Dr Charlotte Russell, Clinical Psychologist

For those of us who love to travel, feeling comfortable on a plane is pretty crucial. Trains and ferries may be a more sustainable way to travel, but flying opens up the world for each of us. But what if flying is less than comfortable for you? What if you find it frightening and it impacts on your enjoyment of your trip? In this guide I’m going to talk you through what we know about fear of flying and how best to manage it.

How common is fear of flying?

It is estimated that 2.5% of the population experience fear of flying that has a debilitating effect and gets in the way of living life (Oakes and Boar, 2010). It is thought that a much larger proportion , up to 25%, experience anxiety whilst flying but without a substantial negative impact (Campos et al., 2019).

The important take away here is that there is a huge range of difficulties spanning from mild discomfort to crippling anxiety that affects quality of life.

Where does fear of flying come from? 

You might assume that fear of flying is a straightforward phobia and is similar to other phobias like fear of snakes or heights, for example. Actually this isn’t the case; there are many factors that can contribute to being fearful of flying and it can vary greatly from person to person.

Fears related to flying may include being confined, not being in control, heights, fear of anxiety symptoms, body sensations and our own coping. Sometimes people will have had a difficult and traumatic experience that flying might trigger. This can happen in ways that are not always obvious.

As fear of flying can stem from a range of factors, this means there is unlikely to be a ‘one-size-fits-all’ treatment approach that is effective for everyone.

How much of a problem is fear of flying for you? 

The most important question to ask yourself is how much fear of flying gets in your way. Do you avoid travelling even though it is something you want to do? Does the fear impact on your enjoyment of your trip?

If the answer to one or both of these questions is yes then it is worth thinking about whether you want to and feel ready to address this fear. Psychological therapy can be very effective, but it requires effort and the willingness to face uncomfortable feelings. You have to be willing and ready to do this work to be able to benefit.

When we are anxious, we may tend to avoid what we are anxious about rather than to face it. This is natural and is the ‘flight’ part of the fight/flight response. The problem with this is that avoiding may lead to short term relief, but it also means that in the longer-term problems go unaddressed.

If you are not sure of whether you are ready to address your fear, write down the costs and benefits of things remaining the same. This can help you to understand the ways in which you might be missing out and whether addressing the fear will fear ‘worth it’ for you.

Can fear of flying be addressed? 

There are effective treatments available so yes, it is possible. The most effective therapies involve a thorough assessment to understand and address each person’s difficulties, rather than a one-size-fits-all approach (Oakes and Boar, 2010).

As an example, panic disorder may underlie fear of flying. This is when we are frightened of the body symptoms of anxiety which can include increased heartrate, faster breathing and light-headedness. Therapy in this case would involve targeting our fears around the body sensations we might experience when we are feeling anxious.

As another example, sometimes fear of flying stems from a traumatic experience that has not been properly processed and happens to have been triggered whilst flying. If you think about it, flying is quite an unusual situation in many ways; there are not many situations where we are confined for such a long period and where the processes are quite rigid and authoritative. So it is unsurprising that this can trigger trauma and then in itself become a feared situation. In this instance, my therapeutic approach would usually be to work with the person to address the earlier trauma. This would mean that flying would feel more manageable.

An additional challenge in addressing fear of flying is that for most of us, flying is not an activity that we do with regularity. One, twice, three times a year maybe. So the ability to opportunity to begin to tackle these fears is reduced.

What is the best therapy for fear of flying?

As mentioned earlier, the most effective treatment will involve a full assessment of your difficulties, and your therapist will then devise a treatment programme which is appropriate to your specific needs (Oakes and Boar, 2010). Depending on your difficulties, treatment may involve some or all of the following:

· Cognitive techniques: challenging fears that may be contributing to your anxiety.

· Relaxation training

· Exposure therapy: being exposed to situations related to flying and being on a plane. This can be done in person, via visualization or virtual reality.

· Psychoeducation: gaining an understanding of anxiety and its impact on the body. For fear of flying specifically, this also involves gaining information about flying and flight safety in order to gain understanding and reassurance.

· Addressing safety behaviours that may be maintaining or exacerbating anxiety

· Specific targeting of panic related symptoms with cognitive behavioural therapy (CBT)

· Addressing any traumatic memories that may be underlying anxiety using trauma focused therapy.

Whilst a thorough assessment and personalised therapeutic approach is the gold standard treatment, many people do find it helpful to take part in group programmes. These are usually provided by airlines or airports. They do not usually include a full assessment of your difficulties but include a range of techniques and often involve physical exposure to an aircraft and a flight.

As an example, a study in the Netherlands involved offered participants individual and group CBT, followed by a guided flight (Busscher and Spinhoven, 2017). The findings showed that those who completed the programme experienced less anxiety and were able to fly more frequently following the intervention. It was also found that those who were more able to put the positive strategies they learned into practise showed a greater reduction in anxiety. The caveat with this study, and subsequent studies is that there was high treatment dropout rate (Busscher and Spinhoven, 2017., Mor et al., 2022). This suggests that people who are fearful of flying may struggle to engage with and complete treatment.

Recently the option of completing an online programme to address fear of flying has been developed. This has shown some positive initial results (Campos et al., 2019). However this was a small study and so it is difficult to make generalisations about how effective this approach is likely to be. Interestingly despite the online nature of the programme there was still a considerable dropout rate (around 28%). This suggests that online programmes are unlikely to be the right approach for everyone experiencing fear of flying.

Summary and advice

If you are anxious about flying but it does not stop you or affect your enjoyment of your trip 

My advice to you would be to use anxiety management techniques. Relaxation and mindfulness techniques can be very effective. However it is important to start practising these well in advance of your trip, so that you can use them effectively when you need to. There are lots of options online and it is important to find one that you like and that suits you. Headspace is one good example of the apps available.

Practising regularly will help you to ease into a state of relaxation more quickly and easily, and this will be beneficial when it’s time to take your plane seat.

In preparation for your journey it is also helpful to take lots of options to keep you entertained whilst you are flying. Download TV programmes to your phone and make yourself a playlist to get you excited for your trip. Reading about your destination whilst you are in flight can be a great way to begin to feel the positive holiday feelings. 

If fear of flying is a significant problem for you and gets in your way 

The evidence tells us that pervasive fear of flying is complex and that the most effective approach is to work with a therapist to understand and address your specific difficulties. As with all psychological therapy, this can be challenging, and so it is important to make sure that you are fully prepared for this work. It is important that you are at a stage in your life where you are able to commit to the therapeutic process. This is the most effective way to address a fear of flying that is debilitating.

If individual therapy is not right for you, then you may find a group programme helpful in getting you to the stage where you can manage flying. It is important to remember that those who benefit most from these programmes are the people who are able to put the strategies they learn into practice. As with anything in life, the more you commit to the process, the more you will get out of it.

References 

Busscher, B., & Spinhoven, P. (2017). Cognitive coping as a mechanism of change in cognitive‐behavioral therapy for fear of flying: A longitudinal study with 3‐year follow‐up. Journal of clinical psychology, 73(9), 1064-1075.

Campos, D., Bretón-López, J., Botella, C., Mira, A., Castilla, D., Mor, S., … & Quero, S. (2019). Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial. BMC psychiatry, 19, 1-16.

Mor, S., Botella, C., Campos, D., Carlbring, P., Tur, C., & Quero, S. (2022). An internet-based treatment for flying phobia using 360° images: A feasibility pilot study. Internet Interventions, 28, 100510.

Oakes, M., & Bor, R. (2010). The psychology of fear of flying (part I): A critical evaluation of current perspectives on the nature, prevalence and etiology of fear of flying. Travel medicine and infectious disease, 8(6), 327-338.

Oakes, M., & Bor, R. (2010). The psychology of fear of flying (part II): a critical evaluation of current perspectives on approaches to treatment. Travel medicine and infectious disease, 8(6), 339-363.

If you liked this article, please check out our Travel and mental health guide (part 1)