers. Since the Boeing 737 Max crashes, activity has increased, he said.
Not everyone responds to his system. Hauptner, who is also a mental health counselor, said fliers who are in the middle of another big event, such as a divorce or quitting smoking, may not respond. "Or, they want perfection, and there is no perfection," she said.
No one strategy may work for everyone. Porges said some people find breathing exercises, a common coping strategy for panic, effective if done with a slow exhale.
Joe Spatola sought help shortly after he got engaged, setting his sights on a honeymoon in Italy.
Spatola said Bunn helped him break down his feelings, recognize his heartbeat and employ a technique for calming himself that transfers anxiety to a cartoon character.
"I use Popeye," he said. His biggest annoyance with turbulence now is not being able to get up to use the lavatory.
I found "Captain Tom" on the internet 18 years ago, back when his program arrived in the mail on audiocassettes. My fear of flying hit at age 26 when I started a new job at CBS News - the age and phase of young adulthood when it typically manifests. I listened to the tapes. I read the typed material. I flew to my destination and worked on an assistant producing assignment.
On the return trip, I was delayed, first in Tallahassee and then in Atlanta because of mechanical problems. As the night wore on, my confidence waned, and I did not want to board the plane. I decided to try the phone session that came with my course.
Bunn picked up right away. His voice reflected his North Carolina upbringing and a calm demeanor, my idealized version of a pilot and therapist rolled into one. I flew home to New York and arrived late that evening, Sept. 10, 2001.
There was no good place to be the following day, tragedy hit families across the country and stranded travelers for days. My own anxieties shifted and grew, and it would take another concerted effort years later to work on flying again.
But I always look back on that night and the indecision I had waiting alone in the Atlanta airport. And I thank Captain Tom for picking up the phone.