Therapy For Fear of Flying
Cognitive behavior therapy (CBT), and Exposure Therapy are two of the key Evidence Based Practices (EBP’s) used to treat fear of flying and other travel related phobias. These include: fear of heights, claustrophobia, and agoraphobia. The best practice treatment skillfully combines both techniques, for example the initial panic experienced during exposure being lessened by awareness of the physiological responses, and the role of distorted thoughts.
Below is an examination of how CBT and Exposure Therapy would view the same client from their own perspective.
Exposure Therapy
Exposure therapy has long been considered the Gold Standard therapy for phobic disorders. Exposure therapy involves habituation, the process by which careful, graduated repeated exposure to the feared stimulus decreases the anxious response.
In simpler terms, by gradually increasing your exposure to airports, airplanes, and then flight, your fear/anxiety about flying decreases. When done properly, exposure therapy has been shown to significantly decrease fear in about 90% of people who complete treatment.
Cognitive Behavior Therapy (CBT)
Cognitive behavior therapy (CBT) is a evidence based method for treating anxiety disorders as well as other mood disorders. CBT works with the interplay between thoughts, feelings, and behaviors.
Our phobias are maintained by distorted thoughts (planes always crash) and unhelpful behaviors (avoiding getting on planes.) To reduce the fear, we have to replace these distorted thoughts with more realistic ones (while planes do crash, statistically, this is very rare) and change behaviors (I’m getting on the plane).
An Example Through The Lenses of Both Techniques
Let’s look at a hypothetical situation, and examine how a therapist would structure treatment using each approach. This is over-simplified, but should give you a sense of how they work.
When Jane was 11 years old, she was on a flight with her parents that had an “aborted landing,” also known as a “go around.” As her otherwise normal flight was landing, an airport service truck crossed the runway at the other end. The pilots did exactly what they have trained for: as soon as the wheels touched the runway, they gave it full throttle, and took off again (there’s a bit more to it than that).
The crew, and the experienced flyers knew what was happening, and after the initial surprise of the unusual event, knew it was going to be fine, and enjoyed the ride. This was Jane’s first flight, and her parents were on what was only their 5th flight. Her parents panicked, not knowing what was happening. For Jane it was worse; not only was she frightened by the “go around,” she was sitting between her parents who were panicking themselves.
After circling back, the plane made a completely routine landing, and neither Jane nor her parents were calm enough to listen to the pilot’s brief apology and explanation as they taxied to the gate.
Jane refused to fly home on that trip. She had a meltdown when it was time for the return flight, all she could think about was the plane “crashing” when it landed. Whenever she thought of flying, the image of the plane having a bad landing, paired with the memory of the panic and fear she experienced was overwhelming.
She was unable to fly again, missing class trips in high school, unable to take advantage of the opportunity to study abroad in college (which was a short drive from her home), caused stress in her new marriage since her husband to be had always wanted to honeymoon in Tahiti. Jane missed out on career opportunities, and advancement in her work. When Jane was 30 years old, she committed to completing a course of treatment in hopes of being able finally take her “honeymoon dream trip” to Tahiti with her husband.
How Exposure Therapy Sees Jane
The goal of exposure therapy, for Jane, is for her to become comfortable with airports, airplanes, take offs and landings. Exposure therapy would culminate in Jane ultimately taking a “graduation flight” prior to her trip. Exposure is done in a graduated method, starting with looking at still images of airports and planes, for example, then movies involving flights, then films of planes taking off and landing.
Exposure therapy for Jane would involve carefully creating the fear response by recalling the frightening memories, then having her develop positive memories of the same types of situations. Instead of her solely recalling the fear of crashing when she thinks about airports, she would have positive airport experiences, that she can access when she is in an airport. She would then sit in parked aircraft, watch take offs and landings from the airport itself, and so on. Ultimately, she would take carefully planned flights involving routine landings.
Exposure therapy for Jane would involve carefully creating the fear response by recalling the frightening memories, then having her develop positive memories of the same types of situations. Instead of her solely recalling the fear of crashing when she thinks about airports, she would have positive airport experiences, that she can access when she is in an airport.
How Cognitive Behavior Therapy Sees Jane
A CBT therapist would approach treating Jane by using a variety of techniques in tandem, including education about airplanes, the mechanics of landing and take-off, flight itself, and pilot training. The CBT therapist would incorporate educational sessions with an experienced pilot who could explain the extensive training exercises pilots go through, exactly what happens during a “touch and go,” and any other airplane related fears, that are identified during a thorough functional assessment completed at the start of treatment. Jane would be taught relaxation techniques, and practice them sitting in actual aircraft seats in the therapist’s office.
The therapy component would help Jane identify her unhelpful beliefs, (“cars, trucks and other airplanes cross runways all the time,” “any turbulence during landing means the plane will crash.”). As Jane gains more knowledge about flight, learns how routine landings are for pilots, and gains more realistic interpretations of her feared situations, her anxiety will decrease.
Prior to taking an actual “graduation flight” she will have accumulated a well stocked “toolkit” of relaxation methods, knowledge and facts about aircraft and pilot training, and the ability to better interpret any negative events in a more realistic way.
The therapy component would help Jane identify her unhelpful beliefs, (“cars, trucks and other airplanes cross runways all the time,” “any turbulence during landing means the plane will crash.”). As Jane gains more knowledge about flight, learns how routine landings are for pilots, and gains more realistic interpretations of her feared situations, her anxiety will decrease.”)
What Else Do These Therapy Methods treat?
CBT and Exposure Therapy are two of the main therapy techniques used to treat a variety of anxiety disorders, particularly other phobias. To learn more about phobias, click here.
Which Technique Would Help Me?
Which technique is best for you? It is essential to understand that no two people will have the same origin of fear, background, and personal characteristics. Everyone responds to therapy in different ways. Determining a treatment approach requires a thorough assessment, history, and evaluation of the client’s ability to tolerate the more challenging aspects of treatment. When you work with me to overcome your fears, we will work together to determine the best course of treatment. I will not expect you to shape yourself to my “standard treatment method,” or follow a book step by step.
I will likely utilize a combination of both graduated exposure and CBT; as well as other methods such as relaxation training and breath control. We will collaborate to find what works best for you, at a pace you’re comfortable with. To learn more about my approach, or to discuss how I can help you with your specific situation, call me toll free at 844.321.TRPS (8777) or email me at paul@travelerspsych.com to set up a no cost, no obligation 20 minute consultation.
