Fear of flying--no longer a symptom without a disease.

This commentary accompanies the article "Fear of flying treatment programs for passengers: an international review," by Van Gerwen and Diekstra, a report on the international aviation community's approach to fearful air travelers. Most of the aeromedical literature has dealt with fear of flying in aircrew; little has been written about such fears among passengers. The aviation community has dealt with fearful passengers through variations in cognitive-behavioral methods, but without any underlying medical model. As a result, these programs go mainly unsupervised and unregulated, and do not address such matters as differential diagnosis, informed consent for treatment, clear therapeutic goals, organized follow-up, or outcome criteria and statistics. Treating agencies also tend to apply the same treatment methods to all applicants, in spite of emerging data that show that, in fact, different causes call for different treatments. This commentary reviews these findings in the larger context of the medical model and calls for further research along the lines developed by Van Gerwen and Diekstra (11).