Treatment of fear of flying: behavioral, subjective, and cardiovascular effects

Aviat Space Environ Med. 2014 May;85(5):550-62. doi: 10.3357/asem.3821.2014.


Background: Nonaviator fear of flying is a common problem usually managed with behaviorally oriented treatment. The unknown time courses of aspects of anxiety and of physiological response were investigated during a 3-d treatment including flights.

Methods: Ratings, heart rate (HR), and heart rate variability (HRV; pNN10, pNN50) of 15 Moderate-Anxious and 9 High-Anxious subjects at critical epochs of treatment and on 2 actual flights, on which 9 Controls participated, were compared.

Results: All subjects took the flights and displayed a remarkably reduced fear when comparing pre- vs. post-treatment ratings. Repeated ratings showed an increase in relaxation and drops in general somatic and cognitive aspects of anxiety during flights. However, cognitive aspects in High-Anxious did not drop to the level of Controls. Level of anxiety was related to cardiovascular activity almost always during treatment and flights, in particular during takeoffs (average maximum HR of 137 bpm in High-Anxious compared to 118 bpm in Moderate-Anxious and 98 bpm in Controls in the first flight). Moderate-Anxious showed no obvious relationship of cardiovascular response to critical flight epochs, but had the lowest HRV on flights.

Discussion: Results indicate that anxiety in Moderate-Anxious is related to flight, but not to single critical epochs of flying, contrary to High-Anxious, for which higher ratings on cognitive aspects of anxiety associated with more physiological load at critical epochs were observed. However, HR and ratings showed a remarkable drop in both treatment groups, in particular in perceived physiological symptoms, indicating that the treatment facilitates coping of fear of flying.

MeSH terms

  • Adult
  • Air Travel / psychology*
  • Anxiety / etiology
  • Female
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Phobic Disorders / physiopathology
  • Phobic Disorders / psychology
  • Phobic Disorders / therapy*
  • Treatment Outcome
  • Young Adult