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Fear of flying treatment programs for passengers: An international review

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Travel Medicine and Infectious Disease (2004) 2, 27–35

www.elsevierhealth.com/journals/tmid

Fear of flying treatment programs for passengers:

an international update
Lucas J. Van Gerwena,*, René F.W. Diekstrab, Josine M. Arondeusa,
Robert Wolfgerc

a
The VALK Foundation, Leiden University, P.O. Box 110, Leiden 2300, The Netherlands
b
Department of Municipal Health, Rotterdam, The Netherlands
c
Austrian Airlines, Vienna, Austria

Received 20 October 2003; received in revised form 5 January 2004; accepted 6 January 2004

KEYWORDS Summary Background. This article is an update of an earlier international review of

Fear of flying treatment;
Flight anxiety; Flight
phobia
fear of flying treatment programs.
Method. One hundred and sixty two airlines and treatment facilities around the
world were approached for information on treatment programs for flying phobia. In
comparison to the earlier review, the number of treatment facilities able to provide
relevant and valid information increased from 15 to 36. Information was obtained both
with a written questionnaire and by obtaining oral information from treatment facility
representatives. This information was obtained at the second international fear of
flying conference in Vienna on December 2000. The increase in the number of
participating facilities can presumably be attributed both to a world wide increase in
the demand for treatment for fear of flying and professionals becoming more
interested in entering the field of fear of flying treatment. However, the increase may
also be due to the fact that some clinics or programs have only recently discovered the
international network of treatment facilities.
Results. In comparison to the previous review, the number of facilities that provide
treatment programs that meet high professional standards has increased considerably
over the past few years. Although there is still substantial variety in the quality and
components of treatment programs, there is also a significant number of facilities that
provide more or less similar qualified treatment programs and carry out treatment
evaluation on a regular basis. Furthermore, experts from the participating centers
reached consensus on ‘golden rules’ for fear of flying patients and flying-phobia
therapists.
Conclusions. There is a growing consensus among fear of flying treatment facilities
on methods and protocols.
q 2004 Elsevier Ltd. All rights reserved.

There appears to be a considerable increase in the
*Corresponding author. Tel.: þ 31-71-5273796; fax: þ31-71-
527396.
E-mail addresses: info@valk.org, stichtingvalk@cs.com
number of people suffering from fear of flying,
probably as a consequence of recent political and
health developments. The events of September 11,
2001, is an example of these types of political
developments, which was followed by an enormous

1477-8939/$ - see front matter q 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.tmaid.2004.01.002
28
fall in the number of people flying either for
business or pleasure. Terrorist attacks are still a
threat for aviation. Similar effects have been
observed as a consequence of health threats posted
by the SARS epidemic, not only on routes to and
from Asian countries, particularly China, Hong Kong
and Taiwan, but also elsewhere. Apparently, many
people around the globe fear today that simply
boarding an airplane increases the chance of being
exposed to security and health risks. The media
tend to present information on air safety issues in
such a way as to highlight the negative aspects of
flying. There is evidence to suggest that fearful
flyers may be affected by media coverage of airline
incidents and accidents.1 It is consequently difficult
to determine whether previous estimates of the
prevalence of fear of flying, usually ranging
between 10 and 40% of the general population in
industrialized countries, are still valid.2 – 4 There are
no recent studies or monitoring data available yet
to shed reliable, valid light on this question.
Nevertheless, fear of flying is a phenomenon that
ranks high on the list of fears afflicting people today
and with which people have to cope.
Fear of flying, whether experienced to a mild,
moderate or high degree, usually affects function-
ing in one or more areas of life, e.g. professional,
social and family life.5 It may also affect marital or
relationship satisfaction because fear of flying
hampers or restricts a partner’s freedom of move-
ment and shared activities. That is why it is not
surprising that demand for treatment for fear of
flying is on the increase. With that in mind, we
embarked upon an update of a previous inter-
national review of fear of flying treatment facilities
around the globe.6 In addition, there has, in recent
years, been a substantial increase in the number of
people flying for business or other reasons, with a
particularly substantial increase in the period from
approximately 1995 – 2000. As a consequence, more
people are also being confronted with possibly
unpleasant or disturbing aspects of air travel, which
may lead to a greater need for information or some
type of professional guidance. This article report
the data collected in a second international review
of fear of flying treatment facilities and the
differences found in comparison to data collected
previously.6
To talk about, fear of flying is no longer a taboo
and public interest in the worries and anxiety
associated with flying has increased. Celebrities
today publicly admit (e.g. ex-world champion
boxing Mohamed Ali) that they suffer or have
suffered from fear of flying. Accordingly, airlines
wishing to provide travelers with a variety of
services to increase comfort before, during and
L.J. Van Gerwen et al.
between flights have asked mental health pro-
fessionals and others specializing in the phenom-
enon of flight anxiety to provide flight anxiety
alleviation services. In the last 15 – 20 years, a
substantial number of airlines (at least 36)6 have
participated in or initiated courses on prevention or
reduction of flight anxiety.
This field has been and to a certain extent still is
characterized by imprecise delineation and defi-
nition of the phenomenon of fear of flying, a lack of
scientific standardization of diagnostic procedures
and treatment methods, and an absence of clear-
cut guidelines for a scientifically based evaluation
of efficacy and effectiveness.6 This situation calls
again for a review of existing flight anxiety
treatment practices. We initiated this review prior
to and during the Second International Fear of
Flying Conference in Vienna (December 2000). For
this purpose, professionals associated with flight
anxiety facilities around the world were
approached, but also to gather information on
their facilities, including treatment characteristics
and evaluation methods. A questionnaire was used
to collect this information prior or during the
conference. This source of information was used
for further data compilation and processing after
the conference. The present article reports the
results of this inventory. In addition, delegates at
the conference discussed and reached consensus on
‘golden rules’ for fearful passengers. ‘Golden rules’
for therapists treating fear of flying patients were
also identified and agreed upon.
Objectives
The objectives of the study were as follows:
1. To gather data about available fear of flying
treatment facilities in terms of number, charac-
teristics, methods and possible effects of
treatment.
2. To compare the data collected with data
gathered in the previous review, both in terms
of number of treatment facilities and their
characteristics.
3. To compile information on what could be called
a consensus on guidelines for fearful passen-
gers, i.e. ‘golden rules’ for phobic passengers,
and on essential guidelines for therapists
treating fear of flying patients, ‘golden rules’
for therapists.
Fear of flying treatment programs for passengers: an international update
Method
Treatment agencies were identified by information
from three sources: a previous review by the
authors,6 from recent literature and current list of
airlines with mental health facilities/mental health
professionals around the world. Representatives of
those facilities were invited to participate in the
second international conference on fear of flying
treatment programs, the ‘Airborne’ Conference
held in Vienna in December 2000, under the
auspices of Austrian Airlines. In the invitation,
they were also asked to provide information
relating to their facilities and about other facilities
that could be contacted for the study. In all, 162
airlines and treatment agencies were approached.
This number is considerably lower than the number
of airlines and treatment agencies approached for
the previous review (212). This is a result of the fact
that it was better known at the time of the second
review whether airlines were active in the field of
treatment for passengers and whether treatment
agencies were still in existence. Eighty-five of the
162 airlines and treatment agencies approached
responded. A reminder sent to the others resulted
in seven more replies, bringing the total number of
respondents to more than half (92) of the original
sample (57% compared to 48% in the first review).
Eleven of those that replied said they were either
no longer operating as a flight anxiety treatment
facility or that their facility provided this type of
treatment so infrequently that their information
would be of little relevance to the study or not
merit their participation in the conference. Of the
81 professionals/researchers that provided infor-
mation, 63 ultimately both participated in the
conference and provided the requested information
(see Appendix A for a list of participants). They
came from 36 agencies/facilities (some agencies
sent more than one representative). Consequently,
the figure on which the present review is based does
not necessarily represent the worldwide number of
fear of flying facilities or constitute a representa-
tive sample of the characteristics and efficacy of
fear of flying treatment programs. However, it is
relatively certain that the more sophisticated and
substantial programs are represented. They com-
prise the most well known active practitioners and
researchers in the fear of flying treatment field to
date. The 36 treatment programs that participated
in the study are based in 21 countries on the
European, Australian, Africa and Northern Amer-
ican continents. Six of them were from the United
States. In the first review, there were representa-
tives from only 10 countries and none from Africa.
29
These 36 were able to provide relevant, reliable
information for the review (compared to 15 the
agencies able to do so in the first review). The 63
representatives of the 36 facilities also actively
participated in formulating the ‘golden rules’ for
patients and guidelines for therapists.
Results
Characteristics of fear of flying treatment
facilities
The general conclusion from the information
provided by the experts and corroborated by the
literature7 – 11 is that fear of flying is a disorder that
can be effectively treated. As shown in Table 1,
facilities differ enormously in the number of
patients treated annually, varying from 5 to 1000
patients a year. Clearly these differences are
related to whether the treatment agency is a
commercial or research facility. An average of 149
patients was treated annually per agency (in 2000).
Twenty-nine of the facilities (80.6%) use some form
of pretreatment diagnostic evaluation. A wide
variety of measures are used. Some have an
extensive diagnostic procedure, including a per-
sonal interview, while others limit themselves to
some type of telephone interview. It is remarkable
that there are still several treatment facilities,
which do not use pretreatment screening or
diagnostic evaluation. Most of the treatment
facilities provide only group treatment, the size of
the groups varying considerably from 3 to 120
people, equaling the number of seats available in
the plane used for test flights. Only a few facilities
also provide individual treatment, if desired or
required. Slightly over half of the facilities provide
their treatment according to a written manual or
protocol, which is also available to other pro-
fessionals. This means that almost 40% of the
facilities do not work with a treatment manual. As
pointed out later, this makes it more difficult to
compile clear-cut information on treatment pro-
cedures and components. With the advent of
cognitive behavior therapy and its expanding treat-
ment horizons, psychologists and psychiatrists are
increasingly entering this field, and the influence of
cognitive behavioral approaches on the structure
and components of the programs is clearly appar-
ent. What is most conspicuous is that programs
conducted by these professionals have more
components, have more frequently written treat-
ment manuals, use more sophisticated efficacy
measures and more often use follow-up measures.
 30
Table 1 Review of fear of flying treatment programs.

Center Clients Pre-treatment diagnostic Individual group Treatment manual Measures of Follow-up Available written
per year evaluation treatment (number available efficacy and audio material
of people in group)

Air MAG, Montreal, Ca-nada 120 Yes question-naire Yes groups of 8–20 No 1,2 Yes No
AKH, Vienna, Austria i.p. No No No i.p. i.p. i.p.
Ansett Fear of Flying Pro-gram, Australia 360 Yes question-naire Yes groups of 5 Yes 1,2,3,5 Yes Yes
Anxiety & Agoraphobia Treatment C, IL, USA 40 Yes telephone Yes groups of 4–8 Yes 1,2,5 Yes Yes
Agentur Texter-Millott, Munich, Germany 1000 Yes Yes groups of 8–14 Yes 1,2 Yes Yes
Austrian Airlines, Vienna, Austria 135 Yes Yes groups of 5–15 No 2 Yes Yes
Avia Safe AB, Väsby, Sweden 130 Yes questionnaire Yes groups of 9 No 1,2,3,5 Yes Yes
AVOLO, Sigtuna, Sweden 10 Yes telephone Only individual No 1,2 No Yes
Behavior Therapy Institute, Canada 50 Yes Only individual No 3 Yes Yes
Braathens, Oslo, Norway 180 No No group 10–12 Yes 3,4,5 Yes Yes
Britannia Airways, Luton, UK 250 Yes Yes group of 120 Yes 1,2,3 Single Yes
assessment
Centrum Integrierte psychotherapy, Germany 100 Yes Yes groups of 10 Yes ? Yes Yes
Crossair, Lausanne, Switzerland 30 No Yes group of 6–10 Yes 1 No Yes
Ronald M. Doctor, CA, USA 100 Yes Yes groups of 6–8 No 1,2,3,4 Yes Yes
Fear of Flying Clinic, San Mateo, CA 100 Questionnaire No groups of 25 No 1,3 No Yes
Fearless Flyers, Inc., Australia 78 Questionnaire No groups of 14–25 Yes 1,3 Yes Yes
Fearless Flying Program, Ireland 150 Questionnaire Yes groups of 5 No 1,3 Yes Yes
Finnair, Helsinki, Finland 60 Telephone questionnaire Yes groups of 7–8 Yes 1,2 Yes Yes
Freedom from Fear of Flying, FL, USA 80 Yes telephone Yes groups of 3–6 Yes 1 No Yes
Freedom to Fly, London, UK 100 Yes telephone Yes groups of 4 No 1,2,3,4,5 Yes No
Have no Fear, Toronto, Canada 100 Telephone interview Yes groups of 15–20 Yes 1,2,3,5 Yes Yes
IcelandAir, Psychological C, Iceland 25 Yes No Groups of 8–12 Yes 1,2,3,5 Yes No
Institute for Human Factors, WI, USA 100–150 Yes Yes groups of 12 Yes 1,2 No Yes
Luxair, Luxembourg 20–30 i.p. Yes groups of 8–12 i.p. i.p. i.p. i.p.
Med.-Psychosomatische Klinik, Germany 40–60 Yes Yes groups of 8–10 Yes 1,2,3,4 i.p. Yes
Alessandra Rea, Italy ? i.p. i.p. i.p. i.p. i.p. i.p.
VALK Foundation, Netherlands 350 Yes Yes groups of max ¼ 8 Yes 1,2,3,4,5 Yes Yes
Open Skies, MA and, NY, USA 500 Yes Yes groups of 5–8 Yes 1,2,3,4,5 Yes Yes
Galit Rosenberg, Herzlita, Israel 20 Yes Yes groups of 2–6 Yes 1,2,3,4,5 Yes Yes
Royal Free Travel Clinic, London, UK 150 Yes Yes groups of 6–8 Yes 1,3,5 Yes Yes

L.J. Van Gerwen et al.

S’envoler sans s’affoler, Geneva, Switzerland 90–120 Yes Yes groups of 6–15 Yes 1,2,3 Yes Yes
Swissair (Fit to Fly), Zurich, Switzerland 100 No No groups of 6–10 No 1 No Yes
Universisade Lusofona, Lisbon, Portugal ? Yes Yes i.p. 2,3 Yes No
University of Cape Town, South Africa 5 Yes i.p. i.p. 3 Yes Yes
University of the Balearic Islands, Spain 70 Yes Yes Yes 1,2,3 Yes Yes software
WINGS, Minneapolis, MN, USA 150 Yes No groups of 5–15 Yes 1,2,3,5 Yes Yes

Measures of efficacy: (1) Therapeutic flight; (2) post-treatment flights; (3) standardized anxiety self-report measures at discharge; (4) standardized general psychopathology measures at
discharge; (5) standardized anxiety self-report measures at follow-up. i.p. ¼ in preparation.
Fear of flying treatment programs for passengers: an international update
It also seems that these programs offer more
extensive pretreatment diagnostic evaluation and
the possibility of tailored individual treatment for
patients with specific phobias and other psycho-
logical problems. Most treatment programs are
short term, but there is still considerable variation
in length of treatment (from one to three days).
Most of the facilities use some type of efficacy
measure or criterion. In all cases, this is test,
therapeutic or post-treatment flights taken by the
patients. Nine of the 36 facilities only use these
flights to measure efficacy. Most of the facilities
also use other measures, such as standardized
anxiety measures. The majority of the facilities
use some type of follow-up measure ðN ¼ 26Þ: In
most cases, they are reports from patients about
other flights taken. Only a few agencies also provide
follow-up meetings or booster sessions. Most
facilities give their patients some type of written
and/or audio material to support their treatment or
inform them about it.
Components of treatment programs
One of the goals of the review was also to gain
detailed insight into the essential components of
the treatment programs. Table 2 shows some
remarkable data in this area, compared to the
first review.6 Most of the facilities now use multi-
component treatment programs, consisting of
diagnostic assessment, individual preparation ses-
sions, behavioral group treatment and cognitive
behavioral group treatment, and follow-up session
after treatment. The general picture is that
facilities report offering programs with at least
five different components, with a range of two to
seven. There are some differences between the
programs in terms of admission. Some do not have
any type of prescreening. Other programs have
extensive screening and assessment procedures
with consequences for the treatment protocol
offered. Surprisingly, the use of prescreening is,
however, seldom related to most facilities’
decision on whether a person will receive individ-
ual or group treatment, because one would expect
that prescreening is motivated by the wish to
tailor individual needs and treatment character-
istics. Most of the facilities provide information
either on aviation or anxiety or both, relaxation
training, some type of cognitive restructuring, in
vitro exposure (either to planes on the ground or
simulator training) and a therapeutic or test
flight. Only a few facilities also incorporate
some type of coping or distraction training,
while the anxiety management literature
clearly provides evidence of the efficacy of such
31
procedures.7,12 In addition, only a few treatment
facilities provide relapse training, despite the fact
that the anxiety management literature shows the
importance of helping patients in coping
with relapse and providing strategies for relapse
prevention.11
None of the experts participating in this study
mentioned the use of medication as a basic
component of treatment, although a few of
them had carried out controlled studies on the
efficacy of pharmacotherapeutic medication for
fear of flying.13 – 15 ‘Airborne’ was the first fear of
flying conference, introducing studies with virtual
reality exposure (VRE) as a component of treat-
ment. VRE therapy is relatively new and not yet
routinely used in clinical practice by any of the
conference participants. The use of VRE therapy
for fear of flying seems promising, and it is
conceivable that some clinical practices will
decide to include it in their standardized fear of
flying treatment programs in the near future. VRE
can have lasting effects in both the short and long
terms, as indicated in the first year-long follow-
up study by Rothbaum et al. and by Maltby
et al.16 – 18
In conclusion, a process of convergence or
consensus seems to have taken place between
treatment facilities on what components treatment
programs should include. This clearly indicates that
the quality of treatment programs has increased in
recent years, both in terms of the number of
components offered and professionalism.
Guidelines for fear of flying patients
One of the goals of the ‘Airborne’ Conference was
to determine whether consensus could be reached
on a set of rules or recommendations to help
phobics cope with their flight anxiety. In a so-called
syntegrity-session,19 each expert/participant was
asked to provide as many guidelines or rules/
recommendations for flying phobics as they could.
Consequently, all these recommendations/rules or
guidelines were compiled and ordered in terms of
similarities and differences. The higher the redun-
dancy/score for specific rules or guideline, the
more consensus was assumed to exist between
experts. The 20 rules or guidelines with the highest
redundancy were then used in a discussion/pro-
cedure. In this procedure, those professionals who
were for a specific guideline and those who were
against were confronted with each other. In the
third phase, the preliminary rules or guidelines
were voted upon. This finally resulted in what was
then called the 10 ‘golden rules’ for fear of
flying patients. These rules or guidelines can be
 32
Table 2 Review of treatment components offered by the treatment facilities.

Components Information Relaxation Coping/distraction Cognitive Exposure simulator Therapeutic Relapse

training training restructuring training flight training

Air MAG, Montreal, Canada Yes Yes No Yes Yes Yes No

AKH, Vienna, Austria i.p. i.p. i.p. i.p. i.p. i.p. i.p.
Ansett Fear of Flying Program, Australia Yes Yes Yes Yes Yes Yes Yes
Anxiety and Agoraphobia Treatment Center, IL Yes Yes Yes Yes No Yes No
Agentur Texter-Millott, Munich, Germany Yes Yes Yes Yes Yes Yes Yes
Austrian Airlines, Vienna, Austria Yes Yes No Yes Yes Yes No
Avia Safe AB, Väsby, Sweden Yes Yes Yes Yes Yes Yes Yes
AVOLO, Sigtuna, Sweden Yes Yes Yes Yes Yes Yes Yes
Behavior Therapy Institute, Canada Yes No No Yes No Yes No
Braathens, Oslo, Norway Yes Yes Yes Yes Yes Yes No
Britannia Airways, Luton, UK Yes Yes No No Yes Yes No
Centrum für Integrierte Psychotherapy, Germany Yes Yes Yes Yes Yes Yes No
Crossair, Lausanne, Switzerland Yes Yes No Yes Yes Yes No
Ronald M. Doctor, Woodland Hills, CA Yes Yes No Yes Yes Yes No
Fear of Flying Clinic, San Mateo, CA Yes Yes No Yes No Yes No
Fearless Flyers, Inc., Australia Yes Yes No Yes Yes Yes No
Fearless Flying Program, Dublin, Ireland Yes Yes Yes Yes Yes Yes Yes
Finnair, Helsinki, Finland Yes Yes No Yes Yes Yes Yes
Freedom from Fear of Flying, FL, USA Yes Yes No Yes Yes Yes No
Freedom to Fly, London, UK Yes No No Yes No Yes Yes
Have No Fear, Toronto, Canada Yes Yes Yes Yes Yes Yes Yes
IcelandAir Psychological Center, Iceland Yes Yes Yes Yes No Yes No
Institute for Human Factors, WI, USA Yes No No No No Yes Yes
Luxair, Luxemburg i.p. i.p. i.p. i.p. i.p. i.p. i.p.
Med.-Psychosomatische Klinik, Germany Yes Yes No Yes Yes Yes Yes
Alessandra Rea, Italy i.p. i.p. i.p. i.p. i.p. i.p. i.p.
VALK Foundation Leiden, Netherlands Yes Yes Yes Yes Yes Yes Yes
Open Skies, Boston, MA and New York, NY Yes Yes No Yes Yes Yes Yes
Galit Rosenberg, Herzlita, Israel Yes Yes Yes Yes Yes Yes Yes
Royal Free Travel Clinic, London, UK Yes Yes Yes Yes No Yes Yes
S’envoler sans s’affoler, Geneva, Switzerland Yes Yes Yes Yes No Yes Yes

L.J. Van Gerwen et al.

Swissair (Fit to Fly), Zurich, Switzerland Yes Yes No Yes No Yes No
Universisade Lusofona, Lisbon, Portugal Yes Yes No Yes No Yes Yes
University of Cape Town, South Africa Yes Yes No Yes No No No
University of the Balearic Islands, Palma, Spain No No No No Yes Yes No
WINGS, Minneapolis, MN, USA Yes Yes Yes Yes Yes Yes No

i.p. ¼ in preparation.
Fear of flying treatment programs for passengers: an international update
considered as a stimulus for patients’ talking
or communicating with themselves when they
experience a recurrence of tension or anxiety or
when they prepare for a flight.
Golden rules for fear of flying patients
(see list of self-help books)20
1. Avoid caffeine, sugar, nicotine and self-medi-
cation.
2. Practice relaxation.
3. Drink plenty of water and avoid alcohol.
Alcohol does not decrease fear but increases
it and contributes to dehydration.
4. Pay attention to your breathing and regular
carry out your breathing exercises.
5. Turbulence is uncomfortable, but safe when
your seatbelt is fastened.
6. Stop the ‘what ifs’ and focus on ‘what is’.
7. Keep flying. Do not avoid it.
8. Motivation is the key to change.
9. Planes are designed and built to fly.
10. Write on cards reminders of personal coping
instructions that work for you.
A similar procedure as described above for the
rules or guidelines for fear of flying patients was
followed to establish consensus on guidelines for
fear of flying therapists. Once again this resulted in
a set of 10 rules, which can be considered
instructions or self-instructions for therapists
while working with flying phobics.
Guidelines/golden rules for fear of flying
therapists
1. Be clear, patient, empathetic and
understanding.
2. Educate patients about how fear and anxiety
manifests itself in the body.
3. Teach patients to assess themselves and label
their anxiety on a scale.
4. Inform patients about technical aspects of
flying.
5. Teach relaxation and breathing techniques.
6. Encourage patients to take an active role.
7. Guide, communicate and provide instructions
to patients during test-/in-therapy flights.
8. Teach patients to deal with thoughts and
images; encourage them to look at the reality.
9. Follow a treatment protocol and inform
patients clearly in advance about the training.
10. Use humor appropriately.
33
Discussion
Fear of flying is still a problem of significant
proportions affecting approximately 30% of the
adult population in developed countries. This
article presents the results of the second inter-
national review of fear of flying treatment facilities
and treatment procedures. Thirty-six programs
from 21 countries participated in the review,
providing information on treatment aspects and
characteristics. The main conclusions from this
review are as follows. First of all, it appears that
the number of fear of flying facilities around the
world that provide highly professional treatment
for flying phobics is on the increase, presumably as
a consequence of the increase in fear of flying and
the number of people who fly, but also possibly as a
result of certain incidental factors such as fear of
terrorism and health risks in air travel. The majority
of the flying programs that provided information
use multi-component treatment procedures, con-
sisting on the average of five components with the
range from 2 to 7. A typical fear of flying program
first of all comprises information on technical
aspects of flying, some type of relaxation pro-
cedure, some type of cognitive behavioral inter-
vention, some type of in vitro training and a test-
/in-therapy flight. Most facilities also use some type
of follow-up measure, although there is a wide
range of sophistication in these measures. Only a
few programs also have follow-up sessions or
meetings. Clearly, the characteristics of the pro-
grams reflect the recent influx of cognitive beha-
vioral practitioners and researches in the fear of
flying field. Participants agreed on what could be
called helpful guidelines or self-instructions for
flying phobics prior to, during or after treatment.
They also reached consensus on main guidelines for
flying therapists. An important and somewhat
worrisome conclusion of the review is that there
are still substantial numbers of facilities that
provide treatment or training without a well
established and written treatment manual or
protocol. It appears that the guidelines identified
for therapists could serve as a base for a general
consensus protocol for fear of flying facilities in the
near future.
Appendix A. List of participating experts
(in alphabetic order)
Chairperson: Dr Robert Wolfger, Austrian Air-
lines, Vienna, Austria
Marit H. Andresen, Braathens, Oslo, Norway
34
Josine M. Arondeus, VALK Foundation, Leiden,
The Netherlands
Americo Baptista, Universidade Lusofona, Lis-
bon, Portugal
Robert Bor, Royal Free Travel Clinic, London,
England
Xavier Bornas, University of the Balearic Islands,
Palma, Spain
Birgit Bukasa, Austria
Bryan Burke, Fearless Flyers, Inc., Quantas,
Sydney, Australia
Bengt Bylander, Avia Safe AB, AVOLO, Sigtuna,
Sweden
Maeve Byrne-Crangle, Fearless Flying Program,
Aer Lingus, Dublin, Ireland
John Byrne, Fearless Flying Program, Aer Lingus,
Dublin, Ireland
Slim T.W. Cummings, Freedom From Fear of
Flying, Coral Cables, FL, USA
Carmen Cummings, Freedom From Fear of Fly-
ing, Coral Cables, FL, USA
Rene F.W. Diekstra, VALK Foundation, Leiden,
The Netherlands
Donald M. Doctor, Woodlan Hills, CA, USA
Frank J. Don, VALK Foundation, Leiden, The
Netherlands
Terence Dowdall, University of Cape Town,
Rondebosch, Cape Town, South Africa
Oivind Ekeberg, MD, Ulleval University, Depart-
ment of Acute Medicine, Oslo, Norway
Lars Elstad, Braathens, Oslo, Norway
Elaine Iljon Foreman, Air UK, Freedom to fly,
London, England
Lucas J. Van Gerwen, VALK Foundation, Leiden,
The Netherlands
Paul Griesbach, Behaviour Therapy Institute,
Toronto, Canada
Imke Grootenhuis, VALK Foundation, Leiden, The
Netherlands
Liz Harrison, Northwest Airlines Wings, NWA,
Minneapolis, USA
Julie Kenfield, Northwest Airlines Wings, NWA,
Minneapolis, USA
Paula Kinnunen, Finnair, Helsinki, Finland
Rudolf Krefting, Lufthansa, Agentur Silvia Tex-
ter, Munich, Germany
Andrea Kropf, Lufthansa, Agentur Silvia Texter,
Munich, Germany
Gernot Langs, Psychosomatische Klinik, Bad
Bramstedt, Germany
Marleen Lorenz, Anxiety and Agoraphobia Treat-
ment Center, Northbrook IL, USA
Ruth Markowitz, Northwest Airlines Wings, NWA,
Minneapolis, USA
Olivier Martin, Crossair, Lausanne, Switzerland
L.J. Van Gerwen et al.
Tony Martinez, Fear of Flying Clinic, United
Airlines, San Mateo, USA
Neil McLean, Ansett, Fear of Flying Program,
Melbourne, Australia
James Millott, Lufthansa, Agentur Texter Millott,
Munich, Germany
Helmut Müller-Ortsein, CIP, Munich, Germany
Cristina I. Nack, Fear of Flying Clinic, United
Airlines, San Mateo, USA
Detlev O. Nutzinger, Psychosomatische Klinik,
Bad Bramstedt, Germany
Carolee Orme, Av. serve, Have No Fear, Air
Canada, Toronto, Canada
Johanna Palmers, AKH, Vienna, Austria
Glenda Philpott, Flyers, Inc., Quantas, Sydney
and Melbourne, Australia
Marc-Antoine Plourde, Air MAG, Inc., Air Canada,
Montreal, Canada
Donald Rayko, Av. serve, Have No Fear, Air
Canada, Toronto, Canada
Alessandra Rea, Alitalia, Rome, Italy
Fabienne Regard, S’envoler sans s’affoler, Swis-
sair, Geneva, Switzerland
Tom Roberts, Northwest Airlines Wings, NWA,
Minneapolis, USA
Diana Ronell, Open Skies, Boston, MA and New
York, NY, USA
Galit Rosenberg, VALK Israel, Herzlita, Israel
Michael Rybak, USA
Di Sansom, Quantas, Sydney, Australia
Bettina Schindler, Swissair, Switzerland
Pall Stefansson, Iceland Air, Reykjavik, Iceland
Alfheidur Steinthorsdottir, Psychological Center,
Iceland Air, Reykjavik, Iceland
Silvia Texter-Millot, Lufthansa, Agentur Silvia
Texter, Munich, Germany
Michael P. Tomaro, Institute for Human Factors,
Milwaukee, WI, USA
Miquel Tortella-Feliu, Spain
Marco Verschragen, VALK Foundation, Leiden,
The Netherlands
Alain Wagner, Luxair, Luxembourg
Peter Ward, Britannia Airways, Luton, UK
Robert Wolfger, Austrian Airlines, Vienna, Austria
George Wright, Air MAG, Inc., Air Canada,
Montreal, Canada
Vreni Wüthrich, Swissair, Switzerland
Mall Yams, Avia Safe AB, Upplands Väsby, Sweden
Claudia de Zeeuw, VALK Foundation, Leiden, The
Netherlands
Viktor Ziegler, Austrian Airlines, Vienna, Austria
and Athens, Greece
Paula Zimmermann, Fear of Flying Clinic, United
Airlines, San Mateo, USA
 Fear of flying treatment programs for passengers: an international update
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