Fear of flying: what is going on and what helps

“We bought the tickets back in February. It’s June now, the flight is nine days away, and every night at three I’m watching videos of turbulence. I know a plane is safer than a car. Everyone tells me so. But in a car I can pull over and get out.”

There is more truth about the fear of flying in that last sentence than in any comparison with cars. The person saying it doesn’t doubt the figures. What they doubt is whether they can last two and a half hours in a seat they cannot get up and leave. And on top of that they feel ashamed, because they know their fear is “irrational” and it is no smaller for knowing it.

I have written about how phobias form, and why reason doesn’t switch them off, in the post Specific phobias, so I won’t repeat it here. This post stays with the aeroplane: why the fear of flying is not really one fear, what part control, confined space and panic play in it, what quietly keeps it going, and what the research says actually helps.

Fear of flying is not a single fear

First, a figure that many people find a relief. In 2010 Margaret Oakes and Robert Bor reviewed the research on fear of flying and noted that estimates of how common it is in industrialised countries range from roughly 10 to 40 per cent of adults. The range is so wide because studies ask the question differently: some count anyone who feels uneasy on a plane, others only people who don’t fly at all because of it. But even the lower end means that on an averagely full flight you are almost certainly not the only one gripping the armrest at take-off.

The second, more important finding is that these people are not all afraid of the same thing. In the 1990s the Dutch psychologist Lucas van Gerwen and his colleagues studied people who had sought help for fear of flying and found that they could not be squeezed into one group. Some fear a crash. Others fear the enclosed space. Others again fear not being in control. And some are not afraid of the plane at all, but of their own panic inside it. For some, height is at the forefront. And for most, several things are tangled together.

This distinction is not academic hair-splitting. What will help you depends on it. For someone afraid of a crash, an explanation of how a plane flies can genuinely take some of the weight off. For someone afraid of losing control of themselves in a sealed cabin, the same explanation says nothing, because their fear was never about the wings.

Why safety figures don’t reassure

Commercial aviation is regarded as one of the safest forms of transport, and the risk has gone on falling from decade to decade. I am deliberately not quoting numbers here. Not because they don’t exist, but because the person who is afraid usually knows them by heart already. And they haven’t helped.

The reason is simple. Statistics speak to the part of the brain that calculates. Fear arises in a part that doesn’t calculate but compares: does this resemble something dangerous? Height, noise, shaking, closed doors, no way of retreating. To a very old alarm system that is a list of reasons to sound off, however small the probability. I described how that system works, and why the body reacts before you have time to think, in the post What happens in the brain during anxiety.

On top of that, the mind doesn’t judge likelihood by numbers but by how easily it can picture something. A plane crash is rare, but when one happens we see it on every news programme, with footage and names. The millions of flights that landed uneventfully that day are not news. So the image is vivid and close to hand, and the brain mistakes vivid for likely. The way a whole scenario grows out of a single “what if” is called catastrophising.

This is why loved ones who keep repeating that flying is safe usually achieve the opposite of what they intend. The frightened person doesn’t hear “you are safe” but “your fear is stupid”. And is left even more alone with it.

Control: a seat from which you steer nothing

Many people who are afraid of flying drive on the motorway without difficulty, even though they know it is riskier. The difference is not the danger but the steering wheel. In a car you decide: when to speed up, when to brake, when to pull into a service area. On a plane the decisions are made by someone you cannot see, by rules you don’t know, and what you have is a seat belt and a tray table.

For some people this is the very core of the fear. They are often people who are highly dependable in everyday life: the ones who plan, check, think ahead and make sure things run. Control is how they stay calm. When circumstances take it away, they are left without the tool they have relied on all their lives. I described a similar pattern in the post Panic and control: why it strikes the person who holds it all together.

The same need gives rise to habits almost every frightened passenger will recognise. Watching the cabin crew’s faces to read whether something is wrong. Listening for every change in the sound of the engines. Sitting rigid with your feet pressed to the floor, as if you were helping to hold the plane up. These are attempts to take control back, at least in imagination. They cost a great deal of energy and don’t make the plane one bit safer.

A useful question, then, is: what in this situation really is in my hands, and what isn’t? A simple tool called the circle of control can help. You have no influence over the course of the flight. You do have influence over where you sit, what you tell the crew, and what you do with your attention and your breath.

Confined space: doors that don’t open

A second group is not afraid that the plane will fall but that they cannot get out of it. The moment these people describe as the worst is often not turbulence at all, but the closing of the doors. Until then it is still possible to leave. From then on it isn’t.

This fear is related to claustrophobia, and those who have it usually know it from elsewhere too: from lifts, tunnels, packed halls, MRI scanners, sometimes from a crowded bus. The common denominator is not the place but the feeling of being trapped. I explained why anxiety so readily appears exactly where retreat is not simple in the post Panic at the wheel, in the lift, in the shop: why there.

With this form of the fear something telling often shows up: shorter flights are bearable, long ones are not. An aisle seat is acceptable, a window seat out of the question. Waiting on the runway with the doors shut is worse than the flight itself. If you recognise yourself here, that is valuable information. It tells you that explanations about aerodynamics won’t help and that the work has to be with the feeling of being trapped, not with the aircraft.

Panic: when you are afraid of your own body

A third group has a panic attack behind them. Sometimes on a plane, but often somewhere else entirely. Since then, what worries them is no longer the flight but the thought that panic might seize them ten kilometres above the ground, in front of a full cabin of strangers, with no chance of stepping out for air. For them, fear of flying is really fear of fear, and I wrote about how that learns to come back in the post Fear of fear: how panic learns to return.

Unfortunately, an aeroplane is an almost perfect stage for it. At take-off you are pressed into your seat, your ears pop, the air is dry, and on descent your stomach is briefly “left behind”. All of these are ordinary bodily responses to an ordinary flight. But someone who monitors their body closely reads them as the first signs of an attack. They take fright, the heart then really does start to beat faster, and that is fresh evidence. The loop closes within seconds.

Two things matter here. First: a panic attack is very unpleasant, but it is not dangerous and it passes by itself. Second: if you have not yet had your attacks checked by a doctor, that is the first step, because physical causes need to be ruled out, not guessed at. How a slow out-breath helps the body settle, and why gulping for air makes things worse, you will find in the post Breathing during panic: what actually helps and why a paper bag is not the answer.

What quietly keeps the fear going

The most obvious way the fear is kept alive is by not flying. The relief of a cancelled flight is immediate and large, and the brain takes note: retreating works. Next time the alarm will be louder. This mechanism holds for every kind of anxiety, and I described it in detail in the post Anxiety and avoidance: why avoiding helps you today and harms you tomorrow.

Less obvious is that the fear can also be kept going in people who do fly. In a 2016 review of the research, Gavin Clark and Adam Rock described what maintains flying phobia and, among other things, pointed to so-called safety behaviours: the small things a person does in order to “get through” the flight. A glass of wine before boarding. Checking the weather forecast every hour. A lucky charm in a pocket. Clutching the armrest. Watching the crew without a break.

The trouble with these behaviours is not that they are harmful in themselves. The trouble is the conclusion the brain draws after landing: “It went fine because I had a glass of wine and kept watch the whole time.” Not: “It went fine because the flight was safe and I got through the fear.” As long as the safety behaviour takes the credit, the belief that you couldn’t have managed without it cannot change.

I would be especially careful with alcohol and tranquillisers. Alcohol does dull anxiety for a short while, but it often returns stronger as the effect wears off, and on a plane it acts differently from what you are used to. On tranquillisers there is an interesting older study by Frank Wilhelm and Walton Roth: in a small group of people with flying phobia, the medication did reduce the fear they reported on a first flight, but on the next flight without it they fared worse than those who had first flown on placebo. The study is small and should not be generalised, but it points to the same mechanism: if you switch the fear off during the flight, you learn nothing about it. Any decision about medication is, of course, a matter for a conversation with your doctor, not a blog. I set out the wider picture in the post Therapy or medication for anxiety: what the research shows.

What the research says helps

The good news is that specific phobias are among the difficulties that respond best to appropriate help. In 2008 Kate Wolitzky-Taylor and colleagues pooled the results of numerous studies of phobia treatment and showed that the most effective approaches are those involving exposure: approaching what you fear gradually and deliberately, instead of retreating from it.

With fear of flying this is somewhat more complicated than with spiders, because you cannot “practise” a plane every Tuesday. So programmes usually combine several things: an explanation of how a plane flies and what particular sounds mean, work with catastrophic thoughts, learning to settle the body and, finally, a real flight, often accompanied. In some countries such courses are also run by airlines and airports. Virtual reality is used as an intermediate rung: as early as 2000 Barbara Rothbaum and colleagues showed in a controlled study that exposure in virtual reality helped about as much as standard exposure and more than waiting without help.

The more recent understanding of exposure, shaped by Michelle Craske, stresses that the aim is not for the fear to vanish during the exercise. The aim is for something other than what you predicted to happen. You predicted you wouldn’t cope, and you coped. You predicted you would lose control of yourself, and you shook and stayed in your seat. That gap between prediction and experience is what the brain learns from. There is more on this in the post Exposure: why panic has to be approached, not avoided.

This kind of treatment is delivered by cognitive behavioural therapists and clinical psychologists. In Slovenia’s public system, a referral from your GP leads to a clinical psychologist or psychiatrist. I do not carry out protocol-based exposure myself, and it seems only fair to say so plainly.

When fear flies as a couple

Fear of flying rarely stays one person’s business. It decides where the family goes on holiday, whether someone will visit a brother abroad, who goes on the business trip. And it almost always creates a conversation that keeps repeating.

“You’re looking at the weather over the Alps again.”
“I’m just checking.”
“Third time today. And then you don’t sleep.”
“If I don’t check, it’s worse. You don’t understand, you’re asleep before we’ve even taken off.”
“I really don’t understand. But I no longer know what to say. When I say it’s safe, you get angry. When I say nothing, you tell me I don’t care.”
“I don’t want you to convince me. I want you not to tell me to relax during take-off.”
“Then what should I do?”
“Give me your hand. And don’t look at me as if I’ve ruined the holiday.”

(The dialogue is composed; it does not describe a real person.)

Something important happens in this exchange: instead of an argument about whether the fear is justified, what comes out is what the person needs when afraid. Not persuasion, but company. I wrote about how to be beside someone who is frightened without correcting them and without wearing yourself out in the post How to help someone you love with anxiety — without burning out.

As a therapist in training in marriage and family therapy, working under supervision, this is the part I can offer a space for: what the fear does between the two of you, the shame that comes with it, and the question of why control has taken on such a large role in your life. I meet clients in person in Ljubljana and also work with English speakers. This does not replace exposure with a professional trained to deliver it. It can, though, prepare the ground for it or go alongside it.

Exercise: a flight plan you start today

This exercise needn’t be saved for the day before departure. It works best if you begin while no flight is yet in sight. You need a sheet of paper and twenty minutes.

1. Write your fear down in one sentence. Not “I’m afraid of flying”, but “I’m afraid that …”. That the plane will crash? That you won’t be able to get out? That you will panic in front of everyone? See which of the four fears in the first picture your sentence belongs to.
2. List your safety behaviours. Everything you do in order to get through a flight: checking, a drink, a particular seat, watching the crew. Choose one that you will drop, or at least reduce, next time.
3. Build a ladder. Write six to eight rungs, from easiest to hardest: a photograph of a cabin, a video of a take-off with the sound on, a visit to an airport, sitting by the window on a train through a tunnel, a short flight. The exposure ladder tool will help.
4. Do the first rung today and write down a prediction. Before you start, write what you expect to happen. Then stay with the rung a little longer than is comfortable. At the end, compare: did the prediction come true?
5. Prepare three sentences for the flight. On a card, write what you will want to read when the fear is at its loudest, for example: “This is fear, not danger. It passes by itself. I don’t have to do anything.” You will find a template under panic card.

One more small but effective step: when you board, tell a member of the crew that you are afraid of flying. Crews are used to it. The mere fact that someone knows takes away part of the weight that hiding otherwise carries.

Where this explanation doesn’t apply

Not every fear of flying is a phobia. Some unease at take-off is entirely ordinary and needs neither exercises nor therapy. We speak of a problem when fear starts deciding for you: when you cancel trips you want to take, when work suffers, or when you don’t sleep for weeks in anticipation of a flight.

Not flying can be a perfectly good decision. If you like travelling by train and don’t miss planes in your life, you don’t have to treat anything simply because the fear has a name. The question is not whether you are afraid, but how much it costs you.

Fear after a harrowing experience is something else. If the fear began after an emergency landing, after losing someone close in an accident or after another shattering event, it may not be a phobia but the aftermath of trauma. In that case it is important to be assessed by a clinical psychologist or psychiatrist, and the work proceeds differently from ordinary exposure.

Sometimes fear of flying is not the main subject. Reviews of the research note that for many people it appears or intensifies in a period of heavy strain, including at turning points in life such as the birth of a child. The plane may then simply be carrying something that has nowhere else to hang. In that case ladder exercises help only partly, and it is worth looking at what is happening on the ground as well.

Doctor first when physical signs are at the forefront. If you are worried about your heart, your breathing or dizziness, or you have a chronic illness, consult your GP before flying. That is not giving in to fear, but ordinary care for yourself.

What to remember

• Fear of flying is not one fear: inside it are fear of a crash, of confined space, of losing control and of your own panic.
• Safety figures rarely reassure, because fear does not arise in the part of the brain that calculates probabilities.
• Safety behaviours, alcohol and cancelled flights bring relief today and stronger fear next time.
• The best-researched help is gradual exposure, delivered by cognitive behavioural therapists and clinical psychologists.
• You can take the first step yourself: find out what exactly you fear, and tell someone close what you need when it comes.