Written by Julie FACCINI

March 13, 2020

Aviophobia or fear of flying is an anxiety disorder of the family of specific phobias. It is very common, affecting about 10% of the French population and 20% of the world population. 

In order to treat this anxiety disorder, therapy through exposure to virtual reality appears to be the most appropriate therapeutic solution with an effectiveness proven by the scientific literature. Indeed, cognitive-behavioral therapies are today the most effective therapeutic method in the treatment of phobias. Exposure is central and determining in the therapeutic success. By definition, to achieve this success, it is necessary to expose the patient to aircraft-related stimuli, which are complex in in vivo exposure. C2Care has developed a software with optimal technological properties to meet the needs of behavioral, cognitive and emotional treatment of aviophobia. The application: an airport with ultra-realistic graphics, the key stages of an airplane trip with a sequential and controllable narrative process, multiple intra-environmental interactions, a maximized feeling of presence. 

Fear of flying is subject to inter-individual variability and requires individualized and personalized treatment. One of the essential steps in this treatment will be the prioritization of anxiety-provoking situations : In concrete terms, certain phases of a plane trip activate the patients’ anxiety to a different degree. Thus, in order to respect the postulates of the exhibition, the patient will be able to live virtually a plane trip in its integrity or, according to the typology of the disorder, to place the subject directly on the problematic stage(s). Among these, the software allows to live :

  • The entrance to the airport : 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 in their entirety: waiting at the counter, destination displayed in a modular fashion, interaction with the flight attendant, ticket withdrawal, sound stimuli… Multi-sensorial immersion offers a complete exposure ground for maximized behavioral work.

  • Boarding gate : Here, the patients begin a complex passage for an aviophobe: the wait before boarding. The therapist will be able to program the wait before the announcement on the flight attendant’s microphone. The situation of waiting in an anxiogenic context gives access to the emotional, cognitive and behavioral experience of the patient. Stimulating the flow of these substrates is the essential key to achieving optimal therapeutic work. In addition, sound and visual stimuli act as emotional triggers to facilitate the goal of habituation. 
  • Entering the plane : The patient will be immersed at the entrance of the plane where he will be welcomed by the hostess. As in reality, the patient will discover the interior of the plane as he takes his seat while waiting for takeoff. Once this step is completed, the wait ontarmac before the departure of the plane could be proposed as an alternative exposure situation.

  • The take-off : Take-off is an anxiety-provoking phase for many people, including non-phobics. This is why, in a therapeutic framework and with regard to 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. C2Care engineers have worked on the development of this software with this perspective. Here, the patient will experience the sensations inherent to the take-off: sound and visual stimuli, height sensations… The therapist will have control over the addition or removal of stimuli in order to vary the severity of the exposure. This phase, like all the other steps in the software, can be repeated as often as necessary until the dysfunctional response is extinguished..

     

  • Flight : The exhibition is carried out in a flight context with a weather modulable by the therapist. With a view on the window, the patient will be able to observe his environment from the plane seat. Seated next to other passengers, the realism of the virtual experience will be in adequacy with the experienced reality. The in-flight exposure can be graduated by adding anxiety-provoking cues (rain, baby noises…). In addition, under the control of the therapist, exposure to areas of turbulence are made possible. This type of exposure provides the therapist and the patient with a global apprehension of the specificity of the disorder, thus allowing the patient to confront reality with solid knowledge.

     

  • The landing : Again, this is an important step in the management of aviophobia. Landing arouses many worries and a very strong activation of anxiety. The C2Care Aviophobia software artificially generates the animation of the factors that maintain the disorder in order to desensitize the patients. In order to allow the extinction of the dysfunctional response, this typical scenario can be repeated as many times as necessary.

  • The exit of the plane : During this last stage, patients will almost automatically display avoidance behaviour and will try to get out of the plane as quickly as possible. This behavioral manifestation has the effect, in the short term, of reducing anxiety but, in the long term, reinforces the disorder. It is therefore necessary to target this phase in the exposure work in order to achieve completeness. The therapist will be able to determine himself the waiting time before getting off the plane. The patient will thus be exposed in the plane, placed behind the queue. 

Aviophobia has made its treatment complex because of the difficulty of access to suitable environments. The present software, a real virtual airport, makes it possible to overcome all the difficulties inherent in in vivo exposure. In addition to the functionalities listed above, the graduation can be refined by a subtlety present in the variations of the stimuli: insistence of the glances, change of the facial expressions of the avatars, addition of disturbing noises. The patient can benefit from a visual aid to cardiac coherence. The bluffing realism is the consequence of the use of the latest technologies (scan) for the creation of this software. Thanks to the multitude of sequenced situations, therapists will be able to respond to therapeutic requests in a personalized manner. Indeed, the importance and the respect of the hierarchy of the situations was underlined in the controller where the therapist will be able to choose the adequate scenario for each stage of the treatment. In this sense, the therapist will be able to respond to even the most urgent requests of aviophobes faced with an imminent displacement situation since the scenes are infinitely reproducible.

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