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Anti Fear of Flying Seminar of Austrian: Physiological Recordings and Ratings
M. Trimmel, Medical University of Vienna, Austria
R. Wolfger, Austrian Airlines, Vienna, Austria
M. Burger, Medical University of Vienna, Austria
3rd World Conference on Fear of Flying, Montréal, Canada, June 4 – 6, 2007 M. Burger
Motivation of Study
Investigating physiological and psychological aspects (habituation, responses to specific aspects of flying, modulation by amount of fear) of people with flight anxiety during an anti fear of flying seminar by:
• Analysing autonomous arousal (HR, HRV)
• Oxygen saturation (SpO2)
• Stress (salivary cortisol)
• Perception of situation: Fear, aspects of control, physiologicalsensations, mood
Procedure of Seminar1st day: Information about anxiety and aviation with clinical
psychologist and professional pilot (headquarter Austrian). 2nd day: Confrontation – exposure in vitro exposure flight by
simulator training, relaxation training, cognitive restructuring, training of coping skills, visit air-traffic control (at airport Schwechat, technical base).
3rd day: Technical and aerodynamic info, visit of an aircraft in the hangar of the airport, relaxation training in the airplane, briefing and explanation of pilots and crew for the flight, scheduled commercial flight in Europe (London, Oct. 2004, n=14; Amsterdam, Mar 2005, n=13; London, Mai 2005, n=8) out and in.
Behavioral and Cognitive Group Treatment for Fear of Flying
(Van Gerwen, L., Dysart, R., Rondos, J., & Wolfger, R., 2006)
Concept behind Anti Fear of Flight Seminar:
• Training program in group-setting • Training by clinical psychologist and professional pilot • Information of relevant psychological factors involved in fear and
anxiety, cognitive model of panic and anxiety • Information about aerodynamics• Information about traffic control and meteorogical aspects• Relaxation exercises and breathing exercises• Coping skills: Learning skills for handling phobic problems, • Systematic de-sensation (visit airplane, simulator, real flights)• Building of personal fear hierarchies and acceptance of fear
Design, Subjects and Procedure
• 3 X 55 ANOVA design of Group (Control, Anxious, Highly Anxious) X Conditions (repeated factor)
• 24 Participants of anti fear of flying seminar • 9 Control persons• Procedure:
• ECG recordings during all days of seminar (Controls only during flights)
• SpO2: Spot measures 2-5 times per day• Cortisol: On the flights out during descend• Ratings of flight anxiety (pre- and post seminar)• Ratings of moods etc. on each day at specific epochs
Recordings and Equipment
Holter ECG - MK3 TOM for ECG recordings
Medilog simple view software for visualisation and analyzing of signals (ECG, HR, Respiration).
Finger- pulse- oxyometer (clip) for oxygen saturation and pulse.
Cortisol salvia sampling to determine the level of stress.
Measures (Variables)Ratings• Flight Anxiety Situations (FAS) questionnaire (Van Gerwen et al., 1999)
• Anticipatory Flight Anxiety Scale• In-Flight Anxiety Scale• Generalized Anxiety Scale
• Flight Anxiety Modality (FAM) questionnaire (Van Gerwen et al., 1999)• Somatic Modality• Cognitive Modality• Panic-score• Number of Panic-items rated
• State-Trait-Inventory (Spielberger et al., 1970) • State anxiety• Trait anxiety
• Fear and Mood: • physiological sensation (Cronbach alpha = .82) • diffuse fear (Cronbach alpha = .74) • cognitive fear (Cronbach alpha = .77) • unconfidence joyless. (Cronbach alpha = .90).
Measures (Variables)
Physiological variables • Mean heart rate (HR)
• Intervalls of 5 min• Only blocks with 5 successive valid PQRST-appearence were analysed
• Heart rate variability (HRV) calculated from N-N intervalls (4 kHz)• pNN50 (percent of sucessive N-N intervall >50 msec)• LF% (percent of power in the range of 0.04 Hz – 0.15 Hz of total power) • HF% (percent of power in the range of 0.15 Hz – 0.40 Hz of total power)• Log LF/HF
• Oxygen Saturation (SpO2)• From the fingerpuls by a clip
• Salivary cortisol
Overview of the procedure for 3 seminars(Seminar1: AMS, Seminar2: AMS, Seminar3: LON)
Moods: 6tSpO2: 5t CortisolHR, HRV: t21-55
Moods: 3t SpO2: 3t Cortisol HR, HRV: t8-20
Moods: 2tSpO2: 2t Cortisol HR, HRV: t1-7
VeryAnxiousn = 9
Mood+Fear: 6tSpO2: 5t CortisolHR, HRV: t21-55
Moods+Fear: 3t SpO2: 3t CortisolHR, HRV: t8-20
Moods+Fear: 2t SpO2: 2t CortisolHR, HRV: t1-7
Anxiousn = 15
Mood+Fear: 6t SpO2: 5t Cortisol HR, HRV: 24t
--------------------------------Controln = 9
Day 3Crew Real flights
Day 2Simulator
Day 1Theory
Post seminar
RATINGS
Pre seminar
RATINGS
Subjects in GroupsControls Anxious Highly Anxious
N 9 15 9Fem. 4 10 5Male 5 5 4Age 32.4 + 11.4 43.2 + 10.9 36.8 + 14.2BMI 22.8 + 1.4 24.96 + 3.96 23.98 + 4.4
Grouping of anxious Ss into “Anxious” and “Highly Anxious”FAS score general >31 andFAS total >47
No group difference (all p’s > .10) regardingnumber of flights taken fear level during the last flightInterventions against fearDemographic variables
Mean HR (bpm)
70,00
80,00
90,00
100,00
110,00
120,00
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n d1
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ar
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ain,
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ing
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ing
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ding
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nes
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fligh
t in
10 m
in
fligh
t in
30 m
in
10 m
in to
land
ing
in
land
ing
in
0 Controls (n=9)1 Anxious (n=15)2 Highly Anxious (n=9)
Day 3
real flight Day 1
therory Day 2
flight-simulator
Take-off 1 Take-off 2
3 h 6 h 12 h
Summarized results of ANOVAs for mean HR and HRV measures of real flights
Group Condition Group x ConditionF(2, 30) F(23, 690) F(46, 690)
Mean HR 4.26* 36.63*** 2.24***pNN50 0.72 2.19** 1.64**Log LF/Hf 1.20 1.61* 1.75**HF% 1.28 1.78* 1.22LF% 5.33* 2.32*** 1.84***
Note: * p < .05, ** p < .01, ** p < .001
Mean Heart Rate +/- 95% CI
hbohse
htrhst
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rsertr
rstrfl
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rdordoc
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Condit ion
60
70
80
90
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140
Mea
n H
R (b
pm)
Controls Anxious Highly Anxious
Flight out Flight inShop
pNN50 +/- 95% CI
hbohse
htrhst
hflhflc
hflcchdo
hdochdocc
hldy
dycrbo
rsertr
rstrfl
rflcrflcc
rdordoc
rdoccrl
-0,10
-0,05
0,00
0,05
0,10
0,15
0,20
0,25
pNN
50
Gruppe Controls Gruppe Highly Anxious Gruppe Anxious
Flight out Shop Flight in
HF% +/- 95% CI
hbohse
htrhst
hflhflc
hflcchdo
hdochdocc
hldy
dycrbo
rsertr
rstrfl
rflcrflcc
rdordoc
rdoccrl
-0,04
-0,02
0,00
0,02
0,04
0,06
0,08
0,10
0,12
0,14
0,16
0,18
0,20
0,22
HF%
Controls Highly Anxious Anxious
Fligh Log LF/HF +/- 95% CI t out
Shop Flight in
LF% +/- 95% CI
hbohse
htrhst
hflhflc
hflcchdo
hdochdocc
hldy
dycrbo
rsertr
rstrfl
rflcrflcc
rdordoc
rdoccrl
0,0
0,1
0,2
0,3
0,4
0,5
0,6
LF%
Controls Highly Anxious Anxious
Shop Flight inFlight out
Log LF/HF +/- 95% CI
hbohse
htrhst
hflhflc
hflcchdo
hdochdocc
hldy
dycrbo
rsertr
rstrfl
rflcrflcc
rdordoc
rdoccrl
0,2
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1,2
Log
LF/H
F
Controls Highly Anxious Anxious
Shop Flight inFlight out
Salivary Cortisol Concentration during flight out of Vienna +/- 95% CI
Controls Anxious Highly Anxious-10
-5
0
5
10
15
20
ng/m
l Cor
tisol
Saturation of Oxygen during real flights +/- 95% CI
D3 Lounge D3 nach Start D3 Sinkf lug D3 nach Start R D3 Sinkflug R92
93
94
95
96
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100
SPO
2%
Controls Anxious Highly Anxious
Take off 1 Take off 2
Moods: Physiological Sensation
seating flight descend seating flight descend-0,5
0,0
0,5
1,0
1,5
2,0
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4,5
phys
iolo
gica
l sen
satio
n
Controls Anxious Highly Anxious
Out In
Moods: Cognitive fear
SeatingFlight
DescendSeating
FlightDescend
-1
0
1
2
3
4
5
6
Cog
nitiv
e Fe
ar
Controls Anxious Highly Anxious
Out In
Moods: Diffuse fear
SeatingFlight
DescendSeating
FlightDescend
-0,5
0,0
0,5
1,0
1,5
2,0
2,5
3,0
3,5
4,0
4,5
5,0
5,5
6,0
Difu
se F
ear
Controls Anxious Highly Anxious
Out In
Moods: Unconfidence, Joyless
SeatingFlight
DescendSeating
FlightDescend
-1
0
1
2
3
4
5
6
7
Unc
onfid
ent,
Joyl
ess
Controls Anxious Highly Anxious
Out In
State-Trait-Anxiety pre-post Seminar
PRE POST15
20
25
30
35
40
45
50
Stat
e A
nxie
ty S
core
High Anxious Anxious
PRE POST30
35
40
45
50
55
60
65
70
75
80
85
90
Trai
t Anx
iety
PR
High Anxious Anxious
Flight Anxiety Modality (FAM) Questionnaire Pre-Post-Seminar
Highly Anxious
SomaticCognitive
PanicNumber Pnaic
-10
0
10
20
30
40
50
60
70
80
90
100
FAM
Sco
res
Anxious
SomaticCognitive
PanicNumber Pnaic
PRE-Seminar POST-Seminar
Flight Anxiety Situations Questionnaire (FAS) Pre-Post-Seminar)
Highly Anxious
InflightAnticipatory
General-10
0
10
20
30
40
50
60
70
80
90
Scor
es F
AS
Anxious
InflightAnticipatory
General
Pre-seminar Post-seminar
Discussion• Fear of flying is associated with higher HR
• 15 bpm during 2nd flight• 20 bpm after 2nd flight
• Maximal HR appear during boarding (also in Controls where they displayed the same HR as Anxious)
• HR during start is associated with fear• Highly anxious show a remarkable acceleration of HR
contrary to other groups• HRV (pNN50) indicate a high sympathic activity in
Controls at boarding which disappears during flight.
• After 2nd flight a relaxation response appear in Controls only.
• HF (parasympathic impact) was most prominent in Controls – after start) and had in general the lowest influence in High Anxious.
Discussion• Autonomic balance (LF/HF) indicate
• a relative high sympathetic load during boarding in Controls
• A rise of load during flight in High Anxious• Cortisol indicated high stress in Anxious and High
Anxious -- at least in the first flight. • SpO2 indicate that oxygen saturation may be
modulated by flight anxiety.• Ratings of moods indicate a systematic decrease
during flights and by flights.• Comparing pre-post FAS and FAM there is clear
evidence that participants of anti fear of flying seminar displayed a remarkable change in fear.
Thanks
• For your attention
pNN50
ANOVA for LF/HF of 1st and 2nd day of seminar Aktueller Effekt: F(16, 352)=2,2124, p=,00481
Means +/- 95% CI
b1b1c
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R1
0,1
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1,0
Log
HF/
HF
Gruppe sehr ängstlich Gruppe ängstlich
ANOVA for mean HF% during 1st and 2nd seminar day, +/- 95% CI
Aktueller Effekt: F(16, 352)=1,8380, p=,02532
b1b1c
thethec
theoccb2
b2cb3
b3csbo
ssesst
stusfl
sresdo
sl-0,05
0,00
0,05
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0,20
0,25
HF%
Gruppe sehr ängstlich Gruppe ängstlich