Fear of flying (FOF) or Aviophobia, classified in the DSM 5 as a Specific ( situational) Phobia, is characterized by “excessive and persistent fear of air travel”. Although there are multiple pathways to fear of air travel, most cases are accounted for by two but very different clinical phenomena:
Fear of mechanical failure and/or accident causing the plane to crash is the number one reason for fear of flying. Individuals with this fear so embed themselves in the possibility of a fatal outcome that the flight becomes contaminated with idea of premature death. This perspective colors the person’s entire reaction to the idea of flying. Individuals in this group focus on every and anything related to the functioning of the aircraft and accident. Common fears seen in this group are:
As a result, they have biased scanning for and memory of aviation accidents, reports of pilot error or irresponsible behavior. Aviation statistics mean nothing to them: 2.5 incidents per million aviation hours ? 8% of passengers in such accidents fatally injured ? “Someone has to go down, why not me”. “ It is unnatural for this much metal to be in the air”. As with many fears that steer away from what is real or plausible, the relationship with possibility, in the fear of aviation accidents is selective and cherry-picked.
As with other anxiety disorders, fear elicits a reaction to "protect" oneself from perceived "threat". If there is no clear threat, the experience of fear can activate scanning to find one. The responses in fear of flying all line up according to the classic survival imperative, but adapted to the context at hand: flying. As described throughout this website, there is always a human uniqueness in how we respond to fear. Nonetheless, the most common (apologies) frequent flyers are:
For those who must remain conscious and functional and who can’t avoid flying-whether it be for business or certain life circumstances, safety seeking behaviors are the premier behavioral coping responses. As described in specific phobias, safety behaviors help you get through the feared situation but they ultimately reinforce fear. Safety behaviors are limitless and they are unique to the person but they are always organized around the relevant context. Some common examples in the context of fear of flying are:
This form of air travel anxiety is experienced by those who suffer from panic disorder. Consequently, the clinical characteristics in general Panic Disorder-described elsewhere on this site- are present when flying. It is important to understand that this group of travelers is not afraid of the plane crashing, as in fear of flying; rather, the fear is having a panic attack while "trapped" on an airplane where escape is not a viable option. As is alway the case in anxiety, the nature of the situation shapes the specific ways anxiety is expressed. Thus certain nuances of panic fears and the specific safety behaviors used are contoured to the context of flying.
CBT is the treatment of choice for both fear of panic and fear of accident during air travel. The core fears of each is different, and, consequently, the focus of cognitive methods varies accordingly. Nonetheless, the fundamentals of CBT are applicable to the treatment of both. Briefly, steps in the approach I use, by category, are listed below:
Treatment of fear of panic while flying blends the technique of scripted imaginal rehearsal used for fear of flying with the methods of panic control therapy. The safety behaviors panickers rely on when flying are very similar to those used elsewhere, but adapted to the agoraphobic context of air travel. Below I have listed treatment steps for fear of panic when flying:
Both fear of panic and fear of accident require exposure air travel. This does present both logistic and financial obstacles, as many do not have the resources or time to fly often.To overcome this limitation and enhance imaginal exposure, very recently, I have introduced Virtual Reality technology as a proxy for exposure. Thus far, VR clearly adds significant value to the overall treatment package. I chose the Ovrcome VR software as it has an extensive library of simulations and is very affordable. Ovrcome was created at the start of the pandemic with tele therapy in mind. It allows the therapist to view and audio into the client's VR simulation. Additional information about the use of this technology will be added to this site over the next several months