The Flight Anxiety Situations Questionnaire and the Flight Anxiety Modality Questionnaire: Norms for people with fear of flying

Summary

Background

The Flight Anxiety Situations Questionnaire (FAS) and the Flight Anxiety Modality Questionnaire (FAM) are widely used in clinical practice and research studies. The aim of this study was to derive norms for people suffering from fear of flying completing the FAS and FAM.

Methods

The sample is composed of 2072 individuals suffering from fear of flying and 1012 non-patients. Means, standard deviations and percentile ranks for raw FAS and FAM subscale scores will be presented. Normative data are provided enabling the comparison of individual scores.

Results

The results showed a conspicuous difference between the patient and non-patient samples. As a whole the patient group scored higher on the scale assessing the level of anxiety experienced in different flight or flight-related situations and on the scale measuring the symptoms of anxiety or anticipatory anxiety in flight situations than the normal controls.

Conclusions

The findings of this study suggest that the FAS and FAM questionnaires can be applied in the investigation of fearful flyers and the normal population. A considerable number of flying phobics obtained scores in the clinically significant range on the subscales assessing anticipatory anxiety, in-flight anxiety, generalized flight anxiety, somatic complaints and cognitive complaints.

Introduction

There has been observed a considerable increase of interest in research on flight phobia during the last decades. The 3rd International Conference on Fear of Flying clearly revealed this growing interest. This world conference on fear of flying, held from 4 to 6 June 2007 at the Headquarters of the International Civil Aviation Organization (ICAO) in Montreal, showed that the group of participants, active in the field of fear of flying treatment, is growing. For the first time, it brought together representatives of major sectors of the world aviation community and academia, a group of professionals ranging from aviation psychologists and airline pilots to aviation lawyers. They discussed a wide range of causes and implications of fear of flying for air transport operations. The conference broadened the scope of fear of flying and recognized the need for a large prevalence investigation in different parts of the world. Fear of flying also included the myriad of events or occurrences that produce anxiety in passengers, potentially culminating in safety and security hazards, as well as negative financial repercussions for the airline industry. In a post-mortem conducted shortly after the Conference, it became evident that the phenomenon of fear of flying should from now on be addressed within the broader context of the overall physical and psychological health of passengers, and that this should be carried out under the guidance and auspices of the recognized world authority for civil aviation – ICAO. Civil Aviation Administrations should ensure that the prevalence of fear of flying is continuously recorded through regular surveys using standardized and comparable questionnaires.

As fear of flying is observed quite often in clinical practice and may cause social and professional impairment, the existence of appropriate assessment tools is of great importance. Although fear of flying pertains to a specific situation, it is still a complex phenomenon. Fear of flying is heterogeneous and not a unitary phenomenon, and appears to be composed of a number of separate fears.⁵ Alternatively, fear of flying can also be the effect of generalization of one of more natural environment phobias as described in the DSM-IV,² such as fear of heights, falling, storms, water, instability, and so on.³ Determinants, which are also important, are fear of loss of control and a great need to have control over a situation.9, 11 In other words, flight anxiety can be considered as the expression of other phobias or even a combination of phobias. There are different cues at different times that trigger fear of flying. Consequently, the construction of reliable and validated measures that reflects its complex structure is necessary. Self-report instruments are being used increasingly often to measure the severity of psychological disorders. This has led to the need for certain psychometric properties to be maintained across subjects and settings, so as to determine the suitability of use for a specific population.

Van Gerwen, Spinhoven, Van Dyck and Diekstra¹⁰ developed two self-report instruments that assess patients' feelings, attitudes and cognitions about specific flying-related events. Their purpose was to construct two questionnaires that cover different and complementary aspects of fear of flying. In particular, the Flight Anxiety Situations Questionnaire (FAS) is related to the level of anxiety produced by different air-travel situations, distinguishing between the preliminary phase and the actual flight; this scale covers a wide variety of situations related to the flight and allows for detailed assessment of the most relevant phobic stimuli for each patient. The second scale is the Flight Anxiety Modality Questionnaire (FAM) that focuses on anxiety responses, on the assessment of thoughts related to the danger of flying, and to the physiological sensations of anxiety while flying. The instruments were found to be cross-validated, with good internal consistency and external validity. Moreover, the subscales of the FAS and FAM were found to be sensitive to change in measuring treatment outcomes.

According to Jenkinson and McGee,⁶ the measures need to be practical, reliable, valid, discriminative and sensitive to change, but also normative data have to be available for the countries in which they will be used. The assessment of most of the psychometric properties of the FAS and FAM is already described.¹⁰ These questionnaires are already widely used. Besides the English and Dutch versions; they have also been translated into French, German, Hebrew, Italian, Icelandic, Korean, Portuguese, Spanish and Swedish. However, normative data for the Flight Anxiety Situations Questionnaire (FAS) and the Flight Anxiety Modality Questionnaire (FAM) still has to be collected. In order to improve the usability of the FAS and FAM for diagnostic and outcome monitoring purposes, scientific research and the necessary prevalence studies, these norms are of importance.

This study presents data obtained from fear of flying patients and non-patients, as assessed with the FAS and FAM. The mean raw scores of the two groups are compared. This comparison will enable us to determine to what extent and concerning which aspects of fear of flying the scores form persons with fear of flying are different from non-patients. Furthermore, an attempt was made to derive norms for the FAS and FAM questionnaires. Finally, we will discuss the observed differences between the two samples and possible factors contributing to such differences.