What Therapists Need To Know About Fear Of Flying

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.


Fear Of Flying

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.