Gulliver | Fright or flight

Modern cures for a fear of flying

Clinical aviophobia affects 2-3% of people in developed countries

By J.T.

WHEN airlines began installing “tail-cams” and streaming live footage of flights to passengers, the idea was to offer a “God’s eye” view of the heavens. It is, indeed, a divine sight, but for those with a fear of flying also utterly terrifying. On a recent transatlantic flight, an anxious gentleman sitting next to Gulliver was glued to tail-cam for eight hours straight, scrutinising the plane (and flight speeds) for any signs of imminent mechanical failure—fearing, perhaps, that a lapse in his vigil could doom us all. It was only upon docking at the gate that his hands unclenched from the armrest and his ordeal came to an end.

Around 2-3% of people in developed countries have clinical aviophobia: an intense and irrational fear of flying. Symptoms include increased blood pressure, hyperventilation, gastric upset and panic attacks. Sufferers are usually aware that air travel is one of the safest forms of transportation, but are unable to shake off anxieties about crashing, or losing self-control. Their severe discomfort is shared by passengers with claustrophobia or post-traumatic stress disorder, who may not necessarily qualify as aviophobes, but still dread a ten-hour flight in economy. And then there are many flyers—as many as a quarter of Americans, by some estimates—who simply feel uneasy about the idea of a 100-tonne metal canister hurtling through the stratosphere at several hundred miles an hour. When turbulence is tossing you from side to side, it is hard to be cheery about the physics of the aerofoil phenomenon or historically low fatality statistics. Even the crew, in spite of their external poise, are known to get the jitters: a survey of 1,000 European deck and cabin staff suggested that nearly 10% feel anxious on a monthly basis.

At worst, aviophobia can be crippling; at best, it is highly inconvenient. Just ask Dennis Bergkamp, a footballer from the Netherlands dubbed “the non-flying Dutchman”, who gained contractual permission to miss far-flung away matches, or Whoopi Goldberg, an American actor, who used to tour America by bus. Such avoidance is financially punitive, to passengers and carriers. A research paper published three decades ago suggested that fear of flying cost American airlines 9% of their revenues, or $1.6 billion in 1978’s money. And the damage is not just pecuniary. Attempting to drive the length of a typical non-stop flight is 65 times more dangerous. More than 300 Americans are thought to have died as a result of abandoning air travel and taking to the roads after the 9/11 attacks.

How, then, to solve a fear of flying? There are various forms of medication, ranging from self-administered booze to prescribed sedatives (which, as with BA Baracus, pictured, the aviophobic enforcer of the "A Team", can be slipped into an unsuspecting passenger's milk if needs be). Better, though, are four types of effective therapy. The first is behavioural. This typically involves breathing exercises, flight simulations, interaction with airline pilots, and finally boarding a plane and taking to the skies. A clinical trial in 2006 ended with 49 out of 50 patients undergoing such treatment “graduating” by taking the flight at the end of the course. All of them were flying independently a year later. A further 50 patients were also given cognitive therapy, which taught them how to regulate anxiety. All 50 graduated, a feat achieved by none of the patients in the control group (who were put on a waiting list for the duration of the trial, and then asked to fly).

Aware of this success, and keen to make up for the costs of aviophobia, many now offer one day fear-of-flying courses that contain elements of behavioural and cognitive therapy. However, sufferers unwilling to spend a day in therapy at the airport have a third option: Eye Movement Desensitisation and Reprocessing (EDMR), in which a doctor attempts to distract the brain (with light or sound) while the patient is envisaging a negative thought. The method, whilst strange, is roughly as effective as behavioural therapy.

The fourth option involves a “God’s eye” view of a very different kind to the one shown during inflight entertainment. Instead of boarding a plane, patients graduate via a series of virtual reality (VR) flights, with simulated turbulence. Once again, the treatment has proved as effective as standard behavioural therapy. And with a proliferation of VR devices now available for reasonable prices, aviophobia could become more curable than ever before—using cameras to soothe, not to scare. If only BA Baracas were around today.

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