FEAR OF FLYING

What is Fear of Flying?

 Fear of Flying is a problem of increasing relevance in industrialized countries. It is estimated that about a 10% of the general population NEVER takes a plane because of an intense fear of flying. Also, a 25% feel intense anxiety while flying and often use alcohol or medication to put up with the flight. Anxiety is not exclusively related to the flight itself. It can appear during the time before taking the plane (from the moment when the individual knows he/she has to take the flight, which can happen several days, or even months before), and in any situation regarding the trip (going to the travel agency to get information about the schedules, buying the tickets, packing the baggage, going to the airport, checking in, waiting before boarding, etc). This anticipatory anxiety is experienced with great distress, extending the "torture" of flying in a plane. This fear can cause a significant impairment in work and social areas that can lead to distressing consequences for individuals who persistently avoid flying.

However, this fear does not correspond with how safe flying is. The death rate is 0.03 deaths out of one million passengers. And the accident rate is still more favorable: one accident out of one million trips and this one accident does not have to be necessarily lethal. (Rubio, Cabezuelo, & Castellano, 1996). Data from the National Transportation Statistic Report carried out in 1985 stated that flying in a plane is:

- 29 times safer than traveling by car

- 18 times safer than staying at home

- 10 times safer than being at work

- 8 times safer than walking down the street

- 6 times safer than the possibility of being murdered by a relative

- 4 times safer than traveling by train

For example, a Boeing 727 should have an accident without survivors every day to reach a similar death rate to the one reached by car accidents (Rubio, Cabezuelo, & Castellano, 1996).

What is our treatment about?

Components: Psychoeducation, breathing re-training, VR exposure, and relapse prevention.

Who can benefit from this treatment? Those persons who cannot take a plane because of the intense fear or anxiety they experience, or those who, despite being able to take the plane, experience intense distress during the flight.

Psychoeducation. It consists of giving a clear explanation about what fear of flying is and of clarifying concepts such as fear, anxiety, and phobia. Possible factors involved in the development of the fear of flying are addressed. Therapist and patient discuss what persons fear when they fly (an accident, bodily sensations, movements of the plane, closure of the aircraft, heights, being far away from home, etc). How and why planes fly is also explained.

Breathing re-training: The goal of this component is to change a fast breathing pattern by a slow breathing pattern. A common response to anxiety provoking situations is hyperventilation. The consequences of hyperventilation are the exacerbation or the appearance of several physiological symptoms that intensify anxiety.

Thought confrontation techniques (Cognitive Therapy): An important issue regarding our responses to events or situations is the way we interpret them, what we think about those situations and what they mean to us. The way we think will determine how we will feel about things. Sometimes we make erroneous interpretations that can lead to distressing feelings. Applying cognitive techniques means trying to behave as scientists do: test if our interpretations are right or wrong and find alternative ways of thinking about the situations. In our treatment for flying phobia, patients are taught to identify, challenge, and fight the "erroneous" thoughts about the flying situations. With the therapists’ guidance, the person learns how to find alternative interpretations useful to reduce anxiety and face the flying situations.

VR exposure: Exposure consists of facing the fear provoking situations gradually and progressively. The importance of staying in the situation until the fear or anxiety goes down is emphasized to the person. In our treatment for flying phobia, patient and therapist elaborate an individualized hierarchy with the feared situations so the person can carry out exposure exercises to face gradually those situations. Then we present VR exposure, addressing its advantages compared to traditional exposure: It provides safety to the patient (and to the therapist); they can control the context generated by the computer at will and without risks. Therefore, VR becomes an intermediate step between the therapist's consulting room (where the patient feels safe and protected) and the real environment (so threatening for some patients that they decide not to face it). It is easier to repeat the same exposure tasks once and again without leaving the therapist’s office. This means an important saving in money and time. Finally, VR exposure allows the designing of a tailored hierarchy so the patient can expose him/herself to all the possible situations, and even to impossible ones. In our treatment for flying phobia, the patient has a great number of situations related to flying situations (before entering the plane: checking-in, waiting in the lounge, and boarding; take-off, from the time the plane runs on the runway, speeds up, and takes off; the flight itself that can be incident-free or encounter problems such as bad weather or turbulence, and landing). The immersion in the different VR scenarios designed for the treatment of flying phobia makes possible that the patient exposes him/herself as many times as necessary for overcoming his/her fear.

VR Scenarios

Fifth moment: Landing. Different conditions and unexpected events