Conquer Fear Of Flying

How to beat aeroanxiety and more

Anxiety Treatments Work On The Ground But Not In The Air

The usual forms of therapy leave fearful fliers anxious. Why?

In systematic desensitization, the client is exposed to an anxiety-producing situation at a level of intensity too low to trigger the release of stress hormones. As treatment continues, exposure is increased in increments too small to be noticed. After a time, the client faces full exposure without releasing stress hormones. Though systematic desensitization works, it is impractical as a treatment for flight phobia because exposure increments cannot be adequately adjusted.

Virtual Reality Exposure Therapy (VRET) uses computer-generated images that can be adjusted. Though it sounds promising, clients seeking desensitization for flight phobia gain little if any benefit. No matter how realistic the images, VRET is artificial. Clients know they in an office, not at 30,000 feet. VRET provides no desensitization to what the anxious flier needs to be desensitized to: actual risk, separation from the ground, lack of control, and no means of escape.

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VRET research at the University of Connecticut compared a treatment group with a group that sat on a parked airliner and pretended they were flying. Those who received VRET showed no permanent improvement versus those exposed to the parked airliner. Rather than accept this failure, the sponsors made an outrageous claim: the research showed - they claimed - that VRET was equal to a traditional fear of flying program. Not so: traditional fear of flying programs include - in addition to exposure to a parked airliner - hours of instruction on how flying works and two actual flights.

Research at the Stanford University School of Medicine involved two flights. On the first flight, half of the anxious fliers were given alprazolam and half were given a placebo. On the second flight, no medication was administered.

Placebo Group: 43% experienced panic on the first flight. Some desensitization took place, as only 29% experienced panic on the second flight.

Active Medication Group: only 7% panicked on the first flight. On the second flight – their first unmedicated flight – 71% experienced panic.

These results showed that alprazolam caused an increase in sensitivity to flying and blocked the ability to become acclimated to flying. See www.ncbi.nlm.nih.gov/pubmed/9299803

Cognitive Behavioral Therapy treatment for flight phobia involves four techniques: breathing exercises, psycho-education, cognitive restructuring, and exposure (continuing to fly)

Breathing exercises - useful in a thoroughly secure environment on the ground - are not effective in the air. While it is true that relaxation and arousal cannot coexist, relaxation does not prevent arousal. And, once aroused, breathing exercises do little if anything in flight. No matter how relaxed a passenger may be at any given moment, if the amygdala senses an unfamiliar or unexpected noise or movement, it will release stress hormones which put an end to the relaxed state.

Psycho-education can help a person accept feelings. But clients whose aim is be rid of the feelings may not able to benefit from acceptance.

Cognitive Restructuring assumes fear of flying is due to irrational thinking that needs to be corrected. Self-talk is used to counteract negative thoughts. This top-down approach ignores the fact that feelings can be caused bottom-up when stress hormones are released by exposure to the unfamiliar or to the unexpected.

Exposure (continuing to fly) - like flooding - is is not always helpful; some clients are increasingly traumatized.

CBT is only marginally effective for fear of flying, notably because it requires cognition which weakens - or indeed collapses - when stress levels rise.

Hypnosis, and self-hypnosis, can produce a calm state in a therapist's office or at other places on the ground. Regardless of the level of relaxation a person can achieve, when the amygdala senses anything unfamiliar or unexpected, releases stress hormones. Relaxation ends, replaced with arousal.

Captain Tom Bunn, L.C.S.W., is an airline pilot and author who has dedicated 30 years to the development of effective methods for treating flight phobia.

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