What Therapy is Best for Fear of Flying?

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What Therapy is Best for Fear of Flying?

There are many therapies out there that address anxieties, worries, and fears. But no single therapy approach today has been specifically developed for flying phobia or fear of flying. The therapies that are being offered are adapted from generic treatment protocols for general anxiety and other kinds of phobias. These adaptations have attempted to address some of the unique issues that sufferers of flying phobia deal with. One of those is the variety of types of triggers that people who experience fear of flying report. Some react to the closing of the airplane door and are stressed by the thought of feeling stuck or trapped with no exit for the duration of the trip (claustrophobia). For others, it is the idea that a large vehicle like a plane can get off the ground and stay aloft without falling out of the sky (fear of heights; fear of falling; fear of water). For still others, it is based on a fear of accidents and a need to be in control of the situation. Finally, there are those that fear losing control of themselves on a plane and have social anxiety. These different types of flight fears are one of the reasons that so few studies have been done on the treatment of this condition.

Another unique issue for flying phobia is the difficulty in testing the effectiveness of whatever approach is used. The ability to fly without fear is only truly known through the lived experience of flying. Thus, the expense and time involved in testing whether a treatment protocol is effective is a major barrier is why so little research has been conducted in this area.

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So let’s examine what your options are if you have flying phobia:

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is the most widely accepted evidence-based treatment available and has been successful for a variety of conditions for over 50 years. Applied to Aviophobia, CBT helps individuals identify and challenge irrational thoughts and beliefs about flying. It involves cognitive restructuring and behavioral techniques to reduce anxiety. CBT basically works toward helping the individual develop more rational beliefs about the world and themselves. But almost no one is offering CBT alone for flying phobia. The reason is simple: It doesn’t work without something else added on. Of the few studies that have been done on the effectiveness of CBT for flying phobia, all involve the use of some form of exposure therapy

Exposure Therapy

This involves exposing patients to feared stimuli to reduce anxiety. The literature on exposure says that it is highly effective for specific phobias. There are different types of exposure therapy, including graded exposure, flooding, and prolonged exposure therapy. Most exposure therapy is done “in vivo”, which means having the person directly face the feared situation. In the case of flying phobia, it means having the person get on a plane since that is the feared situation. There are many practical and logistical issues with this type of treatment for flying phobia. The primary one being that it’s expensive and not easy to arrange. The client not only pays for their own airfare, but also for their therapist’s ticket. The second issue is there are limited options for “graded” exposure. After all, you’re either flying or you’re not. Since each flight has just one takeoff and one landing, it’s not possible to do multiple exposure sessions to the elements of flight typically most scary for clients.  Finally, there is an issue of confidentiality as the client is boarding a plane with their treatment provider, who is ostensibly conducting the session in front of hundreds of other passengers.

Another version of exposure therapy is imaginal exposure. People with vivid imaginations might be able to successfully engage in this type of therapy. For it to work, however, the imagined scenes must correspond well enough to the real world so that the person gets the phobic reaction of fear and panic. The therapist needs to be skilled enough to track their client’s responses and to guide their client into the right degree of imaginal exposure in terms of duration and intensity. It is easy to see how this type of therapy is “hit or miss”.

A more recent development in the delivery of exposure-type intervention for phobia is Virtual Reality Exposure Therapy. While this modality has been around since the late 1990s, in recent years it has become much more realistic and immersive as technology and software have advanced. VR exposure has many of the same advantages as traditional in vivo without the practical and logistical disadvantages. The virtual reality environment is a controlled setting that can be graded at varying degrees of exposure so that systematic desensitization of the feared stimuli can be accomplished. Clients can be interviewed about what types of scenarios are triggering for them and to what degree. The virtual reality environment can then be tailored to each client’s unique needs. While the research in this modality is limited and recent, thus far it appears to be as effective as the traditional in vivo modality. There are some recent studies using VR Exposure Therapy specifically for flying phobia that are positive and look promising for future use.

Cons of Exposure Therapies

The main negative of exposure therapy is that it is exposure therapy! In other words, while it can be a highly effective approach to resolving phobia, it also can be very distressing for clients. Whether it is in the real world, imagined world, or virtual world, exposure involves reliving and re-experiencing one’s worst fears and reactions, repeatedly until the response is extinguished. The more severe the phobia, the more distress the client is likely to experience with exposure therapy.  For these reasons, it has been highly controversial in professional circles, with some providers characterizing it as unethical and harmful. Studies of exposure interventions have found high dropout rates. And those participants are the ones who signed up and consented to being in a research study. None of the research in exposure therapy accounts for the people who are so fearful that they would never even consider signing up for a study on the effectiveness of exposure therapy. So there is a major response bias in all of the literature on exposure interventions and in the limited literature on virtual reality exposure therapy for flying phobia. Additionally, there is limited accessibility for VR Exposure Therapy at this time, given it is still considered new.

Systematic Desensitization

This is a form of exposure therapy that combines relaxation techniques with gradual exposure to the fear-inducing stimulus. Patients learn to remain relaxed while gradually facing their fear.

Pros: It combines relaxation with exposure, making it less distressing than traditional exposure. It can be tailored to individual needs.

Cons: This requires more time and commitment as the experience is more gradual than traditional exposure therapy to reduce the dosing of distressing stimuli. The data show that it may not be as effective for severe cases without additional support. The longer time in treatment (can be 3+ months) means that there is a higher cost as well as more time the client is living with their distress.

Pharmacological Treatment

Medications such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs) can be prescribed to manage anxiety symptoms. Medications are often used as an adjunct to therapy. They can provide short-term relief but are not a long-term solution4.

Pros: Provides quick relief from anxiety symptoms and can be used in combination with other therapies.

Cons: There is a potential for dependency and side effects. More importantly, they do not address the underlying cause of the fear or phobia. Many of my former clients who went on benzodiazepines (Xanax, Klonopin) and stayed for more than a few weeks became dependent on them and never addressed their anxiety, fears, or phobias.

Fear-of-Flying Courses

How it works: These courses often combine education about flying, relaxation techniques, and exposure therapy. They are usually conducted by airlines or specialized organizations.

Studies: These courses have been shown to be effective in reducing fear of flying4.

Pros: Provides comprehensive support and education. Often includes real-life exposure with professional guidance.

Cons: They can be expensive and often require a considerable time commitment. For those who are severely anxious to the level of a phobia, mindfulness in some circumstances can worsen the phobia instead of lessen it.

Self-Help Techniques

How it works: Techniques such as mindfulness, relaxation exercises, and breathing techniques can help manage anxiety symptoms.

Studies: While not as extensively studied as other methods, self-help techniques can be beneficial as part of a broader treatment plan5.

Pros: Can be practiced independently. Low cost and accessible.

Cons: May not be sufficient for severe cases. Requires self-discipline and consistency. For those who are severely anxious to the level of a phobia, mindfulness in some circumstances can worsen the phobia instead of lessen it.

Total Reset Method Program

This is a little-known but proven method that has been around for about 40 years. It takes a maximum of 3 sessions and does not involve exposure or systematic desensitization. It does not require reliving or re-experiencing distressing feelings from the feared situation. It is designed to be done in complete security, competence, and comfort for the client. It is not a cognitive technique so there is no challenge by the therapist of irrational thoughts and beliefs. The client need not even describe or discuss the feared situation. It is a guided visualization that allows the client to see their experience from a totally different perspective, without reexperiencing any of the feelings that create the phobia. It bypasses both the Amygdala and the Cognitive systems of the brain to get to how the memory is encoded. It allows for a re-coding of the memory of the feared situation so that a new memory is formed -one that does not trigger the brain’s fear system.

Pros: It’s fast so it’s lower cost in time and money. It’s painless. It’s easy for the client as they don’t need to talk about it. It can be done virtually or in person.

Cons: It’s so easy for the client to complete that sometimes they have had difficulty believing it worked until they go back into the real world and test it for themselves.

If you are interested in learning more about how the Total Reset Method can change your life by enabling you to attend family events, go on stress-free vacations with your romantic partner, and supercharge your business by allowing you to easily meet with clients and potential clients anywhere in the world, then use the link below to schedule your free strategy session. .

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conquer your flying phobia - permanently.