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Pilots who offer fear of flying courses say “knowledge is power.” They believe that a person who knows how safe flying is will have no fear of it. There is far more to fear than that. To illustrate the point, here is an email from a private pilot.
I hold a private pilot's license and have a major passion for aviation. I understand all of the concepts of flying and the safety relating to it. This is not my problem. I’m afraid only when I’m a passenger.
It’s the feeling of not being in control. Also, my fear is associated with the plane’s movements, and not knowing if or when a turn is coming.
The following is my response:
In the brain, the amygdala releases stress hormones when it notices anything unexpected or non-routine. When you fly as a passenger, movements and noises happen that you are not expecting. Though, as a pilot, you know all about how the plane turns, what the noises are, and understand the plane’s movements, when any of these things happen unexpectedly the amygdala releases stress hormones. When stress hormones are released, they cause arousal, an increase in heart rate, breathing rate, tension in the body, perspiration, and, of course, a heightened sense of alertness.
When these physical and psychological changes hit you, they compound the problem; they happen unexpectedly. As a passenger, you don’t know when to expect the noises, movements or turns. You also don’t know when you are going to be surprised by a shot of stress hormones. It all puts you on edge. You worry about when it is going to happen. Yet, that worry does not prepare you when it happens.
Many passengers — even passengers who are not pilots — do not have this problem. So, we need to consider why arousal causes you distress. Arousal should not be a problem. It is just the amygdala’s way of getting you to pay attention to something out of the ordinary, something that may be dangerous, but also something that may be an opportunity. Or, it may be irrelevant. In other words, arousal is simply arousal.
A person who feels secure simply gets curious when stress hormones cause arousal. They look around to see what the amygdala has picked up. But if someone's personal history includes trauma, arousal can be disturbing.
Trauma researcher Dr. Bessel van der Kolk says developmental trauma results in a child when arousal is not responded to consistently enough by a caring and calming caregiver, and therefore arousal is not linked with a sense of calm. Arousal may even be linked to being criticized, abandoned, punished or abused. If so, arousal means there is going to be trouble.
PTSD can result from a major traumatic event. Either type of trauma can cause a person to experience arousal and fear as one and the same. Trauma can also cause fear to automatically signal danger. If so, arousal equals fear equals danger.
When you are in control of a plane, this problem does not arise. When flying a plane yourself, you make a decision every few seconds. At the moment you commit and begin to carry out your plan, the decision-making part of the brain signals the amygdala to stop releasing stress hormones. When in command of a plane, your moment-to-moment commitments inhibit the release of stress hormones. With arousal under control, feelings of fear, which may be linked to arousal due to personal history, do not develop.
To understand this dynamic, think about your phone. When your phone rings, the ringing gets your attention. At the moment you answer it, the ringing stops. It would be hard to focus on your conversation if the ringing continued. When your amygdala releases stress hormones, feelings get your attention. At the moment you commit to a plan of action, the release of stress hormones stops. It would be hard to focus on carrying out your plan if stress hormone release continued.
How Can This Problem Be Treated?
The answer to what this pilot is dealing with is a combination of Cognitive Behavioral Therapy and Pavlovian conditioning.
Cognitively, an anxious flyer needs to accept that unexpected noises and motions cause arousal. The person needs to recognizes that those noises and motions aren't accompanied with danger. At least, no harm other than arousal. That means challenging the belief that causes arousal to be disturbing. Arousal does not necessarily mean danger. Arousal needs to be recognized as a completely normal part of human life that calls attention to something out of the ordinary and prepares a person to take action if required.
When the fearful stimulus is harmless, this approach is enough. Through exposure, the person learns to expect no harm. But, with flight phobia, the person knows exposure is not always harmless. Though crashes are rare, they are not impossible.
The fact that an unexpected noise or motion was not followed by a crash this time, proves nothing about next time. Same with arousal. Though arousal was a false alarm this time, next time could be different.
Though not all planes crash, the experience of flying may result in the psychological crash of the person. It is not enough to say nothing bad happens if the person has a panic attack.
Based on Joseph LeDoux’s research, when exposure is able to extinguish a person’s fear, subsequent stress could cause the fear to return. Even if exposure were to end a person's phobic response to flight, one turbulent flight would likely cause return of the phobia.
Therapists need to recognize that flight phobia is not the same as other phobias. Since exposure is not absolutely safe, the issue of risk must be addressed. The person must decide whether or not flying is an acceptable risk. If it is an acceptable risk, how does the client deal with the problem this pilot faced: control of arousal when not absolutely safe, not in control and not able to escape?
In the case of this pilot, arousal is triggered in two ways: “top-down” and “bottom-up.” His “top-down” arousal is due to stress hormones that are released when he's hit by feelings of arousal, which he conflates with fear and danger. His “bottom-up” arousal” results from the release of stress hormones — not due to thoughts — but due to the natural response of the amygdala to the non-routine and to the unexpected.
For an answer to the “bottom-up” difficulty, we turn to Pavlovian conditioning. There are two ways conditioning can be effectively employed. One is hormonal, and one is neurological.
Hormonal Conditioning
When produced in the brain, oxytocin inhibits release of stress hormones by the amygdala. To inhibit the amygdala's response, the goal is to associate the sequence of events that takes place during flight with a memory that causes the production of oxytocin. Thus, as the flight unfolds, oxytocin is released that inhibits the amygdala, preventing the release of stress hormones.
Neurological Conditioning
When the vagus nerve is stimulated, the heart rate slows and the parasympathetic nervous system is activated. These changes take place even if stress hormones are present. Researcher Stephen Porges, Ph.D calls this the “Vagal Brake.” Think of being in a car with an automatic transmission. If one foot applies pressure to the brake, even though the other foot may press on the accelerator and send more fuel into the engine, the car goes nowhere. Similarly, when stress hormones are released, if the Vagal Brake is activated, the effects of the stress hormones are overridden.
To stimulate the vagus nerve, the goal is to associate the sequence of flight events with the relived memory of a person whose presence, at least at the remembered moment, stimulated the vagus nerve. The vagus is stimulated by signals that are unconsciously sent, received and processed that the person is physically safe, psychologically attuned and non-judgmental.
To accomplish conditioning, link an oxytocin-producing memory and a vagus nerve stimulating memory to the sequence of flight events shown in the collection of photographs at http://www.fearofflying.com/photos
