Two caterpillars were crawling laboriously through the undergrowth, when a butterfly fluttered by. Watching in horror, the first caterpillar exclaimed to the second “No way would you ever get ME up in one of those things!” People who suffer from a fear of flying will frequently resort to the “it’s not natural” argument – “If man was meant to fly, he would have been born with wings”. Countering this with “If man was meant to go at seventy miles per hour on the motorway, he would have been born with spots, four legs and a furry tail”, does little to shake the conviction.
Searching for agreement on the nature of fear of flying, let alone the causes and the best form of treatment, reveals a myriad of often contradictory opinions. In this chapter, the major prevailing perspectives from the published clinical literature will be presented. It will not be possible to provide a comprehensive summary of the whole field – one Internet search on “Fear of Flying” yielded seven hundred and twenty eight thousand sites alone!
The range of people who can be affected by a fear of flying, extends from those who have never flown before, to frequent flyers, including civilian and even military aircrew (Dyregrov et al 1992, Goorney 1970). The consequences of the fear can be far-reaching. It can limit the person’s professional opportunities, affect leisure options, and even mean that one person may decide to take holidays without their partner on a regular basis, if the partner will not fly. There are implications for long term relationships, and likewise difficulties in family holidays if children refuse to travel. The problem can have a substantial impact on professional life, social life and family life, (Van Gerwen 1988), and can affect marital or relationship satisfaction because fear of flying hampers or restricts either partner’s freedom of movement. When considering the range of the population who suffer from fear of flying, Ekeberg, Seeberg and Ellertsen (1989) propose that individuals affected can be divided into 3 groups – those who avoid all flights, those who restrict flying to an absolute minimum, and experience considerable discomfort prior to and/or during each flight, and those who display continuous mild or moderate apprehension about flying, but do not avoid it, even though it remains an unpleasant experience.Jones (2000) suggests that in the early years, a reluctance to fly was regarded as a normal human attitude, and not as evidence of a mental disorder. Those who wanted to fly were regarded as the ones whose sanity might be doubted. Reference is made to such diagnostic categories of “aeroneurosis” and “aerophobia” (Anderson 1919, Gotch 1919). Fear of flying can be a symptom that may be a product of an acute or post-traumatic stress disorder, a generalised or phobic anxiety disorder or part of some other major or minor psychiatric condition. Fear of flying is classified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) American Psychiatric Association (APA) (1994) as a specific phobia, situational type. It is characterised by a marked, persistent, excessive fear that is precipitated by the experience or immediate prospect of air travel. Exposure to this phobic stimulus almost invariably provokes an anxiety response – sometimes to the point of a panic attack –which the individual recognises as unreasonable, and which produces significant interference or distress. It is in a different category to the other non-situational phobias, which are categorised as “social” or “agoraphobias”. In the previous edition of DSM, (DSM III-R) (1987), fear of flying was classified as a simple phobia, more akin to spider phobia, or needle phobia.
People suffering from a fear of flying quite frequently report the presence of other psychological difficulties. Wilhelm and Roth (1997) reported that 44% of their sample had met criteria for current panic disorder with agoraphobia, or had done so in the past. This group was more concerned with internal, or social anxiety. The simple phobics in this study did not have this worry, but both groups were equally concerned regarding the worry about “external danger.” Iljon Foreman and Borrill (1994) found that 60% of their sample reported “other fears”, besides that of flying. These included a diverse range such as spiders, swimming, agoraphobia, claustrophobia, fear of heights, falling, social embarrassment, crowds, collapsing and “being under some one else’s control”. Dean and Whitaker (1982) examined the association between fear of flying and psychiatric disorders and suggest that 46% of travellers with a fear of flying have other phobias; 33% present with agoraphobia, and 25% with claustrophobia.
It is generally agreed that fear of flying is not a unitary phenomena, but consists of various underlying fears. These may meet the criteria of identifiable psychological disorders, or may just be factors which apply only to the situation of air travel. Howard, Murphy and Clarke (1983) identified 6 separate “source” fear categories, in the following order of significance : crashing 51.8%, heights 23.2%, confinement 17.9%, instability 11.1%, panicking 5.4% and lack of control 5.4%. In their sample of 38 fearful flyers, Walder et al (1987) found that 37% were afraid of “being enclosed”, 34% were afraid of crashing, and 13% were afraid of heights. The remaining 16% were afraid of either losing control, air sickness, or had a multitude of worries. Dean and Whitaker (1982) reported that out of 562 responses by fearful flyers, 29% were associated with a fear of dying, 24% with a fear of heights, and 7% with fears of bad weather. Beck, Emery and Greenberg (1985) also emphasised the heterogeneous nature of fear of flying, and highlighted the following fears: fear of suffocation due to deprivation of air, fear of subjective tension and loss of control, fear of crashing and death, fear of loss of control in social situations, fear of vomiting or fainting and the subsequent humiliation, agoraphobia, fear of being trapped in an enclosed space, fear of being separated from a caretaker, and experiencing a serious disorder such as a heart attack. Heller (1993) suggested that people are less bothered by a fear of heights, the plane crashing, or even dying, than they are about experiencing negative feelings, perceived loss of control, and what others may think of them. Howard, Murphy and Clarke (1983) have identified four underlying categories for the fear of flying: heights, crashing, instability and confinement.
Rosenhan and Seligman (1989) suggested that specific phobias can be grouped into three categories – situational phobias, animal phobias and mutilation phobias. The difficulty with classifying fear of flying as a “specific phobia” is that this does not clarify what it is ABOUT flying which frightens the person. It could as easily fit into the “situational” as the “mutilation” categories, depending on what it was that the person feared. As one person seeking help for their fear of flying succinctly put it: “Flying? That doesn’t bother me at all! CRASHING? Now THAT bothers me!!”. Another person said that he was so terrified that he might make a fool of himself if he could not escape that he found himself almost wishing the plane WOULD crash.
Perhaps the most parsimonious proposal is that of Iljon Foreman and Borrill (1993). Based on clinical assessment and standard questionnaires, analysis indicated that the fears could be conceptualised as two separate categories, with some people experiencing fears from both categories. The first group reported fears that concerned a “loss of internal control”. These subsumed all those fears relating to social anxiety, panic disorder, claustrophobia and agoraphobia. In this first group, the person fears some form of internal catastrophe, where in some way they will go “out of control”. They are unable to employ the strategy of escape, and therefore remain terrified of the frightening prospect. The second group report a fear of a “loss of external control” – something happening to the plane. The latter fear encapsulates heights, turbulence, bad weather, and all of the precursors to crashing. The third group have both fears – a loss of internal and of external control.
This view fits neatly with the findings of McNally and Louro (1992), who looked at fear of flying, agoraphobia and simple phobia in thirty four people. They concluded that the distinguishing features were that Danger Expectancies (loss of external control) motivate flight avoidance in simple phobia, whereas Anxiety Expectancies (loss of internal control) motivate flight avoidance in agoraphobia. This view builds on the earlier findings of Reiss and McNally (1985). It is therefore not so much panic per se that differentiates simple phobias from agoraphobia, but rather the fear of panic (Goldstein and Chambless 1978). This view is supported by the findings of Wilhelm and Roth (1997) who found that those with panic disorder and agoraphobia were more concerned with internal, or social anxiety, while simple phobics did not have this worry, but all were equally concerned regarding external danger. Likewise, it was reported by Howard, Murphy and Clarke (1983) that specific flying phobics fear crashing, while agoraphobics fear panic attacks.
Van Gerwen and Diekstra (2000) suggested that treatment of fear of flying can generalise to other phobias. This is consistent with the findings reported by Iljon Foreman and Borrill (1994). There is considerable concern that the existing diagnostic and classification systems such as DSM IV and ICD-10 do not appropriately acknowledge the diverse nature, aetiology and types of fear of flying. It is a heterogeneous, not a unitary phenomena (Van Gerwen et al, 1997).
One of the most detailed studies in the literature is that of Van Gerwen et al (1997) who carried out an analysis of data from four hundred and nineteen patients who were referred to a treatment agency because of fear of flying. They examined in depth the nature of the fear, and reported that female patients stated “fear of being involved in an accident” as their primary fear, while males stated “not being in control”. Given the conceptualisation of Iljon Foreman and Borrill (1993), rather than this indicating a difference between males and females, both genders can be seen to be reporting the same thing – a fear of an external loss of control. When considering the second reason given for the fears, women reported a “fear confined spaces/claustrophobia (lifts, underground travel, tunnels)” while men cited a “fear of losing control over themselves (crying, fainting, going mad, heart attack or heart palpitations)”. Once again, rather than a gender difference, both of these fears neatly fall into the same category of a fear of a loss of internal control. The phobic fears that are most specifically associated with high levels of flight anxiety are claustrophobia, fear of water, and fear of heights. This is intuitively likely, as these are central to the experience of flying – one is trapped, does fly over water, and is it’s a long way down! Thus it seems logical that anyone fearing these will be highly likely to fear flying as well. Claustrophobia is also moderately related to agoraphobia, and once again, this is intuitively logical, given that those suffering from claustrophobia often worry about panicking in public and the difficulty in escaping. Van Gerwen et al (1997) add that while people have come forward with specific fear of flying, it “may be accompanied by other phobic reactions such as death, travel, heights, confined spaces (lifts, subways, tunnels) crowds, going crazy, darkness, fire, thunderstorms, illness, heart attack, palpitations, blood, wounds, hospitals and bad weather”. It would therefore seem that all of the above, while appearing at first glance to be totally heterogeneous, can be neatly divided into the two categories of “loss of control” fears previously described.
The current concensus is best summarised by Moller, Nortje and Helders (1998) who conclude that while there is agreement on the heterogeneous nature of the fear of flying, there is at the present time no agreement on the nature of the underlying and the associated fears.
When considering the range of the population who suffer from fear of flying, Ekeberg, Seeberg and Ellertsen (1989) propose that individuals affected can be divided into 3 groups – one which avoids all flights, one that restricts flying to an absolute minimum, and experiences considerable discomfort prior to and/or during each flight, and one that shows continuous mild or moderate apprehension about flying, but does not avoid it, even though it remains an unpleasant experience. The problem can have a substantial impact on professional life, social life and family life, (Van Gerwen 1988), and can affect marital or relationship satisfaction because fear of flying hampers or restricts one partner’s freedom of movement.
Epidemiological studies have reported a wide range of point prevalence, from 10-25% of the population (Dean and Whitacker 1980), 10-20% (Agras et al 1969), to 2.6% (Frederikson et al 1996), with the disorder being found in the latter study to be twice as common in women as in men. Expanding the range still further, it has been reported by Capafons, Sosa and Vina (1999) that 45-50% of the population suffer anything form a slight discomfort or apprehension to a very intense fear, and about 10% suffer from such a high degree of fear or anxiety that they avoid flying. Despite the oft cited belief that if someone is afraid of doing something, they will avoid it, Greco (1989) cited a study indicating that one in every four flyers shows a significant degree of fear or anxiety. This high prevalence is extended still further by the report of Van Gerwen (1993) who suggested that 30% of the Dutch population are afraid of flying. In a recent survey of travellers in Scotland, McIntosh et al (1998) found that 40% of their sample were worried by take off and landing One can also ponder what proportion of the 50% of a random sample of a Norwegian population who have never flown, reported by Blomkvist (1987) have not done so because of their fear. The high prevalence seems to be an international phenomena, remaining high up to the present time, a view which is supported by the finding of Ost, Brandberg and Alm (1997) who found that 10% of their Scandinavian sample totally avoided flying, and 25% said they would avoid where possible, plus use tranquillisers and/or alcohol.
Looking at the people who do fly, despite their fear, Greist and Greist (1981) report that 20% of fearful flyers who travel by air use alcohol or sedatives to cope with severe anxiety, and this view prevails within the vast majority of the literature reviewed. Substantial costs are incurred through the fear of flying – In 1982, average revenue loss for the airline industry through fear of flying was estimated at $1.6 billion by Roberts (1989).
However, despite the high levels of reported fear cited in the studies of prevalence, Spilka et al (1997) asserted that, apart from the automobile, the aeroplane is the most popular form of transport. Overseas flights by British residents rose form 5.9 million in 1971 to 16.5 million in 1986. (Iljon Foreman and Iljon 1994). By 2001 the Civil Aviation Authority reported that 180 million passengers used U.K. airports. These figures are reflected internationally, with a report from the European Airline Association stating that 2 billion people travelled by air in the year 2000. Looking at the recent growth in air travel, David Henderson (2002) of the European Airline Association (EAA) states that in the last forty years, the European air travel market has doubled in size five times – that is to say in 2000 it was 32 times bigger than in 1960. The last doubling cycle, to the year 2000, took 10 years, the previous one, twelve years. While there were two periods of a marked downturn, at the time of the Gulf War in 199 and 1991, and in 1986 following the Chernobyl disaster and the bombing of Tripoli, in both cases, growth resumed quite quickly, and the lost market was recaptured. It has not been all growth, however. Any study of air travel cannot fail to refer, as Henderson does, to the “shocking, savage events” of September 11th, 2001. In the following 24 weeks, EAA carriers lost over a quarter of their North Atlantic traffic, and more than 10% of their shorthaul, with overall volume down 15% compared to the previous year. By February 2002 North Atlantic air travel was steadying to minus 10%, while European routes gradually produced a small growth for the first time, and even Asia-Pacific routes rose from the minus 23 % to near-previous year levels. The cost to the Industry, were the losses to be sustained over 12 months, would amount to 12 billion euros. The previous worst ever annual loss, in 1992, was 2.4 billion USD. In the aftermath of September 11th, at least two airlines, Sabena and Swissair which had encountered some economic problems before the terrorist attack were no longer in existence six months later. Henderson states “that’s respectively, 78 and 71 years of aviation history swept away”. The differential recovery of air travel implies that people are reaching alternative conclusions on the advisability of air travel, depending on the route and the airline. Another factor is that of cost, with the “no-frills” airlines being the ones to support a steady growth.
The above seems to reflect that a key factor in people’s judgement is that as emotional beings we formulate responses on the basis of the “perceived” risks, and not the “true” risk of an activity. Gewertz (1995) refers to the hackneyed statistical construct that one has a greater chance of dying in a car crash on the way to the airport, than during the flight itself. I have actually been on a flight where the Captain’s greeting to the passengers began: “Congratulations, ladies and gentlemen. You have just completed the most dangerous part of your journey – getting to the airport!” The following table compiled by Greco (1989) on the probability of coming to harm in different situations makes for fascinating reading.
|Danger of flying in relation to other modes of transport or situations in the U.S.A.|
|Mode of transport/situation||Number of deaths per year in U.S.A.||Comparative safety of airline travel|
|Car||45000||29 times safer|
|Walking/being a pedestrian||8000||8 times safer|
|Staying at home||20000 accidental deaths||18 times safer|
|Working on the job||11000 accidental fatalities||10 times safer|
|Homicide by spouse or relative||7000 homicides||6 times safer|
|Bus||4 times safer per mile|
|Train||4 times safer|
|Boating||8 times safer|
|Source: U.S.A. Department of transport Document. Greco (1989)|
As can be seen, one has a greater statistical chance of dying if one avoids flying and stays at home, than of being killed in a plane crash, and given the odds of 1 in 14 million to win the U.K. National Lottery, it is sobering to realise that one is more likely to be dead by the end of the week, than to have won the lottery. It would be interesting to see if this bet was ever featured in the Bookie’s odds!
While it has not been possible from the literature review to find a concensus on the reasons why people are afraid of flying, some authors have grappled with the underlying causes of the fear. Early writings on fear of flying from 1920-1966 emphasise the internal, unconscious processes and mechanisms behind the fears. Morgenstern (1966) states that “it is a reflection of the pervasive dualism and of man’s feelings when neurotic illness causes the metamorphosis of an intense need to fly into an equally strong dread of flight”. Freud’s (1960) writings also suggest an underlying cause, whereby the aeroplane itself might represent the displacement of a strong figure of threat or desire in the person’s internal world. Shneck (1989) refers to “separation anxiety” as an underlying cause of the fear. From an early behavioural perspective, other authors have proposed that the fears can be seen as a conditioned response to an aversive experience (Watson and Rayner 1920). Taking the cognitive behavioural perspective, a pattern of avoidance behaviour is set up which reinforces the anxiety and prevents the possibility of testing, and invalidating, the feared predictions of future catastrophes (Marks 1987, Greenberger and Padesky 1995, Clark 1999, Salkovskis 1992, and Wells 1997). Building on this view, Wilhelm and Roth (1997) propose that their results support a “vulnerability-stress” model, with flying phobia developing in people who were more susceptible to events that had little impact on non phobics. They suggest that flight phobia began for many of the sample by a rise in anxiety while flying, either triggered internally, or by a transitory overreaction to a minor external event. This resulted in direct conditioning of a phobic response to flight stimuli. They further propose that specific vulnerabilities of various kinds present at phobia onset may have promoted this process, and add that cognitive biases could have played an important role particularly in the initial progression and maintenance of the phobia.
Returning to the search for the underlying causes of the fear, Williams (1982) proposed that fear of flying actually represented a difficulty in communication. He hypothesised that the phobic person is expressing a different message by refusing to fly. Examples could be of the child who does not want to return to boarding school, or the partner who resents being uprooted yet again to follow their spouse’s promotion trail.
The way in which a treatment type is linked to the conceptualisation of the fear of flying in highlighted by Goorney (1970). In the case of Williams’ (1982) theory, treatment can be in some cases a matter of validating the refusal to fly, rather than trying to change the person’s behaviour. Looking at the psychodynamic perspective, the hypothesis of an underlying, unconscious cause implies that it is clinically necessary to obtain insight into this, in order for the unconscious to be brought into consciousness, and processed in a new and more productive manner. The treatment of choice from this theoretical perspective would therefore be one of the forms of psychodynamic psychotherapy. Carr (1978) reported that before 1965, the treatment of choice was indeed psychodynamic psychotherapy and the success rate of treatments was on average 18%. After the development of behavioural treatment, however, the success rate rose to 77%. In a review of psychological treatment of a fear of flying, Bor, Parker and Papadopoulos (2000) confirm that long term explorative psychoanalytic therapy has not been shown to be effective in the treatment of a fear of flying.
An interesting meta-view of the relationship between psychodynamic, cognitive behavioural and even virtual reality therapies is propounded by Vincelli (1999). He suggests that starting from the interpretation of dreams until the most up to date procedures of cognitive restructuring, the common goal has been to intervene on the internal representations of reality that prove to be non-functional with respect to the required adaptation to the environment.
More recent results from treatments based on cognitive behavioural principles have shown success in 70%-98% of cases (Van Gerwen and Diekstra 2000). Cognitive behaviour therapy proposes that it is not events per se, but rather a person’s interpretation of them that is responsible for the production of feelings such as anxiety and/or depression. In anxiety, it is hypothesized, the interpretations relate to an exaggerated perception of danger. It is not only the external events that can be seen as a source of danger, but also internal events such as the physiological symptoms of anxiety themselves. There is also a reciprocal relationship between the external event and the perception of danger, such that once individuals have labelled a situation as dangerous, they tend to selectively scan and interpret situations in ways that augment their sense of being in danger. Specific techniques to modify cognitions and thus affect the interaction between thoughts, feelings and behaviours form the predominant core of the cognitive behavioural approach.
A close examination of the different forms of Psychological Therapy by Iljon Foreman (2002) highlighted the range to show such a breadth that it can make even the experienced clinician wonder whether all of these can indeed be subsumed under the same heading Of these different forms of psychological therapy, a vast number have been utilized specifically to enable people to overcome their fear of flying. Psychoanalytic therapy, systemic therapy, hypnosis, virtual reality, reattributional training (Capafons, Sosa and Vina 1999), systematic desensitisation, stress inoculation training, coping self-talk, cognitive preparation, flooding, implosion, in vivo exposure and relaxation training and cognitive behaviour therapy have all been described in the literature (Denholtz and Mann 1975, Haug et al 1987, Roberts 1989, Beckham et al 1990, Rothbaum, Hodges and Kooper 1997). Comparisons between treatments reveals that systematic desensitisation, flooding, implosive therapy and relaxation training, are all equally effective compared to no treatment control (Howard, 1983). In a more recent randomised controlled trial, Anderson, Rothbaum and Hodges (2001) carried out a study comparing Virtual Reality (VR), a technique which allows individuals to become active participants, interacting through sight, sound and touch, in a computer generated 3 dimensional world, to standard exposure and to a control group. They found that VR and standard exposure were better than controls, with no difference between the two treatment groups at 2 and 6 month follow up.
Given that to date a single effective treatment component responsible for improvement in all cases has yet to be established, there is disagreement within the literature on whether to employ a “multifaceted package of interventions” (Sidley 1990). Greco (1989) supports the proposal that a multi-modal treatment programme is the most effective. This view is further supported by Agras, Sylvester and Oliveau (1993) who suggests that “combinations of medication and exposure therapy may be the optimal approach to treatment”. They cite the work of Mavissakalian Michelson and Dealy (1983), and of Mavissakalian and Michelson (1986) in support of this, noting that this hypothesis requires further testing in controlled trials. Following on from this, a trial by Wilhelm and Roth (1997) raises concerns about the efficacy of such a combination in the treatment of fear of flying. They found that using a combination of medication and cognitive behavioural interventions produced a poorer result than the cognitive behavioural treatment alone.
Considering established treatment programmes for fear of flying, rather than individual research studies which are of a more academic nature, Jones (2000) highlights the concerns raised by Van Gerwen and Diekstra (2000) that there can be a “one size fits all!” approach. In addition, concerns are expressed that “the treatment of fear of flying may be undertaken by anyone, whether or not trained as a therapist, whether or not licensed to treat patients”. Jones concludes that the Tarrytown study highlights the need for differential diagnosis. This is based on the premise that those whose fears derive from underlying anxiety processes respond best to a different therapeutic approach from those whose fears derive from a specific traumatic experience. As perhaps one would expect with such a “fascinating and complex problem” as the treatment of fear of flying, a concensus on this issue has yet to be reached by those working in this field.
The most parsimonious treatment study published to date appears to be that of Ost, Brandberg and Alm (1997). A single three hour session of massed treatment, including a return domestic flight was compared to five sessions of exposure and cognitive restructuring for 28 randomly assigned patients. The former group were more successful immediately post treatment. At one year follow up, there was a reduction in the number who took the behavioural test with immediate post treatment results of 93% of the one session group and 79% of the five session group falling to 64% of both groups. The patients studied fulfilled the DSM-IV criteria for specific phobia, but were excluded if they had “other psychiatric problems requiring immediate treatment”. It is thus unclear whether people with panic disorder, claustrophobia and social phobia were included in the study, and therefore one cannot tell if this treatment is of the “one size fits all” variety.
The results of Iljon Foreman and Borrill’s study (1994) indicated that employing the conceptualisation of the two types of fears – a “loss of internal control” (subsuming panic disorder, social anxiety, claustrophobia and agoraphobia) and “loss of external control” (subsuming fears of heights, turbulence, and all the elements which ultimately can be reduced to a fear of crashing) can enable a treatment programme to be successfully employed in which one size does indeed fit all.
No clinician or researcher would ever be likely to claim a 100% success rate, however. The next challenge is to examine in more detail both people for whom treatment of whichever form has been successful, and also those who could be considered as “failures”. The latter terminology may be seen as somewhat harsh, and alternative terminology that published articles have employed are “negative outcomes, therapeutic drop outs, change resistant, treatment resistant, lack of success”, and finally people who indicate: “lack of treatment related progress”. Published research has often been criticised for a reluctance to examine the group showing “lack of treatment related progress”. This must be viewed in the context of 8% of British clinical psychologists being responsible for 50% of the published work. Understandably, perhaps, the choice is to focus on the factors implicated in “success”, especially as negative findings are substantially less likely to accepted for publication. The modal number of journal articles and conference papers published by British clinical psychologists is zero, and it is therefore important to bear in mind that published articles are likely to be atypical of normal clinical practice. The challenge therefore is one of trying to apply these research findings in a meaningful way to normal clinical practice. Concentrating on both the negative as well as the positive research findings, it should be possible to identify the critical factors that make for therapeutic efficacy.
A model to elucidate the process of cognitive change in the treatment of fear of flying has been proposed by Borrill and Iljon Foreman (1996) which could prove valuable in the search for agreement of the key elements of treatment efficacy. Given that at long term follow up many studies have reported a decrease in the level of treatment effects, employing the model may also enable clinicians to account for this decrease, and to develop relapse prevention strategies that would help to maintain the therapeutic gains achieved.
For those who currently see themselves as “just plane scared”, there is the option in the future not to be grounded by fear. Once that fear is conquered, and given the pending arrival in 2006 of the new Airbus 380, whose maximum passenger load is 840 people, literally thousands more people will be taking off because, for them, the sky will no longer be the limit – they will be free to fly.
Finally, looking back on air travel and its development, a historical perspective highlights just how far we have come – and all this within the lifetime of “Britain’s Favourite Grandmother”.
Reach for the Sky?
4th August 1900
Lady Elizabeth Angela Marguerita Bowes Lyon is born. On that day, Britain’s first escalator transports astonished visitors at Crystal Palace to the upper galleries
17th December 1903
Orville Wright makes the world’s first flight in a power-driven, heavier than air machine flying 120 feet in 12 seconds.
The “Wright Flyer” crashes. First passenger, Lt Thomas Selfridge, killed, and Orville Wright injured.
Commercial air transportation begins in the USA
6th February 1952
King George VI dies. His daughter Elizabeth becomes Queen. His wife receives the title of Elizabeth, the Queen Mother.
21st January 1976
Concorde, the world’s only supersonic passenger aircraft, capable of cruising at twice the speed of sound (1350mph), commences service.
25th July 2000
Concorde crashes, killing 113 people. The aircraft is soon taken out of service for extensive testing and improvements.
7th November 2001
Concorde returns to passenger service.
1st January – 31st December 2001
180 million people arrive and/or depart by air from U.K. airports, and 10 billion people travel by air worldwide.
6th May 2001 The world’s first “Space Tourist”
Denns Tito touches back down to earth after his eight day holiday in space. “It was paradise … well beyond my dreams.”. There are several more customers on the waiting list, all willing to pay the Earth for a holiday in space. Over 1000 people have put their names down on the waiting list for a trip to the moon.
30th March 2002 Queen Elizabeth, the Queen Mother, dies.
The above graphically illustrates how, within the span of a single lifetime, air travel has been transformed out of all recognition and, thus, we see how the development of air travel IN one lifetime can ultimately result in the holiday OF a lifetime! From the ground breaking first 120 foot flight to the exploration of the galaxy and the advent of space tourism, Air Travel continues to expand its frontiers. What will we see by 2103? Maybe someone will yet fulfil the lyrics of that popular ballad: “Fly me to the moon, and let me play among the stars. Let me see what Spring is like on Jupiter and Mars”. In other words, You’ve reached the sky. In other words, You’re free to fly.
Agras, S., Sylvester, D., Oliveau, D. The Epidemiology of Common Fears and Phobias. Comparative Psychiatry 1969; 10: 151-6
Agras, S. The Diagnosis and Treatment of Panic Disorder. Annual Review of Medicine 1993; 44: 39-51
American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders (3rd Edition Revised) 1987 Washington, DC: APA
American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders (4th Edition) 1994 Washington, DC: APA
Anderson, H.G. The psychology of Aviation. In: The Medical and Surgical Aspects of Aviation. London: Oxford University Press, 1919: 67-109
Anderson, P.L., Rothbaum, B.O., Hodges, L. Virtual Reality: Using the Virtual World to Improve Quality of Life in the Real World. Bulletin of the Menninger Clinic 2001; 65 (1); 78-91
Bach, R. Jonathon Livingston Seagull. 1972; Turnstone Press Ltd.;
Beck, A.T., Emery, G., Greenberg, R. Anxiety and its disorders: A cognitive perspective. New York; Basic Books 1985
Beckham, J.C., Vrana, S.R., May, J.G.,, Gustafson, D.J., Smith, G.R. Emotional Processing and Fear Measurement Synchrony as Indicators of Treatment Outcome in Fear of Flying. Journal of Behavior Therapy and Experimental Psychiatry 1990; 21(3): 153-162
Blomkvist, A.C. Public Transportation Fears and Risks. In: Lennart Sjoberg (Ed) Risk and Society: Studies of Risk Generation and Reactions to Risks. The Risks and Hazards Series 3; 1987: Unwin Hyman, London xvii: 35-45
Bor, R., Parker, J., Padadopoulos, L. Psychological Treatment of a Fear of Flying: A Review Journal of the British Travel Health Association 2000; 1: 21-6
Borrill, J. Iljon Foreman, E. Understanding Cognitive Change: a Qualitative Study of the Impact of Cognitive-Behavioural Therapy on Fear of Flying. Clinical Psychology and Psychotherapy 1996; 3(1): 62-74
Capafons, J. I., Sosa, C.D., Vina, C.M. A Reattributional Training Program as a Therapeutic Strategy for Fear of Flying. Journal of Behavior Therapy and Experimental Psychiatry 1999; 30: 259-72
Carr, J.E. Behaviour Therapy and the Treatment of Flight Phobia. Aviation, Space and Environmental Medicine 1978; 115-8
Clark, D.M. Anxiety Disorders: Why they persist and how to treat them. Behavior Research and Therapy 1999; 37(1): S5-S27
Dean, R.D., Whitacker, K. Fear of Flying: Impact on the US Air Travel Industry, Boeing company Document 1980 BCS-00009-RO/OM: Seattle, Boeing
Dean, R.D., Whitacker, K.M. Fear of Flying: Impact on the U.S. Travel industry. Journal of Travel Research 1982; 21: 7-17
Denholtz, M.S., Mann, E.T. An Automated Audiovisual Treatment of Phobias Administered by Non-Professionals. Journal of Behavior Therapy and Experimental Psychiatry 1975; 4: 111-15
Dyregrov, A., Skogstad, A., Hellesoy, O. and Haugli, L. (1992) Fear of flying in civil aviation personnel. Aviation, Space and Environmental Medicine 63 (9), 831-8
Ekeberg, O., Seeberg, I., Ellertsen, B.B. The Prevalence of Flight Anxiety in Norway. Norsk Psykiatrisk Tidsskrist 1989; 43: 443-8
Frederickson, M. Annas, P., Fischer, H., Wik, G. Gender and Age Differences in the Prevalence of Specific Fears and Phobias. Behavior Research and Therapy 1996; 34(1) : 33-39
Freud, S. The Standard Edition of the Complete Psychological Works of Sigmund Freud. 1960; The Hogart Press: London
Gewertz, B.L. Presidential Address: Overcoming our fear of flying – Vascular surgery in the next decade. Journal of Vascular Surgery 1996 23(5) 745-8
Goldstein, A.J., Chambless, D.L. A Reanalysis of Agoraphobia. Behavior Therapy 1978; 9: 47-59
Goorney, A.B. Psychological Measures in Aircrew – normative data. Aerospace Medicine 1970; 41: 87-91
Gotch, O.H. The Aeroneurosis of War Pilots. In: The Medical and Surgical Aspects of Aviation. London: Oxford University Press, 1919: 109-49
Greco, T.S. A Cognitive-Behavioural Approach to Fear of Flying.: A practitioner’s guide. Phobia Practice and Research Journal 1989; 2(1): 3-15
Greenberger, D., Padesky, C. Mind Over Mood. The Guildford Press;1995: New York
Greist, J.H., Greist, G.L. Fearless Flying: A passenger’s guide to modern air travel. Chicago; 1981: Nelson Hall
Haug, T., Brenne, L., Johnson, B.H., Bentzen, D., Gotestam, K., Hugdahl, K. A Three System Analysis of Fear of Flying: A comparison of a consonant vs a non-consonant treatment method. Behavior Research and Therapy 1987; 25: 187-194
Heller, R.F. Overcoming the Fear of flying. In: W. Dryden and L.K. Hill (Eds), Innovations in Rational Emotive Therapy. 1993; Newbury Park: Sage Publications pp 238-252
Henderson, D. Uncertainty and the Outlook for World Air Travel – Europe and the North Atlantic. Paper given at the FAA Commercial Aviation Forecast Conference, Washington, March 12-13 2002
Howard, W.A., Murphy, S.M., Clarke, J.C. The Nature and Treatment of Fear of Flying: A controlled investigation. Behavior Therapy 1983; 14: 557-567
Iljon Foreman, E., Borrill, J. Plane Scared – Brief cognitive therapy for fear of flying. Scottish Medicine 1993; 13(4): 6-8
Iljon Foreman, E., Borrill, J. Long-Term Follow-Up of Cognitive Behavioural Treatment for Three Cases of Fear of Flying. Journal of Travel Medicine 1994; 1(1) 30-34
Iljon Foreman, E., Iljon, Z. Highwaymen to Hijackers: A Survey of Travel Fears. Travel Medicine International 1994; 12:(4) 145-152
Iljon Foreman, E., Putting Fear to Flight: Cases in Psychological Treatment. In Robert Bor and Lucas Van Gerwen (Eds) Psychological Perspectives on the Fear of Flying. Ashgate, London 2002 In press.
Jones, D.R. Fear of Flying: No longer a symptom without a disease. Aviation Space and Environmental Medicine 2000; 71(4): 438-40
Marks, I.M., Fears, Phobias and Riuals.: Panic, Anxiety and their Disorders. Oxford University Press; 1987: New York
Mavissakalian, M., Michelson, L., Dealy, R.S. Pharmacological Treatment of Agoraphobia: Imipramine versus Imipramine with Programmed Practice. British Journal of Psychiatry 1983; 143: 348-55
Mavissakalian, M., Michelson, L. Agoraphobia: Relative and combined effectiveness of Therapist-Assisted In Vivo Exposure and Imipramine. Journal of Clinical Psychiatry 1986; 47: 117-22
McIntosh, I.B., Swanson, V., Power, K., Raeside, F., Dempster, C. Anxiety and Health Problems Related to Air travel. Journal of Travel Medicine 1988; 5: 198-204
McNally, R.J., Louro, C.E. Fear of Flying in Agoraphobia and Simple Phobia: Distinguishing features. Journal of Anxiety Disorders 1992; 6(4): 319-24
Moller, A.T., Nortje, C., Helders, S.B. Irrational Cognitions and the Fear of Flying. Journal of Rational-Emotive and Cognitive Behavior Therapy 1998; 16(2): 135-148
Morgenstern, A.L. Fear of Flying and the Counterphobic Personality. Clinical Aviation and Aerospace Medicine 1966; 37: 404-7
Ost L.G. Brandberg, M., Alm, T. One versus Five Sessions of Exposure in the Treatment of Flying Phobia. Behavior Research and Therapy 1997; 35(1): 987 – 996
Reiss, S., McNally, R.J. Expectancy Model of Fear. In S. Reiss and R.R. Bootzin (Eds) Theoretical Issues in Behavior Therapy 1985 San Diego, CA: Academic Press pp107-121
Roberts, R.J. Passenger Fear of Flying: Behavioural treatment with extensive in vivo exposure and group support. Aviation, Space and Environmental Medicine 1989; 60: 342-48
Rothbaum, B.O., Hodges, L., Kooper, R. Virtual Reality Exposure Therapy. Journal of Psychotherapy Practice and Research 1997; 6(3): 219-226
Rosenhan, D.L., Seligman, M.E.P. Abnormal Psychology 1989 New York: Norton
Salkovskis, P. M., Clark,, D. M. Cognitive Therapy for Panic Attacks. Journal of Cognitive Psychotherapy 1992; 5(3): 215-226
Shneck, J.M. Separation Anxiety and Fear or Avoidance of Flying. Journal of Clinical Psychiatry 1989; 50(1`2) 474
Sidley, G.L. Brief Clinical Reports: A Multi-Component Intervention with a Lady Displaying an Intense Fear of Flying – A Case Study. Behavioural Psychotherapy 1990; 18: 307-310
Van Gerwen, L.J. Director, VALK Foundation, Leiden 1993. Personal communication
Van Gerwen, L.J. Fear of Flying: Reasons, Effects and Remedy 1988. In Van Gerwen, L.J., Spinhoven, P., Diekstra, R.F.W., Van Dyck, R. People Who Seek Help for Fear of Flying: Typology of Flying Phobics. Behavior Therapy 1997; 28: 237-251
Van Gerwen, L.J., Diekstra, R.F.W. Fear of Flying Treatment Programs for Passengers: An International Review. Aviation, Space and Environmental Medicine 2000; 71(4): 430-437
Van Gerwen, L.J., Spinhoven, P., Diekstra, R.F.W., Van Dyck, R. People Who Seek Help for Fear of Flying: Typology of Flying Phobics. Behavior Therapy 1997; 28: 237-251
Vincelli, F. From Imagination to Virtual Reality: The Future of Clinical Psychology. Cyber Psychology and Behaviour 1999; 2(3): 241-8
Walder, C.P., McCracken, J.S., Herbert, M., James, P.T., Brewitt, N. Psychological Intervention in Civilian Flying Phobia. British Journal of Psychiatry 1987; 151: 494-498
Watson, J.B., Rayner, R. Conditioned Emotional Reactions. Journal of Experimental Psychology 1920; 3: 1-14
Wells, A. Cognitive Therapy of Anxiety Disorders: A Practical Manual and Conceptual Guide. 1997; Wiley
Wilhelm F. H., Roth, W.T. Acute and Delayed Effects of Alprazolam on Flight Phobics during Exposure. Behavior Research and Therapy 1997; 35(9): 831-841
Williams, M.H. Fear of Flight: Behaviour Therapy versus a Systems Approach. The Journal of Psychology 1982; 111: 193-203