What Research Shows for Fear of Flying, Phobias, and CBD
September 15, 2019
You're in good company actually.
One study looked at flight crews and fear of flying:
Flight phobia was less frequent among pilots (37.4%) than the other aircrew members (62.6%).
https://www.ncbi.nlm.nih.gov/pubmed/15945401
Ummm….that's their job!!
The fear of flying in incredibly common in the general population ranges from 2% in studies up to 80%.
Only fear of public speaking (very relevant) and fear of death can beat those numbers.
Why the wide range?
The latter reflected self-reported experience on flying anxiety.
To some extent, that's what really matters.
As expected there's some cross-over with panic attacks and anxiety (especially social anxiety) in general.
As a phobia, fear of flying is slightly nuanced.
Just wait till we introduce you to the part of the brain that anticipates worst-case...the habenula.
We'll look at the research on what's happening with this phobia and then we'll see if CBD operates in those same pathways.
Some will be familiar with our CBD and anxiety or CBD and panic attacks articles.
Others may pull from our CBD and negative thoughts review.
Just wait till you see what CBD does with the most prominent phobia out there...fear of public speaking.
We'll look at that in-depth.
Either way, we'll cover the following:
- Fear of flying in the brain
- Fear extinction and flying
- Catastrophizing and fear of flying
- Social anxiety cues for fear of flying
- The endocannabinoid system
- Can CBD help with flight anxiety
- How much CBD to take for fear of flying
- What's the best CBD to take for flight fear
Let's get started.
What causes fear of flying in the brain
Fear of flying falls under the category of "specific phobias" in medical science.
It could be spiders, the sight of blood, high places, or even...fear of flying!
There are even some studies that fear of flying incorporates some of the others:
- Fear of high places (acrophobia)
- Fear of enclosed places (agoraphobia)
- Social phobia (to be embarrassed by not responding well to flying)
This all makes perfect sense in hindsight.
There's actually some good research on specific phobias as a category and then we'll drill down into actual flight fear.
First, we have to start with the anxiety pathway for fear of flying.
We covered that circuit in detail at our CBD and anxiety or CBD and general anxiety disorder but a quick refresher.
Let's start with our fear center, the amygdala.
It's part of our old "reptilian" brain and is designed to process emotional and fear signals across the brain.
Too much activity (or with too little restraint) in this area of the brain can lead to hypervigilance for threat detection, fear, and worry.
Individuals who suffer from phobias have been shown to display increased activity of the amygdala when exposed to phobia-inducing stimuli, noted on functional MRI.
https://www.neurologytimes.com/blog/phobias-and-brain-activity
In fact, the right amygdala is tied to expectations of fearful emotions and responses while the left is tied to expectations of pleasant emotions.
Where does that restraint come from?
The prefrontal cortex.
Simply put:
Also, in specific phobia strong emotional responses towards phobic objects can be described in terms of diminished down-regulation of emotions.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728632/
And where does that "regulation" of fear and emotional response happen?
The prefrontal cortex (a much newer addition to the brain evolutionarily speaking):
Emotion regulation studies indicate that these prefrontal cortex regions are involved in both effortful (dorsal PFC and anterior cingulate cortex regions) as well as automatic (ventral PFC regions) emotion regulation processes.
The PFC is the prefrontal cortex....the part of our anxiety circuit that's not keeping up with the amygdala.
This is a classic anxiety circuit as you can see from CBD and anxiety or CBD and general anxiety disorder.
Brains scans are finding this across the phobia range such as fear of blood taking:
We observed diminished medial prefrontal cortex (MPFC) activity in patients compared to controls for phobia-relevant and disgust-inducing pictures.
One last piece to this brain puzzle.
The hippocampus.
See our article on CBD and the hippocampus.
Yes, it figures into the anxiety circuit alone but the right side of it lights up in brain scans for phobic fear:
phobic fear was only associated with the right-sided hippocampal activity.
https://pure.mpg.de/rest/items/item_2614106/component/file_2622697/content
Other studies looked at general social phobia:
Smaller right-sided hippocampal volumes of GSP patients were significantly related to stronger disorder severity.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834794/
The severity piece is important.
The smaller the volume of the hippocampus, the more severe the symptoms.
That establishes a better cause-effect relationship.
There's good news on the hippocampus repair front which we'll cover below!
But repair from what?
What causes imbalance besides being a teenager (when the PFC gets shut down for remodeling)?
Lots of things!
- Chronic stress (see CBD, stress, and anxiety)
- Trauma (see CBD, PTSD, and anxiety)
- Inflammation (see CBD, inflammation, and anxiety)
- Infection early in brain development (see CBD, neuroinflammation, and anxiety)
- Genes tied to stress response and brain repair (see CBD, genes, and anxiety)
- Even THC has an effect on the PFC! (see CBD versus THC for anxiety)
We walk through all the various insults at our CBD and the mechanism of anxiety here.
As for fear of flying, there specific elements of the above that come into play.
The most common risk factors are generally:
- Hereditary - the genetic risk for fear of flying or phobia is estimated between 33-45% depending on specific phobia
- Patterning - learning phobias from family members
- Trait anxiety - a general anxious state (see general anxiety disorder)
- Trauma - a negative experience with the subject
- One-off panic attack - fear of repeating becomes a self-confirming situation
New research is pointing underactivity in the PFC as being tied specifically to the panic side of anxiety issues:
Those disorders involving intense fear and panic--panic disorder, post-traumatic stress disorder, and phobias--seem to be characterized by an underactivity of the prefrontal cortex, thus disinhibiting the amygdala.
https://www.ncbi.nlm.nih.gov/pubmed/18019606
Anxiety states definitely figure into fear of flying.
One study found that people with high anxiety had more physical responses across the entire flight process:
Results indicate that anxiety in Moderate-Anxious is related to flight, but not to single critical epochs of flying, contrary to High-Anxious, for which higher ratings on cognitive aspects of anxiety associated with more physiological load at critical epochs were observed.
https://www.ncbi.nlm.nih.gov/pubmed/24834570
This leads us to another study.
Many people think that fear of flying is born out of a traumatic flight experience.
A study found that only 1 out of 5 of their subjects had a traumatic flight experience which led to flight anxiety.
The other 4 out of 5 were responding to general fear.
The results suggest that FOF is based more on several flight-embedded innate fears than on learned fears.
https://www.ncbi.nlm.nih.gov/pubmed/21961401
As we mentioned above, they found that the root of the fear of flying may come from other fears (which are very common in the general population):
However, existing literature suggests that FOF is a manifestation of fears of other stimuli (e.g., heights) embedded in the flying situation, but not specific to it.
Fear of heights and fear of enclosed spaces both come into play here.
We really have to look at panic attacks with phobias.
A detailed study investigated "comorbidities" or shared pathways for many different anxiety disorders.
Their findings across genetics, experience, and other attributes?:
The strongest associations using both measures were found between MD and GAD and between panic disorder and phobia.
https://www.gwern.net/docs/genetics/correlation/1995-kendler.pdf
A review of CBD and panic attacks are in order.
Speaking of panic attacks, let's look at fear extinction.
Fear extinction and flying
We mentioned that 1 out of 5 people with a fear of flying have it as a result of past experience.
There's also the fear of losing it on the plane (panic attack) after a one-off response.
Finally, there's seeing family members with phobias and "learning" fear.
The opposite of this learned fear is fear of extinction in medical terms.
An interesting study looked at exposure therapy, phobias, and brain activity up to 8 years out.
Exposure therapy is when you introduce the subject of fear (such as spiders of flying on planes) over and over again to desensitize the fear response.
It's one of the primary treatment options for phobias like fear of flying.
It can be very effective:
At posttreatment follow-up (after an average of 4 years), 90% of these patients still had a significant reduction in fear, avoidance, and overall level of impairment and 65% no longer had a specific phobia.
https://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
Back to the long term study, they found that one area of the brain "tracked" with the phobia response over the 8-year duration.
The anterior insular cortex:
The anterior insula has been implicated in extinction learning [6], the neural process upon which exposure therapy relies.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296915/
There's some interesting research on CBD's effect on exposure therapy we'll see below.
Let's now head to the sky is falling section (especially relevant for fear of flying).
Catastrophizing and fear of flying
Catastrophizing is the technical term for seeing the worse case in a situation.
There's a pain in my side...it's cancer and I have 2 weeks to live.
Or it's a muscle??
This worldview obviously figures into phobias swirled in with a panic component as we saw above.
Let's zero in on a little known part of the brain...the habenula.
The what???
What a terrible job it has:
Researchers from University College London have identified the habenula as part of your brain responsible for predicting negative events.
They went on to show through brain scans that it was also tied to catastrophizing:
Roiser noted how the habenula didn’t just express whether something would lead to a negative event or not, it also signaled (with its increased activity) “how much bad outcomes are expected.”
In fact, scientist surgically turned "fear" on and off by affecting GABA (our brain's "brake") levels in the habenula:
By studying circuits and the molecular mechanisms underlying this adaptive response, we show that cholinergic neurons of the medial habenula reduce fear memory expression through GABAB presynaptic excitation.
https://www.cell.com/cell/pdf/S0092-8674(16)30794-2.pdf
This part of the brain may be key to fear extinction (the basis for exposure therapy) and avoidance.
Let's look at another phobia that acts as a unique bridge between state anxiety, panic attacks, and fear of flying.
Social anxiety.
Social anxiety cues for fear of flying
Above, we looked at a study of hippocampus volume and general social phobia.
General social phobia. Social anxiety. Either way, it's an interesting intersection for fear of flying.
There's an interesting aspect of flight anxiety that many readers can probably find familiar.
The whole fear of flying may result from a one-off panic attack while flying.
Once this happens, we start to worry or anticipate a similar response on another flight.
This is learned fear (we'll look at the system that controls this below) with social anxiety elements.
Let's face it...if we were alone on the plane, we wouldn't be as worried.
Part of the anxiety is that we're worried about losing our #%*^ in front of other people.
In fact, a study of people with a fear of flying found the following:
Diagnostically, 27% met criteria for current Panic Disorder with Agoraphobia, and 17% criteria for that diagnosis in the past.
Interestingly, they were less concerned with external danger (the plane going down) than with their reaction to panic attacks and social anxiety:
These two groups were more concerned with internal or social anxiety stimuli during a flight than the group who had never had panic attacks but met the criteria for Simple Phobia (flying).
https://www.ncbi.nlm.nih.gov/pubmed/9220299
This one survey tells a great deal about the underpinnings of flight anxiety.
Learn all about the pathways of CBD and social anxiety or CBD and panic attacks here to dig deeper.
In the CBD section below, we're going to look at the next best thing to a direct study of CBD and fear of flying.
CBD for public speaking phobia...among people with social anxiety!!!
First, the area within which CBD operates.
The endocannabinoid system
Every animal (including us) has one.
It's dated back to 600 million years ago so clearly evolution found a system it wanted (needed) to keep.
It's generally tasked with balancing other key systems in the body:
- Nervous system - neurotransmitters
- Endocrine system - hormones including stress responders
- Immune system - brain inflammation agents
This system has its connections to almost every cell in the body (aside from red blood cells).
It's really interesting in terms of the stress response, anxiety, and….fear extinction!
To put a point to it:
eCB signaling seems to determine the value of fear-evoking stimuli and to tune appropriate behavioral responses
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871913/
eCB is short for the endocannabinoid system and references the two receptors (CB1 and CB2) plus all the chemicals that interact with these receptors.
We've covered how this system works with trait anxiety and panic attacks separately.
Let's zero down to fear extinction...the ability to "forget" or remove the fear response from memory or anticipation.
We'll introduce two key endocannabinoids you have in your body right now.
Anandamide and FAAH.
Anandamide is the called the "bliss" molecule, named after the Hindu goddess of bliss, Anand.
FAAH breaks it down.
To see how powerful this "circuit" is, check out the woman who is unable to feel pain or anxiety (or depression for that matter).
We can add fear to her list of "never knowns".
Why?
Humans and mice homozygous in this allele (FAAHA/A) show decreased anxiety-like behavior and increased fear-extinction learning
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871913/
With this specific mutation, they make little if any FAAH (so they have anandamide running over).
If they feel fear, it's immediately erased.
That's fear of extinction and the endocannabinoid system governs its pathway.
Fear is just learning to the brain, albeit colored with an emotional tone to make sure it sticks (just like joy!).
"Avoid THIS!"
Scientists have actually "paired" a negative action with a neutral one (a bell with a shock) to where the bell will elicit a fear response after a while.
If they remove the shock and keep hitting the bell, eventually, the fear will go away.
That's fear of extinction.
In a nutshell, we just described exposure therapy for phobias like fear of flying.
Do it over and over again till it doesn't elicit a panic response.
To see how powerful this process is, a study actually "tricked' the brain into receiving a reward from a previously fearful signal.
They used an AI system to detect the brain signature for a fear response to given stimuli.
After the switch in reward?
This meant that we'd been able to reduce the fear memory without the volunteers ever consciously experiencing the fear memory in the process
Early days for this but it shows how nuanced our brain can be.
Back to fear extinction...is it even involved in phobias like flight anxiety?:
Clinically, extinction is thought to be impaired in patients suffering from specific fear-related disorders, such as phobias or post-traumatic stress disorder (PTSD).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871913/
There are a number of studies now that tie the endocannabinoid system to this process.
Subsequent experiments using mice lacking CB1R in cortical glutamatergic neurons revealed that CB1R in these cells is necessary for proper reduction of the fear response
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871913/
CB1R is the endocannabinoid receptor primarily found in the brain.
When they block another endocannabinoid, 2-AG (more prominent in the brain ahead of anandamide), the effects were equally interesting:
These mutant mice exhibit no impairments in fear acquisition but show impaired fear extinction
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871913/
Again, there's lots of research on this aspect at that link.
This system may even be the tie between social anxiety and panic with phobias.
In fact, chronic stress (especially social stress) can weaken this system's ability to moderate fear response:
Chronic social-defeat stress also impairs contextual fear extinction, an effect that is alleviated by the treatment with the FAAH inhibitor
https://www.ncbi.nlm.nih.gov/pubmed/23948212/
Goodness.
Learn all about CBD, stress, and anxiety here.
Let's finally move on to CBD itself.
Can CBD help with flight anxiety
CBD helps to bolster the endocannabinoid system above...especially via CB2 receptors.
You can learn about what exactly CBD is here.
We're going to leave the effects of CBD on panic attacks and general anxiety for separate reading.
We want to dive down into the pathways we discussed above for phobias generally and fear of flying specifically.
We'll then wrap with some great studies on public speaking phobia and others.
Let's look at the component pieces first.
First, fear extinction.
Can CBD have an effect there?
Yes!
Goodness...this study found CBD affects 3 different aspects of fear processing:
- (1) cannabidiol decreases fear expression acutely,
- (2) cannabidiol disrupts memory reconsolidation, leading to sustained fear attenuation upon memory retrieval, and
- (3) cannabidiol enhances extinction, the psychological process by which exposure therapy inhibits learned fear.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121237/
Their interpretation of where this would be relevant?
More recently, the effects of cannabidiol on learned fear have been investigated in preclinical studies with translational relevance for phobias and PTSD.
How is CBD able to do this?
Remember how reduced FAAH levels led to better fear of extinction?
By definition, this means more Anandamide.
What does CBD do for these two endocannabinoids?
We further found that cannabidiol, at a concentration that reduces FAAH activity by ∼50%
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316151/
The result on anandamide from this?
Check out the chart here where they compared it against an antipsychotic for schizophrenia:
The net effect:
Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia
Let's turn to that study on public speaking phobia. It's a great proxy for fear of flying.
The physiological panic responses are similar. The fear of looking bad is equally present (if not worse).
The great thing about this study on CBD and public speaking phobia is that they also included a group of people who had diagnosed with a social anxiety disorder.
Let's look at the highlights.
Prior to an anticipated (key for fear of flying) public speaking, there were two groups of participants:
- One group was given 600 mg of CBD prior to public speaking
- One group was given a placebo
Finally, there was a separate division of people who had a diagnosed social anxiety disorder.
We established the importance of social phobia and fear of flying.
What were the results of CBD?
Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech
https://www.ncbi.nlm.nih.gov/pubmed/21307846
The keyword there is anticipatory for phobias like fear of flying.
Remember that there is self-fulfilling anticipation of panic response for flight anxiety.
Reducing this anticipatory response can short circuit the panic response.
Physiological results showed reduced anxiety responses to the public speaking but the self-reported effects were even more impressive:
The SSPS-N scores evidenced significant increases during the testing of the placebo group that was almost abolished in the CBD group
SSPS-N is a Negative Self Statement test.
Furthermore, people with social anxiety disorder showed reduced anxiety and were in line with the control group after CBD.
People, this is a wonderful proxy for fear of flying or any phobia really.
Learn all about that study at our CBD and public speaking phobia here.
Just knowing CBD has this effect can have a powerful effect on the anticipatory fear of flight.
Let's look at exposure therapy...the pretty successful treatment we discussed above for phobia including fear of flying.
Why not combine CBD and exposure therapy (or CBT for that matter) since CBD bolsters fear extinction and neurogenesis.
There's a big trial scheduled in Europe to determine just this question.
What we do know is that many of CBD's effects for depression and anxiety deal with brain repair (see CBD and neurogenesis for anxiety in the hippocampus here).
Serotonin and BDNF are powerful players here.
Learn all about CBD's relationship there in our CBD and long term anxiety.
One of our favorite studies looks at this in a specific area of the brain we focused on above.
The prefrontal cortex...it's the restraint for our anxiety and fear center.
What does CBD do there?
Cannabidiol Induces Rapid and Sustained Antidepressant-Like Effects Through Increased BDNF Signaling and Synaptogenesis in the Prefrontal Cortex.
https://www.ncbi.nlm.nih.gov/pubmed/29869197
- So...BDNF (acts like fertilizer in the brain). Check
- Synaptogenesis. Building new brain pathways. Check
- Prefrontal cortex! Check
There are many studies like this for different brain areas.
See our artilce on CBD and BDNF and brain repair.
New habits and reactions require new brain pathways. Simple as that.
Let's look at some practical questions.
How much CBD to take for fear of flying
Let's look at the short and longer-term aspects of fear of flying.
Short term...there's a flight tomorrow at 8am.
The studies above looked at 300 mg to 600 mg about 1 hour prior to the event in question.
That's a higher amount and it makes sense to test CBD on your system first at about 25-30mg and work up from there.
Longer-term, we found from anxiety studies that the brain repair aspect (neurogenesis) peaked at about 300 mg.
That's more for in-between flights.
Remember that a big part of phobias is a general trait anxiety (internal versus from an event).
That goes for panic as well.
The 300 mg may be key to balancing this response.
Check out:
CBD and long term anxiety
CBD and mechanisms of anxiety
Both get into this longer-term aspect with levels probably lower than when you're about to get on a flight.
By the way, the half-life of CBD is generally 4-6 hours so that should take care of most flights.
I've carried CBD (must be Isolate) on planes with no issues.
Although, Disneyland confiscated my oil!
Speaking of isolate, let's look at what type of CBD for flight anxiety.
What's the best CBD to take for flight fear
First, we need the basic requirements:
- Organically grown in the US
- CO2 extracted (much cleaner)
- 3rd party tested free of:
- NO THC (THC actually can cause anxiety and create histamine response)
- NO pesticides
- NO heavy metals
- NO mold
- NO bacteria
We actually test IndigoNaturals twice (once for biomass and once for finished product).
It should also be Isolate (not full spectrum which is what 90% of the market pushes).
Look, all the research above and the 100's of studies we've looked at are on CBD isolate….not full spectrum.
Full-spectrum may smell and taste like hemp which is not what you want in an airport going through security.
We use MCT oil (from coconut oil) as the base.
More importantly, roughly 40-60% of the population has histamine issues.
Think allergies.
What does an allergy attack feel like?
Very much like a discount panic or anxiety attack. See CBD histamine and anxiety for the reasons why.
We don't want all that plant material before getting on a plane.
Clean CBD isolate and MCT oil as a base.
We actually created IndigoNaturals after trying 3-4 major brands and having bad reactions to them including a fever-like response and racing heart.
Those issues went away with isolate.
Hopefully, we've helped some people by explaining the pathways of CBD and phobias.
Take one hour before, hold under tongue for up to 60 seconds before swallowing, and enjoy your flight...if not the food!
Sorry CBD can't do much for legroom.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.