by Samantha Smith, Ph.D. & Barbara O. Rothbaum, Ph.D.

Almost a third of the population has a fear of flying. Many of them will avoid flying even it means not taking a job that requires travel or visiting a country that is too far away. A therapy using a tool called Virtual Reality Exposure (VRE) is effective in helping the white knucklers overcome their fear and anxiety when flying. Virtual Reality allows a user to be an active participant within a computer-generated three-dimensional virtual world that changes in a natural way with a person's head and body motion. 

To show how effective VRE is in reducing fear and anxiety when flying, psychologists Samantha Smith, Ph.D., of Walter Reed Army Hospital and Barbara O. Rothbaum, Ph.D., of Emory University School of Medicine, enrolled 45 participants (ages 24-69) with a fear of flying in three different experimental conditions. The participants had either been diagnosed with a specific phobia or agoraphobia with or without panic attacks that were triggered by flying.

Four sessions of anxiety management training were given to the treatment participants followed either by exposure to VRE (n=15) or going to an actual airplane at the airport (standard exposure or SE) (n=15). Participants in the waitlist control group received no treatment (n=15).

Those in the VRE treatment experienced virtual reality by sitting in an airplane, takeoffs, landings and flying in both calm and stormy weather. Those in the SE treatment traveled to the airport, sat on a stationary airplane and imagined takeoffs, cruising and landings.

After eight sessions over a six-week period, a flight on a commercial airline was offered to determine the participants' willingness to fly and their anxiety level during the flight. The flyers in both the VRE and SE treatments were found to be equally effective in decreasing their anxiety symptoms as measured by standardized questionnaires and by increasing the number of flights on a real airplane following the treatment.

The treated participants reported significant reductions in their apprehensions about flying as well as equal satisfaction with both the VRE and SE treatments. And when wait-listed participants were allowed to choose which treatment they would receive, the overwhelming majority chose the VRE treatment. "Six months after the treatment," said the authors, "93 percent or 14 out of the 15 participants of both the VRE and SE participants had flown."

"The advantages of VRE over SE," said the authors, "are that VRE can be done in a clinical setting (someone's office) where SE can be very costly and inconvenient. You need to travel to an airport, then be able to schedule an actual airplane flight. Plus, it takes longer than a regular hour therapy session." Furthermore, VRE allows the therapist to manipulate situations to best suit the patient, for example, "to repeatedly fly the virtual airplane within one session or to experience takeoffs, landings and turbulence," said the authors.


Samantha Smith, Ph.D., can be reached at (202) 782-8934. Barbara O. Rothbaum, Ph.D., can be reached at (404) 778-3875.


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