- Desensitising the client to the stimulus i.e. spiders, the flying experience.
- Learning a new, more relaxed response and helping you to become much calmer in situations where you are likely to encounter the stimulus.
- Uncovering the source of the phobia although this is not generally necessary.
- Teaching you how to feel more in control so you can be free of your fears and start to go where you want and do what you want.
- NLP techniques are also particularly useful with phobias and fears.
A fear of flying is a fear of being on an airplane (aeroplane), or other flying vehicle, such as a helicopter, while in flight. It is also sometimes referred to as aerophobia, aviatophobia, aviophobia or pteromechanophobia.
OverviewFear of flying may be a distinct phobia in itself, or it may be an indirect combination of one or more other phobias related to flying, such as claustrophobia (a fear of enclosed spaces) or acrophobia (a fear of heights). It may have other causes as well, such as agoraphobia (especially the type that has to do with fear of open spaces). It is a symptom rather than a disease, and different causes may bring it about in different individuals.
The fear receives more attention than most other phobias because air travel is often difficult for people to avoid—especially in professional contexts—and because the fear is widespread, affecting a significant minority of the population. A fear of flying may prevent a person from going on vacations or visiting family and friends, and it can cripple the career of a businessperson by preventing them from traveling on work-related business.
Commercial air travel continues to cause a significant proportion of the public and some members of the aircrew to feel anxiety. When this anxiety reaches a level that significantly interferes with a person's ability to travel by air, it becomes a fear of flying.
SymptomsA fear of flying is a level of anxiety so great that it prevents a person from travelling by air, or causes great distress to a person when he or she is compelled to travel by air. The most extreme manifestations can include panic attacks or vomiting at the mere sight or mention of an aircraft or air travel.
CausesThe fear of flying may be created by various other phobias and fears:
- a fear of closed in spaces (claustrophobia), such as that of an aircraft cabin
- a fear of heights (acrophobia)
- a feeling of not being in control
- fear of vomiting, motion sickness can make the person vomit, thus making flying hard.
- fear of having panic attacks in certain places, where escape would be difficult and/or embarrassing (agoraphobia)
- fear of hijacking or terrorism
- fear of turbulence
- fear of flying over water or night flying
- the result of hormone release during pregnancy
- the result of difficulty with the regulation of emotion when not in control due to developmental issues
- fear of crashing resulting in injury or death
Some suggest that the media are a major factor behind fear of flying, and claim that the media sensationalize airline crashes (and the high casualty rate per incident), in comparison to the perceived scant attention given the massive number of isolated automobile crashes. As the total number of flights in the world rises, the absolute number of crashes rises as well, even though the overall safety of air travel continues to improve. If only the crashes are reported by the media (with no reference to the number of flights that do not end in a crash), the overall (and incorrect) impression created may be that air travel is becoming increasingly dangerous, which is untrue. In a way, the media coverage is forcing confirmation bias on viewers.
Misunderstandings of the principles of aviation can fuel an unjustified fear of flying. For example, many people incorrectly believe that the engines of a jet airliner support it in the air, and from this false premise they also incorrectly reason that a failure of the engines will cause the aircraft to plummet to earth. In reality, all aircraft glide naturally, and the engines serve only to maintain altitude during the flight. A big cause of fear of flying is that it’s difficult to imagine how planes stay in the air, thus a person's understanding of the science behind flying can affect the person's fear about flying.
Non-pharmacologicIn some cases, educating people with a fear of flying about the realities of air travel can considerably diminish concern about physical safety. Learning how aircraft fly, how airliners are flown in practice, and other aspects of aviation can assist people with a fear of flying in overcoming its irrational nature. Many people have overcome their fear of flying by learning to fly or skydive, and effectively removing their fear of the unknown. Some people with a fear of flying educate themselves; others attend courses (for people with the phobia or for people interested in aviation) to achieve the same result. Some airline and travel companies run courses to help people get over the fear of flying.
Education plays a very important role in overcoming the fear of flying. Understanding what a certain sound is or that an encounter with turbulence will not destroy the aircraft is beneficial to easing the fear of the unknown. Nevertheless, when airborne and experiencing turbulence, the person can be terrified despite having every reason to know logically that the plane is not in danger. In such cases, therapy — in addition to education — is needed to gain relief.
Behavioral therapies such as systematic desensitization developed by Joseph Wolpe and cognitive behavior therapy developed by Aaron Beck rest on the theory that an initial sensitizing event (ISE) has created the phobia. The gradually increased exposure needed for systematic desensitization is difficult to produce in actual flight. Desensitization using virtual flight has been disappointing. Clients report that simulated flight using computer-generated images does not desensitized them to risk because throughout the virtual flight they were aware they were in an office. Research shows Virtual Reality Exposure Therapy (VRET) to be no more effective than sitting on a parked airplane.
Cognitive therapy may be useful when there is no history of panic. But since in-flight panic develops rapidly, often through processes which the person has no awareness of, conscious measures may neither connect with - nor match the speed of - the unconscious processes that cause panic.
Hypnotherapy generally involves regression to the ISE, uncovering the event, the emotions around the event, and helping the client understand the source of their fear. It is sometimes the case that the ISE has nothing to do with flying at all.
Neurological research by Allan Schore and others using EEG-fMRI neuroimaging suggests that though it may first be manifest following a turbulent flight, fear of flying is not the result of a sensitizing event. The underlying problem is inadequate development of ability to regulate emotion when facing uncertainty, except through feeling in control or able to escape. According to Schore, the ability to adequately regulate emotion fails to develop when relationship with caregivers is not characterized by attunement and empathy. Chronic stress and emotional dysregulation during the first two years of life inhibits development of the right prefrontal orbito cortex, and hinders the integration of the emotional control system. This renders the right prefrontal orbito cortex incapable of carrying out its executive role in the regulation of emotion.
When emotional regulation is not adequately built inside, anxiety develops when not personally in control or unable to physically escape. Since flight affords the passenger neither control nor physical escape, anxious fliers may attempt to escape psychologically by dissociating from the flight and focusing awareness elsewhere. Turbulence, because it is physically intrusive, defeats this strategy. When awareness of the flight is restored, being far from the ground with neither control nor escape may throw the person into panic. A specialized treatment to provide control of emotion during flight was developed by therapist-airline captain Tom Bunn based on Schore's research, attachment theory and object relations theory.
PharmacologicFear of flying may be treated by anti-anxiety medications such as benzodiazepines or other relaxant/depressant drugs. A double blind, controlled, crossover clinical study found that alprazolam (Zanax) "acutely reduces self-reported anxiety, tension, desire to leave, and symptom number and score in flight phobics to a clinically and statistically significant degree, although these measures were still well above levels experienced by non-anxious controls." However users of alprazolam that then were switched to placebo had higher anxiety and sharply increased incidence of in-flight panic. This study reveals that alternatives to drug therapy such as exposure therapy are incompatible. A patient who is treated with benzodiazapienes one time should be treated similarly the next.
Typical pharmacologic therapy is 0.5 or 1.0 mg of alprazolam about an hour before every flight, with an additional 0.5-1.0 mg if anxiety remains high during the flight. The alternative is to advise patients not to take medication, but encourage them to fly without it, instructing them in the principles of self-exposure.
Paruresis is a social phobia involving urinary retention and "thought to affect some 17 million or 7% of the American population" (p. 92). Also known as "bashful bladder."
"This is a book for the thinking clinician" (p. 401). "The editors are to be congratulated for making this volume much more coherent than most edited books" (p. 402). "My impression is that the book is best suited for an intermediate or advanced course on hypnotherapy, or for people who are already using hypnosis in treatment. Although there is some material on the basics of hypnotic inductions and a few introductory sample scripts for inductions, a beginners'' course should probably use a different book, or this book could be accompanied by an inductions manual. ... I recommend it very highly" (p. 403).
The therapist suggested that "her mind would take her back to a time that was important in understanding her fears and that she would be able to stay calm and relaxed while this past event was revealed to her" (p. 69. She subsequently imagined being in a cave, peaceful and calm. "On being roused from hypnosis, Francesca eagerly described her cave image. She was enthusiastic about the significance of this experience, claiming that it was evidence that in a _previous life_ she had died from being locked into a cave as some sort of punishment and that this pexperience made her fear of enclosed places rational and comprehensible to her" (p. 69).
"Summary. This report presents the hypnotherapy of a patient with claustrophobia. The crucial event responsible for symptom formation occurred in military service when the patient was trapped in a trench by a tank which stopped over the patient before proceeding, and at which time the sides of the trench began to cave in. Subsequent traumatic events served as reenforcement. It is likely that a low threshold for the development of anxiety predisposed this patient to the development of the claustrophobia, although the major trauma sustained was undoubtedly of tremendous impact and a distinct threat to life. Emotional experiences were sealed and free expression was permitted through hypnotic revivification. The dynamics, further elaborated in the report, suggest that similar occurrences not necessarily in military settings may be approached therapeutically in this way. Aside from the reliving technique, recall stimulation through a dream induction approach was employed. Other hypnotic methods were described and further implications for psychotherapy in general were elaborated. Hypnotherapeutic and hypnoanalytic approaches to phobic reactions have been described at length elsewhere" (p. 260).