Virtual Reality Exposure and Cognitive Behavioural Hypnotherapy For Fear of Flying:

Last week I headed back over to the virtual reality flying simulator team that I'll be delivering my fear of flying course alongside. I've written already about the VR machine and the fear of flying course we have developed, in these two articles: i) New fear of flying course - help to overcome flying nerves and anxiety; and ii) Fear of Flying - Calmly Taking To The Air in a Boeing 737.

Naturally, one thing I've spent a fair amount of time researching and investigating is the added value of virtual reality for helping with fear of flying and the best methods of integrating that aspect with my cognitive behavioural hypnotherapy. And there is actually a fair amount of research out there that has looked at virtual reality exposure treatment for fear of flying and its benefits and effectiveness.

Many existing approaches make use of anxiety management and cognitive techniques, alongside providing accurate information about aeroplanes and flying as a way to calm that fear. Some approaches make use of exposure techniques that could range from going to an airport, watching and listening to the sound of aeroplanes taking off and landing and then, where practical, sitting in a plane before then moving on to actually flying somewhere.

Of course, some of these elements are easier to realise than others to help you overcome your fear of flying. As long as it isn't too far, getting to an airport and watching and listening to planes is probably achievable. Actually arranging to sit on a stationary plane for a bit is harder to achieve and the opportunities for repeating this and subsequent steps become less and less. This is where virtual reality exposure can really nail the gap in your progress to reduce your fear before you actually fly.

Virtual Reality Exposure For Fear of Flying

Virtual reality exposure has many benefits that can really aid your treatment for overcoming your fear of flying.

As Muhlberger et al. (2003) writes regarding VR exposure for fear of flying, 

"The patient can be immersed (i.e. feel present) and act in the virtual environment. VR exposure may help to circumvent several problems with in vivo exposure treatments for fear of flying, First, in vivo exposure to flying is expensive; therefore, repeated exposure if rarely realized. Second, in vivo exposure is difficult to provide in a continuous fashion because real flights represent an all-or-nothing situation....Finally, individually tailored exposure situations (e.g. weather conditions, air turbulence) can be realized with VR exposure but are difficult to provide with in vivo exposure because the therapist has only limited control over the situation."

In that study, 'Efficacy of one-session virtual reality exposure treatment for fear of flying', the authors concluded that, "The current study supports the efficacy of a one session VR exposure treatment for fear of flying over a 6-month follow-up period." In fact, those in the VR exposure group showed greater reductions in fear of flying than those who only received written information about fear of flying or information plus one session of cognitive therapy.

Like the VR simulator we'll be using, this study involved a Boeing 737 and included flight phases such as take-off, ascent, descent and landing. And, again as with our course, all participants received information about anxiety and its cognitive, behavioural and physiological components.

virtual reality exposure fear of flying hypnotherapy


In another paper, 'Virtual Airplane For Fear of Flying Therapy', Hodges et al. (1996) talk about the natural order to events that occur in a real airplane flight. You sit at the airport terminal for a while, taxi to a specific spot on the runway, take-off, be in flight for an extended time and subsequently land. Some of these events, such as take-off and landing are relatively brief events whereas others, such as the actual flight can vary in duration up to a few hours. Conditions can also vary.

In that study, VR exposure was utilized with a 42 year old female with a debilitating fear and avoidance of flying and who had not flown for the previous two years. As the authors conclude after treatment, "Virtual reality exposure treatment was successful in reducing the subject's fear of flying."

And discussing the same case study, Rothbaum et al. write,  

"Virtual reality exposure treatment was successful in reducing this subject's fear of flying. Although the sole contribution of VR exposure to her improvement is not possible to determine given the inclusion of AMT techniques, the contribution of VR exposure to the overall outcome is considered significant for many reasons. First, her self-reported anxiety on all measures decreased further following VR exposure. Second, she was able to complete a long flight, one that she had successfully avoided for the past 2 years. Third, as mentioned above, the usual treatments for the fear of flying include a combination of AMT and exposure. Had VR exposure not been available, this therapy would have included exposure with actual airplanes, possibly with the therapist flying with the patient before she flew with her family. Instead, the treatment goals were accomplished using VR exposure in place of in vivo exposure, which is the significance of this report."

And in the final study that I'll mention here, Rothbaum et al, (2000), randomly assigned forty nine people with a fear of flying to virtual reality exposure therapy, standard exposure therapy or a wait-list control group. They each received anxiety management training followed by either exposure to a virtual airplane (VRE) or exposure to an actual airplane at the airport. A post treatment flight on a commercial airline measured participants' willingness to fly and anxiety during flight immediately after treatment. The results indicated that virtual reality exposure and standard exposure were both superior to the waiting list, with no differences between virtual reality exposure or exposure to an actual plane at the airport. The gains observed in treatment were maintained at a six month follow up. Both virtual reality exposure therapy and standard exposure therapy for treatment of fear of flying were 'unequivocally supported in this controlled study'.

As well as the exposure therapy for their fear of flying, “Brief breathing retraining was taught to manage physical signs of anxiety such as increased heart rate. Cognitive restructuring to learn how to challenge irrational thoughts was taught…Typical irrational thoughts included "This plane is going to crash" and "I will panic on this plane and [embarrass myself/go crazy/die/have a heart attack]." Thought-stopping to counter ruminative thinking was taught...

So there's a whole load of positive research and examination of virtual reality exposure for fear of flying. And, as mentioned in much of the research, virtual reality sits nicely alongside anxiety management training and techniques and receiving accurate information about planes and flying. All of this makes me very excited and positive about what we've built into our new fear of flying course that will provide you with skills, knowledge and understanding, as well as practical advice to give you the tools to work towards conquering your fear of flying.

If you want to know more then give me a shout and I'll be more than happy to chat with you about how you could benefit and soon find yourself feeling more calm, relaxed and confident about flying.

To your success,

Dan Regan

Hypnotherapy in Ely & Newmarket


Like to read more about overcoming your fears? You can read more of my articles here: Fears and Phobias

Seeking help to overcome your fear of flying? Book your Complimentary Hypnotherapy Strategy Session with Dan now: Appointments

Find out what other people have said after their hypnotherapy sessions with Dan: What People Say

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Andreas Mühlberger, Georg Wiedemann & Paul Pauli (2003) Efficacy of a One-Session Virtual Reality Exposure Treatment for Fear of Flying, Psychotherapy Research, 13:3, 323-336, DOI: 10.1093/ptr/kpg030

L. F. Hodges, B. O. Rothbaum, B. Watson, G. D. Kessler and D. Opdyke, "A virtual airplane for fear of flying therapy," Proceedings of the IEEE 1996 Virtual Reality Annual International Symposium, Santa Clara, CA, USA, 1996, pp. 86-93.doi: 10.1109/VRAIS.1996.490515

Rothbaum, Barbara Olasov, Larry Hodges, Benjamin A. Watson, G. Drew Kessler, and Dan Opdyke. "Virtual reality exposure therapy in the treatment of fear of flying: A case report." Behaviour Research and Therapy 34, no. 5-6 (1996): 477-481.

Rothbaum, Barbara Olasov, Larry Hodges, Samantha Smith, Jeong Hwan Lee, and Larry Price. "A controlled study of virtual reality exposure therapy for the fear of flying." Journal of consulting and Clinical Psychology 68, no. 6 (2000): 1020.