Group Tx of Fear of Flying:Group Tx of Fear of Flying:The Common Pathway The Common Pathway

David Carbonell, Ph.D.David Carbonell, Ph.D.

www.anxietycoach.comwww.anxietycoach.com

Disclosure InformationDisclosure Information8484thth Annual AsMA Scientific Meeting Annual AsMA Scientific Meeting

David Carbonell, Ph.D.David Carbonell, Ph.D.

I have no financial relationships to disclose.I have no financial relationships to disclose.

I will not discuss off-label use and/or investigational use I will not discuss off-label use and/or investigational use in my presentation in my presentation

Heterogeneity of the ProblemHeterogeneity of the Problem

• People develop the fear of flying in different People develop the fear of flying in different ways and in response to different triggersways and in response to different triggers

• People also vary in terms of feared outcomePeople also vary in terms of feared outcome• How can we tailor a group program which will How can we tailor a group program which will

work across these differences?work across these differences?

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Finding a unifying themeFinding a unifying theme

• They all want to fly, despite their fears. Why?They all want to fly, despite their fears. Why?• What kind of fears do people want to What kind of fears do people want to

overcome?overcome?• Exploration of this topic leads to realization of Exploration of this topic leads to realization of

the Anxiety Trickthe Anxiety Trick

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The Anxiety TrickThe Anxiety Trick

• They experience Discomfort, and get fooled into They experience Discomfort, and get fooled into treating it like Dangertreating it like Danger

• When they get tricked this way, they act in ways When they get tricked this way, they act in ways that make the fear worse, rather than betterthat make the fear worse, rather than better

• What’s good for Danger is the Opposite of What’s good for Danger is the Opposite of what’s good for Discomfortwhat’s good for Discomfort

How they get TrickedHow they get Tricked

• They resist the role of passengerThey resist the role of passenger• They think they have to lose their fear before They think they have to lose their fear before

flyingflying

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Key Points in AssessmentKey Points in Assessment

• What do you fear will happen when you fly?What do you fear will happen when you fly?• Why do you still want to fly?Why do you still want to fly?• What do you do to overcome this fear?What do you do to overcome this fear?• And the most important point: Does your fear And the most important point: Does your fear

have any predictive power? Does it discriminate?have any predictive power? Does it discriminate?• Is it a Signal Fear or a Conditioned Fear?Is it a Signal Fear or a Conditioned Fear?

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What maintains What maintains a conditioned fear?a conditioned fear?

• AnticipationAnticipation• AvoidanceAvoidance• Fighting and hiding the experience of fearFighting and hiding the experience of fear• These are what we have to targetThese are what we have to target

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The Plight of the Fearful FlierThe Plight of the Fearful Flier

• Their efforts to not be afraid are what maintain Their efforts to not be afraid are what maintain their fear, avoidance and anticipationtheir fear, avoidance and anticipation

• My focus in the group is on turning this around, My focus in the group is on turning this around, using the practice flight as a chance to practice using the practice flight as a chance to practice being afraid and offering no resistancebeing afraid and offering no resistance

• Virtually everything I do serves this goalVirtually everything I do serves this goal

Highlights of the weekend Highlights of the weekend programprogram

• We practice worrying, rather than struggle We practice worrying, rather than struggle against itagainst it

• Use the flight to experience and observe Use the flight to experience and observe symptoms of fear, rather than oppose themsymptoms of fear, rather than oppose them

• Q & A with a commercial pilotQ & A with a commercial pilot• Why are we going to St. Louis?Why are we going to St. Louis?

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History with 5 weekly sessions:History with 5 weekly sessions:A brief, powerful interventionA brief, powerful intervention

• 200+ attendees in approximately 40 groups over 200+ attendees in approximately 40 groups over 15 years15 years

• 3 individuals were not able to board practice 3 individuals were not able to board practice flight. One chose to take a rental car back.flight. One chose to take a rental car back.

• One year follow-ups revealed that more than One year follow-ups revealed that more than 75% had flown as prescribed, virtually all with 75% had flown as prescribed, virtually all with diminishing levels of anxiety.diminishing levels of anxiety.

• Does compressed format lose power? We’ll see.Does compressed format lose power? We’ll see.

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Thanks for coming!Thanks for coming!

• Visit my website for information about anxiety Visit my website for information about anxiety disorders of all kindsdisorders of all kinds

• List of flying phobia programs in U.S.List of flying phobia programs in U.S.• www.anxietycoach.comwww.anxietycoach.com