Journal of Psychosomatic Research
Volume 69, Issue 3 , Pages 309-317 , September 2010

Physiological reactivity to phobic stimuli in people with fear of flying

  • Bert Busscher

      Affiliations

    • VALK Foundation, Leiden, The Netherlands
    • Department of Clinical, Health and Neuropsychology, Leiden University, Leiden, The Netherlands
    • Corresponding Author InformationCorresponding author. VALK Foundation, Postbox 110, 2300 AC Leiden, The Netherlands. Tel.: +31 715273733; fax: +31 715273796.
    • ,
  • Lucas J. van Gerwen

      Affiliations

    • VALK Foundation, Leiden, The Netherlands
    • ,
  • Philip Spinhoven

      Affiliations

    • Department of Clinical, Health and Neuropsychology, Leiden University, Leiden, The Netherlands
    • Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • Eco J.C. de Geus

      Affiliations

    • Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands

Received 18 April 2009 ,Revised 3 November 2009 ,Accepted 8 December 2009.

References 

  1. Van Gerwen LJ, Diekstra RF. Fear of flying treatment programs for passengers: An international review. Aviat Space Environ Med. 2000;71:430–437
  2. Dean RO, Whitaker NM. Fear of flying: impact on the U.S. air travel industry. J Travel Res. 1982;21:7–17
  3. Curtis GC, Magee WJ, Eaton WW, Wittchen HU, Kessler RC. Specific fears and phobias. Epidemiology and classification. Br J Psychiatry. 1998;173:212–217
  4. Depla MF, ten Have ML, van Balkom AJ, de Graaf R. Specific fears and phobias in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol. 2008;43(3):200–208
  5. Van Gerwen LJ, Spinhoven P, Diekstra RFW, Van Dyck R. People who seek help for fear of flying: Typology of flying phobics. Behav Ther. 1997;28(2):237–251
  6. Van Gerwen LJ, Spinhoven P, Diekstra RFW, Van Dyck R. Multicomponent standardized treatment programs for fear of flying: Description and effectiveness. Cogn Behav Pract. 2002;9(2):138–149
  7. Howard WA, Murphy SM, Clarke JC. The nature and treatment of fear of flying: A controlled investigation. Behav Ther. 1983;14:557–567
  8. Thyer BA, Himle J. Phobic anxiety and panic anxiety: How do they differ?. J Anxiety Disord. 1987;1(1):59–67
  9. Roth WT. Physiological markers for anxiety: Panic disorder and phobias. Int J Psychophysiol. 2005;58(2-3):190–198
  10. Van Gerwen LJ, Spinhoven P, Van Dyck R, Diekstra RFW. Construction and psychometric characteristics of two self-report questionnaires for the assessment of fear of flying. Psychol Assess. 1999;11(2):146–158
  11. Thyer BA, Papsdorf JD, Davis R, Vallecorsa S. Autonomic correlates of the subjective anxiety scale. J Behav Ther Exp Psychiatry. 1984;15(1):3–7
  12. Ekeberg O, Hedley L, Einvik G, Rostrup M, Hoffart A. Sympathetic reactivity in agoraphobic patients with and without personality disorders. J Psychosom Res. 2003;54(5):457–463
  13. Nesse RM, Curtis GC, Thyer BA, McCann DS, Huber-Smith MJ, Knopf AF. Endocrine and cardiovascular responses during phobic anxiety. Psychosom Med. 1985;47(1):320–332
  14. Lundgren J, Berggren U, Carlsson SG. Psychophysiological reactions in dental phobic patients during video stimulation. Eur J Oral Sci. 2001;109:172–177
  15. Jönsson P. Respiratory sinus arrhythmia as a function of state anxiety in healthy individuals. Int J Psychophysiol. 2007;63:48–54
  16. Johnsen BH, Thayer JF, Laberg JC, Wormnes B, Raadal M, Skaret T, et al. Attentional and physiological characteristics of patients with dental anxiety. Anxiety Disord. 2003;17:75–87
  17. Emmelkamp PM, Felten M. The process of exposure in vivo: Cognitive and physiological changes during treatment of acrophobia. Behav Res Ther. 1985;23(2):219–223
  18. Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Decreased heart rate variability in men with phobic anxiety (data from the normative aging study). Am J Cardiol. 1995;75:882–885
  19. Alpers GW, Wilhelm FH, Roth WT. Psychophysiological assessment during exposure in driving phobic patients. J Abnorm Psychol. 2005;114(1):126–139
  20. Lyonfields JD, Borkovec TD, Thayer JF. Vagal tone in generalized anxiety disorder and the effects of aversive imagery and worrisome thinking. Behav Ther. 1995;26:457–466
  21. Ekeberg O, Kjeldsen SE, Greenwood DT, Enger E. Correlations between psychological and physiological-responses to acute flight phobia stress. Scand J Clin Lab Invest. 1990;50(6):671–677
  22. James W. The physical basis of emotion. 1894. Psychol Rev. 1994;101(2):205
  23. Lange CG. The Emotions. Williams & Wilkins Company; 1922;
  24. Pollatos O, Herbert BM, Matthias E, Schandry R. Heart rate response after emotional picture presentation is modulated by interoceptive awareness. Int J Psychophysiol. 2007;63(1):117–124
  25. Pollatos O, Schandry R, Auer DP, Kaufmann C. Brain structures mediating cardiovascular arousal and interoceptive awareness. Brain Res. 2007;1141:178–187
  26. Richards JC, Bertram S. Anxiety sensitivity, state and trait anxiety, and perception of change in sympathetic nervous system arousal. J Anxiety Disord. 2000;14(4):413–427
  27. Craig AD. Interoception: The sense of the physiological condition of the body. Curr Opin Neurobiol. 2003;13(4):500–505
  28. Critchley HD. Neural mechanisms of autonomic, affective, and cognitive integration. J Comp Neurol. 2005;493(1):154–166
  29. Critchley HD, Wiens S, Rotshtein P, Ohman A, Dolan RJ. Neural systems supporting interoceptive awareness. Nat Neurosci. 2004;7(2):189–195
  30. Vanden Bogaerde A, De Raedt R. Cognitive vulnerability in fear of flying: The role of anxiety sensitivity. Depress Anxiety. 2008;25(9):768–773
  31. Smits JA, Powers MB, Cho Y, Telch MJ. Mechanism of change in cognitive-behavioral treatment of panic disorder: Evidence for the fear of fear mediational hypothesis. J Consult Clin Psychol. 2004;72(4):646–652
  32. Reiss S. Expectancy model of fear, anxiety, and panic. Clin Psychol Rev. 1991;11(2):141–153
  33. McNally RJ. Anxiety sensitivity and panic disorder. Biol Psychiatry. 2002;52(10):938–946
  34. Beckham JC. Emotional processing and fear measurement synchrony as indicators of treatment outcome in fear of flying. J Behav Ther Exp Psychiatry. 1990;21(3):153–162
  35. Wilhelm FH, Roth WT. Acute and delayed effects of alprazolam on flight phobics during exposure. Behav Res Ther. 1997;35(9):831–841
  36. Bornas X, Llabres J, Noguera M, Lopez AM, Barcelo F, Tortella-Feliu M, et al. Looking at the heart of low and high heart rate variability fearful flyers: Self-reported anxiety when confronting feared stimuli. Biol Psychol. 2005;70(3):182–187
  37. Ekeberg O, Kjeldsen SE, Eide IK, Greenwood DT, Enger E. Effects of beta-1-blockade and beta-2-blockade on blood-pressure and sympathetic responses to flight phobia stress. Clin Pharmacol Ther. 1990;47(5):599–607
  38. Ekeberg O, Ellertsen BB, Seeberg I, Kjeldsen SE. Plasma-catecholamines in some airline passengers. Scand J Clin Lab Invest. 1989;49(2):183–188
  39. Goedhart AD, Kupper N, Willemsen G, Boomsma DI, de Geus EJ. Temporal stability of ambulatory stroke volume and cardiac output measured by impedance cardiography. Biol Psychol. 2006;72(1):110–117
  40. Willemsen G, de Geus EJ, Klaver CH, Van Doomen LJ, Carroll D. Ambulatory monitoring of the impedance cardiogram. Psychophysiology. 1996;33(2):184–193
  41. Houtveen JH, Groot PF, de Geus EJ. Validation of the thoracic impedance derived respiratory signal using multilevel analysis. Int J Psychophysiol. 2006;59(2):97–106
  42. Goedhart AD, van der Sluis S, Houtveen JH, Willemsen G, de Geus EJ. Comparison of time and frequency domain measures of RSA in ambulatory recordings. Psychophysiology. 2007;44(2):203–215
  43. Riese H. Large-scale ensemble averaging of ambulatory impedance cardiograms. Behav Res Methods Instrum Comput. 2003;35(3):467–477
  44. Sherwood A, Allen M, Fahrenberg J, Kelsey R, Lovallo W, van Doornen LJ. Methodological guidelines for impedance cardiography. Psychophysiology. 1990;27(1):1–23
  45. Berntson G, Cacioppo J, Binkley P, Uchino B, Quigley K, Fieldstone A. Autonomic cardiac control: III. Psychological stress and cardiac response in autonomic space as revealed by pharmacological blockades. Psychophysiology. 1994;31(6):599–608
  46. Grossman P, van Beek J, Wientjes C. A comparison of three quantification methods for estimation of respiratory sinus arrhythmia. Psychophysiology. 1990;27(6):702–714
  47. Nousi A, Van Gerwen LJ, Spinhoven P. The Flight Anxiety Situations Questionnaire and the Flight Anxiety Modality Questionnaire: Norms for people with fear of flying. Travel Med Infect Dis. 2008;6(5):305
  48. Wolpe J. The practice of behavior therapy. New York: Pergamon Press; 1973;
  49. Reiss S. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24(1):1–8
  50. Vancleef LM, Peters ML, Roelofs J, Asmundson GJ. Do fundamental fears differentially contribute to pain-related fear and pain catastrophizing? An evaluation of the sensitivity index. Eur J Pain. 2006;10(6):527–536
  51. Rodriguez BF, Bruce SE, Pagano ME, Spencer MA, Keller MB. Factor structure and stability of the Anxiety Sensitivity Index in a longitudinal study of anxiety disorder patients. Behav Res Ther. 2004;42(1):79–91
  52. Alpers GW, Sell R. And yet they correlate: Psychophysiological activation predicts self-report outcomes of exposure therapy in claustrophobia. J Anxiety Disord. 2008;22(7):1101–1109
  53. Wilhelm FH, Roth WT. Taking the laboratory to the skies: Ambulatory assessment of self-report, autonomic, and respiratory responses in flying phobia. Psychophysiology. 1998;35(5):596–606
  54. Bosch JA, de Geus EJC, Veerman ECI, Hoogstraten J, Nieuw Amerongen AV. Innate secretory immunity in response to laboratory stressors that evoke distinct patterns of cardiac autonomic activity. Psychosom Med. 2003;65(2):245–258
  55. Bosch JA, de Geus EJ, Kelder A, Veerman ECI, Hoogstraten J, Amerongen AVN. Differential effects of active versus passive coping on secretory immunity. Psychophysiology. 2001;38(5):836–846
  56. Sarlo M, Palomba D, Angrilli A, Stegagno L. Blood phobia and spider phobia: Two specific phobias with different autonomic cardiac modulations. Biol Psychol. 2002;60(2-3):91–108
  57. Sarlo M, Buodo G, Munafo M, Stegano L, Palomba D. Cardiovascular dynamics in blood phobia: Evidence for a key role of sympathetic activity in vulnerability to syncope. Psychophysiology. 2008;45(6):1038–1045
  58. Pennebaker JW, Lightner JM. Competition of internal and external information in an exercise setting. J Pers Soc Psychol. 1980;39(1):165–174
  59. Pennebaker JW, Skelton JA. Selective monitoring of physical sensations. J Pers Soc Psychol. 1981;41(2):213–223
  60. Houtveen JH, Rietveld S, de Geus EJ. Exaggerated perception of normal physiological responses to stress and hypercapnia in young women with numerous functional somatic symptoms. J Psychosom Res. 2003;55(6):481–490
  61. Sturges LV, Goetsch VL. Psychophysiological reactivity and heartbeat awareness in anxiety sensitivity. J Anxiety Disord. 1996;10(4):283–294
  62. van der Does WAJ, Antony MM, Ehlers A, Barsky AJ. Heartbeat perception in panic disorder: A reanalysis. Behav Res Ther. 2000;38(1):47
  63. van der Does AJ, van Dyck R, Spinhoven P. Accurate heartbeat perception in panic disorder: Fact and artefact. J Anxiety Disord. 1997;43:121–130
  64. Ehlers A, Breuer P, Dohn D, Fiegenbaum W. Heartbeat perception and panic disorder: Possible explanations for discrepant findings. Behav Res Ther. 1995;33:69–76
  65. Schandry R, Bestler M. The association between parameters of cardiovascular function and heartbeat perception. In:  Vaitl D,  Schandry R editor. From the heart to the brain. Frankfurt am Main: Verlag Peter Lang. Europaischer Verlag der Wissenschaften; 1995;p. 105–120
  66. Schandry R, Bestler M, Montoya P. On the relationship between cardiodynamics and heartbeat perception. Psychophysiology. 1993;30:467–475
  67. Gross JJ, Levenson RW. Emotion elicitation using films. Cogn Emotion. 1995;9(1):87–108
  68. Hubert W, de Jong-Meyer R. Psychophysiological response patterns to positive and negative film stimuli. Biol Psychol. 1990;31(1):73–93
  69. Palomba D. Cardiac responses associated with affective processing of unpleasant film stimuli. Int J Psychophysiol. 2000;36(1):45–57
  70. Bornas X, Llabres J, Noguera M, Lopez AM, Tortella-Feliu M, Fullana MA, et al. Changes in heart rate variability of flight phobics during a paced breathing task and exposure to fearful stimuli. Int J Clin Health Psychol. 2006;6(3):549–563
  71. Bornas X, Llabres J, Noguera M, Lopez AM, Barcelo F, Tortella-Feliu M, et al. Self-implication and heart rate variability during simulated exposure to flight-related stimuli. Anxiety Stress Coping. 2004;17(4):331–339
  72. Wik G, Fredrikson M, Ericson K, Eriksson L, Stone-Elander S, Greitz T. A functional cerebral response to frightening visual stimulation. Psychiatry Res Neuroimaging. 1993;1:15–24
  73. Fredrikson M, Wik G, Annas P, Ericson K, Stone-Elander S. Functional neuroanatomy of visually elicited simple phobic fear: Additional data and theoretical analysis. Psychophysiology. 1995;32:43–48

PII: S0022-3999(09)00510-8

doi: 10.1016/j.jpsychores.2009.12.005

Journal of Psychosomatic Research
Volume 69, Issue 3 , Pages 309-317 , September 2010

Article Tools

* Image Usage & Resolution