This was the fourth session for the treatment of Karen's fear of flying.  Today Karen was introduced to virtual reality therapy (VR).  Prior to beginning the VR sessions Karen rank ordered the different parts of the flight in terms of how much anxiety occurred.  The least anxious time was landing, which was rated a 20 on a 100 scale.  Flying in good weather was rated a 40, taxiing was rated a 50, sitting on the plane prior to takeoff was a 60, takeoff was an 80 and finally flying in bad weather was 100.  Today's VR session began with Karen spending 15 minutes practicing breathing and relaxation skills and then practicing landings in the virtual reality program.  During the session Karen was able to practice 10 landings.  Whenever she became anxious she was instructed to do the breathing she was taught.  Additionally, I constantly helped her to correct any distorted thoughts about the plane, or flying, as these thoughts occurred.  By the final landing practice Karen reported no anxiety.  She was instructed to continue practicing her breathing and relaxation skills at home and that the next VR session would focus on flying in good weather.