Fear of flying

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An Iberia 747-200

Fear of flying is a fear of being on an airplane, or other flying vehicle, such as a helicopter, while in flight. It is also referred to as flying anxiety, flying phobia, flight phobia, aviophobia, aerophobia, or pteromerhanophobia (although aerophobia also means a fear of drafts or of fresh air). [1]

Contents

Acute anxiety caused by flying can be treated with anti-anxiety medication. [2] The condition can be treated with exposure therapy, which works better when combined with cognitive behavioral therapy. [3] [4]

Signs and symptoms

People with fear of flying experience intense, persistent fear or anxiety when they consider flying, as well as during flying. They will avoid flying if they can, and the fear, anxiety, and avoidance cause significant distress and impair their ability to function. [5] Take-off, bad weather, and turbulence appear to be the most anxiety-provoking aspects of flying. [5]

The most extreme manifestations can include panic attacks or vomiting at the mere sight or mention of an aircraft or air travel. [3]

Around 60% of people with fear of flying report having some other anxiety disorder. [5]

Cause

The causes of flight phobia and the mechanisms by which it is maintained were not well understood as of 2016. [5] [6] It is not clear if it is really one condition; it appears to be heterogenous. It appears that some people get aerophobia from being or having claustrophobia to the small spaces inside the fuselage of the plane or helicopter. Though highly unlikely, fear of plane crashes may induce symptoms as well. [7]

Diagnosis

Fear of flying is a specific phobia classified as such in the DSM-5. [5]

The diagnosis is clinical. It is often difficult to determine if the specific phobia of fear of flight should be the primary diagnosis, or if fear of flying is a symptom of a generalized anxiety disorder or another anxiety disorder such as agoraphobia or claustrophobia. [7]

Management

Acute anxiety caused by flying can be treated with anti-anxiety medication. The condition can be treated with exposure therapy, including use of virtual reality equipment, which works better when combined with cognitive behavioral therapy. Relaxation techniques and education about aviation safety can also be helpful in combination with other approaches. [3] [4]

A new and advanced treatment for aviophobia is virtual reality exposure therapy. This type of treatment uses computer technology where the patient enters a virtual reality of flying. [8]

Virtual reality exposure therapy

Effective treatment for phobias such as fear of flying would be one that activates and modifies the fear structure. [9] Activation of the fear structure can be achieved by exposing the patient to the feared stimuli, flying in this case, to elicit the fearful response. [9] Modification of the fear structure can be achieved by the processes of habituation and extinction after eliciting the fearful response several times. [9] A new and advanced treatment for aviophobia is virtual reality exposure therapy (VRET). This type of treatment uses computer technology where the patient virtually experiences flying. [10] This experience includes visual, auditory, and motion stimuli to imitate flying in a plane as close as possible. [10] Thus, VRET is considered an effective treatment for aviophobia. While it can be argued that vivo exposure treatment, patients being exposed to an aircraft, is the most effective way of treatment, but VRET is more cost-effective, accessible, [10] less time-consuming, and requires less organization. [11] Another advantage of VRET over vivo exposure treatment is that it focuses on the main reason that elicits fear of flying easily. For example, if the patient's most anxiety-inducing-component is takeoff, in VRET the patient would be exposed to a plane takeoff repeatedly while in vivo exposure the patient would have to wait for the plane to land and then take off again. [12]

Outcomes

Studies of interventions like cognitive behavioral therapy have reported rates of reduction in anxiety of around 80%; however, there is little evidence that any treatment can eliminate fear of flying. [4]

Epidemiology

Estimates for prevalence have ranged between 2.5% and 40%; estimates on the lower end are probably generated through studies where the condition is diagnosed by a professional, and the higher end probably includes people who have diagnosed themselves. [5]

History

Fear of flying was first discussed in the biomedical literature by a doctor in the UK at the end of World War I, who called it "aero-neurosis" and was describing pilots and crew who were or became anxious about flying. [13] It was not much discussed until the 1950s and rise of commercial air travel and the vogue in psychoanalysis. Starting in the 1970s fear of flying was addressed through behavioral and cognitive approaches. [7]

Following the September 11 attacks, Americans chose to travel more by car instead of flying; because of the extra traffic, around 350 more people died in traffic accidents than would have normally occurred. [14]

A number of celebrities have suffered from a fear of flying, including former Arsenal FC and Netherlands footballer Dennis Bergkamp, famously dubbed the "non-flying Dutchman", [15] Agnetha Fältskog, Travis Barker, who got into a plane crash in 2009, and early rock artist Ritchie Valens, who died in a plane crash less than a year into his fame. David Bowie also expressed a fear of flying. [16]

Research directions

As of 2016, the causes of fear of flying as well as the psychological mechanisms through which it persists had not been well researched. A few studies had looked at whether mechanisms like illusory correlation and expectancy bias were present in all or most people with fear of flying as well as other specific phobias; these studies have not led to clear outcomes. [5] [6]

Research into the most effective ways to treat or manage fear of flying is difficult (as it is with other counselling or behavioral interventions) due to the inability to include a placebo or other control arm in such studies. [4]

See also

Related Research Articles

<span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

<span class="mw-page-title-main">Agoraphobia</span> Anxiety disorder

Agoraphobia is a mental and behavioral disorder, specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own. Being in these situations may result in a panic attack. Those affected will go to great lengths to avoid these situations. In severe cases, people may become completely unable to leave their homes.

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

<span class="mw-page-title-main">Claustrophobia</span> Fear of small spaces

Claustrophobia is a fear of confined spaces. It is triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.

<span class="mw-page-title-main">Acrophobia</span> Extreme fear of heights

Acrophobia, also known as hypsophobia, is an extreme or irrational fear or phobia of heights, especially when one is not particularly high up. It belongs to a category of specific phobias, called space and motion discomfort, that share similar causes and options for treatment.

Emetophobia is a phobia that causes overwhelming, intense anxiety pertaining to vomit. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting or seeing others vomit. Emetophobes might also avoid the mentions of "barfing", vomiting, "throwing up", or "puking."

Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on behaviorism's theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.

Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation and breathing. From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.

Flooding, sometimes referred to as in vivo exposure therapy, is a form of behavior therapy and desensitization—or exposure therapy—based on the principles of respondent conditioning. As a psychotherapeutic technique, it is used to treat phobia and anxiety disorders including post-traumatic stress disorder. It works by exposing the patient to their painful memories, with the goal of reintegrating their repressed emotions with their current awareness. Flooding was invented by psychologist Thomas Stampfl in 1967. It is still used in behavior therapy today.

Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment; and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated, interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD, and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.

Mysophobia, also known as verminophobia, germophobia, germaphobia, bacillophobia and bacteriophobia, is a pathological fear of contamination and germs. It is classified as a type of specific phobia, meaning it is evaluated and diagnosed based on the experience of high levels of fear and anxiety beyond what is reasonable when exposed to or in anticipation of exposure to stimuli related to the particular concept. William A. Hammond first coined the term in 1879 when describing a case of obsessive–compulsive disorder (OCD) exhibited in repeatedly washing one's hands.

Cynophobia is the fear of dogs and canines in general. Cynophobia is classified as a specific phobia, under the subtype "animal phobias". According to Timothy O. Rentz of the Laboratory for the Study of Anxiety Disorders at the University of Texas, animal phobias are among the most common of the specific phobias and 36% of patients who seek treatment report being afraid of dogs or afraid of cats. Although ophidiophobia or arachnophobia are more common animal phobias, cynophobia is especially debilitating because of the high prevalence of dogs and the general ignorance of dog owners to the phobia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) reports that only 12% to 30% of those with a specific phobia will seek treatment.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the patient to the anxiety source or its context. Doing so is thought to help them overcome their anxiety or distress. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and specific phobias.

Blood phobia is an extreme irrational fear of blood, a type of specific phobia. Severe cases of this fear can cause physical reactions that are uncommon in most other fears, specifically vasovagal syncope (fainting). Similar reactions can also occur with trypanophobia and traumatophobia. For this reason, these phobias are categorized as blood-injection-injury phobia by the DSM-IV. Some early texts refer to this category as "blood-injury-illness phobia."

Ailurophobia is the persistent and excessive fear of cats. Like other specific phobias, the exact cause of ailurophobia is unknown, and potential treatment generally involves therapy. The name comes from the Greek words αἴλουρος, 'cat', and φόβος, 'fear'. Other names for ailurophobia include: felinophobia, elurophobia, gatophobia, and cat phobia. A person with this phobia is known as an ailurophobe.

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<span class="mw-page-title-main">Thalassophobia</span> Fear of the sea or large open water

Thalassophobia is the persistent and intense fear of deep bodies of water, such as the ocean, seas, or lakes. Though related, thalassophobia should not be confused with aquaphobia, which is classified as the fear of water itself. Thalassophobia can include fears of being in deep bodies of water, the vastness of the sea, sea waves, aquatic animals, and great distance from land.

Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient's conditioned response that the physical sensations will cause an attack to happen.

Driving phobia, driving anxiety, vehophobia, amaxophobia or driving-related fear (DRF) is a pathological fear of driving. It is an intense, persistent fear of participating in car traffic that affects a person's lifestyle, including aspects such as an inability to participate in certain jobs due to the pathological avoidance of driving. The fear of driving may be triggered by specific driving situations, such as expressway driving or dense traffic. Driving anxiety can range from a mild cautious concern to a phobia.

References

  1. ↑ "aerophobia". Merriam-Webster . Retrieved July 20, 2014.
  2. ↑ "Anxiety Disorders". National Institute of Mental Health (NIMH). Retrieved March 24, 2023.
  3. 1 2 3 Mulcahy, RA; Blue, RS; Vardiman, JL; Castleberry, TL; Vanderploeg, JM (2016). "Screening and Mitigation of Layperson Anxiety in Aerospace Environments". Aerospace Medicine and Human Performance. 87 (10): 882–889. doi:10.3357/AMHP.4536.2016. PMID   27662351.
  4. 1 2 3 4 Oakes, M; Bor, R (November 2010). "The psychology of fear of flying (part II): a critical evaluation of current perspectives on approaches to treatment". Travel Medicine and Infectious Disease. 8 (6): 339–63. doi:10.1016/j.tmaid.2010.10.002. PMID   21071281.
  5. 1 2 3 4 5 6 7 Clark, GI; Rock, AJ (2016). "Processes Contributing to the Maintenance of Flying Phobia: A Narrative Review". Frontiers in Psychology. 7: 754. doi: 10.3389/fpsyg.2016.00754 . PMC   4887486 . PMID   27313550.
  6. 1 2 Wiemer, J; Pauli, P (August 2016). "Fear-relevant illusory correlations in different fears and anxiety disorders: A review of the literature". Journal of Anxiety Disorders. 42: 113–28. doi:10.1016/j.janxdis.2016.07.003. PMID   27454587.
  7. 1 2 3 Oakes, M; Bor, R (November 2010). "The psychology of fear of flying (part I): a critical evaluation of current perspectives on the nature, prevalence and etiology of fear of flying". Travel Medicine and Infectious Disease. 8 (6): 327–38. doi:10.1016/j.tmaid.2010.10.001. PMID   21050826.
  8. ↑ Czerniak, Efrat; Caspi, Asaf; Litvin, Michal; Amiaz, Revital; Bahat, Yotam; Baransi, Hani; Sharon, Hanania; Noy, Shlomo; Plotnik, Meir (April 1, 2016). "A Novel Treatment of Fear of Flying Using a Large Virtual Reality System". Aerospace Medicine and Human Performance. 87 (4): 411–416. doi:10.3357/AMHP.4485.2016. PMID   27026126.
  9. 1 2 3 Rothbaum, Barbara Olasov; Hodges, Larry; Smith, Samantha; Lee, Jeong Hwan; Price, Larry (2000). "A controlled study of virtual reality exposure therapy for the fear of flying". Journal of Consulting and Clinical Psychology. 68 (6): 1020–1026. doi:10.1037/0022-006X.68.6.1020. ISSN   1939-2117. PMID   11142535.
  10. 1 2 3 Czerniak, Efrat; Caspi, Asaf; Litvin, Michal; Amiaz, Revital; Bahat, Yotam; Baransi, Hani; Sharon, Hanania; Noy, Shlomo; Plotnik, Meir (April 1, 2016). "A Novel Treatment of Fear of Flying Using a Large Virtual Reality System". Aerospace Medicine and Human Performance. 87 (4): 411–416. doi:10.3357/AMHP.4485.2016. ISSN   2375-6314. PMID   27026126.
  11. ↑ Wechsler, Theresa F.; Kümpers, Franziska; Mühlberger, Andreas (September 10, 2019). "Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?—A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia". Frontiers in Psychology. 10: 1758. doi: 10.3389/fpsyg.2019.01758 . ISSN   1664-1078. PMC   6746888 . PMID   31551840.
  12. ↑ Maltby, Nicholas; Kirsch, Irving; Mayers, Michael; Allen, George J. (2002). "Virtual reality exposure therapy for the treatment of fear of flying: A controlled investigation". Journal of Consulting and Clinical Psychology. 70 (5): 1112–1118. doi:10.1037/0022-006X.70.5.1112. ISSN   1939-2117. PMID   12362961.
  13. ↑ Anderson, H. Graeme (March 16, 1918). "The selection of candidates for the air service". The Lancet. 194.
  14. ↑ "Afraid to Fly After 9/11, Some Took a Bigger Risk - In Cars". Wall Street Journal. March 23, 2004. Retrieved October 11, 2013.
  15. ↑ "PHOBIA Bomb jokes, a faulty engine and tragedy – How Arsenal legend Dennis Bergkamp became the Non-Flying Dutchman". talkSPORT. August 26, 2020. Retrieved November 16, 2022.
  16. ↑ "'Pot' holds rock singer". Rochester Democrat and Chronicle. Retrieved November 16, 2022.
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