Fear of flying

"Fear of Flying" redirects here. For other uses, see Fear of flying (disambiguation).

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 referred to as flying phobia, flight phobia, aviophobia or aerophobia (although the last also means a fear of drafts or of fresh air).

Fear of flying may be a distinct phobia in itself, or it may be an indirect combination of one or more other disorders, such as claustrophobia (a phobia of being restricted, confined, or unable to escape) or acrophobia (anxiety or dread of being at a great height). It may have other causes as well, such as agoraphobia (especially the type that has to do with having a panic attack in a place they can't escape from). It is a symptom rather than a disease, and different causes may bring it about in different individuals.

This phobia receives more attention than most other phobias because air travel is often difficult for people to avoid—especially in professional contexts—and because it is common, affecting a significant minority of the population. Inability to maintain emotional control when aloft 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.

Symptoms

Anticipatory anxiety of being out of control and overwhelmed can prevent a person from planning to travel by air. The thought of an upcoming flight can cause great distress, particularly when 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

Aerophobia may be associated with other anxiety disorders or phobias:

• claustrophobia
• acrophobia
• emetophobia
• agoraphobia
• panic

The precipitating cause may be a traumatic flight, a flight regarded near-fatal, awareness of personal vulnerability, the death of a loved one, or increased responsibilities, particularly when becoming a parent.

Some suggest that the media are a major factor, and claim that the media sensationalize airline crashes (and the high casualty rate per incident), in comparison to the perceived scant attention given to 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 aerodynamics can cause anxiety. For example, many people incorrectly believe that the engines of a jet airliner support it in the air.This false premise causes anxiety that at any moment the engines could fail, causing the plane to plummet. In reality, all fixed-wing aircraft glide naturally, and the engines serve only to maintain altitude during the flight. Understanding how the plane is held in the air requires abstract thinking. Anxiety can be caused by concrete thinking such as, if nothing can be seen holding the plane up, it should fall. Unable to grasp the principles of aerodynamics, many anxious fliers are uncomfortable at the thought of being held up high by something they cannot see.

Treatment

Non-pharmacologic

In some cases, education can considerably diminish concern about physical safety. Learning how aircraft fly, how airliners are flown in practice, and other aspects of aviation can reduce anxiety. Many people have dealt with the problem by learning to fly or skydive, effectively removing their fear of the unknown. Some educate themselves; others attend courses offered by pilots or airlines.

Though education plays an important role, the knowledge that turbulence will not destroy the aircraft does not stop the amygdala - the part of the brain responsible for the release of stress hormones - from reacting. In turbulence, repeated downward movements of the plane trigger one release of stress hormones after another. A build-up of stress hormones can cause a person to 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 prevent the release of stress hormones so that the anxious flier may 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 desensitize 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. As a practical substitute for systematic desensitization, the amygdala can be taught to regard a stimulus as benign by linking it to an experience already regarded by the amygdala as benign. This alternative has been termed systematic inhibition of the amygdala.

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. "Because these mothers are unable to regulate their own distress, they cannot regulate their infant's distress." 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. Some who disagree with the importance of early experience regard this view point as contentious. However, Harvard University and the National Scientific Council on the Developing Child state, "Genes provide the basic blueprint, but experiences influence how or whether genes are expressed. Together, they shape the quality of brain architecture and establish either a sturdy or a fragile foundation for all of the learning, health, and behavior that follow."

When it senses anything unfamiliar or unexpected, the amygdala releases stress hormones. In humans, stress hormones activate both the sympathetic nervous system and executive function. The sympathetic nervous system produces an urge to mobilize. Initially, to assess the situation, executive function overrides the urge to mobilize. If assessment reveals no threat, executive function dismisses the matter, and signals the amygdala to end stress hormone release. If risk is apparent, executive function considers what can be done to deal with the risk. Upon commitment to a plan, either of action or of inaction, executive function signals the amygdala to end stress hormone release.

In a non-phobic person, the arousal caused by the release of stress hormones results in a sense of curiosity, not a sense of emergency. Phobic response is significantly different. The phobic person equates arousal with fear, and fear as proof that there is danger. Upon arousal, the person's executive function is called upon not merely to assess the situation, but - if stress hormones are to be regulated - to prove no danger exists. If danger cannot be ruled out, executive function can no longer inhibit the urge to mobilize. Though phobics regard control as the antidote to fear, it is commitment to a plan - not control alone that ends the release of stress hormones. If a person has control but cannot commit to a plan, fear persists. It is interesting to note that commitment to any action - even unwise action - provides relief, and signals the amygdala to terminate stress hormone release.

If a phobic flier were able to fly in the cockpit, the pilot's facial response to an unexpected noise or motion would adequately prove the absence of danger. But with information in the cabin limited, it is impossible to prove no danger exists. Stress hormones continue to be released. As levels rise, anxiety increases and the urge to escape becomes paramount. Since physical escape is impossible, panic may result unless the person can escape psychologically through denial, dissociation, or distraction.

In the cognitive approach, the passenger learns to separate arousal from fear, and fear from danger. Cognitive therapy is most 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.

In another approach, emotion is regulated by what neuroscientist Stephen Porges calls neuroception. In social situations, arousal is powerfully regulated by signals people unconsciously send, receive, and process. For example, when encountering a stranger, stress hormone release increases the heart rate. But if the stranger's signals indicate trustworthiness, these signals override the effect of stress hormones, slow the heart, calm the person, and allow social interaction to take place. Because neuroception can completely override the effect of stress hormones, fear of flying can be controlled by linking the noises and motions of flight to neuroceptive signals that calm the person.

Lastly, frequent flyer experts at Flightfox suggest that pteromerhanophobia is a reaction caused by the panic and tension of so many travellers in close quarters - once one person is uneasy the rest soon feel uncomfortable as well. Their solution, odd as it may seem, is to fly in premium class to experience flying in a comfortable and relaxed setting, so as to avoid the tension and anxiety of coach.

Pharmacologic

Flight experience with the use of anti-anxiety medications like benzodiazepines or other relaxant/depressant drugs varies from person to person. Medication decreases the person's reflective function. Though this may reduce anxiety caused 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 29% 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.

September 11 implications

Flight phobia has long been a topic in the psychological and psychiatric literature, as well as in economic research. The former literature is mainly concerned with mode of travel choices after the September 11 attacks. Respondents to what extent they felt safe on planes and the number of high-risk incidents on airplanes in which they had been involved. Captain Michael (Miki) Katz, whose experience with helping nervous and claustrophobic flyers have brought him to also assume relations between fear of flying and September 11 attacks. Those who have the condition are either so paralyzed they stop flying entirely, and some continue flying but suffer intensely on each flight. In contrast, Katz said that "in countries such as in Israel as an example, where the public is much more experienced in dealing with security threats, there is no significant increase in the number of people who are afraid to fly, but the ones who were anxious to begin with have become more afraid." Immediately after the September 11 attacks, Americans took to the nation's highways, a decision that many experts on risks said could be a fatal error. U.S. Department of Transportation data for the last three months of 2001 showed a significant increase in the number of fatal road accidents versus the same period in the year before the attacks. Because of the extra traffic, 353 more people died in traffic accidents, calculates Gerd Gigerenzer of the Max Planck Institute for Human Development in Berlin, an expert on how people respond to low-probability but high-consequence events called "dread risks." Research by Michael Sivak and Michael Flannagan showed that driving 10.8 miles on an Interstate highway exposes the motorist to same risk of fatality as taking a domestic flight. They based their findings by comparing the statistics for 10 major U.S. airlines for a 10-year period from 1992 through 2001. Airline safety has increased dramatically since that time. Based on more recent performance by U. S. airlines, the risk of taking a flight would be approximately the same as driving merely 3 miles. Since most of the risk is during takeoff and landing, Sivak and Flannagan regarded the length of the flight as relatively insignificant.

Malaysia Airlines Flight 370

On the 10th of March, 2 days after the disappearance of the MH370, Jamila Rizvi wrote that she struggled to wake up this morning due to the fact that she had to catch a plane today. She then questioned on what might have happened to the MH370.

Malaysia Airlines Flight 17

Former Malaysia Airlines crew member, Nirmala Nadaraja, was interviewed by South-East Asia correspondent Samantha Hawley in Kuala Lumpur about the shoot down of Malaysia Airlines Flight 17. She said the staff she had been speaking too had now developed a fear of flying. "Many of them have been having phobias flying, but it's a job and they've got to do it even though they are scared," she told the Australian Broadcast Company.

Many people have questioned and criticized the safety of air travel after the shoot down.

Notable people with the phobia

• Sara Boulila
• Isaac Asimov
• Travis Barker
• Dennis Bergkamp
• Ben Burnley
• Doris Day
• Agnetha Fältskog
• Whoopi Goldberg, says she travels by a bus or train when she wishes to visit other U.S. states.
• Ara Guler
• Jérôme Haehnel (per his Wikipedia page)
• Sandara Park
• Kim Jong-il
• KRS-One
• Stanley Kubrick
• John Madden
• McG
• Eamon McGee, has spoken of his wish to be knocked unconscious ahead of flights to matches held at far-flung destinations.
• Alexander Mogilny
• Eric Prydz
• Ronald Reagan
• Sam Shepard (per his Wikipedia page)
• Kemal Sunal (per his Wikipedia page)
• Lars von Trier

Fictional cases

• Thelma Frye from the 1986 NBC sitcom Amen has Pteromerhanophobia and the church staff takes her on a trip in a private jet to try and help her overcome her phobia.
• Marge Simpson from The Simpsons developed a severe case of Pteromerhanophobia when she was a child after she learned about her father becoming a stewardess at an airport and actually saw him dressed up like a stewardess on one of the airplanes.
• B. A. Baracus from The A Team has flight phobia.

See also

• List of phobias
• Travel aversion