Fear of Flying (Aviophobia): Efficacy and Methodological Lessons Learned from Outcome Trials

Abstract

The pathological fear of flying, also called aviophobia, falls under the subtype of specific situational phobias in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) or under specific (isolated) phobia in the International Classification of Diseases (ICD)-10. The term fear of flying was actually coined during World War II and referred to the mixture of fear and anxiety seen in aviators involved in combat. People presenting for treatment for the pathological fear of flying may have either a well-defined specific phobia or their fear of flying may be part of another anxiety disorder such as panic disorder with agoraphobia, post-traumatic stress disorder, or claustrophobia. People suffering from the specific phobia of flying are afraid of events directly related to the flying experience (crashing, losing control of themselves, not having control over the situation, having a panic attack in planes, turbulence, etc.), whereas those with panic disorder with agoraphobia suffer from a more general fear of having an uncued and unexpected panic attack, those with claustrophobia are more afraid of suffocating or being confined to an enclosed space, and people with post-traumatic stress disorder have a more complex pattern of fears following exposure to a traumatic event (such as a plane crash) characterized by re-experiencing the traumatic event (flashbacks, distressing dreams, etc.), persistent avoidance of stimuli associated with the trauma, and hyperarousal. Some people suffering from aviophobia do actually fly, but with extreme discomfort or by using drugs like benzodiazepines or alcohol to deal with their anxiety. Aviophobia is also characterized by negative cognitions when thinking about the flying experience, unproductive coping strategies such as self-blame, rumination, or catastrophizing, and significant anticipatory anxiety observed, for example, when planning trips and vacations, buying plane tickets, going to the airport, or waiting in the boarding area.