5 Reasons Exposure Therapy Doesn't Work For Fear of Flying

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5 Reasons Exposure Therapy Doesn't Work For Fear of Flying

If you search online for the most common and most effective treatment for phobia, you will find that Exposure Treatment is most often cited. Exposure therapy for phobias involves gradually exposing individuals to the feared object or situation in a “controlled” or “safe” manner until they no longer fear that object or situation. It is sometimes referred to as systematic desensitization. The idea behind it comes from the theory of classical conditioning, first identified by Pavlov in his famous experiments with dogs in which he rang a bell just as he fed them on several occasions. Then when he rang the same bell without the presence of food, they began to salivate as if the food was presented. So we can see how this type of conditioning involves a physiological response. Given that the fear response is also physiological, we can understand phobia as a conditioned response involving pairing of a situation or thing with a specific fear response. Exposure therapy tries to “de-condition” that physiological fear response by repeated controlled pairing under “safe” conditions.

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  1. It’s Painful: Many people with specific phobias cannot recall the first time they learned to pair an object or situation with extreme fear. But I once had a client who did remember how she developed her flying phobia. She recounted to me how once during a particularly bumpy flight on a commuter plane she felt sick due to a virus or a reaction to something she ate. Having paired her “sick” feelings with the plane ride, she had associated flying with a negative physical feeling that eventually turned into a phobia of flying. She had considered exposure therapy but did not want to have to revisit those feelings. And therein lies the first and most salient reason why exposure treatment does not work for many people.
  2. Symptom Exacerbation: Reports from case studies indicate that exposure therapy can and often does worsen phobic symptoms before it improves them. But if you had a choice between a therapy approach that worsens your symptoms, even temporarily, and one that does not worsen them at all and in fact creates a secure feeling from the very beginning, which one would you select?
  3. Logistical Impediments: There is a real practical drawback for people with flying phobia to arrange for in vivo (real time) exposure to flying because there is no gradual dosing of the “flight” experience. One is either flying or not flying. Virtual Reality (VR) Exposure treatment is a recent development that seems to overcome this logistical issue, with research showing it is effective at recreating the flight experience. However, since there are very few providers who offer this service, it is not available to most people. So from a practical perspective, it is not yet an option. I actually do offer VR but not as an exposure modality. Instead, I use it to help people become fully comfortable with flying after they have removed the phobia.
  4. Variability of Response: The existing literature is clear that Exposure Therapy does not work for many people who have overwhelming or unmanageable symptoms that turn into panic. It also does not work for violent trauma. So if a method only works for mild cases of phobia and trauma, does it really deserve its reputation as being the best therapy available for phobia?
  5. Myths about Treatment: At the heart of the theory of Exposure Therapy is a presumption that to resolve symptoms, there must be emotional processing of the experience and for this to occur the “fear structure must be activated” through confrontation with the “fear stimuli” so that there can be “habituation and extinction” of the fear response. But from over 25 years of successfully providing people with relief from phobia and trauma without repeated activation of “fear structure” and without confronting “fear stimuli”, I can attest that this is a complete myth. In fact, my experience has told me that the best route to restoring a phobic or traumatized brain back to its healthy state begins with activating a “safety structure” and triggering and holding a “secure” internal state throughout the change process. See How Do I Overcome My Fear of Flying for more information. 

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