The psychology of fear of flying (part I): A critical evaluation of current perspectives on the nature, prevalence and etiology of fear of flying

Summary

Fear of flying, its nature, prevalence, etiology and treatment, has been the subject of a substantial quantity of research over the past 30 years. With the exception of a dated review of treatment methods however, there has been no evaluation of this expanding body of evidence, its contribution to theory and influence on clinical practice. Published research has also generally failed to apply developments in the understanding and treatment of anxiety disorders generally to fear of flying. This review provides a critical evaluation of the existing literature and what it reveals about theory and practice. It does this from the perspective of Cognitive Behavioural Therapy. The evidence reviewed demonstrates that fear of flying is a heterogeneous phenomenon which is acquired under the influence of complex psychological, social and physiological factors unique to each affected individual. Effective psychological interventions must therefore be founded on a comprehensive functional assessment of each individual, a finding which is considered in detail in the second part of this review.

Introduction

Flying has been an object of fascination and fear for many since before the Wright brothers first demonstrated powered flight in 1903. Initially, a fear of flying could only be considered a rational reaction to a dangerous activity which frequently led to injury, mutilation or death.¹ Since then, civil aviation has become a truly international phenomenon which can safely transport people to the other side of the planet in little more than 24 h. Global accident rates are now less than 2.5 incidents per million flying hours and less than 8% of passengers involved in these rare incidents are fatally injured.² Indeed, flying is, according to some statisticians, safer than staying at home, driving or taking the train.³ To be afraid to fly is concomitantly no longer viewed as rational. Fear of flying now demands attention from the airline industry, medical professionals and psychologists because it results in a reduction in airline revenue and has significant adverse consequences for those affected.

There has been a significant increase in the quantity of published literature on fear of flying since 1990. In the same period, demand for and supply of psychological treatment for fear of flying has increased.⁴ However, there has been almost no attempt to evaluate the published literature as a whole. The primary aim of this review is to critically evaluate the published literature which examines the etiology of fear of flying. In doing so, the focus is the psychological, social and physiological processes which contribute to it. The intention is to highlight possibilities for improving treatment outcomes by relating treatment design to an understanding of the processes underlying a fear of flying.⁵

The last twenty years have seen numerous advances in the understanding of the causes, symptoms and treatment of anxiety disorders and specific phobias. However, there have been few published papers that endeavour to relate this progress to the psychological understanding of fear of flying. The second intention of this review is to identify those areas where modern advances in understanding phobias and anxiety disorders are most applicable to fear of flying.

This paper starts by evaluating what can be determined from published research. It then presents what can be derived about the etiology of fear of flying. Finally, it examines the contribution published research makes to theory and clinical practice and suggests directions for future research.