Fear of flying

Overview
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 aviation accident
  • Fear of panic.
Fear of fatal accident of 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 from mechanical failure, accidents in the air, birds hitting the engine, weather conditions, turbulence, wind sheer to pilot competence and health. 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.
Behavioral responses
  • Number 1: “I am not flying”. “I’ll drive, take the train, bus or even walk”.
  • Number 2: “Drug me, even if I have to get on the plane in a wheelchair”.
  • Number 3 : For those who must remain conscious during the flight and who can’t avoid flying-whether it be for business or certain life circumstances, the premier coping response is the use of safety behaviors. These are specific to the fear of crashing such as seeking reassurance, inquiring about the type of aircraft, praying, mastering the science of meteorology, studying the reactions of other passengers and flight attendants during turbulence. There are many, and they are unique to the person. As described in specific phobias, the safety behaviors help someone get through a flight but they ultimately reinforce fear.
Fear of a panic attack on the plane is the second most common reason for aviation phobia. This group is comprised of people with panic disorder and agoraphobia. Airplanes are feared not because they could crash, but because they have sealed doors that cannot be opened once in flight, and consequently, there is no “escape” to “safety” if panic were to occur. Those with this fear could really care less about the aircraft. The central focus for this group is fear of panic itself not the air travel. Flying for a panicker presents a significant challenge, as there is no exit, or emergency room, until the plane has landed. But it is important to understand that air travel, for someone with panic, is only one of many situations avoided. Whereas for those fear of crashing, flying is THE situation!
Behavioral responses
  • Number 1 for a paniker: “I am not flying”. “I’ll drive, take the train, bus or even walk”.
  • Number 2: “Drug me, even if I have to get on the plane in a wheelchair”. Yes, similar to those seen in fear of crashing.
  • Number 3: Once again safety behaviors. Panickers who must flying and remain conscious, rely on many of the safety behaviors employed by their crashing counter parts, such as reassurance seeking and tracking the time remaining in the flight. But because the focus of fear is safety of body and mind and not the aircraft, panickers rely on certain types of safety behaviors intended to distract attention away from body and mind in the context of air travel, such as gum- chewing, distraction, seating, gripping the arm supports, multimedia distractions and concealing their reactions from those around them.
Other Fears
  • Fear of heights (acrophobia)
  • Fear of vomiting (emetophobia) or being near someone who is vomiting
  • Fear of hijacking or terrorism
Treatment
Fear of Aviation Accident
Cognitive and Behaviors Therapy is the treatment of choice for fear of flying, but the specific methods used depend on the subtype being treated. As with all anxiety disorders, it is necessary to face the feared situation repeatedly in order to desensitize. Treatment of fear of aviation accident, however, presents a logistic-financial challenge, as many people do not have the resources or time to fly often. There is a workaround for this, however. Briefly, steps in the approach I use include:
  • Defusing catastrophic fears is necessary to gain and to is the cognitive and narrative foundations of this fear is therefore essential . the is viewed of a fatal crash the expectation of a catastrophic away from the expectation of a catastrophic acc of Cognitive therapy techniques with some blending of reframing to decatastrohize these fears (essentially the Beckian, “what is the evidence for and against?)
  • Identifying the specific justifications that maintain the “construction” of the fear- a technique used in Inferential-Based Treatment (IBT)
  • Creating a reality-based counter perspective and narrative of flying
  • Writing out in detail a narrative of an imagined flight, that includes fears, urges to act on safety behaviors, responses to the fears, calming strategies and measurable, clear behaviors in line with story of not crashing.
  • Repeated rehearsal of the narrative, together with youtube videos
  • Rating fear responses during imaginal exposure
  • Setting up a flight
  • Mapping of the imaginal exposure onto the real flight
  • Rehearsal and preparation for the real flight.
  • The flight with strict no-safety behavior contract along with use of all strategies practiced
  • Rating the flight
  • Debriefing the flight and adjusting strategies
  • Setting up at least two more flights over a 4-6 month period
  • Repeating all the steps above
Fear of Panic
In line with the prevalence data, most prospective clients in my practice, who seek treatment for flying phobia, are in the aviation crash subtype. For fear of panic while flying, panic control treatment methods are used. Almost always someone with the panic subtype of air travel fear, is already in treatment with me for panic/agoraphobia, and flying is addressed as yet another situational exposure. Hence, the treatment foundation is usually already in place. Nonetheless, it is still important to:
  • Identify safety behaviors that occur specifically while flying
  • Write out a detailed narrative of an imagined flight and follow all of the steps outlined above.
Over time, of how treatment of FOF is delivered will be added to this page.