Written by Julie FACCINI

March 13, 2020

Aviophobia or fear of flying is an anxious pathology in the family of specific phobias. It’s a very common phobia that creates an unpleasant experience for around 20 % of the world population.

In order to treat this anxiety disorder, therapy by virtual reality exposure appears to be the most adequate therapeutic solution with efficacy proven by the scientific literature.

This is because cognitive behavioral therapies are the most effective therapeutic method in the treatment of phobias. Exposure is a central and decisive aspect in therapeutic success. By definition, to become successful in this, it is necessary to expose the patient to stimuli related to the airplane travel, and this can be quite complex in reality.

C2Care has developed software with optimal technological properties to meet the needs of behavioral, cognitive and emotional treatment of aviophobia.

The fear of flying application contains an airport with ultra-realistic graphics, the key stages of an airline travel with a sequential and controllable narrative process, multiple intra-environment interactions and the feeling of maximized presence for the patient

Fear of flying is subject to inter-individual variability and requires individualized and personalized care. One of the essential steps in this treatment is the prioritization of anxiety-provoking situations: concretely, certain phases of an airplane trip activate patient anxiety to a different degree. Thus, with the aim of respecting the postulates of the exposure, the patient will be able to experience virtually a plane trip in his integrity or else, depending on the typology of the disorder, place the subject directly on the problematic stage. Among these, the fear of flying program presents different stages to immerse the patient.

  • The airport entrance: this stage is one of the most anxiety-provoking for patients. During this phase, they will experience realistic interactions allowing them to apprehend the anxiety-provoking stimuli as a whole: waiting at the counter, modular display destination, interaction with the flight attendant, withdrawal of the ticket, sound stimuli and more.  Multi-sensory immersion offers a complete exhibition area for maximized behavioral therapy work.
  • Boarding gate: Here the patient begins a complex passage for an aviophobic person: the waiting before boarding the aircraft. The therapist has the option to schedule the wait before the announcement by the flight attendant. The waiting situation in an anxiety-provoking context gives access to the patient’s emotional, cognitive and behavioral experience. Generating the flow of these substrates is the key to achieving optimal therapeutic work. In addition, sound and visual stimuli in this scene act as emotional triggers to facilitate the goal of habituation.
  • Entering the aircraft: Here the patient is immersed at the entrance of the plane where she is welcomed by the flight attendant. As in reality, the patient will discover the interior of the aircraft when taking her seat while awaiting takeoff. Once this stage has been completed, the wait for the security brief before the plane’s departure can be proposed as an alternative exposure situation.
  • The take-off: The take-off is an anxiety-provoking phase for a many of people, including non-phobics. This is why, in a therapeutic setting and in view of the disorder encountered by aviophobes, it is essential to be able to expose the subjects in a virtual context where the degree of realism is preeminent. The C2Care engineers has worked on the development of this software with this perspective. Here, the patient will experience the sensations inherent in take-off: sound, visual stimuli and height sensations. The therapist has control over the addition or removal of stimuli in order to vary the severity of the exposure. This phase, like all the other steps present in the software, can be repeated as much as necessary until the dysfunctional response by the patient disappears.
  • In-flight: The exhibition takes place in the context of in flight where the therapist can change the weather. With a view of the window, the patient can observe her environment from the seat of the plane. Sitting next to other passengers, the realism of the virtual experience is in line with the proven experience of reality. The flight exposure can be graduated via the possibility of adding anxiety-inducing indices (rain, baby noises, etc.). In addition, under the supervision of the therapist, exposures to areas of turbulence are made possible. This type of exposure provides the therapist and his patient with a global understanding of the specificity of his disorder, thus enabling him to confront reality with solid knowledge.
  • Landing: The landing phase is also an important step in the treatment of aviophobia. The landing may cause a lot of concern and a very strong anxiety activation for the patient. C2Care Aviophobia software artificially generates the maintenance factors of the disorder to effect desensitization in patients. In order to allow the occurrence of the extinction of the dysfunctional response, this standard scenario can be repeated as many times as necessary.
  • Exiting the plane: During this last step, fear of flying patients will usually try to get out of the plane as quickly as possible. This behavioral manifestation has the short-term effect of reducing anxiety but, in the long term, reinforces the disorder. It is therefore necessary to target this phase in the exhibition work for the sake of completeness. The therapist can decide for himself how long to wait before letting the patient out of the plane. The patient will be exposed inside the plane, placed behind the queue.

In the past, treatment of aviophobia has been complex due to the difficulty to access required environments. The C2Care fear of flying software – a real virtual reality airline travel experience – overcomes all the difficulties inherent in exposure in vivo. In addition to the features listed above, the graduation can be refined by a subtlety present in the variations of the stimuli: insistence of the looks from passengers, change of the facial expressions of the avatars, additions of disturbing noises. The patient is also able to benefit from a visual aid for cardiac coherence. The stunning realism is the consequence of the use of the latest technologies (3D scan) for the creation of this software. Thanks to the multitude of sequenced situations, therapists are able to respond to therapeutic requests in a personalized manner. In fact, the importance and the respect of the hierarchy of the situations has been closely paid attention to, when designing the therapists controller for this application. Here the therapist is able to choose the suitable scenario for each stage of the assumption of responsibility. In this sense, the therapist will be able to respond to even the most urgent requests of aviophobes facing an imminent displacement situation since the scenes are infinitely reproducible.

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