THE SKY IS THE LIMIT
Tips for Anxious Travelers
By Dr. Jan Weiner, Ph.D.
More than 25 million Americans experience some form of flight anxiety. Aviophobia, or the fear of flying, defined as a specific phobia- a persistent, irrational fear of a situation that leads a person to have a compelling desire to avoid it. People with aviophobia often experience irrational thoughts accompanied by intense bouts of anxiety and/or fear. Physiological activation can be experienced anywhere along a spectrum from ‘what if’ worries and anxious ruminations, to feelings of dread, and/or all the way to experiencing full-blown panic attacks. The anxious brain will often times also produce catastrophic thoughts accompanied by vivid imagery. Common themes involved with aviophobia include: irrational fears of crashing, dying (in a horrific way), fainting, losing control, and/or being trapped. Regardless of any facts, information, or reassurance that flying is the safest mode of transportation, people with flight phobia will experience extremely high levels of anticipatory anxiety and panic-driven thoughts.
Many studies have shown that Cognitive Behavioral Therapy (CBT) techniques are extremely effective in treating people with aviophobia and can provide long-term benefits. CBT is a short-term, goal-oriented treatment that provides a practical approach aimed at changing maladaptive patterns of thinking and/or behaviors. It proposes the notion that if you can change the way you think about a situation, then you can change the way you feel. Flying with ease is an attainable goal following a successful course of CBT.
Here are 11 tips to help alleviate flight phobia.
1. Know the facts- Learning the facts and other information about how a plane flies, weather patterns and turbulence, statistics regarding the unlikelihood of plane crashes, and the meaning of the events during a typical flight can all help to alleviate anxiety. Enrolling in a fear of flying program can allows you to learn the relevant information to assuage your fears of flying.
One major caveat- When fear of flying meets criteria for a specific phobia (an excessive or irrational fear of a specific object or situation that results in great distress and avoidance associated with the object or situation), or when/if there is another underlying anxiety disorder present (ie., generalized anxiety disorder and/or panic disorder) knowing the information and facts alone will simply NOT work. When anxiety disorder is present, the brain will override all rational thoughts with irrational ones and fully engage the fear system. When this occurs, a different set of techniques, based on cognitive behavioral therapy, must be employed. The rest of this article will focus on the CBT techniques to help manage and prevent flight phobia.
2. Identifying fear triggers- Figuring out what triggers your fear is an important first step toward conquering flight anxiety. Different aspects of flying can trigger different fears—for example, one person may be afraid of turbulence, while another may be afraid of fainting, or having a heart attack. Despite the variety in fear themes, most people with aviophobia have one thing in common-- anticipatory anxiety, the fear experienced in anticipation of an event or situation (ie., taking a flight). This anticipatory anxiety can be so severe that one refuses to step foot on an airplane. In order for an anxiety treatment to be successful, it must address and attempt to manage the anticipatory anxiety associated with flying. Being able to recognize and pinpoint your personal fear triggers is the most important step to managing them. Try asking “What scares me about flying?” as a way to extract some of these triggers.
3. Feel the fear and do it anyway- Once you have pinpointed your specific fears, you can begin to change the way you respond to them. The first step in managing fear is to ignore the brain’s signal in the same way that you would ignore a fire alarm. Say that you are in your kitchen one morning making toast, and the smoke of your toaster sets off your fire alarm. At first, you may startle, but quickly realize that burnt toast is not an emergency. Calmly, you wait for the smoke to clear and the alarm to shut off. Changing your perception of the presence of anxiety signal, and treating it like a false alarm, is a technique that can help change your physiological experience. Another useful analogy is to treat your anxiety like a child tantrum. Behavioral therapy has established that the consequence of a behavior can increase or decrease the likelihood of that behavior occurring in the future. Imagine a child throwing a tantrum in a candy store. If the parents give into the child’s demands and give them candy to quiet the tantrum, the child will learn to scream louder and longer the next time to get what they want. If you ignore the child’s behavior and do not give them the candy, they eventually become exhausted, and, thus, learn that tantrum behaviors do not get them what they want. Thinking of your anxiety as either fire alarm or child’s tantrum may help you to begin to disregard the brain’s false fear signal. Anxiety is a nuisance, but not a real emergency.
4. What to do with “What ifs”- People with flight phobia will often worry about a multitude of ‘what if’ possibilities. What if the plane crashes? What if I’m trapped? What if I faint? What if I lose control? What if I have a heart attack? Fear themes tend to include potential safety threats, harm to self and others, uncertainty, and loss of control. Worries tend to begin with classic “what if….” statements. The good news is that worrying can be thought of as a form of maladaptive problem solving, because anxiety sufferers tend to make a common error: they do solve the actual problem. Deliberately producing the worst case scenario can actually help reduce anxiety. Even though this may seem counterintuitive, the best way to combat this error is to simply answer the question, in the same way that standing up to a bully will shut them down. For example, what if I fainted? Well, what if, you did? Try to answer the question: Well, I would probably fall on the ground and the flight attendant would have to help me and I may look silly or foolish in front of people? What if there is a terrorist on the plane? Continue to answer the question. Well, what if there was…. Well, then they might blow up the plane and I would die. Okay, well, then what… continue to answer the question. Where would you have your funeral, who would you hope to attend it? Keep going with the worry until it makes you laugh or seems silly. Sarcasm is greatly welcomed here. Deliberately answering the "what if" worry with the worst case scenario can reduce anxiety.
5. Tolerating Uncertainty- The two most common themes involved with flight phobia are uncertainty and the loss of control. For many people, the idea of uncertainty is uncomfortable, but for anxiety sufferers, the concept of uncertainty is utterly intolerable/unbearable. Because uncertainty is so distressing, many of us try to control or eliminate it altogether. However, the ability to tolerate uncertainty is a skill that can be trained and practiced. Like a muscle in the body, tolerating uncertainty must be practiced and exercised to successfully modify anxiety producing settings. This is often uncomfortable in the same way that a muscle can get sore and/or burn during and after exercising. A personal situation that we value highly and/or has extreme importance or significant to us is even more arduous. One way to build tolerance to uncertainty is to change the language you are using in your brain by injecting additional coping statements. Modify the thought, “I can’t handle the uncertainty about this flight,” with: “I don’t particularly care for uncertainty, but I can bear it and I can tolerate it even if it is uncomfortable.” Accepting uncertainty with coping statements is an important way to reduce anxious thoughts and feelings.
6. Be Mindful- Mindfulness is another skill that helps to have a moment-to-moment awareness and acceptance of your thoughts, feelings, bodily sensations, and current environment. Mindfulness techniques involve paying attention to your thoughts and feelings without judging and engaging them. Mindfulness skills help us to learn to sit with feelings of uncertainty and discover that you are indeed able to do so. When we are focused on the present moment, it is difficult to worry. Ask yourself, “Is there anything wrong right now?" Focus your attention to your body and your mind without judgment. Watch the thoughts or bring a mindfulness mediation app or tape along with your flight. Mindfulness techniques when used in conjunction with tolerating uncertainty can be very useful to combat anxious thoughts and feelings.
7. Change your language, change your brain- Anxiety sufferers tend to use catastrophic language statements. “I CANT do it,” “This is awful/horrible,” “This will NEVER go away.” Studies have shown there is a strong connection between the language that we use and activation of the emotional areas of the brain. Therefore, the stronger and more emotionally-laden language we use, will result in the heightened intensity of the emotions we feel. De-catastrophizing the language in your brain, can significantly help reduce emotional distress. For example, your brain may be telling you, “Flying is AWFUL. I can’t handle turbulence, it is dreadful, and I can’t bear it.” Try to replace your brain’s dialogue with dampened down language, i.e., “Flying can be uncomfortable at times, turbulence is unpleasant, but it will pass, and I can do this!” Language that is filled with coping statements will reduce anxiety and other negative emotional states.
8. Just Breathe- Learn Box breathing or Belly/Diaphragm breathing techniques. People who have anxiety have a tendency to take in too much or too little oxygen. Breathing techniques can help to regulate the oxygen flow which helps reset the sympathetic nervous system, bringing the body back to a calmer state. Box breathing: focus on counting your breaths in counts of 4’s. For example, Inhale, 2, 3, 4… Hold, 2, 3, 4… Exhale, 2, 3, 4….Hold, 2, 3, 4. This simple breathing exercise quickly retrains your nervous system to breathe properly and prevent hyperventilation. Diaphragmatic/Belly breathing is done by contracting the diaphragm, or concentrating on expanding the abdomen rather than the chest when breathing. Deep breathing involves slow and deep inhalation through the nose, usually to a count of 10, followed by slow and complete exhalation for a similar count. The process may be repeated 5 to 10 times, several times a day, or as needed. There are a multitude of apps available that provide guided breathing techniques.
9. Eye on the prize- As discussed earlier in this article, people with anxiety often believe that unpleasant feelings are unbearable, should be avoided at all cost, and have the tendency to overly focus on the sensations and feelings of discomfort and anxiety. This often yields statements such as “I should not feel anxious on the plane, therefore I won’t fly.” Instant gratification is the idea that it is absolutely necessary to feel good and this must not/should not be delayed (ie. There’s a warm chocolate chip cookie on the table and you eat it). Delayed gratification is associated with resisting a smaller but more immediate reward in order to receive a larger or more enduring reward later (ie. I’m trying to lose weight for the summer and cookies are not on my diet). Withstanding the smaller more immediate discomfort of flying will lead to a greater reward of getting to your destination. If the reward of the outcome is positive, you will be more likely to engage in more flying behavior in the future, leading to more rewards. And, as a bonus, the ability to delay gratification has been shown to host of other positive outcomes, including academic success, physical health, psychological health, and social competence.
10. Talk it Out- If you happen to be traveling with family, a friend or spouse, talking to them throughout the flight can help alleviate anxiety. It is important to let this other person know what you are thinking and feeling when discomfort increases. This can help to serve the purpose of letting the thoughts out and provide a healthy form of distraction. Somebody who cares about you will be willing to help support you through a challenging flight and reinforce the other skills mentioned in this article.
11. The Last Resort- Have a relaxation medication handy—but only as a last resort. Fast-acting anxiety medications like Xanax, Ativan, or Klonopin can be helpful for anxious flyers to prevent panic attacks and reduce generalized anxiety. You may find that simply knowing the medication is there in case of emergency is comforting enough. Note: Bringing the medications with you on the flight, can be helpful to reduce anxiety in the short-term, but is not helpful for longer term anxiety reduction and may prevent gains with phobia retraining through cognitive behavioral strategies.
The preceding tips and tricks are intended to help you feel more comfortable flying. It is recommended that you face this fear while working with a Cognitive-Behavioral therapist. Exposure and response prevention, systematic desensitization, virtual reality programs and/or biofeedback programs during which fearful fliers are exposed to computer simulations of flight triggers, are also helpful. You do not need to be gripping the armrest in terror, getting drunk in the airport bar or avoiding flying altogether. You can learn to fly with ease.
The sky is the limit!