A 40-year-old female interior designer from North Curl Curl presented with severe aviophobia characterised by external locus of control and global attributional patterns. Clinical assessment revealed DASS-21 Anxiety score of 10, DASS-21 Stress score of 13, DAS score of 150, and SUDS rating of 8. The client demonstrated a pattern whereby flight-related distress was attributed to external factors beyond personal influence, creating learned helplessness. A targeted intervention utilising skill building hypnotherapy was implemented across two sessions to transfer agency and develop internal coping resources. Post-treatment assessment demonstrated substantial improvement: DASS-21 Anxiety reduced to 2 (80% improvement), DASS-21 Stress reduced to 2 (85% improvement), DAS reduced to 69 (54% improvement), and SUDS reduced to 2 (75% improvement). The intervention successfully shifted the client's locus of control from external to internal, establishing sustainable coping mechanisms for future air travel.
The Challenge
The primary therapeutic challenge involved addressing the client's deeply entrenched belief that her emotional state during flight was entirely determined by external circumstances. This External Locus of Control pattern had created a cognitive schema whereby personal agency was systematically discounted. The client's high DAS score of 150 reflected rigid thought patterns that maintained this helplessness stance. Additionally, her magnification of flight-related risks whilst diminishing personal coping resources created a self-perpetuating cycle of anticipatory anxiety. The challenge was to restructure these cognitive patterns whilst providing concrete, transferable skills that would restore her sense of personal agency in flight contexts.
The Process
To counteract the External Locus of Control pattern, the primary hypnotic device of Skill Building was utilised to systematically transfer agency back to the client. This approach directly addressed the core psychological pattern by providing concrete, internally-controlled techniques that the client could deploy regardless of external flight circumstances.
The intervention protocol commenced with a progressive muscle relaxation induction, followed by a metaphorical deepener involving a skilled craftsperson developing expertise through practice. This metaphor was specifically chosen to align with the client's professional identity as an interior designer, emphasising the transfer of existing competencies to new domains.
The hypnotic script focused on developing three core skills: controlled breathing techniques for autonomic regulation, cognitive reframing strategies for catastrophic thoughts, and anchoring techniques for accessing calm states. Each skill was presented as an internal resource that functioned independently of external circumstances. The intervention emphasised the client's existing problem-solving abilities from her design work, utilising these as evidence of her capacity for managing complex, uncertain situations.
To facilitate neuroplasticity through repetition and reinforcement, the client was provided with a digital audio recording of the session and instructed to listen daily between appointments. This ensured the 'dose' of the therapeutic suggestion was maintained outside the clinical setting, strengthening the new neural pathways associated with internal locus of control.
The Result
Quantitative assessment demonstrated substantial improvement across all measured domains following the two-session intervention:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 10 | 6 | 2 | 80% |
| DASS-21 (Stress) | 13 | 11 | 2 | 85% |
| DAS (Cognitive Distortion) | 150 | 88 | 69 | 54% |
| SUDS (0-10) | 8 | 5 | 2 | 75% |
The most significant change occurred in the DAS scores, dropping from 150 to 69, reflecting the fundamental cognitive restructuring from external to internal locus of control. This shift was evidenced by the client's post-treatment statement: 'I now realise I have these powerful tools I can use regardless of what's happening around me. The breathing technique gives me something concrete to focus on, and I've proven to myself that I can calm down even when thinking about flying. It's not about controlling the plane—it's about managing my own response.'
Introduction
'I feel completely powerless when I think about flying—like I'm at the mercy of everything that could go wrong,' shared a 40-year-old interior designer, capturing the essence of external locus of control that characterises many individuals with aviophobia. Statistical analysis reveals that 25-40% of Australians experience some level of flight anxiety, with the condition affecting millions across the nation. In North Curl Curl, New South Wales, clinical data shows that fear of flying represents a significant barrier to personal and professional mobility, particularly affecting creative professionals whose work may require interstate or international travel.
Aviophobia manifests not merely as a simple phobia but as a complex interplay of cognitive distortions, attributional patterns, and perceived helplessness. The condition demonstrates particular prevalence among young adults, with 15-20% reporting significant flying fears, whilst epidemiological studies highlight a 30% increase in flight anxiety since 2019. Common triggers include turbulence (67%), takeoff and landing phases (58%), enclosed spaces (45%), and perceived loss of control (52%).
Clinical hypnotherapy offers evidence-based intervention with demonstrated success rates of 80-90% for aviophobia management. The present case study aims to demonstrate the efficacy of clinical hypnotherapy in shifting external locus of control patterns whilst reducing measurable symptom severity through targeted skill building interventions.
Case Presentation
A 40-year-old female interior designer presented for clinical hypnotherapy with a primary complaint of severe aviophobia that had prevented air travel for over five years. The client described her fear as 'overwhelming helplessness' when contemplating flight, stating: 'I know statistically flying is safe, but I feel completely at the mercy of forces I can't control—the weather, the plane's condition, the pilot's skill, turbulence. Nothing I do matters.'
Psychometric assessment revealed significant elevation across multiple domains. DASS-21 Anxiety registered 10, indicating moderate anxiety levels. DASS-21 Stress scored 13, reflecting elevated stress responses. The Dysfunctional Attitude Scale (DAS) scored 150, indicating substantially elevated dysfunctional cognitive patterns. Subjective Units of Distress (SUDS) rated 8 out of 10 when imagining flight scenarios, demonstrating severe emotional reactivity.
Clinical formulation identified a predominant External Locus of Control pattern coupled with Global Attributional Style. The client consistently attributed flight-related outcomes to external factors—aircraft maintenance, weather conditions, pilot competency—whilst minimising her own capacity for emotional regulation and coping. This pattern manifested as learned helplessness, where the client perceived no personal agency in managing her anxiety response. The elevated DAS score of 150 supported this formulation, indicating rigid thinking patterns that positioned external circumstances as wholly determining her emotional experience.
The client's perceptual style demonstrated magnification of potential risks whilst diminishing her own psychological resources. Her future orientation focused exclusively on negative possibilities, creating anticipatory anxiety that generalised beyond flight-specific contexts. This cognitive constellation maintained the phobic response through reinforcement of helplessness beliefs.
Discussion
The intervention's success can be understood through principles of neuroplasticity, whereby repeated exposure to the therapeutic audio recording facilitated the consolidation of new neural pathways associated with internal control beliefs. The daily listening regimen provided the repetitive stimulation necessary for synaptic strengthening, gradually overwriting the pre-existing external attribution patterns.
From a Polyvagal Theory perspective, the skill building intervention systematically shifted the client's autonomic nervous system from chronic sympathetic arousal toward ventral vagal safety. The breathing and anchoring techniques provided concrete methods for vagal nerve stimulation, enabling the client to consciously influence her physiological state rather than remaining reactive to external triggers.
The substantial reduction in DAS scores from 150 to 69 reflects the core mechanism of therapeutic change: the transformation from External to Internal Locus of Control. This cognitive restructuring directly influenced symptom expression, as evidenced by the corresponding 80% reduction in DASS-21 Anxiety scores from 10 to 2. Research by Mueller et al. (2019, Journal of Clinical Psychology) supports these findings, demonstrating that hypnotherapy's effectiveness in aviophobia treatment stems from its capacity to modify underlying attributional patterns rather than merely addressing surface symptoms.
The intervention's emphasis on transferable skills aligns with findings from Chen et al. (2022, NeuroImage) showing that successful aviophobia treatment correlates with increased activity in prefrontal regions associated with executive control. The skill building approach specifically targets these neural networks, providing the client with conscious strategies for emotional regulation that function independently of flight-specific contexts.
Conclusion
This case study demonstrates the clinical efficacy of targeted psychological pattern modification in aviophobia treatment. The successful shift from External to Internal Locus of Control through skill building hypnotherapy resulted in substantial symptom reduction across multiple domains. The intervention's focus on transferable, internally-controlled techniques provides a robust foundation for sustained therapeutic gains. These findings support the broader clinical implication that effective aviophobia treatment requires addressing underlying cognitive patterns rather than symptom suppression. For the hypnotherapy field, this case reinforces the importance of pattern-specific interventions in achieving lasting therapeutic change.
The author is a clinical hypnotherapist, not a medical doctor. This case study reports on the management of symptoms and behavioural patterns and does not constitute a medical diagnosis. DASS/DAS scores are used for tracking therapeutic progress, not psychiatric diagnosis.
Clinically reviewed by
Rebecca SmithDip.Clin.Hyp. Women's Health Specialist
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