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What does a pilot know about fear of flying?

As a psychologist and pilot, Bert Busscher is interested in the phenomenon often termed as fear of flying. Busscher discovered that the heart rate of a person undergoing a therapeutic flight shows how much they still suffer from fear of flying. The post-flight heart rate can even predict whether the fear of flying will persist long term. PhD defence on 7 September.

'Fear of flying often involves anticipatory anxiety,' Busscher explains. 'We’ve had people in our research project that lived in North Holland, but would take a large detour around Utrecht just to avoid driving past Schiphol.' Fortunately, fear of flying can be treated. With cognitive behavioural therapy, you can tackle your avoidance of and anxiety about the situation. Busscher: 'Such non-adaptive coping strategies are often the culprits that make it so difficult to conquer this fear.' 'In the end, what helps most is actually exposing patients to the situation and tackling their avoidance behaviour head on. Meaning, hopping on a plan.'

Long-term effect

During his research, Busscher worked closely with Stichting VALK, an organisation offering therapy for fear of flying. 'Almost everyone goes on a return flight as the final portion of their treatment process. If patients agree to take this flight, the therapy is considered successful,' says Busscher. 'But what is their situation in three years time? Are they still flying? Because, interestingly enough, this has never been researched.' For his PhD research, Busscher followed up on a large number of people who had completed therapy for severe fear of flying up to three years ago. How many of them have flown in those years? And how do the participants respond to videos of airplanes, to two simulated flights and two real airline flights?

Examine the entire treatment process

This is the first time research has been conducted on the long-term effect of this therapy for fear of flying. Busscher looked at the degree of anxiety both during and after the behavioural therapy. In this way, a participant will be able to see his/her anxiety scores shortly before the final flight, or when already on the flight. Busscher: 'We can then measure whether the patient has learned enough from the therapy to get the maximum effect from this ‘exposure’ flight.' This seemed to be the case with all the research participants, and everyone boarded the plane. 'We did discover however, that, after three years, a number of them did have a relapse and the fear was back.'

In-flight measurements

As a research first, Busscher also investigated the physiological functions of people suffering from fear of flying, specifically the response of the autonomic nervous system. 'Because phobic anxiety is associated with physiological reactions, such as changes in heart rate, can this information help in diagnosing fear of flying, or in predicting the treatment result?' Busscher wonders. As a man of practice, captain Busscher wanted to measure this in practice: he measured the physiological responses of the participants during the flight. Technically speaking, this is more difficult than in a laboratory, where you have better control of the circumstances.

Post-flight heart rate predictor of successful therapy

Busscher: 'The results are not conclusive. However, the heart rate response during and after the flight tends to be a key physiological predictor of the therapy’s success, also after three years.' A drop in the heart rate response in flight was indicative of the degree of flight anxiety in the short-term: a more significant drop was associated with lower levels of flight anxiety after the flight. A lower heart rate response after the flight seems to be predictive of long-term success: these patients also had lower levels of flight anxiety three years after completing the therapy. 'Therefore, the ones who relapsed were the ones who differed in heart rate response to the group which did not relapse.' Thus, measuring the activation of the autonomic nervous system may contribute to the diagnosis of fear of flying, and the prognosis of the treatment outcome.

Psychologist or pilot

Is the psychologist now sitting in the pilot’s seat? Or is the pilot inputting his practical research results into the psychologist's databank? For the moment, Busscher is only focusing on flying. 'For the moment, I won’t be taking a laptop on my travels as a KLM Boeing 747 captain, and will continue enjoying the beauty of all my destinations.'