Flying Phobia. The Fear of Flying. Diagnosis and Treatment in Dubai

Flying phobia, also called aerophobia, affects millions of people around the world. This type of phobia is an anxiety-based disorder and shows in an extreme fear. It can also involve having panic attacks. For many individuals with this disorder, very upsetting, anticipatory anxiety already sets in as soon as they know that they will be travelling on a plane. Mental healthcare professionals can treat flying phobia with evidence based treatments. Treatments can include “talk therapy,” medication, and hypnosis.

Anxiety or Anxiety Disorder—What’s the Difference?

Anxiety is a biological reaction signalling a danger and preparing the individual to take protective measures. In an anxiety disorder, the feeling of fear gets excessive and irrational. The border line between “normal” and pathological anxiety considered a disorder is often fluid. The physiological anxiety acts as a defence mechanism, protecting us from possible threats. It helps us either avoid or deal with a danger. Once the threat is gone, the anxiety fades away. However, if anxiety becomes a constant companion, it could signal an anxiety disorder.

With an anxiety disorder, intense fear arises in situations that aren’t objectively dangerous. People with this disorder are afraid of things or situations others see as normal. They experience very real symptoms, both physically and mentally, such as racing heart, sweating, and shortness of breath. In Germany, about 9% of men and 21% of women aged 18 to 79 experience an anxiety disorder each year.

What Are Phobias?

Crowds, particular animals (like spiders), or objects (like needles) can all be triggers for phobias. These fears have a clear cause and are predictable, as those affected are aware of what provokes their fear. For example, in social phobia, individuals are afraid of situations where they might be the center of attention and judged by others, such as during a speech or at a party. They fear behaving awkwardly or inappropriately. A common reaction to these triggers can be a panic attack, which is why many people try to avoid them.

In the case of fear of flying, the experienced fear is greatly out of proportion to the actual risk. Commercial aeroplanes, alongside trains, have the lowest accident rates of any form of transport. The likelihood of a fatal accident is more than 800 times higher per kilometer traveled in a car than on a flight. Therefore, the intense fear of flying felt by those affected is not based on facts, and many realize their fear is irrational.

In most cases, fear of flying arises without a traumatic flight experience beforehand. Even people who have flown without issue for years can develop a fear of flying or flight phobia.

How to Diagnose Flying Phobia?

The term “fear of flying” refers to general anxieties related to flying, ranging from mild discomfort to intense fear. Flying phobia, on the other hand, describes a more specific condition with clearly defined criteria. The main symptom of aviophobia is a severe fear of flying, both before and during the flight, which is avoided whenever possible.
Additionally, this fear must cause significant distress in the person’s life. This can be difficult to assess if the individual is not required to fly regularly.

ICD-10 Criteria for Diagnosing Flying Phobia

Fear of flying is classified as a specific phobia, and therefore a mental disorder, under the International Classification of Diseases (ICD-11) if the following criteria are met:

• Intense fear of flying that consistently occurs when exposed to this situation and is out of proportion to the actual risk involved.
• Flying is actively avoided or endured only with extreme anxiety.
• The fear or avoidance of flying has lasted for several months.
• The symptoms cannot be better explained by another mental disorder.
• The condition causes significant mental distress and/or impairs important areas of life functioning, or normal functioning can only be maintained with great effort.

How Does Fear of Flying Manifest?

In cases of flying phobia, the fear is often so intense that affected individuals try to avoid flying altogether, even if this means spending much more time on alternative travel options or completely giving up certain destinations. Just thinking about flying, through books, movies, or news on the topic, can trigger anxiety, which is why people often avoid these as well. If a flight is absolutely unavoidable, the anxiety often begins long before the departure and increases as the flight approaches.

Anxiety Before and During a Flight

People with flying phobia experience fluctuating fear both before and during the flight. This anxiety can escalate to such an extent that a panic attack occurs. A panic attack involves an even more intense level of fear. Generalized anxiety disorder is similar to the less severe anxiety that those with flying phobia experience. This constant fear creates a state of inner tension, which can manifest as restlessness, muscle tension, or headaches.

The acute anxiety that arises during a flight is identical to a panic attack. In panic disorder, sudden bouts of fear occur along with physical symptoms like a racing heart, sweating, dizziness, lightheadedness, chest pressure, and nausea. Many people even fear that they might die from these symptoms.
However, panic attacks usually subside within ten minutes. There is no distinction between a “classic” panic attack and one brought on by a fear of flying.

Why Does Flying Phobia Develop?

There are several theories about why some people develop aviophobia. Genetic factors, stress, childhood experiences, observed or learned behaviours, and especially the active avoidance of anxiety-provoking objects can contribute to the development of specific phobias. Changes in certain brain regions and in neurotransmitters, the brain’s chemical messengers, have also been linked to anxiety disorders.

The psychological mechanism behind fear of flying
Fear of flying can develop through various mechanisms and causes.

Fear of Flying: Learning by Example

Often, the fear of flying begins with an experience in childhood or adolescence. When children see their parents fear flying, they may also develop a fear of flying. Even if adults don’t openly express their fear, children can sense the tension and nervousness and adopt the behavior. As a result, children can develop a fear of flying, even without having flown themselves.

Fear of Flying: Conditioning of Fear

A specific phobia, such as fear of flying, can also arise from a traumatic event. For example, an emergency landing might trigger a life-threatening fear. This negative experience can then lead to a lasting fear of future flights. The next time this person sees a plane, the feeling of fear resurfaces. This is known as negative conditioning: the plane is no longer neutral but becomes associated with negative experiences.

Learning from Information

Media reports about plane crashes play a significant role in amplifying the fear of flying. About 70% of affected individuals report that such news stories intensify their fear.

Neurobiological Mechanisms Causing Flying Phobia

As with other phobias, there are a number of biological factors that affect the susceptibility to flying phobia. Family and twin studies suggest that the risk for phobias is partially inherited genetically. Fear of flying is also associated with an imbalance of neurotransmitters in the brain.

Information from the environment is processed in the brain through two different pathways. A key player in this process is the amygdala, which acts as our fear center, functioning like an alarm system that quickly and unconsciously evaluates situations and dangers. The amygdala receives information about external influences from the thalamus, a part of the brain that serves as a gateway to consciousness and a relay center for sensory information.

In addition, there’s the conscious evaluation of situations. The thalamus also sends information to the cortex and hippocampus, where sensory impressions are analyzed. Previous experiences in similar situations play a role in this analysis. Once the situation is assessed as dangerous or not, the amygdala is informed. However, this conscious analysis takes about twice as long as the amygdala’s initial, unconscious reaction.

When this “fear system” is disrupted—due to neurotransmitter imbalances, genetic factors, or prolonged stress during childhood—an anxiety disorder may develop. The body of the affected individual then goes into a fight-or-flight response without any real danger, such as when seeing a harmless spider. This triggers the release of stress hormones and leads to physical reactions like a racing heart or rapid breathing.

Why Does Flying Phobia Tend to Increase Over Time?

The confined space, uneven landings, thunderstorms, or turbulence can all cause feelings of anxiety during flights. Some people are frightened by media reports of crashes. The sense of losing control also plays a role: when flying, personal control is limited, and one is dependent on the flight crew. In contrast, when driving, you’re in control, which gives a sense of (perceived) safety.

Negative thoughts start a vicious cycle of fear. Even before the flight, affected individuals imagine everything that could go wrong. These thoughts alone cause their heart rate to rise. They then interpret these physical changes as threats, which intensifies the fear.

When a plane crash happens somewhere, people with fear of flying see it as confirmation of their fears. They don’t notice that most flights go smoothly because they focus on the rare negative events. Experts refer to this as selective perception.

Other Phobias Contribute to Fear of Flying

Agoraphobia: the fear of being in public spaces or areas, including public transportation.
Claustrophobia: the fear of enclosed or tight spaces.
Acrophobia: the fear of heights.

Flying Phobia: Evaluation and Diagnosis

For people with flying phobia, the fear is often so intense that they cannot manage it without therapeutic help. If you suffer from severe fear of flying, your first point of contact should be a psychiatrist. Following a physical examination, lab tests, and an ECG, the psychiatrist will conduct an interview to gain an understanding of the disorder. This process is important to rule out any physical causes for the symptoms.

If everything appears normal physically, and the suspicion of aviophobia is confirmed, the psychiatrist will decide which treatment is most appropriate: medication, psychotherapy, or a combination of both.

Therapy with Medication for Flying Phobia

For frequent flyers, such as business travelers, medication is often recommended to quickly alleviate symptoms. Antidepressants are suitable for long-term treatment and relapse prevention of fear of flying. Benzodiazepines, on the other hand, are prescribed for short-term use, particularly to suppress a panic attack during the flight.

Antidepressants

Antidepressants can be used to treat agoraphobia and social phobias. Despite the name, this doesn’t mean that anxiety patients always suffer from depression. Certain antidepressants are highly effective in treating anxiety disorders, especially selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
As with any medication, the benefits, risks, and personal preferences of the individual are weighed carefully. These medications can have side effects, such as insomnia or restlessness. However, with careful dosage and monitoring by the treating doctor, medication for anxiety disorders is generally well-tolerated.

It’s important for patients to understand that it takes about two weeks for antidepressants to take effect. Additionally, they should continue taking the medication for at least six to twelve months, even if symptoms improve. This reduces the risk of relapse. Cognitive behavioral therapy, conducted alongside medication treatment, can further help prevent a relapse.

Benzodiazepines

To reduce fear of flying, medications known as benzodiazepines can be used. These sedatives and tranquillizers work quickly and help people with a fear of flying feel significantly less anxious on the plane.

While benzodiazepines are effective for anxiety disorders, they should only be used in exceptional cases. This includes circumstances like bridging acute phases, such as when a flying-related panic attack occurs.

Psychotherapy for Treatment of Flying Phobia

Anxiety disorders like phobias can be treated through psychotherapy. In therapy, individuals learn to face the specific triggers of their fear, manage their anxiety, and change harmful thought patterns.

Various therapeutic approaches can be used to treat phobias, with cognitive behavioural therapy (CBT) being the preferred method. This often involves prolonged and intense exposure to the fear-inducing object or situation, known as exposure or confrontation therapy, under the guidance of the therapist.

Facing the Fear

Confrontation with the phobia can initially be very intense and accompanied by strong physical reactions. However, over time, individuals realize that the fear naturally subsides. Through these new experiences, they learn that they can face and control their fear. The exposure process can be gradual. For instance, someone with a severe fear of spiders might start by imagining spiders, then progress to looking at pictures and videos, and eventually move closer to live spiders, possibly even touching them. Before these exercises, the therapist carefully explains what will happen and prepares the patient for the experience. Guided exposure exercises are often discussed during sessions and practiced independently at home.

Restructuring Thoughts

In cognitive behavioral therapy, patients also learn to develop helpful thoughts. The therapist uses specific questions to help them identify the thought patterns that fuel their anxiety and how these patterns worsen the fear. Phobias often involve an overestimation of danger, with harmless things or situations being perceived as extreme threats (catastrophizing). Once this is understood, patients can work on reinterpreting these thought patterns and addressing avoidance behaviors.

There are now also online programs based on behavioral therapy techniques that can help phobia patients. These programs can be useful for bridging long wait times for therapy or as a supplement to ongoing therapy. However, they are not suitable as a standalone treatment. Discuss with your doctor or therapist whether such a program could be helpful for you. They can also recommend a specific program.

It takes a lot of courage to face one’s fears, but with new experiences, individuals can learn to control their anxiety.

Duration of Flying Phobia Therapy

The length of anxiety therapy depends on how severe the anxiety disorder is, whether there are additional conditions present, and the patient’s current life situation.

Tips For Overcoming Fear of Flying

Be aware of the difference between fear and actual danger. Experiencing feelings of fear doesn’t necessarily mean that you are in real danger. You can feel safe on a plane, even if you’re very anxious.

Familiarize yourself with facts about flying. This will help you better manage your fear. Remember that air travel is much safer than driving. Learn about the high safety standards that airlines must meet.

Focus your thoughts on the time after the flight, such as your business meeting or vacation.

Arrive at the airport early to avoid stress and time pressure during check-in.

Breathing exercises and relaxation techniques, like autogenic training or progressive muscle relaxation, can help you manage your anxiety—especially if you practice them for a few weeks before the flight and become comfortable with them.

If possible, don’t fly alone. Travel with someone you trust.

Distract yourself during the flight with conversations, reading, puzzles, or using your smartphone or tablet.

Let the flight attendants know about your fear of flying; they can help you manage it. Simply expressing your fear might reduce some of your inner tension.

Celebrate completing a flight as an important step towards reducing your fear of flying.

During the flight, distracting yourself and focusing on your destination can be helpful in managing fear of flying.

Self-help for Flying Phobia

Those affected can support professional treatment with the following tips:

Relaxation techniques such as yoga, progressive muscle relaxation, or autogenic training can complement therapy. However, they are not suitable as a sole method for self-treatment.

Some people find it helpful to connect with others facing similar fears, such as through support groups.

Regular aerobic exercise, like running, can be a useful addition to therapy.

Avoiding anxiety-inducing situations only reinforces fears. As often as possible, try to face your fears—even if it takes some effort. The more frequently you succeed, the sooner you can reduce excessive fear.

Relaxation Techniques

Many therapists incorporate relaxation techniques into their work. Clients can learn these methods under guidance and practice them independently at home. Suitable techniques include:

Breathing Exercises

Breathing exercises are a simple and effective way to manage anxiety. Controlled, mindful breathing relaxes the muscles and promotes a sense of well-being.

Progressive Muscle Relaxation

Progressive muscle relaxation (PMR) is an easy-to-learn technique. It involves progressively relaxing all major muscle groups after tensing them first. The physical relaxation helps calm the mind as well. Practice PMR for a few minutes each day, breathing calmly throughout. Since the exercises can be done sitting or lying down, you can also use this technique during stressful situations, such as on a flight.

Autogenic Training

Another effective relaxation method is autogenic training. It can be applied in various situations, such as dealing with anxiety, reducing stress, and improving sleep. It’s best to learn autogenic training under professional guidance. Audio guides can also be helpful for beginners.