People with fear of flying experience intense, persistent fear or anxiety when they consider flying, as well as during flying. They will avoid flying if they can, and the fear, anxiety, and avoidance cause significant distress and impair their ability to function. Take-off, bad weather, and turbulence appear to be the most anxiety provoking aspects of flying. The most extreme manifestations can include panic attacks or vomiting at the mere sight or mention of an aircraft or air travel. Around 60% of people with fear of flying report having some other anxiety disorder.
Cause
The causes of flight phobia and the mechanisms by which it is maintained were not well understood as of 2016. It is not clear if it is really one condition; it appears to be heterogenous. It appears that some people get aerophobia from being or having claustrophobia to the small spaces inside the fuselage of the plane or helicopter.
Diagnosis
The diagnosis is clinical. It is often difficult to determine if the specific phobia of fear of flight should be the primary diagnosis, or if fear of flying is a symptom of a generalized anxiety disorder or another anxiety disorder such as agoraphobia or claustrophobia.
Classification
Fear of flying is a specific phobia classified as such in the DSM-5.
Management
Acute anxiety caused by flying can be treated with anti-anxiety medication. The condition can be treated with exposure therapy, including use of virtual reality equipment, which works better when combined with cognitivebehavioral therapy. Relaxation techniques and education about aviation safety can also be helpful in combination with other approaches.
Outcomes
Studies of interventions like CBT have reported rates of reduction in anxiety of around 80%, however there is little evidence that any treatment can completely eliminate fear of flying.
Epidemiology
Estimates for prevalence have ranged between 2.5% and 40%; estimates on the lower end are probably generated through studies where the condition is diagnosed by a professional, and the higher end probably includes people who have diagnosed themselves.
History
Fear of flying was first discussed in the biomedical literature by a doctor in the UK at the end of World War I, who called it "aero-neurosis" and was describing pilots and crew who were or became anxious about flying. It was not much discussed until the 1950s and rise of commercial air travel and the vogue in psychoanalysis. Starting in the 1970s fear of flying was addressed through behavioral and cognitive approaches.
Society and culture
Immediately after the September 11 attacks, Americans chose to travel more by car instead of flying; because of the extra traffic, around 350 more people died in traffic accidents than would have normally occurred.
Research directions
As of 2016, the causes of fear of flying as well as the psychological mechanisms through which it were persists had not been well researched. A few studies had looked at whether mechanisms like illusory correlation and expectancy bias were present in all or most people with fear of flying as well as other specific phobias; these studies have not led to clear outcomes. Research into the most effective ways to treat or manage fear of flying is difficult due to the inability to include a placebo or other control arm in such studies.
