Fear of flying

Virtual reality makes the skies friendlier


Afraid to fly? Emory wants you.

Researchers there are conducting a clinical trial using virtual reality to tackle fear of the not-so-friendly skies. Although virtual reality exposure therapy has been used before, researchers are adding a new twist. They want to see if this will prevent a relapse.

Principal investigator Barbara Rothbaum, PhD, associate vice-chair of clinical research and professor in Emory’s department of psychiatry is a pioneer in the development of virtual reality therapy.

How will the study work?
Everybody is getting active treatment. People who are eligible will get eight sessions of treatment for free. The first four sessions are anxiety management techniques: breathing, relaxation methods, information about flying and statistics and airplanes. In the last four sessions, we do virtual reality exposure therapy. We have a virtual airplane and they wear a headmounted display–kind of a helmet with two little television screens in front of each eye–earphones, and a position tracker so as they move their head in reality, their view changes in real time.

It starts in the airport in the gate area and they move through the walkway and end up on the airplane. We can construct the “perfect” exposure. If they’re not ready for turbulence, we can guarantee there won’t be turbulence. If they are ready, there will be turbulence.

What’s different about this study than others involving virtual reality?
If you do a very brief fear cue 10 minutes before the session starts, it seems to protect against relapse. They don’t feel anything different. It’s an audio/visual trigger, a couple seconds long. We’re going to follow people for a year when they finish to see how they’re doing.

What type of volunteers are you looking for?
We’re in Atlanta and people are motivated to get treated for their fear of flying. They can’t travel for work. They can’t go on vacation. We find that about half of the people have a fear of crashing. About half have more claustrophobic fear that they’re going to have a panic attack on the airplane.

For the study, they have to have an excessive fear of flying. They have to either avoid flying or endure it with a good deal of anxiety and it has to interfere with their life. It has to cause some problems for them.

Currently, how do most people treat their fear of flying?
The primary way is they avoid. The next way is drugs and alcohol. People will usually take tranquilizers or they drink. Some people really have to drink a lot. They have to fly the day before because they’re going to be blotto the day they get there.

Do you think virtual reality will work?
We’ve done two studies in the past and it was very effective. By the six-month follow-up, 90 percent of people had flown. That’s what’s cool. It does seem to transfer to real life.

For information on the study, call 404.712.8300 or email regross@emory.edu

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  • http://www.fearofflying.com Capt Tom Bunn LCSW

    As both a pilot and a therapist, I was involved in the original research done by Nicholas Maltby, Irving Kirsch, Michael Mayers and George J. Allen on VRET at the University of Connecticut.

    The test group was given VRET. The control group merely sat on a parked plane. As it turned out, the people who simply sat on a parked plane has results that were as good (in one measure better) than those that got VRET.

    Instead of acknowledging that VRET did not work for fear of flying, the sponsors claimed VRET was equal to a “traditional fear of flying program.”

    Not true. A traditional fear of flying program includes lectures about how flying works, and an actual flight.

    VRET cannot desensitize anxious fliers becomes they are not exposed to risk, nor to not being where they have no control or means of escape.

    Though there are a lot of so-called cures to be found, the only effective treatment for moderate to severe fear of flying is the treatment available at http://www.fearofflying.com

  • http://www.dragonsofthinair.com Fear Dragon

    Crikey Tom, you sure are lucky in being blessed with the “only” solution to the world’s problems.

    This looks like a research project to me, and they’re charging a whole lot less than you do for your services. People are many and varied in their makeup, motivations and responses, and your “only” solution simply may not suit everyone.

    I have a sneaking suspicion that there may be more than one way to open a can of beans.

    Best wishes to the Emory team for their ongoing FoF program.

  • http://www.fearofflying.com Capt Tom Bunn LCSW

    Actually, Fear Dragon, VRET is expensive. At several times the cost of other methods, it is a lot to pay for something that does not work.

    It is truly unfortunate that VRET , CBT, medication, hypnosis, and pilots offering assurance and relaxation exercises mislead people. When a person tries one or more of these things and is not helped, they get the idea that nothing will work for them.

    Failure is awful for them. It damages them. They don’t realize they didn’t fail but that it was the ineffective “treatment”that failed them. There is more than one way, as you say, to open a can of beans, but there is – as I said correctly – that at this time there is no other effective treatment for moderate to severe fear of flying.

    Which includes your book. Though your book (which we have corresponded about) may help a child who is frightened to fly, it – like the other methods can help only the mildest forms of the problem.

    Thought this is shown as a research project, supposedly to check out relapse, how can you relapse from something that their own research shows is ineffective: no better than sitting on a parked airplane.

    When the VRET people claim it is as effective as a traditional fear of flying program, that is misleading; a traditional fear of flying program is MUCH more than sitting on a parked airplane. A traditional fear of flying programs actually involve (OMG !) an actual flight.

    VRET desensitizes some phobia, but since it is conducted on the ground in an office, does not desensitize what the flight phobic is concerned about: risk, no control, and no escape.

    • Les Posen

      Hi Tom and Fear Dragon,

      Good to see you two know each other and are sharing methods and outcomes. I’ve read Fear Dragon’s book, but don’t have much of a chance to use it since I principally work with adults.

      It’s interesting, Tom, to see you continue to pour cold water on Virtual Reality utilisation approaches, such as those at Emory who have been researching this field for more than a decade.

      And also to see you continue to cite the same early study where you claim you were involved with Maltby, Kirsch, Mayers and Allen (2002). This is the main study you set up as a straw man to pour cold water on all VRET approaches. Did you know at the 3rd Fear of Flying International conference at ICAO headquarters in Montreal in 2007, there was a whole stream looking at the usefulness of VR? For someone who “holds all the answers”, it was a pity you weren’t there to share your knowledge freely like so many of us were.

      Looking at the Maltby et al study: My searching online suggests they only published one study, in the Journal of Clinical and Consulting Psychology of October, 2002. This is an APA journal, and not easy to get passed by the peer reviewers.

      If this is the study you keep referring to (please let me know if there is another one), then there are some conflicts with your recall of the study. Let me outline them for you:

      1. You say “The control group merely sat on a parked plane”. That’s not what the study reports. The control group in fact “consisted of education about the safety and mechanics of flight and elicitation of each participant’s flying history and fears about flying. Participants were encouraged to comment on each other’s stories and otherwise engage in group process. No behavioral techniques were used and the therapists made no references to exposure or anxiety management skills.” (p.1114).

      2. You say “A traditional fear of flying program includes lectures about how flying works, and an actual flight”
      Indeed, the study makes it clear both groups received information about how flying works. Here’s what Maltby et al say the experimental group (VR) received:

      Session 1 lasted 90 min and consisted of an orientation to the rationale for VRE, anxiety management skills, and an introduction to the virtual reality equipment. Participants also were given an educational handout on the safety and mechanics of flight. They were encouraged to read it but received no didactic instruction on these topics. Anxiety management consisted of imaginal relaxation/progressive muscle relaxation and the development and use of rational responses to counter anxiety-producing thoughts and images about flying. Specifically, participants were taught relaxation skills for 20 min and were asked to practice relaxation twice a day during the study. They were then guided by the therapist to list anxiety-producing thoughts they typically had about flying and to develop rational responses to use during flight. To aid immersion during the exposure phase of treatment, patients ended the session with a brief introduction to the virtual environment.

      To some extent, I think Maltby et al erred in these early days of VR by not seeing VR as a therapeutic tool, augmenting the therapist’s work. It’s not a therapy in and of itself.

      3. The other worrying part of the Malty et al study was its use of a light plane for the test flight, and not a commercial flight. The Gold Standard for Fear of Flying, as discussed at the 2nd International conference in Vienna in 2000, strongly asserted a commercial flight be taken as part of the treatment.

      4. The quantitative measures Maltby et al used were based on Lucas Van Gerwen’s PhD thesis, and as you will know Lucas (who was a co-organiser of the 2007 conference) is a KLM pilot and clinical psychologist who is part of the VALK team in the Netherlands. VALK is a major user of VR in its treatment protocols.

      5. A couple of final issues. While Maltby et al describe the hardware they used (it was really quite low powered Windows based Pentium II) they don’t describe the VR software they employed. This make it hard to replicate, and as you may know not all VR software creates the same level of presence so as to elicit a fear response.

      6. While you have often said you were involved in this research, unless there is another paper somewhere, you are not mentioned at all in this APA journal paper. Why is that? It is customary to print acknowledgements where appropriate in journals of this quality.

      7. I’m disappointed to see you move further into an ossified state of such self-assurredness as to assert yours is the only successful means of achieving a positive outcome for moderate to serious fear of flying. Touting yourself as the all-knowing, all-seeing leader of the field is likely unethical. It smacks of cultish behaviour. Perhaps tone it down a bit when you next decide to comment.

      Regards from Melbourne,
      Les Posen
      Fellow, Australian Psychological Society

  • Anonymous

    I am afraid of flying and take many steps to avoid it. I usually choose vacation destinations that I can reach via car. And if I HAVE to fly, I drink a few shots of alcohol. I dislike doing that, however, because I want to be alert in the event of a disaster.

    My main fear is pilot error at takeoff and landing (which is typically the reason for most plane crashes). Mid-air not so much. Turbulence doesn’t even bother me.

    I would likely not participate in this study for exactly the reasons that “Capt Tom Bunn LCSW” stated. I simply would not be afraid in a virtual environment.

    If the study is anything like those virtual reality machines in most store malls, I’ve taken numerous rides on them and found them fun but not particularly scary.

    In the back of my mind, I will always know that I can get up and walk out, and a “crash” wouldn’t affect me. So there’s not much to fear.

    Also, I have no idea about Capt Bunn’s program or its costs, but I appreciate his point about the costs associated with the study. Unless you can trick the participants into thinking they’re on an actual flight (doubtful), then the study seems like a waste of research funds.

    • Les Posen

      In my experience and in discussion with others who employ VR in their therapeutic toolbox, it’s not for everyone. That said, many people come with similar doubts as yours as to whether a fear response will be elicited.

      And many are unpleasantly surprised when they grip the seats on takeoff or utter relief when the “plane” touches down and they hear and feel a full-powered reverse thrust.

      Amusement arcade VR games are not aimed or tested for fearful flyers and you can be misled as to the efficacy of VR in eliciting fear responses when the sights, sounds, movements and in some cases smells in the therapy setting are a good enough match for a patient’s fear response to be aroused. That response is both cognitive but also physiological and affective, over riding the initial belief that “it’s just a game and not real enough”.

      Receiving Federal Grant research money is an extremely competitive and challenging activity with many strings attached including expected publication in a peer reviewed journal. Please ask Capt Tom the cost of his program and where and when he published his outcome data before signing up, or advising others to do so, evidence unseen. I have done so over the years and keep getting referred back to the Maltby VRET paper.

      Now that you have nominated pilot error as the source of your fear of flying, reappraising the perceived risks factually would appear to be a good place to start. On the basis of published studies, you have an 85-95% chance of success if done so with a qualified CBT practitioner, for instance. Most won’t use VR, not necessarily because they don’t think it effective, but because of initial costs and their own technology inexpertness. That will change with the next technically savvy group of therapists coming through training.

      If you’re in a geographic area of a therapist who uses VR, make one appointment and ask for a trial. But go in curious, rather than determined to prove your doubts. Hold your breath and tightly gripping the seats will accentuate any fearful responses. Who knows, thus might happen automatically!

      Les Posen
      Fellow, Australian Psychological Society