Anxiety at 35,000 Feet

An Introduction to Clinical Aerospace Psychology

Robert Bor

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429910876
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book covers the mental health and psychology of pilots, including the psychological requirements for certification, environmental challenges, psychological problems among air crew, the effects of disruption to personal relationships, alcohol and drug misuse, and pilot reactions to accidents.

CHAPTER ONE

Towards the development of clinical aerospace psychology

On 11 September 2001, millions of people watched in horror as two commercial airliners crashed into the World Trade Center in New York City, one into the Pentagon in Washington, D.C., and a further one into a field in Pennsylvania. This constituted one of the most terrifying and audacious terrorist attacks experienced. Mental health professionals the world over could never have anticipated the psychological repercussions of such events. The images of the large commercial jets slamming into the sides of the Twin Towers–often replayed on television and reprinted in magazines and newspapers-have now become indelibly branded on our consciousness. Some clients and patients have discussed these events and their wider implications with trained therapists, and sometimes, too, with a new quality of anxiety.

It is reasonable to assume that every psychotherapeutic encounter has become affected by recent world events in a number of different ways. For many people, the terrorist attacks have aroused previously palpable feelings of insecurity and lack of safety that might have emerged in therapeutic work in other ways. Others who had been seasoned travellers have now developed an overt phobic reaction, or a fear of flying.

For those of us working in the mental health profession, we have become quite used to the notion that a fear of flying is irrational-something experienced by phobic and anxious personalities. Several decades ago, this problem might have been ascribed to those with “histrionic personalities”. We now find ourselves on the cusp of revising this position, because it may be that in spite of statistical reassurance about the safety of air travel, none of us can be certain of this reassurance any more.

Some readers–even mental health professionals themselves-may be surprised to learn that psychologists and psychotherapists have been closely associated with the airline industry for many years, working to support and consulting to passengers, aircrew, and airlines. This speciality is known as “clinical aerospace psychology”. We felt that the time is now ripe to better publicize this speciality, in the hope of making help better available and to further enlist the cooperation of mental health colleagues from cognate divisions of the psychological professions.

Psychologists working in the field of aerospace have concentrated, by and large, on certain ergonomic aspects of psychological consultation to the airline industry. They have, for example, developed better physical working conditions for pilots, improved the layout of the flight deck instruments, helped to eliminate potentially dangerous ambiguity in the communication between air traffic controllers and pilots, and taught crews how to operate more safely through Crew Resource Management (CRM). They have also studied the effects of jet lag in order to advise how best to mitigate against the unpleasant effects. A sub-speciality within aerospace psychology is clinical aerospace psychology, which is concerned with the mental aspects of aviation, and the insights are typically applied to helping to understand the behaviour of crew, passengers, maintenance personnel, air traffic controllers, and others involved in commercial and military aviation (Bor, 2003a; Bor & Van Gerwen, 2003).

Air travel, together with the aerospace industry, constitutes one of the world’s largest industries. Yet, it was only a little over 100 years ago-on 17 December 1903, on a bitterly cold day–that the Wright brothers flew a distance of 120 feet in twelve seconds from the dunes at Kill Devil Hills in Ohio, heralding the age of modern flight. They could not have imagined the subsequent developments in aviation and space exploration that followed over the last century, which have been both rapid and stunning. Air travel affects so many aspects of our lives and how we able to relate, although these developments are now largely taken for granted. However, flight directly challenges our evolutionary capabilities because, as a species, we have not evolved naturally to fly. While most travellers appear to adapt to the physical and psychological demands of modern air travel, various penalties may be exacted in the course of doing so, and some may suffer from jet lag, a fear of flying, or travel stress. For a proportion, air travel poses an insurmountable challenge that may present in clinical settings. Until recently, a deeper understanding of these and related problems associated with air travel had not been readily available to mental health practitioners. This book seeks to remedy this in relation to certain key areas of practice.

Some of the other areas that are considered in the ever-widening arena of clinical aerospace psychology include: psychological treatment for fear of flying, helping passengers to cope with the disrupted attachments that occur as a result of boarding an aeroplane, assisting the aircrew in the management of their own fears and anxieties inherent in their job situation, as well as contributing their expertise to the selection of aircrew (pilots and cabin crew). Readers who require an understanding of the physiological and health-related aspects of air travel should consult Jane Zuckerman’s (2001) excellent book on the topic. In the safety-conscious climate of the modern era, there is also in certain cases a behind-the-scenes profiling of passengers. Psychologists are also concerned with developing ways to help airport managers and ground crew to become better resourced in their work to ensure greater job satisfaction and safety. An important further role is to provide post-incident counselling to survivors, family members, crew, and other employees who have become involved in airline incidents and disasters. We also know that long-haul, transmeridian air travel can often exacerbate previously existing mental health disorders, and, thus, the diagnosis and treatment of such individuals will become an increasingly important area for mental health practitioners to consider (Jauhar & Weller, 1982). Returning travellers are also at increased risk of psychiatric illness due to a multitude of problems, ranging from homesickness and not coping well with change to the side effects of antimalarials and the effects of illicit drug use, among many possible triggers (Beny, Paz, & Potasman, 2001).

Many airline and military pilots regard the potential value of psychology as quite risible. This deep scepticism towards psychologists stems, perhaps, in large measure from the long-standing historical use of psychometric testing in both the initial selection of pilots for training and, later, in job promotion. Some airline workers hold a rather narrow notion of the breadth and scope of the mental health profession, and it is hoped that this concise book will help to better explain the role of the clinical aerospace psychologist or psychotherapist. Especially in an industry that privileges physical safety and robustness of pilots, airline workers may be loath, in such a machismo community, to seek professional help for mental health difficulties or anxieties and, understandably, regard mental health workers with suspicion. In a profit-driven industry, mental health welfare tends to be marginalized and regarded as a luxury, unless a pilot becomes overtly depressed or alcoholic. Airlines have not been particularly knowledgeable about or sensitive to brewing stresses in their employees.

It is axiomatic that aviation involves extensive teamwork. As psychologists and psychotherapists, we can draw on the enormous amount of research and clinical experience about the dynamics of group interactions that we can bring to bear to the aviation industry (Foushee, 1984). Our knowledge of difficulties stemming from small-group interaction, sibling rivalry, complications arising from hierarchical interactions, and so forth, can all help to shed light on what might occur on the flight deck and among passenger-crew relationships.

Finally, whereas previous advertising for air travel concentrated on the leisure and pleasure of flying, our current preoccupations will be with safety and low-cost air travel. Airlines will have to face the problem of coping with new advertising strategies. This will be an arena in which psychologists might make a further important contribution, assisting the airline advertisers to become increasingly sensitive to the fears that are experienced by millions of contemporary airline travellers worldwide.

The aim in preparing this short book is to introduce mental health practitioners to the basic concepts of clinical aerospace psychology, with a primary emphasis on psychotherapeutic and clinical psychological issues that may present among passengers and aircrew, rather than those of ergonomics, which have previously dominated this arena. Readers are provided with an up-to-date and condensed account of current practices and issues in this burgeoning and increasingly important speciality within psychology. A variety of inter-related topics are explored, ranging from the mental health of airline pilots to the causes and treatments of travel phobias. Some overt psychological recommendations are also given for ways in which mental health workers might improve the psychological well-being of those who fly on planes. Some of the issues raised will be able to impact directly on efficiency, safety, and security in the airline industry.

One aim in preparing this book has been to avoid, wherever possible, psychological jargon, to which our profession has become so increasingly prone, so that this book may be profitably enjoyed by both mental health colleagues and those who work in the airline industry. We hope that the book will also be of use to those colleagues who do not anticipate developing their expertise further in the field of clinical aerospace psychology, but who nonetheless seek a deeper understanding of some of the issues. Some of these will be working with clients or patients who bring their travel-related fears and phobias (whether rational or irrational) into the clinical consulting room. The remainder of the book provides an overview of some of the main current issues and psychological perspectives relating to these broad topics.

CHAPTER TWO

Understanding passenger behaviour

Air travel has never been so accessible to travellers. An estimated one billion people worldwide make at least one plan trip each year. Unfortunately, the dream of flight nurtured by Leonardo da Vinci and the Wright brothers is sometimes tarnished by stress and anxiety. Less than four decades ago, air travel was exciting, attracting a small number of the elite and wealthy passengers, and although sometimes dangerous, it was usually a great adventure that enabled people to travel at greater speeds than ever before. Passengers were both pampered and obedient. The advent of large commercial aircraft in the 1960s, in an industry of mass air transportation, and cheap accessible flights has changed all this. Airline advertisements continue to raise expectations among air travellers, because the product being promoted is still being perceived as glamorous. Disappointment sets in when expectations are not met, and high levels of stress may be one outcome.

Man has not naturally evolved to fly, as the psychologist, James Reason reminded us (1974). Even though as a species we have evolved over millions of years, our bodies are largely still designed to hunt and gather in small groups, probably on the plains of Africa. We remain a species that is best designed and equipped to be self-propelling at a few miles per hour in two dimensions under the conditions of terrestrial gravity (Reason, 1974). There are several obstacles and “physical evolution barriers” to our position or motion senses, as well as our capacity for processing information, that is apparent to both the novice air traveller and the most seasoned pilot. While there have been remarkable achievements in engineering over the past century that have made air travel both possible and highly accessible within the span of a single lifetime, this has not been without its challenges. When evolutionary barriers to motion are exceeded, numerous penalties are exacted, the most common of which are motion sickness, jet lag, and increased arousal and stress. For flight crew, there may be additional problems related to judgement, decision-making, perception, and concentration, among others. Air travel often brings us into close contact with strangers, and an understanding of the social psychology of behaviour within groups and teams is relevant. Emerging problems, such as the advent of larger commercial aircraft and flying greater distances non-stop, are likely to become increasingly challenging in years to come. Air travel disrupts human relationships and behaviours, as well as bodily functions and systems.

Stress may begin long before passengers set out for the airport: making travel arrangements, preparing to leave home, and saying goodbye to family, friends, or colleagues can all increase stress and distress. Frequent air travel may also disrupt relationships. Psychologists have studied relationship dynamics among both aircrew and passengers and examined attachment patterns in “intermittent spouse” relationships, by which is meant disruption to enduring personal relationships by the comings and goings of the frequent traveller–whether business-person or pilot. In one study, attachment behaviour in adults (measured by avoidance and anxiety levels) and symptoms of emotional distress (e.g. insomnia, emotional upset, feelings of isolation) were found to be affected by relationship status, length, and strength, with anxiously attached partners displaying or suffering greater distress (Fraley & Shaver, 1998). Crowds at airports, or the close proximity of fellow travellers on board aircraft, coupled with noise, apprehension about travel, fatigue, hunger, emotional arousal due to separation from a loved one, as well as language and communication difficulties can test even the most resilient and healthy of air travellers.

Most passengers have expectations about travel, and these may be built around punctuality, quality of service, or amenities available at airports or on board aircraft. Many travellers will attempt to cope with the anxiety of flying by relying upon what psychoanalysts refer to as “transitional objects” or comforters, such as magazines and sweets, a personal stereo, alcohol, and so forth, as familiar sources of pleasure to ease the stress of separation from terra firma. When little sources of comfort (such as a chicken dinner instead of beef or a sufficiently warm towel to wipe one’s face) are not provided, then primitive distress may ensue.

There are times when passengers’ expectations are not met, due to delays or poor service. These may be predictable, but they are no less annoying as a result. We have learned that passengers react differently to stress. Some resort to alcohol ingestion to relieve boredom, anxiety, or irritation. Others become militant about what they believe to be their rights, and they may become insistent or hostile towards ground staff or cabin crew. Another sub-group of passengers become quite withdrawn or servile, enduring things that they would not do ordinarily. Still others reach for medication to reduce anxiety or to induce sleep. Paradoxically, some of these coping strategies may further aggravate the situation and increase stress, as they directly effect people’s behaviour, their ability to cope with demanding situations, and their cognitive abilities in general.

In view of all the potential disruption to one’s lifestyle at 35,000 feet, even the well-heeled traveller who flies frequently will find himself or herself in both physically and emotionally unfamiliar territory, and this setting can readily prime the individual to become anxious and irascible. Each air traveller must develop his or her own strategies to make the journey more manageable. As psychologists, we have a role to play in educating passengers about what some of the anxieties might be, so that these fears can be made more conscious, rather than simmering away unconsciously (Bor, 2003a).

Fear of flying

For some passengers, the ordinary anxieties of travelling reach more insidious levels and can come to constitute a constellation of symptomatology known formally as “fear of flying”. A fear of flying ranges from minor and usually transient apprehension at one end of the scale, either in anticipation of or during an actual flight, which does little more than cause the smallest amounts of psychological turbulence and which soon disappears. At the other end of the scale, one can be presented with a full-blown phobic reaction, which can even result in a breakdown at an airport, with the potential passenger in hysterics and tears, vomiting, and even refusing to board the aeroplane. Some of these people will, in fact, never have boarded an aircraft. As Mark Twain remarked, many anxious people spend their lives “suffering from tragedies that never occur”.

While there is an increasing amount of published literature on the psychological treatment of fear of flying (e.g. Bor & Van Gerwen, 2003), many unanswered questions remain about the causes, classification/diagnosis, epidemiology, and spectrum of symptoms of the problem. In DSM-III-R (APA, 1987), fear of flying was listed and defined as a simple phobia. Subsequently, as with many other psychological disorders, this conceptualization was revised. In DSM-IV, fear of flying was placed in the category of specific phobias (APA, 1994). This is not, however, entirely helpful to either the clinician or the researcher. A fear of flying can be a sub-category or main category of one or more other phobias, such as claustrophobia and a fear of confinement. Equally, a fear of flying may be a symptom of the effect of generalization of another phobia that is common in certain environmental conditions described in DSM-IV (APA, 1994), such as a fear of heights, instability, or falling, among others. Understandably, mental health practitioners–both clinicians and researchers–sometimes disagree over the diagnosis and classification of fear of flying.

Psychologists can measure the fear of flying with a certain amount of objectivity through the use of standardized psychometric tests specifically developed for this purpose (Van Gerwen, Spinhoven, Van Dyck, & Diekstra, 1999). Although some people score much more highly on these tests than do others, even those reporting only a mild fear of flying should be treated seriously by mental health professionals, as the suffering is relative from person to person. Furthermore, as has already been pointed out, a fear of flying may also be a symptom of another underlying psychological problem.

Two questions emerge–namely, what causes a fear of flying, and why is everyone not affected in the same way when presented with the same potential threat? There are several different causes of the fear of flying, and the main ones are listed below:

1. Lack of familiarity. The person is certain that if he or she flies, the plane will crash, and death will follow. The patient looks at the plane and surmises that given its weight and structure, it cannot possibly be supported or lifted by moving air. Patients also fail to understand or to accept that air traffic controllers maintain separation between aircraft, and that pilots can still land the plane, even in conditions of poor visibility. People are distressed by any unfamiliar sounds in the aircraft cabin, or turning motions. They scrutinize the crew’s faces for indications that something is terribly wrong and seldom leave their seat during flight. These people often have large gaps in their knowledge of how planes fly, or have distorted the information of safety statistics and information that is available.

2. Past experiences. Previous experiences of delays, turbulence, or of aborted take-offs or landings may instil fear that becomes more pronounced when the person has to go on another journey. This is in spite of the fact that the person has already survived an unpleasant experience. The fear is th...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• SERIES FOREWORD
• ABOUT THE AUTHORS
• FOREWORD
• 1 Towards the development of clinical aerospace psychology
• 2 Understanding passenger behaviour
• 3 The mental health of pilots
• 4 The psychodynamics of travel phobia: a contribution to clinical aerospace psychology
• 5 Clinical aerospace psychology in the future: a dialogue
• REFERENCES
• INDEX