A novel treatment of fear of flying using a large virtual reality system
Abstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Virtual reality exposure therapy's effectiveness for the treatment of flying phobia has been demonstrated.
“Virtual reality exposure therapy (VRET) has become a popular alternative for in vivo exposure, and its effectiveness for the treatment of FP has been demonstrated (Botella et al., 2004; Cárdenas et al., 2016; Czerniak et al., 2016; da Costa et al., 2008; Riva et al., 2001; Rothbaum et al., 2006).”
From An internet-based treatment for flying phobia using 360° images: A feasibility pilot study (2022) · cites this paper as Czerniak et al., 2016
Cited by
Sorted by citations
Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0788-4 · Cited by 460 · see citing works
Virtual reality in the diagnostic and therapy for mental disorders: A systematic review
Wiebe, A., Kannen, K., Selaskowski, B., Mehren, A., Thöne, A.-K., Pramme, L., Blumenthal, N., Li, M., Asché, L., Jonas, S., et al. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102213 · Cited by 223 · see citing works
Guna, J., Geršak, G., Humar, I., Song, J., Drnovšek, J., & Pogačnik, M. (2018) · Future Generation Computer Systems · doi:10.1016/j.future.2018.08.049 · Cited by 82 · see citing works
Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis
Fernández-Álvarez, J., Rozental, A., Carlbring, P., Colombo, D., Riva, G., Anderson, P. L., Baños, R. M., Benbow, A. A., Bouchard, S., Bretón-López, J. M., et al. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.06.005 · Cited by 79 · see citing works
Using Siamese Neural Networks to Perform Cross-System Behavioral Authentication in Virtual Reality
Miller, R. A., Banerjee, N. K., & Banerjee, S. K. (2021) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr50410.2021.00035 · Cited by 72 · see citing works
“…real-world, virtual reality (VR) is being explored as a critical tool for a diverse range of essential services such as virtual education [11,27,32,57,70,75], retail [56,81], personal finance [8,77], virtual remote teleoperation and driving [33, 41, 50, 51, 67], and healthcare [7,13,18,39,42,52,69].”
BackgroundWithin-System and Cross-System Behavior-Based Biometric Authentication in Virtual Reality
Miller, R. A., Banerjee, N. K., & Banerjee, S. K. (2020) · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · doi:10.1109/vrw50115.2020.00070 · Cited by 59 · see citing works
“The rapid incorporation of virtual reality (VR) in non-recreational applications propagating everyday environments, such as healthcare [2, 13], education [9], and virtual remote teleoperation and driving [6,8, 12], necessitates the development of novel authentication techniques that do not use traditional PIN and 2D/3…”
BackgroundAjit, A., Banerjee, N. K., & Banerjee, S. K. (2019) · IEEE International Conference on Artificial Intelligence and Virtual Reality (AIVR) · doi:10.1109/aivr46125.2019.00012 · Cited by 56 · see citing works
Miller, R. A., Banerjee, N. K., & Banerjee, S. K. (2022) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr51125.2022.00060 · Cited by 44 · see citing works
“…(VR) in consumer domains with critical data such as surgical training [30,33], remote teleoperation and driving [29,34,44,45,52], healthcare [7,10,12,32, 35,46,53], education [9,26,28,51,54,55], retail [50,57], and personal banking [8,56], a large number of approaches have emerged to…”
BackgroundIdentifying institutional barriers when implementing new technologies in the healthcare industry
Kulkov, I., Tsvetkova, A., & Ivanova-Gongne, M. (2021) · European Journal of Innovation Management · doi:10.1108/ejim-02-2021-0093 · Cited by 42 · see citing works
Flight anxiety: investigating the role of airline service quality and flight crew’s competence
Batouei, A., Iranmanesh, M., Nikbin, D., & Hyun, S. S. (2019) · Asia Pacific Journal of Tourism Research · doi:10.1080/10941665.2019.1630457 · Cited by 37 · see citing works
“Fear of flying affects around 7–40% of the general population in industrialized countries (Busscher & Spinhoven, 2017; Czerniak et al., 2016).”
BackgroundTemporal Effects in Motion Behavior for Virtual Reality (VR) Biometrics
Miller, R. A., Banerjee, N. K., & Banerjee, S. K. (2022) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr51125.2022.00076 · Cited by 38 · see citing works
Kulkov, I., Berggren, B., Hellström, M., & Wikström, K. (2021) · Journal of Engineering and Technology Management · doi:10.1016/j.jengtecman.2021.101614 · Cited by 35 · see citing works
“Numerous VR applications contribute to overcoming different types of phobias or fears, like the fears of flying (Czerniak et al., 2016), public speaking (North et al., 2015), or spiders (Morina et al., 2015).”
BackgroundApplications of the metaverse in medicine and healthcare
Hulsen, T. (2023) · Advances in Laboratory Medicine / Avances en Medicina de Laboratorio · doi:10.1515/almed-2023-0124 · Cited by 36 · see citing works
“Patients su ff ering from certain phobias (e.g., agoraphobia [48], acrophobia [49], fear of fl ying [50]) or disorders such as posttraumatic stress disorder (PTSD) can be helped by applying ‘ exposure therapy ’ [51], in which they are exposed to situations that gives them an anxiety attack.”
BackgroundOvercome Acrophobia with the Help of Virtual Reality and Kinect Technology
Suyanto, E. M., Angkasa, D., Turaga, H., & Sutoyo, R. (2017) · Procedia Computer Science · doi:10.1016/j.procs.2017.10.062 · Cited by 24 · see citing works
Gesundheit 4.0 – Wie gehts uns denn morgen?
Müschenich, M., & Wamprecht, L. (2018) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-018-2702-6 · Cited by 23 · see citing works
Ribé-Viñes, J. M., Gutiérrez-Maldonado, J., Zabolipour, Z., & Ferrer-Garcia, M. (2023) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x23000119 · Cited by 19 · see citing works
“Czerniak et al .”
InfluentialGottlieb, A., Doniger, G. M., Hussein, Y., Noy, S., & Plotnik, M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.641393 · Cited by 19 · see citing works
“, claustrophobia) and may be comorbid to panic attacks and generalized anxiety disorder (Czerniak et al., 2016).”
BackgroundSelf-citationResearch on the characteristics of acrophobia in virtual altitude environment
Hu, F., Wang, H., Chen, J., & Gong, J. (2018) · IEEE International Conference on Intelligence and Safety for Robotics (ISR) · doi:10.1109/iisr.2018.8535774 · Cited by 18 · see citing works
Virtual Reality and Anxiety Disorders Treatment: Evolution and Future Perspectives
Serrano, B., Botella, C., Wiederhold, B. K., & Baños, R. (2019) · Virtual reality technologies for health and clinical applications · doi:10.1007/978-1-4939-9482-3_3 · Cited by 12 · see citing works
Gardini, V., Gamberini, G., Müller, S., Grandi, S., & Tomba, E. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11216463 · Cited by 8 · see citing works
“Virtual reality exposure treatment (VRET) in particular appeared to be a useful form of intervention to reduce behavioral avoidance in adults with specific phobias (such as flying, driving, going to the dentist, spiders) [41,44,45,54,55,60,61], social anxiety disorder [46], panic disorder with agoraphobia [50,51], and…”
BackgroundInfluentialAn internet-based treatment for flying phobia using 360° images: A feasibility pilot study
Mor, S., Botella, C., Campos, D., Carlbring, P., Tur, C., & Quero, S. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100510 · Cited by 7 · see citing works
Applications of the Metaverse in Medicine and Healthcare
Mittal, V., Upadhyay, P., & Sharma, A. (2024) · Information systems engineering and management · doi:10.1007/978-3-031-72418-3_7 · Cited by 3 · see citing works
Correia, C. M., Ventura, P. R., da Silva, H. C., Lobo, I., Paiva, J. M., Melani, M., Arantes, L., Raposo, A. B., Silva-Calpa, G. F. M., & Berger, W. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116784 · Cited by 1 · see citing works
Karner, A., Obenaus, L., Zhang, M., Lor, C. S., Kostorz, K., Pegler, D., Leopold, M.-L., Melinščak, F., Steyrl, D., & Scharnowski, F. (2024) · doi:10.31234/osf.io/ht2pr · Cited by 1 · see citing works
Virtual Reality For Missile Combat Simulation
Shi, X. (2017) · AIAA Modeling and Simulation Technologies Conference · doi:10.2514/6.2017-3672
Özgül Fobilerin Bilişsel Davranışçı Terapilerinde Sanal Gerçeklik Uygulamaları
KILIÇASLAN, Y. (2023) · Journal of Social Research and Behavioral Sciences · doi:10.52096/jsrbs.9.18.34
Aplicaciones del metaverso en medicina y atención sanitaria
Hulsen, T. (2024) · Advances in Laboratory Medicine / Avances en Medicina de Laboratorio · doi:10.1515/almed-2024-0004
“El metaverso también puede ayudar a los pacientes que padecen algunos tipos de fobias (p. e. agorafobia [48], acro-fobia [49], miedo a volar [50]) o trastorno de estrés pos-traumático (TEPT), a través de la ‘ terapia de exposición ’ [51], mediante la cual se expone a los pacientes a las situaciones…”
BackgroundKadınlarda Uçuş Kaygısı ile İlgili Deneyimlerin Tematik Analiz ile İncelenmesi
Halıcı, Ö. Y., Sarı, S., & Arıkan, S. (2025) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.1569324
Xiao, X., & Tang, W. (2026) · Lecture notes in computer science · doi:10.1007/978-3-032-29653-5_33
Martins, S., Vairinhos, M., Soares, S. C., Félix, A. L. S., Araújo, C. A., & Diniz, F. (2026) · Lecture notes in computer science · doi:10.1007/978-3-032-33500-5_31
Taking Flight: How Low‐Altitude Tourism Shapes Flight Anxiety
Hao, W., Han, E.-J., & Jittithavorn, C. (2026) · International Journal of Tourism Research · doi:10.1002/jtr.70410
- Authors
- Czerniak, E., Caspi, A., Litvin, M., Amiaz, R., Bahat, Y., Baransi, H., Sharon, H., Noy, S., & Plotnik, M.
- Affiliations
- Sheba Medical Center (IL)
- Venue
- Aerospace Medicine and Human Performance
- Publisher
- Aerospace Medical Association
- Published
- 2016-04-01
- Volume
- 87
- Issue
- 4
- Pages
- 411-416
- ISSN
- 2375-6314 (ISSN-L)
- 2375-6322
- OpenAlex
- W2320096428
- Cited by
- 34
- References
- 0
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 3
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Aerospace Medicine and Human Performance (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Physical Sciences › Engineering › Control and Systems Engineering › Simulation and Modeling Applications
- Keywords
- fear of flying, aviophobia, virtual reality exposure therapy, phobia treatment, anxiety reduction, subjective units of distress, avoidance behavior
- MeSH terms
- Adult, Humans, Male, Middle Aged, Phobic Disorders, Virtual Reality Exposure Therapy, Air Travel
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
