Desensitizing a pilot with a phobic response to required helicopter underwater escape training

INTRODUCTION: A systematic desensitization program designed to help aircrew who have a phobic anxiety of the Helicopter Underwater Escape Training (HUET) has been developed. CASE PRESENTATION: A student pilot presented with a severe phobic anxiety of the HUET course--a result of a being trapped underwater on a marine survival training course. A treatment team was assembled and concluded his phobia could be treated by a systematic desensitization method. An exposure matrix of graded difficulty of in/underwater escapes was performed over 2 d. The student reported that his confidence increased and anxiety reduced as he became accustomed to being strapped into a seat in the escape trainer while wearing increasingly difficult levels of equipment which increased the difficulty of escape, such as taking away nasal protection and goggles. At the end of Day 1, he was able to jettison the exit door/hatch while inverted underwater with a facemask and dressed in a simple coverall. At the end of Day 2, without nasal protection, inverted underwater, wearing full military equipment, he was able to cross the cabin, jettison the exit door, and successfully escape. DISCUSSION: A systematic desensitization treatment program can be used to successfully treat aircrew for phobia of the helicopter underwater escape trainer.     

Psychological differences noted in aircrewmembers undergoing systematic desensitization and their subsequent functioning

This study presents the results of a 3-year follow-up of patients treated for flight anxiety via relaxation/desensitization. Noted differences between successfully and unsuccessfully treated patients are discussed as well as the long-range effectiveness of relaxation/desensitization. Significant differences were noted on MMPI (Minnesota Multiphase Personality Inventory) scale elevations and major presenting symptoms. There was a significant relationship between specific MMPI profiles and failure to successfully treat flight anxiety. Individuals most likely to benefit from therapy were those subjects who exhibited normal MMPI profiles and manifested airsickness as their major presenting symptom.     

飞行学员情绪稳定性评定效标的验证性因子分析模型比较

目的 建立飞行学员情绪稳定性评价模型,为飞行学员情绪稳定性的评价提供效标工具。方法 通过与63名现役飞行员和飞行教员的结构式访谈,编制出有9个项目的“飞行学员情绪稳定性效标评价量表”;由该飞行员和飞行教员采用该量表对153名19～21岁飞行学员的情绪稳定性进行评价。结果 Spearman相关分析表明,除项目1外,其余8个项目间均存达显著性相关(P＜0．05);探索性因子分析显示,9个项目分为3个次级因子;验证性因子分析显示,模型4获得最佳验证效果。结论 飞行学员情绪稳定性效标体系由飞行操作稳定性、飞行前紧张和一般外显情绪组成。     

Stress management and factors related to the deployment of Italian peacekeepers in Afghanistan

This cross-sectional study evaluated the stress levels in Italian military personnel involved in a peacekeeping (PK) mission in Afghanistan and a homogeneous group stationed in Italy (SI group). The study was performed from April 2004 to June 2004 in a sample of 160 long-time, career volunteers of the Rossi Barracks of the Alpini di L'Aquila (Italy) (SI group, n=120; PK group, n=40). A 10-item, self-evaluation questionnaire proposed in the U.N. Stress Management Booklet was administered to each volunteer. The total item score (TIS) values for the 10 items for the two groups were calculated. These values were greater for the PK group than for the SI group for all 10 items. The TIS values were grouped into three classes of symptoms, anxiety symptoms (items 1-4), stress-induced depression (items 5-7), and posttraumatic stress (items 8-10). The class total item score (CTIS) values were then calculated as the sum of the respective TIS values. The three CTIS values for the PK group were greater than those for the SI group. In particular, the anxiety CTIS was 72 points greater in the PK group (p < 0.001). Therefore, the peacekeepers were inclined to have a greater increase in anxiety symptoms. Consequently, antipanic techniques could be used to reduce anxiety and progressive muscular relaxation training, an important preventive relaxation technique, to face stressors and to reduce clinical anxiety.     

Phobic fear of flying in aircrews: epidemiological aspects and comorbidity

BACKGROUND: Phobic fear of flying may affect aircrew members during any phase of their flying careers. Symptoms are beyond voluntary control and may lead patients to avoid flying and seek medical advice. METHODS: Of 1101 psychiatric files from our institute for 1985-2002, 150 represented cases of fliers who suffered from phobic fear of flying. Data collected from those files included assessment of fear-evoking situations, type of aircraft, class of aircrew duties, aircraft accident history, past medical history, age, and associated psychiatric comorbidity. RESULTS: We compared a group of 56 pilots with 94 other aircrew members. Results included 143 cases of flight phobia behavior and 7 cases of anxiety about parachuting. Flight phobia was less frequent among pilots (37.4%) than the other aircrew members (62.6%). We found a history of aircraft accident to the patient or an acquaintance in 25% of the cases. Observed comorbid psychiatric disorders (54%) consisted of depressive disorders (22%), anxiety disorders (16%), and personality disorders (7.4%). Fixed-wing pilots and aircrews members had a higher incidence of depression than did rotary-wing pilots and crewmembers (p < 0.05). Rotary-wing pilots and crewmembers had a higher rate of anxiety disorders (p < 0.05). DISCUSSION: Flight phobia encompasses a wide spectrum of clinical origins that may lead pilots or other aircrew members to refuse to fly. We recommend a careful psychiatric evaluation and close follow-up to adequately diagnose fliers with flight phobic reactions, as well as establishing adequate medical and/or psychological treatment.     

Virtual reality exposure in the treatment of fear of flying

BACKGROUND: Recently, a growing body of research has appeared on different aspects of virtual reality exposure (VRE) therapy applied to the treatment of anxiety disorders. The purpose of this article was to review with a systematic methodology the evidences that support the potential effectiveness of this therapy in the treatment of fear of flying (FOF), a problem that significantly affects patients' social functioning and personal welfare. METHODS: Potential studies were identified via computerized search using the PubMed/Medline and Web of Science databases, and additional review of their references. Articles ranged from 1969 to 2007 and the keywords used in the search were: "virtual reality" and "fear of flying"; "virtual reality" and "flying phobia"; or "virtual reality" and "flight phobia." RESULTS: There were 40 studies using VRE in the treatment of FOF identified, mostly on the effectiveness of VRE therapy in group and case studies. Several components of the treatment protocols differed among the studies, which made the results comparison a challenging task. Nevertheless, controlled studies demonstrate that VRE treatment is effective with or without cognitive behavior therapy (CBT) and/or psychoeducation and that it is considered to be an effective component of the treatment of FOF. CONCLUSIONS: All studies that used cognitive and relaxation techniques in addition to VRE treatment were effective. More randomized clinical trials are required in which VRE therapy could be compared with standard exposure therapy. Thus, we suggest that CBT, psychoeducation, and VRE could be combined to treat FOF.     

Determination of lumbar muscular activity in helicopter pilots: a new approach

BACKGROUND: Discomfort in the lumbar region is a frequent complaint of helicopter pilots. Two factors that helicopter crewmembers relate to back pain are exposure to vibration and poor posture during flight, because during flight the seat and controls force the pilot to adopt an asymmetric posture. Repeated exposure to these adverse flight conditions could cause pathological changes in the spine. The purpose of this study was to compare right and left sided lumbar muscular activity in helicopter pilots under real flight conditions, using surface electromyography (SEMG) to demonstrate the effects of asymmetrical posture on the musculoskeletal system. An attempt was also made to correlate lumbar muscular activity with environmental factors and such variables as type of flight, type of helicopter, duration of flight, age, physical fitness, and height. METHODS: Right- and left-sided lumbar electrical activity were measured using two-channel SEMG during 35 flights in 2 types of helicopter and a cockpit mock-up. RESULTS: There was a statistically significant increase in right-sided lumbar activity when related to the duration of flight. CONCLUSIONS: The data showed that when the pilot used the manual controls during flight, he did not maintain a symmetrical posture and contracted one side more than the other. We think the relationship between the greatest right-sided contraction and flight duration is due to maintaining an asymmetric posture over a long period. We also noted a tendency towards greater right lumbar musculature activity in older pilots.     

Passenger fear of flying: behavioural treatment with extensive in-vivo exposure and group support

The techniques used in the treatment of passenger fear of flying are described. They include behaviour modification techniques (relaxation, systematic desensitization, and cognitive restructuring), an educational programme, high in-vivo exposure, and group support. Results from self-rating scales and qualitative feedback from course participants during 1979-1985, show that the collective use of these techniques contribute significantly to a reduction of fear and discomfort associated with passenger flying.     

Noise, vibration and changes in wakefulness during helicopter flight

The investigation was carried out in cooperation with the helicopter school AF 1 in Boden. Measurements were made in two different types of helicopter, Hkp 3 and Hkp 6. Three different parameters were recorded during the flights: noise, vibrations, and wakefulness. Noise and vibration exposures were mainly correlated to the main rotor energy and frequency. Both types of exposure were dominated by lower frequencies, below 10 Hz. Analyses of wakefulness during long-distance flights, about 4 h, and short-distance flights, less than 2 h, were based on EEG and EKG recordings. As expected the level of wakefulness was influenced by the stress upon the pilots. Take-offs and landings, as well as unexpected events during the flight, were correlated to an increased level of wakefulness. In some cases flying was correlated to a gradual increase of weariness. The correlation between weariness, types of flying, and the external environmental factors of noise and vibration, is also discussed.     

The right and wrong stuff in civil aviation

Aircrewmembers (ACMs) enter a mortally hostile environment when they take off from Earth in their flying machines. Their physiological adaptation has been augmented and supported through ergonomics, avionics, and engineering, but no such technological aid helps them adapt their minds to that atypical condition. They must rely upon their own psychic resources, i.e. "aeronautical motivation" in the three levels of consciousness, and defense mechanisms to counteract their "aeronautical anxiety." Various relationships of motivation and defense give rise either to the flying adaptation syndrome or the various forms of the secondary flying disadaptation syndrome when ACMs must face the dangers of flight. These alterations of the ACMs' psychic balance may cause temporary or permanent medical disqualification due to the impairment of safety which they provoke. This paper proposes an analysis of the interplay between motivation, psychic defenses, and aviation stress to explain the manifestations of flight adaptation and disadaptation seen in some aircrewmembers.     

Different flying histories in flying phobics: association with psychopathology and treatment outcome

INTRODUCTION: Passengers experiencing fear of flying can threaten the safety of a flight, its passengers, and crew. In the present study we investigated the effect of different flying histories on the nature and treatment of fear of flying and attempted to determine the following: 1) the prevalence of different flying histories in a sample of self-referred flying phobics; 2) the demographic and psychopathologic characteristics of flying phobics differing with respect to flying history; and 3) the predictive value of different flying histories for treatment outcome. METHODS: Of 2001 self-referred adults who applied for a flying treatment program, 85.6% reported that they had flown before and that their flights had been uneventful; 8.7% had no previous experience with flying; 5.7% had flown before and had experienced an eventful (5.4%) or even a traumatic flight (0.3%). RESULTS: Participants who had never flown before reported higher levels of fear of flying (FAS, FAM, VAFAS), agoraphobia (FSS-III), and general anxiety (SCL-90). Moreover, these subjects showed significantly more anxiety reduction following a 1- or 2-d group treatment than the other participants (statistically corrected for any pretreatment differences). CONCLUSIONS: For participants who had never flown before, anxiety probably primarily reflects more generalized avoidance tendencies and a proneness to over-predict the magnitude and intensity of their fear.     

Cognitive coping and anxiety symptoms among people who seek help for fear of flying

INTRODUCTION: Fear of flying among potential passengers is rather common. In order to treat fear of flying most efficiently, it is important to find out which aspects are related to flight anxiety. The objective of the present study was to examine the extent to which various cognitive coping strategies in response to a flight were used by airline passengers and their relationship with anxiety symptoms. METHOD: A total of 261 persons who were all seeking treatment for fear of flying filled in the Cognitive Emotion Regulation Questionnaire, the anxiety subscales of the Symptom Check List (SCL-90), the Flight Anxiety Situations questionnaire, and the Flight Anxiety Modality questionnaire. RESULTS: Respondents reported using refocus on planning, rumination, putting into perspective to the highest extent and catastrophizing and other-blame to the lowest extent. Furthermore, respondents who reported using self-blame, acceptance, rumination, and/or catastrophizing to a higher extent also reported significantly higher levels of anxiety. DISCUSSION: As the present study suggests that several cognitive coping strategies are related to anxiety, intervention programs should pay attention to these aspects. The present study gives important clues about which cognitive coping strategies should be challenged in treatment of flight anxiety.     

Fear of flying treatment programs for passengers: an international review

BACKGROUND: There are facilities established around the world for treating passenger flight anxiety, often as a joint activity of airlines and private entrepreneurs or mental health professionals. In the scientific and professional literature, there is little information about how these facilities operate and what the components of their treatment programs are. This paper is the first review to date to provide this information. METHOD: There were 212 airlines and treatment facilities approached for information on treatment programs for flying phobia, 43 of which were active in this field. Extensive information could be obtained from 15, which were the best known and well-developed. Information was collected both with a questionnaire and by meeting representatives from 15 international fear of flying treatment facilities that participated in the First International Conference on Fear of Flying (Feb. 1996). RESULTS: Fear of flying among passengers is a phenomenon with epidemic proportions, effecting roughly 10-40% of the adult population. All treatment programs share two basic elements, an information component and a test flight. The programs vary considerably in terms of treatment components. However, there is little available information on efficacy. CONCLUSIONS: To date there is a wide variety between facilities for the treatment for fear of flying in terms of methods and protocols used. Experts agree on the clear-cut need for standardization of a "best" minimum protocol for fear of flying treatment programs for which the main components where identified.     

Evaluation of three psychologic interventions to reduce anxiety during MR imaging

The authors compared the effectiveness of three anxiety-reducing interventions for patients undergoing magnetic resonance imaging. Each of 50 subjects was randomly assigned to one of the interventions. Intervention 1 involved provision of information about the imager and nature of the examination. Intervention 2 included information and counseling. Intervention 3 included information and a 12-minute relaxation exercise. Anxiety levels were measured by means of a 20-item questionnaire before and after imaging. The latter provided a retrospective report of anxiety experienced during imaging. Patients in intervention group 3 showed significantly less increase in anxiety compared with those in groups 1 and 2. Overall, only patients who participated in intervention 1 showed a significant increase in anxiety during imaging. When anxiety levels experienced before and during the examination were compared, with the focus on each questionnaire item for each group, those in group 1 showed a significant increase in anxiety on eight of 20 items; those in group 2, three items; and those in group 3, none. Psychologic preparation that includes relaxation strategies is more effective than provision of information alone.     

Physiologic monitoring during civilian air medical transport

We used a questionnaire to survey the physiologic monitoring practices of 106 civilian helicopter flight programs in the United States. Respondents indicated whether they used specified items of equipment "all the time," "only as needed," or "never." Properly completed questionnaires were received from 94 of the 106 programs. Although basic EKG and blood pressure monitoring were done routinely by all programs, temperature was not measured by over half the programs. Less than 20% of programs are able to monitor systemic or pulmonary arterial pressures invasively during flight. Routine monitoring of the fetus is done only rarely during transport of high-risk obstetrical patients. We conclude that monitoring during air medical transport can be improved by taking better advantage of available technology.     

Anxiety in adult fixed-wing air transport patients

INTRODUCTION: Critically ill patients may experience anxiety because of the method of transport, possibly having an impact on both patients and their health care providers. The purpose of this research was to study the presence and degree of anxiety in fixed-wing air transport patients. METHODS: Subjects were 41 patients 25 to 79 years of age. Self-ratings of anxiety were obtained and vital signs were recorded at five predesignated points before, during, and after the flight. Additional questions addressed current and previous experiences and perceptions of flying. RESULTS: Anxiety ratings were generally low, averaging approximately 1.9 on a 1 ("worry-free") to 10 ("completely terrified") scale. Anxiety was greatest in anticipation of the flight. Fourteen percent of patients had never flown before; patients with little or no flight experience had significantly higher anxiety ratings. However, in all cases anxiety declined steadily as the flight progressed. Most patients (82%) reported greater worry about their medical condition than about the flight. CONCLUSION: Anxiety is generally low among adult fixed-wing air transport patients and decreases further over time. This decrease was true even for patients who initially reported high levels of anxiety before the flight. The data suggest that previous flight experience can be used to predict anxiety during air medical transport.     

The occurrence of the vection illusion among helicopter pilots while flying over water

U.S. Coast Guard helicopter pilots were questioned on the occurrence of the vection illusion while flying over water under different light and sea conditions. A total of 267 (79.9%) pilots completed the study questionnaire. The illusion of vection was experienced by 248 (92.5%) of these pilots. The majority of the pilots, 209 (84.6%), reported that dark rather than light visual conditions increased the likelihood of experiencing vection. Vection was considered likely to occur over rough seas by more pilots [114 (46.2%)] then over smooth seas [81 (37.8%)]. Several pilots commented that they had responded to the illusion with aircraft movement. The vection illusion is a common experience among helicopter pilots while flying over open water. Low light conditions and rough sea states are conducive to experiencing the vection illusion. Pilots may respond to the illusion with aircraft control movements, which raises flight safety concerns.     

Low back pain in the AH-1 Cobra helicopter

Pilots of the AH-1S helicopter maintain a vertical sitting position in the gunner's position (front seat), whereas in the pilot's seat (rear), they lean forward and to the left in order to operate the controls. A cross over study with pilots flying alternately in the front and rear positions was used to assess the effect of crew position on the prevalence of low back pain during flight. In the pilot's seat, there was an increased prevalence of pain (72.2%, 13/18 versus 55.6%, 10/18); the onset of pain was quicker than experienced in the gunner's position (64.3%, 9/14 versus 7.1%, 1/14, p less than 0.001); and the intensity was greater (85.7%, 12/14 versus 7.1%, 1/14, p less than 0.001). We conclude that posture is an important component of the low back pain experienced by helicopter pilots during flight.     

Influence of helicopter flight on temperature of helicopter EMS crewmembers

Introduction

Thermoregulation of critically ill patients during helicopter emergency medical service (HEMS) transport can be influenced by the flight, increasing the risk of hypothermia. However, the literature is unclear as to whether temperature decrease among those patients is affected by the flight itself or by the patients' clinical status and therapies. We evaluated the effect of helicopter flight on the body temperature of the healthy members of the HEMS crew of the Friuli Venezia Giulia region, Italy.

Methods

From August 12 to September 3, 2009, and from February 12 to April 1, 2010, tympanic temperature was measured, on a voluntary basis, before and after the flight among the crewmembers. The effect of flight and personal characteristics on temperature after the flight was analyzed through multivariate regression.

Results

Ninety-five records were analyzed. On average, the temperature increased by 0.2 ± 0.5°C. In 29.5% of the cases, however, it decreased. The only factors that were significantly associated with the temperature after the flight were temperature at liftoff and mountain rescue flights.

Conclusion

Among healthy subjects, the helicopter vibrations may induce an increase in body temperature. Small sample size and lack of information on a number of potential confounders prevented the identification of the possible determinants of a temperature decrease among some subjects.     

Task and postural factors are related to back pain in helicopter pilots

BACKGROUND: A previous survey by Shear et al. revealed a high prevalence of back pain in Royal Navy helicopter aircrew, compared with controls. It was recommended that a second survey be undertaken, taking account of flying tasks and cockpit ergonomics. This was the purpose of the present investigation. METHOD: A questionnaire containing items on back pain and posture was circulated to all 246 acting pilots, with returns of 75%. The questionnaire sought information on pain in both the flying pilot and co-pilot/instructor roles. RESULTS: The 12-mo prevalence of back pain was 80%. Task-related back pain was greatest in instrument flying (72%) and least in the co-pilot and instructor roles (24%). Self-ratings of posture indicated that forward flexed trunk postures predominated in the flying roles and were most extreme in instrument flying. In non-flying roles, symmetrical, reclining postures were more often reported. No demographic or psychosocial variables were significantly related to back pain prevalence or disability. CONCLUSIONS: Much of the back pain experienced by helicopter pilots appears to be due to the posture needed to operate the cyclic and collective controls. In instrument flying, it is suggested that the visual demands of scanning the displays may exacerbate the pain by causing the pilot to lean further forward.