A novel treatment of fear of flying using a large virtual reality system

Efrat Czerniak, Asaf Caspi, Michal Litvin, Revital Amiaz, Yotam Bahat, Hani Baransi, Hanania Sharon, Shlomo Noy, Meir Plotnik*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Fear of flying (FoF), a common phobia in the developed world, is usually treated with cognitive behavioral therapy, most efficiently when combined with exposure methods, e.g., virtual reality exposure therapy (VRET). We evaluated FoF treatment using VRET in a large motion-based VR system. The treated subjects were seated on a moving platform. The virtual scenery included the interior of an aircraft and a window view to the outside world accompanied by platform movements simulating, e.g., takeoff, landing, and air turbulence. Relevant auditory stimuli were also incorporated. Case Report: Three male patients with FoF underwent a clinical interview followed by three VRETs in the presence and with the guidance of a therapist. Scores on the Flight Anxiety Situation (FAS) and Flight Anxiety Modality (FAM) questionnaires were obtained on the first and fourth visits. Anxiety levels were assessed using the subjective units of distress (SUDs) scale during the exposure. All three subjects expressed satisfaction regarding the procedure and did not skip or avoid any of its stages. Consistent improvement was seen in the SUDs throughout the VRET session and across sessions, while patients ' scores on the FAS and FAM showed inconsistent trends. Two patients participated in actual flights in the months following the treatment, bringing 12 and 16 yr of avoidance to an end. Discussion: This VR-based treatment includes critical elements for exposure of flying experience beyond visual and auditory stimuli. The current case reports suggest VRET sessions may have a meaningful impact on anxiety levels, yet additional research seems warranted.

Original languageEnglish
Pages (from-to)411-416
Number of pages6
JournalAerospace medicine and human performance
Issue number4
StatePublished - 1 Apr 2016


  • Anxiety
  • Phobia
  • Virtual reality exposure therapy


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