The Psychology And Treatment Of Flight Anxiety
Terms to help non-therapists
understand the text
When the article uses the term
“object”, it means a person who has psychological importance to you, since they
play a role in your ability to regulate feelings. It can mean an actual
physical person, but — even if it does — its more important meaning is
psychological. We “internalize” . . . we built into ones self . . . what that
person is to us. That person has a life — not just outside in the world — to a
life INSIDE us.
The term “affect” means
feeling. Affect regulation has to do with our ability to regulate our feelings
on our own, and via persons whose characteristic ways of interacting with us
are carried inside ourselves, to help us manage emotion.
The term “paranoid-schizoid position” refers to the way infants and very young children are psychologically organized inside. It is, I believe, an unfortunate term for a simple concept in which we all, originally, think in very simple
terms or good and bad, right and wrong, safe and unsafe.The term “depressive position”,
again, could have been better named. The depressive position refers to having
outgrown, somewhat, seeing everything in simple terms.
We have to be able to regulate
emotions to move from the over-simplified way to seeing things to the more
advanced way of seeing things.
And, when we get emotionally
distressed, we can lose our ability to continue seeing things in more advanced
way, and we slide back to oversimplified ways, such as safe and unsafe, and
then get even more upset when we feel locked into an unsafe state (even though
a person in the more advanced state would have a very different view).
The Psychology Of Flight Anxiety
Feeling Out of Control
Anxiety arises when we reach the limit of our ability to regulate affect internally. Since our internal ability is not easily increased, we turn outward for relief through control of the situation. If external control is insufficient, we seek escape from the situation, or from awareness of the situation.
Anxious fliers complain of
“feeling out of control” on the plane. They have neither internal nor external
means to regulate affect. Sensations of flight are so intrusive, particularly
during takeoff and in turbulence, that strategies to escape awareness can fail
even when aided by drugs and alcohol. Anticipating failure to control affect,
some choose physically more risky – but emotionally safer – transportation.
Thus, although risk of fatality
is far greater when driving, anxiety is less. Imagination of a car coming at us
is easily countered by imagination of escape, by turning the wheel. Though
escape is not always
possible, this illusion of
control preempts stress hormone release.
Fear Of Flying/ Rather Than Assurance, Statistics Provide A Focal Point For Distress
Statistics tell us the risk of
crashing is one in several million flights. To the anxious flier, one in a
million flights and one in a hundred-million flights mean the same thing. Both
include the term “one”. How is the anxious flier to know he or she will not be
that “one”? Awareness of safety as relative (rather than absolute) produces
intolerable anxiety. The most remote possibility of disaster makes affect
regulation impossible.
Affect regulation can be so
limited that routine daily functioning demands rigidly correct alignment within
a world of simplistic absolute categories: safe and dangerous, right and wrong,
or good and evil. Any challenge to the this simplistic world-view causes
anxiety, which leads to defense, such as attempts to convert others to the same
point of view, or aggressive accusations of being unpatriotic or having no
values.
Flying strips away the illusion
of absolute control, and with it, the illusion of absolute safety. The more
airtight the defense, the more dependent on absolutes, the less prepared one is
for any confrontation with reality, including the confrontation with reality
flying imposes.
Anxiety management can
therefore be seen to be divided between two groups, each of which utilizes a
different strategy. The first group, incapable of internal affect regulation,
manages anxiety, ambiguity and conflict externally via control, illusion of
control, and correct alignment within the absolute categories. Correct
alignment may lead to control of others, conversion of others, or the
destruction of others who are evil by virtue of being incorrectly aligned.
The second group, capable of
affect regulation to manage anxiety, ambiguity and conflict internally, is able
appreciate complexity, see humans as relational, values as relative, and
discrete events as distributed to form a bell curve.
Fear Of Flying/ Concrete Support For Soothing Transitional Objects
For those who cannot manage
affect regulation internally, concrete evidence of safety and connectedness
becomes crucially important. Though high altitude cruise is the safest phase of
flight, it is emotionally the most difficult phase, because of the earth’s
remoteness. The earth, like Linus’s security blanket, is a Transitional Object,
i.e. a concrete object that can be used to soothe the separation anxiety
incurred when an object of attachment (like the mother) is not available, and
the internalized representation of that object is not yet fully integrated.
Internalized representations of objects which cannot stand unaided are
buttressed by the concreteness of the Transitional Object.
When the concreteness of a
Transitional Object is compromised, its power to support internal
representation is lost, and the Representational object loses the capacity to
provide soothing. Therefore, when physical contact with the earth is lost, the
power of the earth to reunite the anxious flier with any Object is lost. Difficulty
with affect regulation begins when instant concrete access to the earth is lost
by the closing of the aircraft’s door. Difficulty increases at the moment when
contact is lost between the ground and the wheels of the aircraft.
Then, difficulty increases as
the earth becomes more visually remote. This is evident in the following email
from a client: “It may be my imagination, but the altitude affects me
negatively. I’ve always said I wouldn’t mind flying if we weren’t up so high.
For example, on a little commuter plane I didn’t fell nauseous at all. I was so
excited. However, when I got on the plane to Germany (note: which flies
higher), the same sick feeling came back.”
At lower flight altitudes,
imagination that one could almost jump from here may provide sufficient
soothing. Higher altitudes make the fantasy untenable and the earth’s ability
to serve as a Transitional
Object tends to collapse.
Psychodynamic Theories Relevant To Fear Of Flying
The work of Melanie Klein
provides a useful psychodynamic perspective from which the roots of fear of
flying can be derived. Thus, the anxious flier starts, on the ground, in the
Depressive Position
with insecure internal
representations buttressed by the earth as Transitional Object. If in flight,
everything representational, transitional, and concrete is lost, he or she
plunges into the Paranoid-Schizoid Position, leaving him or her in a relational
void in which positive self and other representations cannot be maintained, the
world becomes full of threatening darkness, and panic results.
Note the concreteness of
expression in this email: “As we were lifting off and once we were in the air,
it felt like bubbles were building up and popping in my brain, it was actually
slightly painful. My body feels so heavy and I’m afraid to move because it will
make me feel dizzy and sick. Are these true physical feelings or is my mind
causing these feelings?”
In the Paranoid-Schizoid
position, concreteness becomes the primary perceptual and conceptual mode of
apprehending the world. In the realm of concreteness, flight does not make
sense, as it is based on Bernouilli’s theorem, an abstraction which can be
processed by the left brain only when there is adequate soothing to support the
ascendancy of abstract reasoning over the visual evidence that “nothing” is
holding the plane up.
So long as left brain
abstraction balances right brain visual evidence, the score is tied one to one,
and anxiety is kept in check. But in turbulence, kinesthetic evidence – the
sensation of falling – is added to the visual evidence. The score changes to:
right brain, two; left brain, one. Closure, that the plane is indeed falling,
takes place.
Fear Of Flying/ Imagination Triggers Stress Hormone Release
With closure, one shot of
stress hormones is released which increases arousal, placing the person in the
“fight or flight” response. This one shot of stress hormones will, on a scale
of zero to ten, take a
person to two or three. But if
further images of disaster follow, each will trigger one additional shot of stress
hormones. A rapid sequence of images will cause a rapid sequence of hormone
releases,
resulting in extreme arousal.
In the absence of a neurally linked internal Soothing Object, extreme arousal
is experienced as high anxiety or panic.
Panic Mimics - But Is Not -
Death
For Self-Representation to
exist, it must be constantly produced. When the mind is overwhelmed by affect,
generation of positive Self and Object Representations falter. If the
Self-Representation vanishes, its
momentary death may result in
panic.
But panic is not always the
result when Self-Representation production is overwhelmed. Consider other
contexts; when sexual pleasure overwhelms the Self-Representation, the self,
the loved one,
and the world are all one. We
regard this as ecstasy.. When the Self-Representation drops away in sports, it
is called “being in the zone”. Mihaly Csikszentmihalyi titles his book on this
subject “Flow”.
Absence Of Control =
Abandonment Affect = Death
When in difficulty, pilots can
also turn the wheel, or can turn to the flight manual for a procedure to avoid
disaster. But for the anxious flier, control in someone else’s hand may seem
worse than no control at all. Control in the hands of another can result in
affect worse than death. The problem with flying is not BEING dead but GETTING
dead; the affect one expects to experience when doomed.
What is the basis for such an
expectation? The anxious flier “knows” and dreads what will be felt when
plunging deathward, profoundly alone, utterly helpless, and nothing can be
done. The fact that this experience is so familiar suggests it is not simply
imagination. It may indeed be the implicit memory of early abandonment affect.
An implicit memory contains
solely affect. It contains no data. It contains no autonoetic sense (the sense
of ones self as the experiencer). Thus, when an implicit memory is recalled,
the subject experiences what the implicit memory contains: affect. The implicit
memory contains nothing to inform the subject that the affect is from memory;
thus, it may appear to be causally connected to the present. This constitutes a
“flashback”.
Abandonment affect can, in the
absence of an internalized soothing object, reach a level at which the mind’s
capacity to produce self-concept is overwhelmed. Loss of temporary self-concept
may be experienced as death.
Treatment Of Flight Anxiety
Where Abandonment Is, Object
Shall Be
A client said, “I just had a
light bulb moment . . . why am I not afraid when I think of sitting in the front
with the pilot . . . but lose it when I can’t see them in my mind?” Attachment
Theory tells us the ability to be soothed by another person is part of our
hard-wiring. Object Relations Theory tells us that a person – and the soothing
contact – can be internalized. Some of us have many neural connections which
soothe; some of us have few.
When a harpoon is shot, it
trails a line behind which connects the person firing it to the object the
harpoon strikes and anchors itself into. Think of Winnicott’s “holding
environment” as a circus tent in which a harpoon is fired. Whether aimed or
not, the harpoon will hit some part of the tent and will anchor itself there.
The trailing line connects the shooter with the tent.
In a soothing holding
environment, every harpoon shot of self-activation becomes neurally connected
with a reliably attuned Object. But if the holding environment is not a
complete enclosure, or if the holding environment is capricious whether a
harpoon shot of self-activation becomes neurally connected to soothing affect,
or to abandonment affect, is hit-or-miss.
Fear Of Flying/ Masterson’s Personality Disorder Triad
Personality disorder results
from a scarcity of neural connections between the child’s efforts at
self-activation and a holding environment constituted by an available, attuned,
empathic Object.
When self-activation is not
neurally connected to a Soothing Object, self-activation leads to dysphoric
affect. Attempting to self-activate, a client said, “If something goes wrong
and the plane is about to crash, I won’t be able to handle it knowing I made
the decision to take this flight.”
Providing Soothing Neural
Connections
The treatment of flight anxiety
requires nothing more than establishing a neural connection between every
expected flight experience and the emotional component of a recalled experience
with a Soothing Object.
First, the client selects a
moment with another person which is pleasant to recall and, when re-lived,
brings warm feelings. Moments frequently chosen are saying wedding vows,
holding a newborn,
becoming engaged, walking on the
beach with a loved one, or enjoying a family holiday feast.
Next, the client is asked to
add something to the memory, to imagine a magazine is lying there, on the
floor, on the sand, or on a table. The client is asked to imagine that on the
magazine page, there is a
small black-and-white
photograph of a flying scene, and to quickly refocus on the memory and the
strong positive affect of the memory. A neural link between the flight image
and soothing affect begins to be
formed. Repetition over several
days establishes the link.
Each image that could come to
mind during the flight is included in the exercise, including images of
disaster. To introduce difficult material without causing stress hormone
release, the client is asked
to imagine that, during the
positive experience, a comic book was lying there. In the comic book, a cartoon
character is seated on a plane. Though the plane is flying normally, the
cartoon character is
imagining the disaster
(depicted above the cartoon character’s head in what cartoonists call a
“balloon”). The client quickly refocuses on the positive memory and its
positive emotion. In this way a neural
link is made between a Soothing
Object and images of hijacking, the plane falling, people screaming, etc.
Then, again using cartoon
characters to prevent stress hormone release, one-by-one, each element of the
fight or flight response is neurally connected to the Soothing Object: rapid
heartbeat, rapid or
difficult breathing,
sweatiness, confusion, disorientation or derealization, and tension in the
body.
Fear Of Flying/ Limited Repair
This exercise achieves limited
repair where anxiety arises due to inadequate neural connection between flight
situations and an internalized Soothing Object. In my experience, after
connecting each flight situation to an Object, high anxiety does not develop,
and panic is prevented.
The exercise can be applied to
elevators, bridges, tunnels, or a MRI. It has been used successfully with one
client suffering from fibromyalgia. In the treatment of personality disorder,
if this approach can enhance affect regulation of dysphoric affect in the
second step of the Triad, defense may be less pronounced.
