Another way of measuring the frequency of fearful flying:  how often is it declared a medical emergency? 

 A journal article in Critical Care published January 20, 2009 gives some clues as to how often fear of flying presents as a situation requiring medical intervention.

If you've been travelling of late and have been a frequent traveller over the last 10 years, you'll know the world of commercial aviation has changed.

A post-9/11 world, changes in economy circumstances, and the development of new aircraft types have seen commercial aviation go from a rather exotic and fun means of getting from A to B, to a much more stressful less pleasant way to go. Fortunately, what hasn't changed is commercial aviation's emphasis on safety, and it remains after elevators and escalators the safest form of mass transport.

What has also changed is the demographic of the flying public. With the advent of no-frills airlines resulting in much cheaper flights, and an aging population, the likelihood of onboard medical incidents has also increased.

To assess this, a group of medical researchers sought information from many of Europe's leading airlines as to incidents on record between 2002 and 2007.

Not all the airlines co-operated unfortunately, but of those who did, more than 10,000 incidents were recorded along with the likely diagnoses.

Here's the title of the article from the actual journal, below:

disorders were responsible for 8.9% of all emergencies (926 cases). The third most common medical emergency was cardiac conditions (509 cases, 4.9%), followed by fear of flying (460 cases, 4.3%), and generalized pain (432 cases, 4.1%)."

What's interesting from an airline's perspective (the cost of diversion is mentioned in the article as being anywhere between $25,000 and $750,000) was that the figures didn't include fear of flying incidents before or during boarding, which can be a "peak experience" time for fearful flyers.

This is when they can baulk and end up being no-shows, requiring time-consuming luggage removal. Or for those feeling overwhelmed by closed doors, can cause the occasional return to the gate after taxiing in order to be let out.

(A former patient who regularly flew domestically and internationally would baulk half the time. So in order not to delay the aircraft he only ever flew with onboard luggage, never checked luggage).

What's also interesting is the total number of incidents - over 10,000 - which were turned over for study by the two out of thirty two airlines who returned data to the researchers, for the five year period under investigation. And that fear of flying was so high up on the list, especially since the conditions labelled as such were serious enough to require medical intervention! Meaning there must have been many many more subclinical cases which did not attract medical attention where the flyer struggled to get through their flight without assistance.

These data suggest airlines need to take onboard medical emergencies seriously, equipping their aircraft with appropriate equipment - particularly oxygen if one carefully reads the report and those of other researchers - and they deserve to reinstall their fear of flying courses, many of which were cut back in cost cutting efforts in recent years.

It may turn out this was a false economy, and airlines might wish to re-instate their courses, not just for the public relations value, for the likely return business it will generate, but because it may well save them money in the long run.

Full report in PDF form here:cc7690.pdf

Am I the only one or is fear of flying common?

Is Fear of Flying common?

You bet!

If you use Google to search for information, you will get a variety of responses to this question. Often, the Dean and Whitaker Boeing 1980 study will be cited.

Above is the title page and I have an original copy of the research, given to me during a visit to Dr. Al Forgione, who runs the Institute for the Psychology of Air Travel in Boston. Al was part of that original 1980 research, which concluded that about 25 million Americans suffered a serious enough fear to cause them not to fly or to fly much less often than they could. Here is the actual Summary from the Dean and Whitaker paper.

Essentially, Boeing had commissioned the research to see how to sell more aircraft, although rumours got around the the President of Boeing perhaps had a family member who had a fear and he wanted to know more about it! (If you would like a pdf copy of the research paper email me - it is about 1MB in size.)

Other research estimates figures from 1 in 6, to 1 in 12 of the general population. When it comes to gender, women are cited as being more fearful than men. I have always been skeptical of such figures, but if you've come here to this page because you have a fear, you are likely to know several other people who owned up to the same fear once you disclosed your's! Try it at the next dinner party or social gathering you attend.

(By the way, if you used Google to both search for information and eventually get to the blog, congratulations! Did you notice how much stuff there is on the web about this fear, and all the various products, services, sites - sheesh!)

At one point, many of the world's first tier airlines ran or facilitated Fear of flying programs for customers and staff (I often had Ansett employees wish to do the course). In recent years, due to harsh economic times, especially following 9-11, many have stopped or reduced their courses.

Here in Australia, QANTAS (please, never insult Australians by spelling it Quantas as its an acronym, not a word) helps facilitate programs in Melbourne twice a year over two weekends. Ansett used to run 4 or 5 programs a year in most capital cities.

My guess is fear of flying has increased since 9-11, although less people have presented for treatment.

How is that so, you may ask?

Well, much of the treatment a psychologist can offer is to help people identify their beliefs leading them to believe flying is a dangerous activity for them. We treat anxiety by identifying irrational or erroneous beliefs or untested assumptions about flying; working with people's sometimes frightening bodily reactions to flying, and providing some educational material about the flying experience. This is a portion of a therapeutic treatment program.

We also teach people breathing skills, and try to expose them to their fearful cues or triggers while practising their breathing and thought changing skills.

With 9-11, we literally had less to work with, as many people found it hard not to believe that flying had indeed become more dangerous, and that their fears were really quite rational. So, their fears became normalised; they felt less weird or marginalised to have this set of fears, and often employers advocated people not fly, but instead drive or use video-conferencing as an alternative to flying, especially if the trip was non-essential or was within 500 miles.

So while most people thought the fear of flying business boomed, the reverse was true in fact.

(Update May 20, 2004: Al Forgione, whom I mentioned above, has also come to a similar conclusion and you can see his reasoning here.)

When things get back to normal, as they seem to be heading, and people take the new flying restrictions as an unavoidable part-and-parcel of travel, I expect to see fear of flying numbers to increase - AND terrorism to be a larger part of people's fear profile. Because of the secrecy surrounding airlines' and governments' anti-terrorism efforts, it will not be easy to offer really definitive rebuttals to clients' terrorism fears.

That said, my experience suggests to me that excellent work can still be done despite recent developments, and fears of terrorism still remains comparatively low on the reasons people fear flying. Low but not absent. One of Europe's main Fear of Flying programs, VALK, presented in May 2002 at a conference in Prague. Here is how the New Scientist website reported it, some 7 months after 9-11:

At an airline technology conference in Prague last week, a delegate from the VALK Foundation said that before 11 September, none of the 4000 people it has helped to overcome their fear of flying had ever cited hijacking as the root of their fear. But since then it has become the main fear for a third of its clients.

Time Magazine Asian edition also reported changes in fear of flying after 9-11, with a special focus on Asian populations a month after 9-11:

Counselors around the world run courses to help people cope with the fear of flying—which affects some 20-25% of passengers. "A classic symptom of a phobia is avoidance," says Peter Hughes, a British Airways pilot with 34 years' experience who runs programs for flying phobics in Britain. "People are simply staying on the ground. They don't feel ready to address their fears." In Asia that kind of avoidance is particularly strong. "It's the whole psychology of loss of face," says Hughes, "never admitting to having a fear, never mentioning it." This may be one reason why the nearest course for Asians who fear flying is Qantas' Fearless Flyers Clinic in Sydney...

Experts agree that the key to facing down fear is knowledge: find out as much as possible about the mechanics of flight and plane safety systems as well as the causes of anxiety. Equally invaluable—however frightening—is experience. Debbie Seaman, who beat her own fear of flying at the Qantas clinic in Sydney and went on to write The Fearless Flier's Handbook, says: "Most of all, if we don't 'get back on the horse,' we're helping the fear take over. A phobia erodes self-esteem in other areas of life and spreads like a cancer." She advises phobic flyers to desensitize themselves: arrive at the airport early to watch planes take off and land. On boarding, alert the crew or even ask to speak to the pilot. The experience of the cabin staff and captain often inspires confidence, says Seaman. For the truly terrified, adds Hughes, all flights carry tranquilizers such as Valium or Temazepam, which crews can give to needy passengers. One thing nobody is recommending, however, is any more drinking.


Update January 26, 2005: I located an interesting study of Dutch fearful flyers, with commentary by a recently Ph.D. recipient and pilot, Lucas van Gerwen. It suggest that about 1 in 6 of the Dutch population has a serious fear of flying, and Lucas suggest medical insurance should help pay for intensive training to help people overcome their fears.