Pteromerhanophobia

Pteromerhanophobia, otherwise known as a fear of flying, is a fear of being on an airplane (aeroplane), or other flying vehicle, such as a helicopter, while in flight. It is also sometimes referred to as aerophobia, aviatophobia, or aviophobia.

Fear of flying may be a distinct phobia in itself, or it may be an indirect combination of one or more other phobias related to flying, such as claustrophobia (a fear of enclosed spaces) or acrophobia (a fear of heights). It may have other causes as well, such as agoraphobia (especially the type that has to do with having a panic attack in a place they can't escape from). It is a symptom rather than a disease, and different causes may bring it about in different individuals.

The fear receives more attention than most other phobias because air travel is often difficult for people to avoid—especially in professional contexts—and because the fear is widespread, affecting a significant minority of the population. A fear of flying may prevent a person from going on vacations or visiting family and friends, and it can cripple the career of a businessperson by preventing them from traveling on work-related business.

Symptoms

A fear of flying is a level of anxiety so great that it prevents a person from travelling by air, or causes great distress to a person when he or she is compelled to travel by air. The most extreme manifestations can include panic attacks or vomiting at the mere sight or mention of an aircraft or air travel.

Causes

The fear of flying may be created by various other phobias and fears:

• fear of crashing which is often and inaccurately believed to most likely result in death, which is the most common reason for the fear of flying.
• a fear of closed in spaces (claustrophobia), such as that of an aircraft cabin
• a fear of heights (acrophobia)
• a feeling of not being in control
• fear of vomiting, where a person will be afraid that they'll have motion sickness on board, or encounter someone having motion sickness and have no control over it (such as escaping it)
• fear of having panic attacks in certain places, where escape would be difficult and/or embarrassing (agoraphobia)
• fear of hijacking or terrorism
• fear of turbulence
• fear of flying over water or night flying

A previous traumatizing experience with air travel or somehow connected to flying can also trigger a fear of flying. For example, the experience of flying to a meeting only to be told that one has been fired might be traumatic enough to subsequently create an association between any air travel and bad or unpleasant events.

Some suggest that the media are a major factor behind fear of flying, and claim that the media sensationalize airline crashes (and the high casualty rate per incident), in comparison to the perceived scant attention given to the massive number of isolated automobile crashes. As the total number of flights in the world rises, the absolute number of crashes rises as well, even though the overall safety of air travel continues to improve. Statistics on various forms of travel show that airplanes are safer than other common forms of transport per kilometer traveled. If only the crashes are reported by the media (with no reference to the number of flights that do not end in a crash), the overall (and incorrect) impression created may be that air travel is becoming increasingly dangerous, which is untrue. In a way, the media coverage is forcing confirmation bias on viewers.

Misunderstandings of the principles of aviation can fuel an unjustified fear of flying. For example, many people incorrectly believe that the engines of a jet airliner support it in the air, and from this false premise they also incorrectly reason that a failure of the engines will cause the aircraft to plummet to earth. In reality, all fixed-wing aircraft glide naturally, and the engines serve only to maintain altitude during the flight. A big cause of fear of flying is that it is difficult to imagine how planes stay in the air, thus a person's understanding of the science behind flying can affect the person's fear about flying.

Treatment

Non-pharmacologic

In some cases, educating people with a fear of flying about the realities of air travel can considerably diminish concern about physical safety. Learning how aircraft fly, how airliners are flown in practice, and other aspects of aviation can assist people with a fear of flying in overcoming its irrational nature. Many people have overcome their fear of flying by learning to fly or skydive, and effectively removing their fear of the unknown. Some people with a fear of flying educate themselves; others attend courses (for people with the phobia or for people interested in aviation) to achieve the same result. Some airline and travel companies run courses to help people get over the fear of flying.

Education plays a very important role in overcoming the fear of flying. Understanding what a certain sound is or that an encounter with turbulence will not destroy the aircraft is beneficial to easing the fear of the unknown. Nevertheless, when airborne and experiencing turbulence, the person can be terrified despite having every reason to know logically that the plane is not in danger. In such cases, therapy — in addition to education — is needed to gain relief.

Behavioral therapies such as systematic desensitization developed by Joseph Wolpe and cognitive behavior therapy developed by Aaron Beck rest on the theory that an initial sensitizing event (ISE) has created the phobia. The gradually increased exposure needed for systematic desensitization is difficult to produce in actual flight. Desensitization using virtual flight has been disappointing. Clients report that simulated flight using computer-generated images does not desensitize them to risk because throughout the virtual flight they were aware they were in an office. Research shows Virtual Reality Exposure Therapy (VRET) to be no more effective than sitting on a parked airplane.^[1]

Hypnotherapy generally involves regression to the ISE, uncovering the event, the emotions around the event, and helping the client understand the source of their fear. It is sometimes the case that the ISE has nothing to do with flying at all.^{[citation needed]}

Neurological research by Allan Schore and others using EEG-fMRI neuroimaging suggests that though it may first be manifest following a turbulent flight, fear of flying is not the result of a sensitizing event. The underlying problem is inadequate development of ability to regulate emotion when facing uncertainty, except through feeling in control or able to escape. According to Schore, the ability to adequately regulate emotion fails to develop when relationship with caregivers is not characterized by attunement and empathy. "Because these mothers are unable to regulate their own distress, they cannot regulate their infant's distress."^[2] Chronic stress and emotional dysregulation during the first two years of life inhibits development of the right prefrontal orbito cortex, and hinders the integration of the emotional control system. This renders the right prefrontal orbito cortex incapable of carrying out its executive role in the regulation of emotion.^[3] Some who disagree with the importance of early experience regard this view point as contentious. However, Harvard University and the National Scientific Council on the Developing Child state, "Genes provide the basic blueprint, but experiences influence how or whether genes are expressed. Together, they shape the quality of brain architecture and establish either a sturdy or a fragile foundation for all of the learning, health, and behavior that follow."^[4]

When it senses anything unfamiliar or unexpected, the amygdala releases stress hormones. These hormones activate the primitive mobilization system, which produces an urge to escape. A more sophisticated system, executive function, takes priority and overrides the urge to escape. In normal (non-phobic) response, the person does not regard arousal as an emergency; this allows executive function to make an assessment of the situation. If no danger is discovered, executive function dismisses the matter, signals the amygdala to end the release of stress hormones, thus allowing a return to homeostasis. If danger is evident, executive function develops a plan to deal with it. Upon commitment to a plan, executive function signals the amygdala to end stress hormone release.

Phobic response is significantly different. The person equates arousal with fear, and believes that if he or she feels fear, there has to be danger. When aroused, the person's executive function is called upon not merely to assess the situation, but - if stress hormones are to be controlled - to prove conclusively that no danger exists.

If a phobic flier were able to fly in the cockpit, the pilot's facial response to an unexpected noise or motion would adequately prove the absence of danger. But with information in the cabin limited, it is impossible to prove no danger exists. Stress hormones continue to be released. As levels rise, anxiety increases and the urge to escape becomes paramount. Since physical escape is impossible, panic may result unless the person can escape psychologically through denial, dissociation, or distraction.

In the cognitive approach, the passenger learns to separate arousal from fear, and fear from danger. Cognitive therapy is most useful when there is no history of panic. But since in-flight panic develops rapidly, often through processes which the person has no awareness of, conscious measures may neither connect with - nor match the speed of - the unconscious processes that cause panic.

In another approach, emotion is regulated by what neuroscientist Stephen Porges calls neuroception. In social situations, arousal is powerfully regulated by signals people unconsciously send, receive, and process. For example, when encountering a stranger, stress hormone release increases the heart rate. But if the stranger's signals indicate trustworthiness, these signals override the effect of stress hormones, slow the heart, calm the person, and allow social interaction to take place. Because neuroception can completely override the effect of stress hormones, fear of flying can be controlled by linking the noises and motions of flight to neuroceptive signals that calm the person.

Lastly, frequent flyer experts at Flightfox suggest that pteromerhanophobia is a reaction caused by the panic and tension of so many travellers in close quarters - once one person is uneasy the rest soon feel uncomfortable as well. Their solution, odd as it may seem, is to fly in premium class to experience flying in a comfortable and relaxed setting, so as to avoid the tension and anxiety of coach. ^[5]

Pharmacologic

Flight experience with the use of anti-anxiety medications like benzodiazepines or other relaxant/depressant drugs varies from person to person. Medication decreases the person's reflective function. Though this may reduce anxiety caused by inner conflict, reduced reflective function can cause the anxious flier to believe what they are afraid will happen is actually happening.

A double-blind clinical study at the Stanford University School of Medicine suggests that anti-anxiety medication can keep a person from becoming accustomed to flight. In the research, two flights were conducted. In the first flight, though patients given alprazolam (Xanax) reported less anxiety than those receiving a placebo, their measurable stress increased. The heart rate in the alprazolam group was 114 versus 105 beats per minute in the placebo group. Those who received alprazolam also had increased respiration rates (22.7 vs 18.3 breaths/min).

On the second flight, no medication was given. Seventy-one percent of those who received alprazolam on the first flight experienced panic as compared with only 29% of those who received a placebo on the first flight. This suggests that the participants who were not medicated on the first flight benefited from the experience via some degree of desensitization.^[6]

Typical pharmacologic therapy is 0.5 or 1.0 mg of alprazolam about an hour before every flight, with an additional 0.5-1.0 mg if anxiety remains high during the flight. The alternative is to advise patients not to take medication, but encourage them to fly without it, instructing them in the principles of self-exposure.^[6][7]

September 11 Implications

Fear of flying has long been a topic in the psychological and psychiatric literature, as well as in economic research. The former literature is mainly concerned with the sources and reasons flying after September 11 attacks. It introduced fear of flying into the model by asking respondents to what extent they felt safe on planes and the number of high-risk incidents on airplanes in which they had been involved.^[8] Captain Michael (Miki) Katz, whose experience with helping nervous and claustrophobic flyers have brought him to also assume relations between fear of flying and September 11 attacks. Those who have the condition are either so paralyzed they stop flying entirely, and some continue flying but suffer intensely on each flight.^[9] In contrast, Katz said that "in countries such as in Israel as an example, where the public is much more experienced in dealing with security threats, there is no significant increase in the number of people who are afraid to fly, but the ones who were anxious to begin with have become more afraid."^[9] Immediately after the September 11 attacks, Americans afraid to fly took to the nation's highways, a decision that many experts on risks said could be a fatal error: Driving 1,000 miles poses a greater risk of deadly accidents than flying the same distance. Statistics show the risk experts were right. In the first analysis of U.S. Department of Transportation data for the last three months of 2001, a study finds there was a significant increase in the number of fatal crashes in this period compared with the same period in the year before the attacks. Because of the extra traffic, 353 more people died in traffic accidents, calculates Gerd Gigerenzer of the Max Planck Institute for Human Development in Berlin, an expert on how people respond to low-probability but high-consequence events called "dread risks."^[10]

Notable people with the phobia

• Isaac Asimov^[11]
• Travis Barker^[12]
• Dennis Bergkamp^[13]
• Ben Burnley^[14]
• Doris Day^[15]
• Agnetha Fältskog^[16]
• Whoopi Goldberg, says she travels by a bus or train when she wishes to visit other U.S. states.^[17]
• Ara Guler^[18]
• Kim Jong-il^[19]
• KRS-One^[20]
• Stanley Kubrick^[21]
• John Madden^[22]
• McG^[23]
• Eamon McGee, has spoken of his wish to be knocked unconscious ahead of flights to matches held at far-flung destinations.^[24]
• Alexander Mogilny^[25]
• Eric Prydz^[26]
• Lars von Trier^[27]
• Jordan White^{[citation needed]}

Fictional cases

• Thelma Frye from the 1986 NBC sitcom Amen has Pteromerhanophobia and the church staff takes her on a trip in a private jet to try and help her get over her fear of flying.
• Marge Simpson from The Simpsons developed a severe case of Pteromerhanophobia when she was a child after she learned about her father becoming a stewardess at an airport and actually saw him dressed up like a stewardess on one of the airplanes.

See also

• List of phobias
• Travel aversion

References