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A fear of flying is a situational phobia, a fear or phobia 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.

Overview

Fear 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[1] 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.

Symptoms

A 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.

Causes

The fear of flying may be created by various other phobias and fears:[2]

  • fear of crashing resulting in injury or death
  • 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 aircraft hijacking or terrorism, - sometimes very reasonable as in cases of heads of state.
  • fear of turbulence
  • fear of flying over water or night flying
  • the result of hormone release during pregnancy and the result of difficulty with the regulation of emotion when not in control due to developmental issues

A previous traumatizing experience with air travel or somehow connected to flying can also trigger a fear of flying. For example, the experience of flying to a meeting only to be told that one has been fired might be traumatic enough to subsequently create an association between any air travel and bad or unpleasant events.

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. Statistics on various forms of travel show that airplanes are safer than other common forms of transport per kilometer traveled. 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.

Treatment

Non-pharmacologic

In 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.[3]

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.[4]

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 [5] was developed by therapist-airline captain Tom Bunn [6] based on Schore's research, attachment theory and object relations theory.

Pharmacologic

Flight experience with the use of anti-anxiety medications such as benzodiazepines or other relaxant/depressant drugs varies from person to person. Medication decreases the person's reflective function. Though this may reduce anxiety cause by inner conflict, reduced reflective function can cause the anxious flier to believe what they are afraid will happen is actually happening.

A double blind clinical study at the Stanford University School of Medicine suggests that anti-anxiety medication can keep a person from becoming accustomed to flight. In the research, two flights were conducted. In the first flight, though patients given alprazolam (Xanax) reported less anxiety than those receiving a placebo, their measurable stress increased. The heart rate in the alprazolam group was 114 versus 105 beats per minute in the placebo group. Those who received alprazolam also had increased respiration rates (22.7 vs 18.3 breaths/min).

On the second flight, no medication was given. Seventy-one percent of those who received alprazolam on the first flight experienced panic as compared with only twenty-nine percent of those who received a placebo on the first flight. This suggests that the participants who were not medicated on the first flight benefited from the experience via some degree of desensitization.[7]

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.[7][8]

See also

References

  1. Medialdea J, Tejada FR (June 2005). Phobic fear of flying in aircrews: epidemiological aspects and comorbidity. Aviat Space Environ Med 76 (6): 566–8.
  2. Captain S. L. Chance. Fear of Flying Media Kit. Press release. Retrieved on 2007-04-29.
  3. Smith, Samantha; Rothbaum, Barbara O., "Virtual Reality Technique Helps with Fear of Flying", Self Help Magazine, 10/27/00; Revised 11/06/08 by Marlene M. Maheu, Ph.D.
  4. Trauma Information Pages, Articles: Allan Schore (2002)
  5. Comparative Effectiveness Of Flight Anxiety Treatments And Programs.
  6. History of Fear of Flying Programs.|
  7. 7.0 7.1 Acute and delayed effects of alprazolam on flight phobics during exposure..
  8. Taylor, C. B., & Arnow, B. A. (1988). The nature and treatment of anxiety disorders. New York: Free Press


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