Washington - 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."
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 organised, equipped with magazines, memorized mental exercises and had an understanding of the expected noises and sensations of flight.
It worked.
"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 programme 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 okay," 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.