Fear, Avoidance, and Why

1

Name

First Name

Last Name

2

What specific fears do you have about flying? Can you describe them in detail?* This field is required.

3

What are some physical and cognitive signs of fear and anxiety you experience while flying or thinking about flying?* This field is required.

4

What do you fear could happen to you as a result of flying or anxiety? List the possible outcomes.* This field is required.

5

Have any of these feared outcomes ever come true for you? If not, why do you think that is?* This field is required.

6

Can you think of any other fears related to flying or anxiety that you haven't mentioned yet?* This field is required.

7

Have you ever avoided flying or other situations that created anxiety for you?* This field is required.

YESNO

8

How did you avoid them?* This field is required.

9

Did it help you feel better in the long term?* This field is required.

YESNO

10

Have you ever partially avoided anything related to flying or anxiety? For example, have you ever modified your travel plans to avoid certain days, booked flights based on weather, or used seat numbers or good luck charms to ease your anxiety?* This field is required.

YESNO

11

How do these avoidance behaviors affect your ability to function in your personal and professional life?* This field is required.

12

Have you ever sought help and reassurance from friends and family to help you feel "safe" and "protected" from fear and anxiety? How often do you do this?* This field is required.

13

Has seeking reassurance helped you in the long term?* This field is required.

YESNO

14

How has it affected your confidence and ability to manage your fears?* This field is required.

15

Do you feel comfortable discussing your fears with others? If not, why?* This field is required.

16

What do you usually do when you find yourself hooked on worrisome thoughts related to flying or anxiety? How do you respond? Can you describe some of the ways you try to calm yourself down?* This field is required.

17

What do the words "what if" mean to you as they relate to anxious thinking?* This field is required.

18

How do these thoughts affect your daily life and functioning?* This field is required.

19

What are some positive aspects of flying or traveling that you enjoy or would like to enjoy?* This field is required.

20

What would be different in your life if you were able to overcome your fear of flying or anxiety related to flying?* This field is required.

21

What are your reasons for wanting to overcome this fear? What do you hope to gain from it?* This field is required.

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Email

example@example.com