Ask the Expert: Fear of Flying

Depending on the source, aviophobia or, the fear of flying, affects somewhere between 20 to 25 percent of adults (that number increases to about one-third if you include adults who experience some level of anxiety). This is despite the fact that air travel is statistically - and by far - the safest form of transportation. According to the National Safety Council, the odds of dying in a plane crash are 1 in 9,737; compare that to the likelihood of dying in a car accident (1 in 113), on a motorcycle (1 in 948) or as a pedestrian (1 in 672). However, for those who experience extreme anxiety when it comes to traveling by air, all the data in the world supporting its relative safety make no bit of difference.

To find out more about aviophobia and what, if anything, can be done to help those who suffer from it, we turned to two experts - Dr. Peter J. Economou, a cognitive behavioral therapist and founder of the Counseling and Wellness Center, and Captain Tom Bunn LCSW, pilot, and author of SOAR: The Breakthrough Treatment for Fear of Flying.

OutTraveler: What is it about flying, specifically, that makes it such a common thing to fear?
Economou: One of the major issues we see is that is not such an accessible behavior to overcome. For example, not many people can afford to fly or have [regular] access to a plane in order to overcome this fear.

OT: Is it really about the airplane or are there other issues at play?
Economou: For each person, it varies and can be broken down into a few categories: a fear of tragedy (in other words, a crash); claustrophobia (the fear of being too close to others); agoraphobia (the fear of no exits); and a lack of control.

OT: Captain Bunn, according to your website fearofflying.com, aviophobia seems to develop, on average, around age 27. Why do you think that is?
Bunn: When we are teenagers, we tend to think bad things happen only to other people, or in places far away. As we mature, we become increasingly aware of vulnerabilities, and as we do, we look for more control. In our late twenties, most of us realize something could do us in, and we can't control everything. Now, something like flying gets more difficult because it offers no control and no escape.

OT: At what point does anxiety cross into a full-on phobia?
Bunn: In short, when alarmed, do you stay alarmed? Or, do you quickly recover?

Think of your phone. When it rings, it gets your attention. When you respond and answer it, the ringing stops. Think how difficult it would be to have a conversation if the ringing did not automatically stop. It's the same with the mind. When the amygdala senses something it rightly or wrongly classifies as a danger, it releases stress hormones to grab your attention. You feel alarmed. It forces you to focus on what the amygdala is reacting to. That's good. But, now you need the alarm to quiet down so you can use your high-level thinking (Executive Function) to survey the situation and determine what, if any, action needs to be taken. But, that high-level thinking can't take place until the feeling of alarm is attenuated.

In other words: When alarmed, as you realize what is going on, do you stay alarmed? If you do, you can't function well. It is hard to distinguish real threats from imaginary threats. That can make flying difficult. Because, for instance, when the plane drops, you get alarmed. If your arousal stays at the alarm level, you will feel certain there is a constant danger and you are likely to fear the plane is going to fall out of the sky.

So, the question is this: does your alarm automatically attenuate or does it stay intense? If it stays intense, flying will be difficult to impossible without therapy.

OT: Can someone be "cured" of this fear?
Economou: The fear of flying, like most phobias, is totally curable.

OT: What is the approach in cognitive behavioral therapy (CBT) to help someone with a fear of flying? Are there types of people that may benefit more from CBT or, conversely, benefit from other approaches?
Economou: The approach with CBT depends on the school of CBT, but in general is aiming at reducing the symptoms before, during and after the flight. This can be done by reframing the thoughts (second wave CBT), learning new coping behaviors (first wave CBT), or building a relationship with the fear (third wave CBT). This explanation is it in its most simple form. 
I will also mention hypnosis, which I have read some studies that show it as an effective tool. I mention it because the client must be "hypnotizable" in order for the treatment to be effective, and not everyone is. As such, whether it is CBT, SOAR, hypnosis, it really just depends on the individual client.

OT: And, SOAR, who might benefit from this method?
Bunn:  We have a free app that is a sort of mini fear of flying course. It also measures turbulence so you can see it isn't a problem for the plane. It is at fearofflying.com/app and it's free.

Other than that, we have courses that are remarkably effective. Most of the people we work with have "tried everything" and think nothing will work. Yet it does.