Fear of flying
Encyclopedia
A fear of flying is a fear
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 pteromerhanophobia.
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 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.
at the mere sight or mention of an aircraft or air travel.
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.
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.
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.
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 was developed by therapist-airline captain Tom Bunn based on Schore's research, attachment theory
and object relations theory
.
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.
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.
Fear
Fear is a distressing negative sensation induced by a perceived threat. It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of danger...
of being on an airplane (aeroplane), or other flying vehicle, such as a helicopter
Helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...
, while in flight
Flight
Flight is the process by which an object moves either through an atmosphere or beyond it by generating lift or propulsive thrust, or aerostatically using buoyancy, or by simple ballistic movement....
. It is also sometimes referred to as aerophobia, aviatophobia, aviophobia or pteromerhanophobia.
Overview
Fear of flying may be a distinct phobiaPhobia
A phobia is a type of anxiety disorder, usually defined as a persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding, typically disproportional to the actual danger posed, often being recognized as irrational...
in itself, or it may be an indirect combination of one or more other phobias related to flying, such as claustrophobia
Claustrophobia
Claustrophobia is the fear of having no escape and being closed in small spaces or rooms...
(a fear of enclosed spaces) or acrophobia
Acrophobia
Acrophobia is an extreme or irrational fear of heights. It belongs to a category of specific phobias, called space and motion discomfort that share both similar etiology and options for treatment.Most people experience a degree of natural fear when exposed to heights, especially if there is little...
(a fear of heights). It may have other causes as well, such as agoraphobia
Agoraphobia
Agoraphobia is an anxiety disorder defined as a morbid fear of having a panic attack or panic-like symptoms in a situation from which it is perceived to be difficult to escape. These situations can include, but are not limited to, wide-open spaces, crowds, or uncontrolled social conditions...
(especially the type that has to do with fear of open spaces). It is a symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
rather than a disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
, 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 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 vomitingVomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
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:- fear of crashing which most likely result in death.
- a fear of closed in spaces (claustrophobiaClaustrophobiaClaustrophobia is the fear of having no escape and being closed in small spaces or rooms...
), such as that of an aircraft cabin - a fear of heights (acrophobiaAcrophobiaAcrophobia is an extreme or irrational fear of heights. It belongs to a category of specific phobias, called space and motion discomfort that share both similar etiology and options for treatment.Most people experience a degree of natural fear when exposed to heights, especially if there is little...
) - a feeling of not being in control
- fear of vomitingEmetophobiaEmetophobia is an intense, irrational fear or anxiety pertaining to vomiting. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting in public, a fear of seeing vomit, a fear of watching the action of vomiting or fear of being nauseated...
, motion sicknessMotion sicknessMotion sickness or kinetosis, also known as travel sickness, is a condition in which a disagreement exists between visually perceived movement and the vestibular system's sense of movement...
can make the person vomit, thus making flying hard. - fear of having panic attackPanic attackPanic attacks are periods of intense fear or apprehension that are of sudden onset and of relatively brief duration. Panic attacks usually begin abruptly, reach a peak within 10 minutes, and subside over the next several hours...
s in certain places, where escape would be difficult and/or embarrassing (agoraphobiaAgoraphobiaAgoraphobia is an anxiety disorder defined as a morbid fear of having a panic attack or panic-like symptoms in a situation from which it is perceived to be difficult to escape. These situations can include, but are not limited to, wide-open spaces, crowds, or uncontrolled social conditions...
) - fear of hijackingAircraft hijackingAircraft hijacking is the unlawful seizure of an aircraft by an individual or a group. In most cases, the pilot is forced to fly according to the orders of the hijackers. Occasionally, however, the hijackers have flown the aircraft themselves, such as the September 11 attacks of 2001...
or terrorismTerrorismTerrorism is the systematic use of terror, especially as a means of coercion. In the international community, however, terrorism has no universally agreed, legally binding, criminal law definition...
, - sometimes very reasonable as in cases of state leadersHead of StateA head of state is the individual that serves as the chief public representative of a monarchy, republic, federation, commonwealth or other kind of state. His or her role generally includes legitimizing the state and exercising the political powers, functions, and duties granted to the head of... - fear of turbulenceTurbulenceIn fluid dynamics, turbulence or turbulent flow is a flow regime characterized by chaotic and stochastic property changes. This includes low momentum diffusion, high momentum convection, and rapid variation of pressure and velocity in space and time...
- 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
Mass media
Mass media refers collectively to all media technologies which are intended to reach a large audience via mass communication. Broadcast media transmit their information electronically and comprise of television, film and radio, movies, CDs, DVDs and some other gadgets like cameras or video consoles...
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
Air safety
Air safety is a term encompassing the theory, investigation and categorization of flight failures, and the prevention of such failures through regulation, education and training. It can also be applied in the context of campaigns that inform the public as to the safety of air travel.-United...
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
Confirmation bias
Confirmation bias is a tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true.David Perkins, a geneticist, coined the term "myside bias" referring to a preference for "my" side of an issue...
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
False premise
A false premise is an incorrect proposition that forms the basis of a logical syllogism. Since the premise is not correct, the conclusion drawn may be in error...
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.
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
Systematic desensitization
Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy / classical conditioning therapy developed by a South African psychiatrist, Joseph Wolpe...
developed by Joseph Wolpe
Joseph Wolpe
Joseph Wolpe was born on April 20, 1915, in Johannesburg, South Africa, and died on December 4, 1997, from lung cancer. He is one of the most influential figures in behavior therapy....
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
Systematic desensitization
Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy / classical conditioning therapy developed by a South African psychiatrist, Joseph Wolpe...
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.
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
Allan Schore
Allan Schore is a leading researcher in the field of neuropsychology, whose ground-breaking contributions have influenced the fields of affective neuroscience, neuropsychiatry, trauma theory, developmental psychology, attachment theory, pediatrics, infant mental health, psychoanalysis,...
and others using EEG-fMRI
EEG-fMRI
EEG-fMRI is a multimodal neuroimaging technique whereby EEG and fMRI data are recorded synchronously for the study of electrical brain activity in correlation with haemodynamic changes in brain during the electrical activity, be it normal function or associated with...
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
Emotional dysregulation
Emotional dysregulation is a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response...
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.
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 was developed by therapist-airline captain Tom Bunn based on Schore's research, attachment theory
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...
and object relations theory
Object relations theory
Object relations theory is a psychodynamic theory within psychoanalytic psychology. The theory describes the process of developing a mind as one grows in relation to others in the environment....
.
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
Alprazolam
Alprazolam is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs. Alprazolam, like other benzodiazepines, binds to specific sites on the GABAA gamma-amino-butyric acid receptor...
(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.
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.
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