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Common Causes of Fear of Flying

Here are four of the main causes I often see and work with

Turbulence
For between a third and half my patients, the unpleasant experience of turbulence is a major feature of their fear of flying. I plan treatments around the idea that you will encounter turbulence regularly, and you do best to know what it is, that it is essentially safe (in your seat with seatbelt on), and what to do about it. It’s important to know how planes are designed to withstand 150% of the worst weather or handling.

In session, we discuss how airline flight and cabin crew give consideration to turbulence, how they rate and deal with it, and how aircraft manufacturers are developing technologies to minimise the effects of turbulence on the smooth flow of air over wing surfaces.

Over the course of treatment, each patient’s new mantra becomes: “Turbulence might be uncomfortable, but it’s not unsafe.”

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Claustrophobia
The fear of being “trapped” inside an aircraft, elevator, tunnel or on a bridge is a very basic and yet misunderstood experience – except for those who experience it and know how dreadful it can feel, preventing them from doing many things others take for granted in our modern world.

Feelings of entrapment, whether physical or psychological, is an ancient fear. We hear about them regularly with news of floods, earthquakes, and drownings and it goes to a very basic, evolutionary protective brain “hardwiring”. Not being able to breathe which feelings of being trapped can trigger, is a primitive yet powerful and scary experience we work on in treatment.

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Panic Disorder
Many people seeking help for fear of flying have already received professional treatment for other anxiety conditions, principally panic, but also agoraphobia, generalised anxiety, social anxiety, and acrophobia (fear of heights). Occasionally, patients also present with emetaphobia (fear of vomiting) which may be experienced onboard or prior to boarding. Patients might also be diagnosed with a bowel disorder such as Irritable Bowel Syndrome (IBS) and Coeliac Disease which can make flying fraught with apprehension and discomfort. In these conditions, patients find they can only fly if they can sit near restrooms which they constantly monitor inflight for a “just on case” moment. Monitoring your surroundings and how you’re feeling, and being on the lookout for warning signs only increases vigilance and paradoxically makes it more likely you’ll have a stressful flight.

Working to overcome fear of flying can occur alongside another professional working with these presentations.

In this category we can add special cases, such as children as well as adults with sensory challenges such as Autism Spectrum Disorder.

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Loss of Control
Many patients come to see me who are senior in their professions: doctors, lawyers, accountants, CEOs and Senior Managers who are very self-directed, and lead and supervise others. They utilise their intellect to achieve great results but discover that it’s not enough to overcome a fear of flying and can actually make it worse. Many speak of feeling anxious about “giving up control” to faceless strangers once they board, and this can produce great discomfort. The task in treatment is to take control of what one can control, and forgo controlling things not relevant for managing oneself on board. Loss of control issues have become very pervasive in 21st Century psychological practice.
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The Approach I take to Fear of Flying and other anxieties

Here are the Evidence-based strategies I employ with my patients
Cognitive Therapy
A very evidence-based approach which assists patients challenge or reappraise their assumptions about the triggers for the fear response, and what they can do about them.

This approach helps patients identify their safety or avoidance behaviours which can often take on the appearance of superstitious thoughts and behaviour, which can be quite frustrating for those people who rely on their rational intellect.

In our sessions, we identify two errors in probability estimation:

  1. Overestimation of the presence of danger in the feared situation
  2. Underestimation of one’s ability to cope with one’s own unpleasant sensations, behaviours and thoughts

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Exposure Therapy
It’s one thing to change thoughts, another thing to put those changes into practice. The evidence is we must go out and do the things we’re afraid of, initially with therapeutic guidance, and later, on our own. Staying in a scary situation and not escaping to seek relief or comfort will better embed new ways of thinking and help recalibrate the brain’s fear centres.

Exposure works by habituating patients to scary but fundamentally safe scenarios. It also means learning to inhibit old but no longer useful automatic behaviours and thoughts and putting in their place more adaptive and accurate ways of behaving and thinking.

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Physiological recalibration
Some of the most important tools I use are technologies to help people see how changing their breathing, behaving and thinking can recalibrate the fear response which so often kicks in automatically when confronted with particular triggers. Using advanced technologies to measure how simple changes can affect Heart Rate Variability – a measure of emotional regulation – enables patients to see how something seemingly beyond their control, like a racing heart, can be brought under voluntary control.

I also take advantage of any wearable devices many patients now use such as the Applewatch, and how to best practise new ways to manage anxiety between sessions. Being able to see and measure typically frightening sensations helps put them in their place and offers greater self-control and self-regulation.

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Visualising and Rehearsing Change
Too often patients are simply asked to imagine their scary situations to “see” themselves doing things differently. In my work, it’s not sufficient to use imagination, one must visualise and experience the challenging scenarios more vividly. For this reason, since 2001, I’ve used Virtual Reality Environments to push my patients to go beyond imagination and make the scary situation much more realistic so they may have evidence that their treatment is effective, and the new skills they’ve learnt really work. We can practise walking onboard,  do multiple takeoffs in one session until real change is experienced; sit in different areas of the plane (front, over the wing, back; window, middle, aisle seats); “fly” at night or in stormy weather, and so on. My VR system is also equipped to move and vibrate to intensify the experience and improve patients’ habituation and new learning.

This is all performed in a way that attends carefully and respectfully to patients’ ability to confront their fears. Too fast and patients don’t return; too slow and patients don’t feel any change occurring. 30 years of clinical experience, ongoing training and leading workshops for other psychologists really helps!

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What other anxieties do I work with?

Heights

Yes, for fear of heights and elevators we use the Eureka

Sooner or later, it becomes difficult to avoid heights

Whether it be flying,  visiting friends who have downsized to a high-rise apartment, going to meetings above the 5th floor, or your company has transferred to a modern tower, it’s getting harder to avoid being high off the ground.

Dogs, Birds and other common animals

My dog Shrek in his younger days

Fear of Dogs can be quite intrusive in a dog-loving Australia

I have a large German Shepherd Dog (pictured) who becomes part of the therapy helping children, adolescents and adults whose day to day lives are interfered with by their fear of dogs. Children refuse sleepovers, and adults won’t visit parks and gardens.

Driving (as a driver or passenger)

Driving

Afraid of driving or being driven is extremely intrusive

Sometimes we have been involved in an incident or near miss where we thought our lives (and that of our passengers) was truly threatened. Whether it be entering a freeway or driving at high speed with a lot of fast moving traffic, avoiding driving can become a very intrusive experience.

"Trapped!" - tunnels, bridges, elevators, social situations

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Feeling “trapped” can occur in a variety of places

They can occur in “real places” or in virtual places such as relationships, dead end jobs or careers, but feelings of being trapped can trigger sensations of panic and disorientation, leading to avoidance behaviours and a painful cycle of feelings/thoughts/behaviours.

Performance Anxiety, e.g. presenting and public speaking, interviews, formal assessments, Fellowship examinations

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Sooner or later, we all need to present and prepare to be evaluated

Being examined – either formally or informally – is now an ordinary to-be-expected part of our lives and careers. But for many it can become an overwhelming experience, setting the pattern for even more challenging experiences to come. For some, it can mean the end of a promising career. It need not to be so, with professional assistance.

Illness anxieties - fear of injections, blood, operations, vomiting, and contracting diseases

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Caring about one’s health is fine, but being anxious about every little sensation is quite something else

Being and looking healthy is a new form of status, given all the “invitations” to engage in all manner of unhealthy activities. But for some, many hours and efforts can be spent worrying about health, and checking Google for symptoms. Often, it’s family or friends who are also affected and ask the person to seek professional help.

Technology-based anxieties - overuse, avoidance, internet-based sexuality issues

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Technologies, especially mobile, are ubiquitous, but occasionally they can be interfering in life quality

Not everyone is comfortable around new technologies. They can be quite frightening for some, especially when one has no choice (i.e., your company makes new technologies a part of your workflow). For others, internet-based depictions of sexuality can be very enticing, where one can spend hours away from one’s responsibilities in search of particular images of videos. It can interfere in work and personal relationships and either lead to, or be a signal for depression and anxiety. Talking confidentiality to someone with specific expertise in this area can be a great start, and offer path to more appropriate, less fraught internet use.

Social Anxiety - being in groups, social situations, dating, social activities,

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Social Anxiety is probably the most common and truly interfering of presentations

Social Anxiety is way, way more than shyness. It’s a truly devastating and interfering disorder which often starts in adolescence and continues into adulthood. People who suffer this often talk about the fear of being criticised, rejected, humiliated, embarrassed, shunned and being left out of social and intimate relationships. They don’t take up new hobbies or activities for fear of failing or being seen to fail, and thus humiliated or ostracised. They thus often talk about missing out on some of life’s great and simple pleasures. For this reason, it’s often linked to depression, especially in young people. Talking confidentiality to someone with specific expertise in this area can be a great start. The addition of specific Cognitive and Behavioural Therapies can assist greatly when practised in line with current evidence based research.

Summary
Name
Les Posen
Website
Company
Flightwise
Address
237C Murrumbeena Road,
Murrumbeena, Victoria, 3163

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