Weekend Program Conquers Fear of Flying

Therapist Jets Around With His Patients

Caroline Helwick

March 28, 2011

March 28, 2011 (New Orleans, Louisiana) — Aviophobic patients can fly the friendly skies after a single weekend program geared at conquering their fears, according to a therapist who claims a high success rate with 2 days of group therapy culminating in real-life exposure, according to research presented here at the 31st Annual Conference of the Anxiety Disorders Association of America (ADAA).

David A. Carbonell, PhD, who runs the Anxiety Treatment Center in Rolling Meadows, Illinois, said that persons who continue to fly despite their fears usually try hard to not feel afraid. They believe that by opposing their fear they can eradicate it. He refers to this misconception as the "anxiety trick."

"The anxiety trick is that what one does in an effort to overcome one’s fears. But it actually maintains and strengthens them. When you get tricked this way, you act in ways that make your fear worse rather than better," he said.

Anticipation, avoidance, and "fighting fears" are robust factors in the persistence of the fears and are addressed in the workshop.

Aviophobics typically experience dread in the days, weeks, and even months ahead of a scheduled flight, often picturing dire scenarios. This anticipation causes them to worry, lose sleep, and cancel their plans to fly. Relieving the negative influence of this anticipation is a key step in overcoming the fear, said Dr. Carbonell.

Avoidance Is Addictive

Many individuals fly only when it is practically unavoidable, and once they cancel a flight or schedule another driving vacation, they experience some relief from that avoidance.

"This avoidance is addictive. They come to feel that the avoidance has protected them in some way, and find that they become more and more phobic over time. Reversing the avoidance is another key step in overcoming the fear of flying," he said.

The third factor, "fighting the fear," is exemplified by the typical aviophobic’s actions in flight — grabbing the armrest, furiously praying, self-medicating with alcohol or drugs, wearing good luck charms. This kind of flying only strengthens and maintains the fear, he pointed out.

"Patients need practice working with, rather than against, the fear," he emphasized. "My focus in the group is on turning this around, using the practice flight as a chance to practice 'being afraid' and offering no resistance. Virtually everything I do serves this goal. I repeatedly tell them, 'We are only going to St. Louis to be afraid.'"

He emphasized that his technique is not cognitive restructuring. Rather than challenge the patients' thoughts, he urges them to accept them, though he does attempt to correct misconceptions about flying risks.

Dr. Carbonell holds his "fear of flying class" over a single weekend, typically with 4 to 8 participants, in his office.

"We start with a full day of work on Saturday. I use that time to teach the participants an overall approach to solving the fear of flying, and give them some specific techniques to use. Some are for the anxiety they feel on board and others are for the anticipatory anxiety. And I usually include some time for a question-and-answer session with a commercial pilot," he said.

Feel the Fear

The main concept, he said, is "the rule of opposites" — that is, the individual should act in a way that is the opposite of his/her gut instinct.

Participants gain accurate information about flying, better understanding of their fear, acceptance of their fear, and techniques for working with fearful anticipation. Their homework for Saturday evening is to "worry twice for 10 minutes at a time, fully focusing on the worry," he said. The aim of this exercise, he added, is to make worrying "boring."

The class meets again Sunday morning to review preparations for flying as a group from Chicago to a city about 1 hour away (St. Louis, Detroit, or Kansas City, Missouri), and back. The purpose of the flight is to give the fearful flier the chance to practice the specific skills and techniques they learned on Saturday, with guidance as needed from Dr. Carbonell.

The group meets at the airport on Sunday morning. Dr. Carbonell alerts the flight crew as to their presence and the participants generally sit together, although chatting is discouraged.

He reminds them they are "only flying to St. Louis in order to get afraid," that the goal is "not to make the fear end." Their mission is to feel the fear, and not "just hang on and get through the flight as they do all others."

"I want them to have a full measure of fear and good practice dealing with it, so they feel they can handle whatever is thrown at them," he explained.

During the flight they keep a panic diary and symptom inventory and they graph their fear level on both flights. They leave at home their usual distractions, safety objects, lucky charms, and medications. "I want no anti-anxiety measures on board," he said.

Playing the Role of Passenger

At this point, participants have been taught the role of passenger — a role they typically resist. "The fearful flier monitors the weather, flies on the 'safest' airline, and so forth. He is consistently trying to sign on as crew, to have control over what he doesn’t have," he explained. "They have to be taught to sit back and fly as one of the passengers."

"I've been offering this fear of flying class for 15 years, and it's a great way to get over the fear of flying," Dr. Carbonell said.

He has led over 40 groups and treated over 200 aviophobics, and only 3 persons have been unable to board the practice flight.

His recommendation is that participants fly at least once each quarter, for at least a year, raising the level of "threat" — that is, flying at night or taking a lengthier flight — 1 relevant variable each time.

At 1-year follow-up, over 90% of participants report having flown as prescribed, virtually all with diminishing levels of anxiety.

The cost of the experience is less than $1000, including $425 for the workshop, $145 for 1 individual session with Dr. Carbonell, and around $200 for the airfare. He works with participants to get the costs reimbursed by their health insurance company.

Beyond Virtual Reality

Martin Franklin, PhD, associate professor of clinical psychology in psychiatry at the University of Pennsylvania School of Medicine, Philadelphia, commented that an intensive workshop with exposure to an actual flight is "a great idea."

"I think that virtual reality approaches can only take you so far. They may be an interim step in treatment of a phobia, but ultimately you want people to have the opportunity to work directly with the stimulus," Dr. Franklin told Medscape Medical News.

"The flights need to be long enough — and I think 1 hour is sufficient — and need to be repeated occasionally. I think if patients just go through the workshop and only fly once, they won’t have the same outcome. Frequency of exposure is important."

Dr. Carbonell reports he conducts several workshops a year for which he is financially compensated. Dr. Franklin has disclosed no relevant financial relationships.

Anxiety Disorders Association of America 31st Annual Conference. Presented March 25, 2011.


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