• Fears about the safety of flying. Most people assume that the fear of crashing is paramount, but this is only true for 1/3-1/2 of fearful flyers. Such fears are more pervasive after a well-publicized crash.
• Fear of frightening feelings, including "feeling out of control" and the symptoms of a panic attack.
  
  and/or
• Associated fears: a) claustrophobic concerns b) fear of the unknown or misunderstood c) fear of giving up control d) fear of the possibility of turbulence or bad weather e) fear of losing composure or "making a scene" f) fear of heights
  
  

  Coping With Fears About the Safety of Flying

• A study of airline fatalities between 1989-1999 suggested that someone who takes a daily airline flight could, statistically speaking, fly every day for 31,000 years before facing a fatal crash. (Barnett, MIT) USA Today says, "The risk of a passenger dying on an airline jet flight has fallen sharply . . . . The risk from 2000 through 2005 was one flight in 22.8 million, a 60% drop from the 1990s." Given these newer data, a passenger on US airlines would have to fly every day for 64,000 years before facing a fatal crash. (USA Today, 6/29/2006)
• When corrected for the number of travelers involved, it is estimated that you are up to 89 times safer each time you travel by airline than you are each time you travel by car. Because of frequent exposure and familiarity, when we travel by car, we can retain our illusions of control and safety. (Imagine if you traveled by car as rarely as you fly and that each automobile fatality was given media attention comparable to airline crashes!)
• Average annual fatalities in the United States:

• Most of our everyday activities involve some measure of risk that we construe as an "acceptable risk" in the service of convenience or pleasure. It is estimated that flying on a major airline is safer than using electrical power, bicycling, swimming, hunting, x-rays, and anesthesia. Statistically, the risk of fatality by airline flight is comparable to the risk of fatality by taking a bath.
• The compelling news headlines, videotaped images and computer recreations after each major crash sensitize all of us to the potential dangers of flying. In contrast, these tiny newspaper articles were buried in the back pages:
  
  

• In any given three month period, there are more people killed on American roads than have been killed by all the airliner crashes in the history of American aviation.
• Rational versus emotional risk assessment: What are the odds?
  

• Airline pilots, co-pilots and flight engineers are trained repetitively for every imaginable emergency situation. Such training is regularly updated to encompass what was learned from air disasters. Frequent refresher courses and flight simulator training is required. The seniority system requires lengthy years of training, experience and demonstrated expertise before pilot status is attained. One publicized lapse will stick in your mind and alarm you. However, flight crews are scrutinized more than any professional in whom you entrust your safety, (e.g., drug/alcohol screens, physical exams, taped cockpit conversation, surreptitious observation of operations, etc.).
• Remember: The flight crew is as invested in their safety as you are in yours. They want to get home safely to their loved ones as much as you do.
• Remember: Your concern about the flight crew is really about your own fear of giving up control or, more to the point, the illusion of control.
  
  
  Fear: "I don't trust a stranger to maintain the plane!"
  
  Rational Response:
• A commercial airliner receives 12 hours of maintenance and inspection on the ground for every hour it spends in the air. In addition to daily maintenance, there are periodic in-depth inspections involving thousands of person-hours of scrutiny. Compare this to our blind trust in the mechanical integrity of our motor vehicles.
• Again, one news story about an incident of shoddy maintenance will stick in your memory. However, every part of the industry and the FAA places top priority on effective maintenance, if for no other reason, because a well-publicized mistake can be a business and public relations disaster.
• If anything, the industry's cautiousness about any minor irregularity may result in your being inconvenienced by a delayed or cancelled flight, even when there is no real decrement in the safety of the plane. The next time you see a disgruntled customer shrieking at airline personnel about delays or cancellations, go out of your way to tell the airline's staff that you appreciate their putting safety first!
  
  
  Fear: "I don't trust the plane!"
  
  Rational Response:
• Airliners are carefully designed to fly safely and efficiently no matter how heavy and awkward they may appear to you. Even a 747 operates efficiently according to simple laws of physics (e.g., lift, power, direction)-they do not somehow defy natural forces in order to fly!
• If your fear of flying is primarily about the fear of the unknown or misunderstood, read about the mechanics of flight and talk to a pilot about what you've read.
• From engines to emergency mechanisms, from hydraulics to electricals, from computers to navigational aids, there are back-up systems, even multiple back-up systems for virtually everything.
  
  
  Fear: "What if we run into bad weather or lightning?"
  
  Rational Response:
• The weather is constantly monitored by radar and radio both onboard by the crew and on the ground. Every effort is made to divert the plane around or above thunderstorms so that you will have a smooth and comfortable flight. If you are in a lightning storm, you are much safer in an airplane than on the ground. The plane is a conductor which lightning can strike without hurting either the plane or its passengers.
• "Wind shear" seems to have contributed to some well-publicized crashes. This has prompted design and installation of wind shear detectors at major airports and on-board wind shear detectors on many airplanes. Pilots are now trained in simulators to manage dangerous wind shear, drawing on data gathered from previous crashes. Veteran pilot T.W. Cummings notes, "Perilous wind shear probably occurs only once in every twenty million takeoffs or landings."
  
  
  Fear: "What if we run into turbulence?"
  
  Rational Response:
• Turbulence is not a threat to the structure or function of the airplane. Modern airplanes are built to handle much more force than is exerted in even the roughest turbulence. Turbulence feels dangerous, but it is not. Pilots try to avoid turbulence for your comfort, knowing that a turbulent flight may make you less likely to choose their airline for your next flight.
• However, turbulence does cause many injuries every year when unrestrained passengers are jostled and hurt. Some experts recommend keeping your seat belt fastened at all times to prevent such injury. With your seat belt fastened, turbulence is no more significant than riding on a bumpy road or a choppy water surface. Just because you can't see turbulence doesn't mean that the plane can somehow drop from the sky like a brick. Turbulence is merely a pothole in the sky.
• Turbulence is uncomfortable because it can leave you feeling more out-of-control of the situation. A vicious circle is created as you feel more alarmed and then overreact to subsequent motions of the plane. Remind yourself that your feeling a loss of control does not mean that the plane and the pilot are not in control. Try not to fight and resist the plane's movements during turbulence-try to go with them, reminding yourself that there is nothing abnormal or dangerous about such motions even though they can feel jarring.
  
  
  Final Note About Safety:
  
  Consider the "acceptable risks" you take dozens of times each day to improve the quality of your life. Decide whether you are willing to view flying as yet another acceptable risk. Of course, safety cannot be guaranteed. However, do not mistake possibility for probability. Remember that your risk assessment is driven by your feelings of danger, not the actual danger. Be sure you are not using your fears about safety as a rationalization for not facing frightened feelings or scary symptoms which you have come to associate with flying.
  
  As Reid Wilson has noted, you are unlikely to make progress until you, first, decide to trust the airline industry and, second, decide to trust your own body. Initially, this will feel like blind, naïve trust, but it is the only way to move forward toward dampening your fears. If you are still not willing, don't fly.
  
  

Coping With Fears Of Panic and Bodily Symptoms While Flying

• Decide to face your fears.
  
  Consider both the costs and the possible payoffs involved in your fearful avoidance of flying. You must decide whether you are serious about facing your fears. Be clear about what your fears are; for example, be careful not to rationalize your fear of feelings by disguising and justifying them as fears about safety. Keep your eye on what you stand to gain by facing your fears.
• Be willing to begin changing your thinking.
  
  Consider how you perpetuate your fears. Do you have remarkably vivid recall for the details of crash stories or of past feelings of panic? You have likely repeated such thoughts hundreds or thousands of times. The jolt you feel when you think such thoughts makes them feel that much more dangerous. Your indulgence in such thoughts unwittingly escalates your fear and "justifies" your avoidance or your anticipatory anxiety. You must be willing to try to shift your thinking toward more hopeful and more realistic content, (e.g., images and self-talk about coping and safety). Of course, you won't believe it for now, but strive to do so anyway so that you stop compounding your problem.
• Notice and accept your anxious feelings.
  
  Remember that the uneasy feelings and bodily sensations you have when you even think about flying reflect your body's natural protective mechanisms, (i.e., a fight-or-flight response to perceived danger). As long as your thoughts give your body reason to think you are in danger, your body will dutifully react as if you really are in danger. Your best, common sense efforts to deal with your discomfort have probably only added to your symptoms and increased your preoccupation with them.
  
  Do not deal with your frightening feelings: 1) by trying to control, contain, or ignore them, 2) by desperately distracting yourself, 3) by closing your eyes to the reality of flying, or 4) by anesthetizing yourself with alcohol. You cannot "get rid of" such feelings and your attempts to do so will only make you feel worse. Give yourself permission not to be and feel perfectly in control. Make a point of noticing and accepting your anxious feelings for what they are-just upsetting feelings. These sensations feel intensely dangerous, yet they are not dangerous. Your task is to encourage your mind not to continue giving your body danger signals.
  
  Notice your feelings, accept your feelings, and decide to respond differently than you usually do to those feelings. Ironically, the more willing you are to invite, endure and even embrace panic, the less likely you are to have panic. Try to bring on a panic attack or try to make your symptoms worse. This is the paradox: You can't do either by willing it-trying to do so with real conviction is a move toward acceptance and will help the feelings pass. Trying to ignore or control panic only fuels such feelings. If your heart is racing, try to will it to beat faster. If your legs feel weak, will them to feel weaker. If your hands are sweating and trembling, will them to do so even more. Similarly, if you tend to clutch the arms of your seat when anxious, do so deliberately and intensely for 10-15 seconds, then let go and focus on your breathing, as described below. If you tend to tighten your legs and push your feet against the cabin floor when anxious, do so deliberately and intensely for 10-15 seconds, then let go and focus on your breathing. Adapt and repeat such exercises as necessary for your situation.
  
  Tell yourself:
  
  "I can be panicky and still fly."
  
  "It's okay to be anxious; it's okay not to feel in control."
  
  "It's an adrenaline surge-it's not dangerous-just accept the feelings."
  
  "If I'm going to have panic, let's go ahead and have it now."
  
  "Just because this feels dangerous doesn't mean it is dangerous."
• Confront your anxious anticipation and worry.
  
  Most fearful flyers' misery occurs more in the anticipation of flying than in actual flight. If you have decided to fly, don't allow yourself to indulge in frightened anticipation of all of the details of your flight or of feelings you may have. Everything you say or think to yourself will influence how you feel. For example, thoughts beginning with "What if…?" or "I can't…" have a very different effect on your feelings than thoughts beginning with "It's okay if…" or "I can…"
  
  If you are overwhelmed by your worries and can't seem to turn away from them, begin by trying to limit them to designated periods of worry. That is, you might choose to spend 10-15 minutes at several set times during the day during which you focus all of your attention on the worst of your worries, then turning your attention to other matters when time is up. Between designated worry periods, strive to postpone your worries to the next designated time. You can't "get rid of" your worries, but you can learn to limit the worrying process and, eventually, to not take your worries so seriously when they do intrude.
  
  If you have decided to fly, do not try to control things that are beyond your control. You can't fly the plane. You can't anticipate and prepare for every bump of turbulence. You can't control your every thought, feeling and action. You can't control the weather. If you are willing to accept that flying is a reasonable risk worth taking and you are willing to accept having uncomfortable, panicky feelings in order to overcome your fears, then your worries and wish for control are just irrelevant noise that alarms your body. Strive to keep yourself attune to here-and-now realities rather than anxiously anticipating your flight. Remember: Your worries prevent nothing.
  
  Tell yourself:
  
  "Stay in the here-and-now."
  
  "I'll deal with that when the time comes."
  
  "It's not the flying-it's the anxious thoughts."
• Before you fly, learn helpful breathing skills.
  
  When you are anxious, you are likely to breathe rapidly and high in your chest. If you are not physically active, this can lead to hyperventilation. Even fairly subtle hyperventilation can cause lightheadedness, shortness of breath, chest discomfort, sensory alterations, or a variety of other symptoms that can further frighten you by adding to the vicious circle of your anxious arousal. In contrast, when you breathe from low in your diaphragm, in a calm and rhythmic manner, you naturally activate the part of your nervous system that calms your body and diminishes your arousal.
  
  By learning to change your breathing, you can interrupt and begin to reverse the upward spiral of anxious arousal. Such diaphragmatic breathing has several benefits: 1) It helps to keep you focused on the here-and-now; 2) It gives you something active to do when you feel passively overwhelmed; 3) It may reduce the intensity of some symptoms; and, 4) It seems to stimulate the parasympathetic nervous system which helps your body return to equilibrium. Like any new skill, diaphragmatic breathing will require practice.
  
  To practice, lie on your back, with one hand on your chest and one hand on your belly. Observe the movement of your two hands as you breathe. Now try to focus your breathing low in your belly so that hand moves while the hand on your chest stays nearly still. Do not aim for deep breaths. Allow your breathing to be calm and rhythmic rather than hurried, forced or overly deep. As you breathe from deep in your belly, allow relaxation to flow into muscles throughout your body. You might find it useful to repeat a calming word or phrase to yourself or to picture a calming image within your mind's eye-experiment with what works best for you.
  
  Once you have developed some skill with daily practice, try the same skills in other positions and situations. Try the skills while you're walking, conversing with someone or driving your car. Eventually, practice the skills while you think about flying or while you visit the airport in preparation for eventual flight. If you learn diaphragmatic breathing effectively, acceptance will come more easily and panicky feelings will pass. However, don't expect to "get rid of" panicky feelings by focusing on your breathing. Remember, this is all about acceptance.
  
  Tell yourself:
  
  "Breathe low and slow."
  
  "Calm and smooth… calm and smooth…" (or similar words)
  
  "I can practice my breathing when I'm anxious."
• Seek exposure to cues related to flying.
  
  You may be remarkably avoidant of any cues about flying, which also serves to reinforce your fears. Make a point to watch television and print advertisements about the airlines. Read travel articles about flying. Visit the airport and departure gates, accompanied by a friend if you wish. Spend time sitting in the departure area, picturing yourself getting on the plane, until the anxiety diminishes. Watch planes landing and taking off. If you have the opportunity to sit on a stationary plane, do so.
  
  Practice your breathing and picture yourself coping with all the experiences of flight, even with your own panicky feelings. If you are a novice flyer or are particularly attune to the noises and other sensations of flight, read about what to expect and how to understand what will happen during your flight (see books below). Watch a video of a flight (see below), imagining that it is your flight, and practicing your breathing and other coping strategies.
  
  Tell yourself:
  
  "Face the fear and the fear will disappear."
  
  "It's not the airport, it's the anxious thought."
  
  "I can be here and do this even with panic."
• Take a practice flight.
  
  You may decide to take a practice flight with an anxiety disorders specialist experienced in working with fearful flyers. If you have decided to face your fear of flying without professional help, you may still want a sympathetic friend or relative to accompany you. The book by Cummings offers some tips for involving a companion in a useful manner. Coach your companion about what you most need to be reminded of during flight-tell them how they can best be of assistance to you.
  
  When planning your practice flight, choose a destination that will require a 45-60 minute flight each way. This will give you enough time to work with your anxiety successfully without facing a flight that's so long that you feel overwhelmed in anticipation. Eventually, on a longer flight, you will have the same opportunity to feel bored or sleepy that other passengers experience. You may find it helpful to take your practice flight at non-peak times so as to reduce other stressors. For example, a late morning flight is usually less crowded, getting to the airport is easier, and you won't face an entire day of anticipating a later flight. You may also want to choose your seat assignment in advance. Your travel agent can assist you; or, if you are booking online, most airlines will give you seating choices.
  
  Using this handout or other sources, write a few key words or phrases that you find helpful on index cards to serve as quick reminders on the plane. You may want to bring a cassette player with favorite music or relaxation cues. You may want to bring a book or magazine, not to distract yourself from the reality of flying, but to remind yourself that you can do ordinary things while flying and while being anxious. If the sensation of fullness in your ears during descent is a concern, bring gum, practice hearty yawns or consider taking a decongestant.
  
  Try to keep the day, or at least several hours, before your flight as free of other stressors as possible. While you wait, practice picturing yourself coping with your anxiety on the plane. Practice your breathing skills. Strive not to anticipate with "what ifs." Strive not to indulge yourself in scary thoughts that "justify" avoidance. Don't be upset if you have trouble sleeping the night before your flight-this happens to many non-anxious travelers, too. You can fly even if panicky and even if sleep-deprived.
  
  On the day of your flight, it is important to allow plenty of time for travel to the airport and boarding the plane so as to minimize other potential stressors. Practice your breathing, imagery and self-talk skills as you travel to the airport and as you await boarding. If it is important for you to board early, tell the agent of your special needs as a fearful flyer. If you board early, it may allow you a moment to meet the pilot or co-pilot which may be reassuring for some fearful flyers. Alternatively, you may find it helpful to wait until most passengers have boarded so that you have less time to wait on the stationary plane before take-off.
  
  Be sure to greet the flight attendants and flight crew as you enter the airplane, pausing a moment to look into the cockpit if possible. You may find it helpful to identify yourself as a fearful or novice flyer rather than striving to hide any sign of anxiety, which can unwittingly add to your discomfort. This may prompt the flight attendants to check with you during the flight; plus, you may feel more comfortable asking them questions that you might otherwise dismiss as silly. The airline personnel will assume that you are most concerned about safety; hence, if you're more afraid of your own panicky response, their reassurances, comments or questions may not be relevant for you.
  
  Do what you can to adjust your comfort level, (e.g., adjust the ventilation nozzle, get a pillow or blanket, adjust the light or window shade). As soon as you get settled, return to reading your index cards and practicing your breathing skills, coping imagery and helpful self-talk; but, don't try to ignore the reality of flying by blocking it all out or by staying in a frenzy of activity or conversation. Once airborne, when the "fasten seat belts" light goes off, allow yourself to get up and leave your seat briefly to visit the restroom or the magazine rack. The activity of your large muscles and lessening of the feeling of being trapped in your seat can be calming. However, at other times, keep your seatbelt fastened to avoid being jostled by turbulence.
  
  Talk to others if you feel up to it, but don't chat incessantly as a means of distracting yourself from the reality that you are in flight. Don't keep an eye on the clock. You may find it useful to look out the window occasionally.
  
  Stauffer and Petee recommend that you join forces with the plane, as if you were connected to it, (e.g., when the plane banks to the left, lean your body to the left rather than resisting the motion; when turbulence causes some bumpiness, experience yourself as part of the plane, riding the bumps as if they were waves rather than trying to "get control" of either the turbulence in the air or the turbulence in your body).
  
  In summary, remember to notice and accept, even to invite and embrace, your own anxious feelings. Don't mistake the intense feeling of danger for actual danger. Remember to practice your breathing skills, coping imagery and helpful self-talk. Finally, remember that with practice and patience, you can recover just as so many others have recovered. Imagine how proud you will be and where you will want to go once you are truly a flyer. Most people find that their anxiety varies over the course of the flight, but that they generally feel more comfortable as time elapses after take-off.
  
  Some people feel triumphant success with their first practice flight while others feel a grim sense of accomplishment. Either way, give yourself credit for facing your fears. How you feel on one flight does not predict how you'll feel on another flight, so don't make too much of your first experience. Think of it as a step in the right direction just because you faced your fears. More practice can lead to more progress. If your first flight went very well, remember that you may still face more anxiety on another flight. Expect it, accept it and deal with it as you have learned.

See ASDI Events for information about our periodic Fear of Flying class
and ASDI Groups for our ongoing fear of flying support group.

Anxiety and Stress Disorders Institute of Maryland:
Treating anxiety disorders and stress-related disorders in Towson, Maryland, since 1978.