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Physiological sensations and discomfort constitute the major symptoms reported by aviophobics. Anxiety sensitivity (AS) seems to moderate the relationship between self-reported somatic sensations and flight anxiety, and AS has been identified as a vulnerability factor for flight phobia. In this study we examined whether AS moderates the effects of somatic sensations and autonomic nervous system reactivity on flight anxiety induced by real flight. In fifty aviophobics participating in Cognitive Behaviour Group Therapy (CBGT), flight anxiety, somatic sensations and autonomic nervous system reactivity were assessed during a guided return flight. Results indicate that physiological reactivity interacted with AS. Changes in heart rate and parasympathetic activity were more strongly associated with changes in reported flight anxiety for high AS participants, and less for participants low on AS. Results did not indicate a moderating effect of AS on the relationship between self-reported somatic sensations and flight anxiety. Our results suggest that therapy for flight phobia might benefit from addressing the physical effect of anxiety, by means of cognitive restructuring and exposure to interoceptive stimuli, particularly in aviophobics high in AS.

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OBJECTIVE: The nature of the relationship between physiological and subjective responses in phobic subjects remains unclear. Phobics have been thought to be characterized by a heightened physiological response (physiological perspective) or by a heightened perception of a normal physiological response (psychological perspective). METHOD: In this study, we examined subjective measures of anxiety, heart rate (HR), and cardiac autonomic responses to flight-related stimuli in 127 people who applied for fear-of-flying therapy at a specialized treatment center and in 36 controls without aviophobia. RESULTS: In keeping with the psychological perspective, we found a large increase in subjective distress (eta(2)=.43) during exposure to flight-related stimuli in the phobics and no change in subjective distress in the controls, whereas the physiological responses of both groups were indiscriminate. However, in keeping with the physiological perspective, we found that, within the group of phobics, increases in subjective fear during exposure were moderately strong coupled to HR (r =.208, P=.022) and cardiac vagal (r =.199, P=.028) reactivity. In contrast to predictions by the psychological perspective, anxiety sensitivity did not modulate this coupling. CONCLUSION: We conclude that subjective fear responses and autonomic responses are only loosely coupled during mildly threatening exposure to flight-related stimuli. More ecologically valid exposure to phobic stimuli may be needed to test the predictions from the physiological and psychological perspectives.

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INTRODUCTION: Passengers experiencing fear of flying can threaten the safety of a flight, its passengers, and crew. In the present study we investigated the effect of different flying histories on the nature and treatment of fear of flying and attempted to determine the following: 1) the prevalence of different flying histories in a sample of self-referred flying phobics; 2) the demographic and psychopathologic characteristics of flying phobics differing with respect to flying history; and 3) the predictive value of different flying histories for treatment outcome. METHODS: Of 2001 self-referred adults who applied for a flying treatment program, 85.6% reported that they had flown before and that their flights had been uneventful; 8.7% had no previous experience with flying; 5.7% had flown before and had experienced an eventful (5.4%) or even a traumatic flight (0.3%). RESULTS: Participants who had never flown before reported higher levels of fear of flying (FAS, FAM, VAFAS), agoraphobia (FSS-III), and general anxiety (SCL-90). Moreover, these subjects showed significantly more anxiety reduction following a 1- or 2-d group treatment than the other participants (statistically corrected for any pretreatment differences). CONCLUSIONS: For participants who had never flown before, anxiety probably primarily reflects more generalized avoidance tendencies and a proneness to over-predict the magnitude and intensity of their fear.

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INTRODUCTION: Fear of flying (FOF) can be a serious problem for individuals who develop this condition and for military and civilian organizations that operate aircraft. The aim of this study was to compare the effectiveness of three treatments: bibliotherapy (BIB) without therapist contact; individualized virtual reality exposure therapy (VRE); and cognitive behavior therapy (CB). In addition, we evaluated the effect of following up VRE and CB with 2 d of group cognitive-behavioral training (GrCB). METHODS: There were 86 subjects suffering from FOF who entered the study; 19 BIB, 29 VRE, and 16 CB subjects completed the treatment protocols. The BIB subjects were then treated with VRE (n = 7) or CB (n = 12). There were 59 subjects who were then trained with GrCB. RESULTS: Treatment with VRE or CB was more effective than BIB. Both VRE and CB showed a decline in FOF on the two main outcome measures. There was no statistically significant difference between those two therapies. However, effect sizes were lower for VRE (small to moderate) than for CB (moderate) and the addition of GrCB had less effect for VRE than for CB. DISCUSSION: VRE holds promise as treatment for FOF, but in this trial CB followed by GrCB showed the largest decrease in subjective anxiety. The results suggest that future research should focus on comparing the effectiveness of VRE vs. VRE plus cognitive techniques or measure the effectiveness of each component of treatment. Moreover, the effectiveness of the GrCB as stand-alone treatment should be investigated, which might even be superior in cost-effectiveness.

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In a long-standing fear-of-flying program, persons with fear of flying (N=150) were after a diagnostic assessment and individual preparation phase randomly assigned to either a 1-day behavioral group treatment (BGT) program, a 2-day cognitive-behavioral group treatment (CBGT) program or a waiting list (WL) control group. A post-treatment flight on a commercial airline measured participants' ability to fly. Different self-report flight anxiety questionnaires were completed before, during and after treatment at 3-, 6- and 12-month follow-up. Results indicated that both treatments were superior to the WL, and equally effective on the flying test and later independent flying, but also that the 2-day CBGT program was significantly more effective than the 1-day BGT program on subjective measures of fear and self-efficacy.

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BACKGROUND: This article is an update of an earlier international review of fear of flying treatment programs. METHOD. One hundred and sixty two airlines and treatment facilities around the world were approached for information on treatment programs for flying phobia. In comparison to the earlier review, the number of treatment facilities able to provide relevant and valid information increased from 15 to 36. Information was obtained both with a written questionnaire and by obtaining oral information from treatment facility representatives. This information was obtained at the second international fear of flying conference in Vienna on December 2000. The increase in the number of participating facilities can presumably be attributed both to a world wide increase in the demand for treatment for fear of flying and professionals becoming more interested in entering the field of fear of flying treatment. However, the increase may also be due to the fact that some clinics or programs have only recently discovered the international network of treatment facilities. RESULTS. In comparison to the previous review, the number of facilities that provide treatment programs that meet high professional standards has increased considerably over the past few years. Although there is still substantial variety in the quality and components of treatment programs, there is also a significant number of facilities that provide more or less similar qualified treatment programs and carry out treatment evaluation on a regular basis. Furthermore, experts from the participating centers reached consensus on 'golden rules' for fear of flying patients and flying-phobia therapists. CONCLUSIONS. There is a growing consensus among fear of flying treatment facilities on methods and protocols.

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Studies have been inconclusive about the influence of personality pathology on treatment outcome in anxiety disorders. In general, it has been presumed that treatment outcome is negatively influenced by the presence of personality pathology. This is a study of the prevalence of personality pathology among persons who were seeking help for fear of flying. Moreover, the effects of personality pathology on the results of a multimodal, standardized, cognitive-behavioral fear of flying treatment program employed by an agency that specializes in treating people with fear of flying were studied. Personality pathology was determined with a self-report questionnaire, which provides ICD-10 diagnoses of personality disorders and dimensional severity scores for personality pathology. Treatment outcome was assessed with three different fear of flying questionnaires. Based on clinical judgment after individual-case conceptualization, participants (N=922) were assigned to a particular treatment for fear of flying. Self-report data for fear of flying were collected at pretreatment and at 3, 6 and 12-month follow-ups in 659 participants who followed the 2-day treatment program. Moreover, the number of flights made in the year following treatment was determined.The results of this study showed that participants with personality pathology, mainly from cluster C (anxiety), report greater fear of flying before treatment than participants without personality pathology. After treatment fear of flying was significantly reduced. Presence of personality pathology was not predictive of the number of flights after treatment and scores on the VAFAS scale at short or long term. Only on two questionnaires for fear of flying collected at short-term participants with personality pathology obtained significantly higher scores, although the size of the differences was relatively small. It was concluded that participants with personality pathology also benefited from fear of flying treatment and that the presence of personality pathology although cannot be regarded as a contra indication for a standardized, cognitive-behavioral group treatment.

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