Fear of flying

Feeling a little nervous on a plane is common. Fear of flying becomes a problem when the anxiety is intense, starts days or weeks before a trip, or leads you to avoid flying.

When the fear is persistent, out of proportion and limits your life, a mental health professional may describe it as a specific phobia. Aviophobia is the clinical-sounding name, though most people simply say they are afraid of flying or a nervous flyer.

Fear of flying is often linked to other fears. Some people are mostly afraid of a crash. Others fear the feeling of being enclosed, heights, turbulence, losing control or having a panic attack where escape is impossible. Understanding what you specifically fear helps shape treatment.

Anxiety on planes can show up before and during the flight:

• Anticipatory anxiety: worry, trouble sleeping and checking weather or flight news in the days before travel.
• Physical symptoms: racing heart, sweating, nausea, shaking, dizziness, shortness of breath or chest tightness.
• Thoughts such as "something is wrong," "I'll lose control" or "I can't get out."
• Hypervigilance to noises, movements and the crew's expressions.
• Panic attacks during takeoff, turbulence or landing.
• Safety behaviors: gripping the armrest, constantly watching the wing, drinking alcohol to cope.
• Avoidance: refusing to fly, choosing long alternative journeys or canceling trips.

If you have chest pain or breathing difficulty, it is important to rule out medical causes with a doctor, particularly before a trip.

Fear of flying can develop for several reasons:

• A frightening experience on a flight, such as severe turbulence.
• Hearing about or seeing news coverage of air accidents.
• A panic attack on a plane, followed by fear of it happening again.
• Underlying fears of heights, enclosed spaces or loss of control.
• General anxiety, which makes the mind more alert to possible danger.
• Life changes, such as becoming a parent, that increase awareness of risk.

Avoidance keeps the fear going. Each time you skip a flight, you feel relief, which teaches your brain that flying was dangerous. Safety behaviors, such as needing to watch the wing at all times, can have a similar effect, because you never learn that you would have been fine without them.

Cognitive behavioral therapy (CBT) with exposure is the most effective treatment for fear of flying. A therapist helps you:

• Understand how planes fly and what normal sounds and sensations mean.
• Identify and test catastrophic thoughts.
• Learn breathing and grounding skills to ride out anxiety.
• Gradually approach flying through exposure: looking at images, visiting an airport, using virtual reality or simulators, and eventually taking a short flight.

If a past traumatic flight experience is involved, EMDR or other trauma-focused therapies may help. If panic attacks are part of the picture, treatment will also address panic.

Some people ask a doctor about medication for a specific trip. A psychiatrist or physician can discuss whether this is appropriate, but medication on its own does not usually reduce the fear in the long term.

A psychologist or clinical psychologist will begin by asking about your fears, your flying history and your goals.

These strategies can help alongside treatment:

• Plan ahead: arrive early, choose a seat that feels more comfortable and let the crew know you're anxious; they are used to helping.
• Breathe slowly: lengthen your out-breath to calm your body.
• Expect sensations: bumps, noises and changes in engine sound are normal parts of a flight.
• Ride the wave: anxiety rises, peaks and falls if you allow it rather than fight it.
• Bring distractions: music, films, puzzles or a book.
• Limit caffeine and avoid using alcohol to cope, as it can worsen anxiety later.
• Reflect afterward on what went better than expected.

If fear of flying is stopping you from seeing family, traveling for work or doing things you value, talking to a licensed professional can make a real difference.