The psychology of fear of flying (part II): A critical evaluation of current perspectives on approaches to treatment
Introduction
Part I of this review1 evaluated published research which examined the nature, prevalence and etiology of fear of flying. It demonstrated that fear of flying demands attention because it has undesirable consequences for the personal and professional lives of those affected and is responsible for an identifiable loss of revenue to the airline industry. It concluded by describing the etiology and nature of fear of flying.
In summary, fear of flying emerges from an individual’s unique background and characteristics. Psychological influences will include co-morbidity such as low mood or existing psychological disorders and traits such as anxiety sensitivity. Indeed, fear of flying may often be a symptom of a psychological diagnosis such as General Anxiety Disorder (GAD) or Panic Disorder. Social factors such as anxious flyers among friends or family or experiences such as turbulent flights may contribute to a fear of flying. Physiological characteristics such as sub-clinical vestibular dysfunction or undetected hypoxia may also play a part. The result of even identical learning history and social influences is likely to be different for each individual and may range from sub-clinical anxiety to an incapacitating clinical phobia, panic disorder or similar anxiety disorder. This is likely to include a number of behavioural, emotional, cognitive and physiological symptoms which will, again, vary among individuals.
The complex etiology and nature of fear of flying would lead one to expect that the most effective interventions are those which consider the distinct aspects of fear of flying. It is, however, also the case that fear of flying is either a symptom or presentation of an anxiety disorder even at sub-clinical levels. Effective interventions should therefore be those which are known to be effective for similar anxiety disorders. The challenge to those providing treatment is to blend the complex demands of fear of flying with the known efficacy of interventions for similar anxiety disorders.
Studies which evaluate interventions to reduce fear and anxiety associated with air travel have been published in disparate sources which include medical, aviation and psychology journals. There has been no previous attempt to provide a systematic critical evaluation of published research in this area, although there have been published overviews, and it is therefore possible that those who provide psychological treatment to fearful flyers may be unaware of some of the findings reviewed here. The primary aim of this review is to undertake such an evaluation. It has been constructed as a systematic review rather than meta-analysis because, as this review will demonstrate, variations in outcome measure, statistical analysis and methodology would make a formal statistical meta-analysis meaningless.
This paper critically evaluates the literature which examines psychological interventions for fear of flying. It also identifies some recent developments in psychological interventions for anxiety disorders which are likely to improve the effectiveness of therapies for fear of flying. Furthermore it highlights conceptual and methodological vagaries in research which has evaluated interventions for fear of flying which so that clinicians may can compare ‘like with like’ and not be misled by the seemingly high success rates reported. This is important to address as there are a plethora of published studies on the efficacy of various fear of flying treatment. There has been one review of 15 multi-component group programmes which suggested that such interventions were effective and presented guidelines for best practice based on the views of participants in a conference on fear of flying.2 No existing review, however, has established guidance for best practice based on a synthesis of studies which consider fear of flying and current perspectives on anxiety disorders in general. This is the aim of the critical evaluation presented here.
Section snippets
Method
The initial selection of literature to be included in the review was achieved by database searches. The databases used were PUBMED, PsycINFO, PsycARTICLES and Science Direct. Each of these databases was searched using the criteria described below. Relevant full text articles were then retrieved as required. Literature retrieved in this way was then also scrutinised for further references as described in the following sections. An initial search was conducted in October 2007 and repeated in
Review
The review identified 43 published studies which met the selection criteria. It also identified one review of the efficacy of virtual reality treatments and two summaries of group programmes.2, 4, 5 The majority of studies consider only psychological approaches to treating fear of flying, although two clinical trials6, 7 and two case study reports8, 9 evaluate the efficacy of medication. Medication has not proven to be effective in resolving fear of flying or anxiety disorders generally in the
Directions for future research
The main limitation of research which evaluates interventions for fear of flying is the tendency to use participants who are unlikely to adequately represent the population of fearful flyers and to consider them to be a homogeneous group who meet one definition of a clinical diagnosis. The assessment of interventions is based on changes in the mean of assessment measures of experimental conditions and disguises individual differences. Few studies have attempted to identify reasons for or
Conflict of interest
None declared.
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