I am a social work specialist and an instructor in the Department of Psychiatry at the University of Iowa Health Care. I will be happy to take your questions on the topic of Fear of Flying. I have spent the last 10 years working with individuals who have a fear of flying. And, during the past year, I have begun to offer discussion groups for people with the fear of flying.

What is the first step in overcoming fear of flying?

I think the first step in overcoming the fear of flying is to start getting information about opportunities in your area to work with someone who can help you take the necessary steps to face this fear.

I hate to fly--I know my fears are way exaggerated but how do I get over it?

I don't think we get over our fear, but I think we learn to face it and, through a series of techniques, we can learn to control our fearful thoughts as well as some of the uncomfortable physical reactions that are associated with those fearful thoughts. Another helpful approach is to get more accurate information about the actual dangers of flying. We know, for instance, that flying is 20 times safer than driving a car. Even though we may know that in our rational, logical mind, often times our fear is really a product of our emotional reaction, and it is very difficult to combat it with logic. It would be nice if we could simply think or feel our way out of fear, but I think that it is very much like conquering other fears or changing other behaviors, and namely we actually have to do something different. Many people, I think, are familiar with the expression from Alcoholics Anonymous that says, "Walk the walk and talk the talk." The idea being that if you change your behavior, eventually your thoughts and feelings will change.

Where does the fear of flying start? Is it a past experience that causes it?

The most accurate answer is that we really don't know because it is probably different for each person. Certainly, for some people a past experience seems to cause it. If someone has a scary experience or an experience that they interpret as scary, they, in fact, may develop a fear. Sometimes we learn to be afraid because other people around us are afraid or are expressing fear. Many fears are the result of misinformation and not understanding, for instance, how an airplane flies. As we look at some of these enormous planes sitting on the ground, it is very difficult to imagine how this thing gets off the ground and stays in the air.

Why do some people hate to fly so much?

I have thought about this a great deal actually, and I have come to the conclusion that people don't really fear flying itself, but that they have a number of other fears that are associated with flying such as the fear of heights or the fear of being trapped in a closed place. I think that for many people there is a fear of crashing and dying. For some people, I have discovered, that the fear of flying is actually tied to a fear of leaving home and leaving a familiar place. However, I have found that the number-one reason that people share with me and talk about in the flying groups is not being in control of the situation. Some people have a fear of going too fast; that was one that came up in my last group, another fear is related to a fear of heights. These people often fear going up in elevators, climbing ladders etc. I think that because there are a number of fears that are a part of this condition, it can be more complicated to treat. On the other hand, one of the things I have discovered is that regardless of the specific reasons that people fear flying, when they finally decide to face their fear and get some help, most of them are able to achieve success.

I hate to fly over large bodies of water--but over land I am ok. Why is this?

If you have a fear of water, it may be that this is part of the fear. Perhaps you believe that on land there would be more people to see you and to help in an emergency. Since most of us spend most of our time on land, it might seem safer to us.

What can I do to make my kids not afraid to fly?

When we are working with our children, one of the things that is very important is for us to be aware of how much impact our own words and fears have. If you are a person who is afraid to fly, it is okay to admit that to your children, but then to say to them, "Even though I am afraid, I am working on this." Also, helping them to realize that there will be many times in life when situations seem scary, but if we face our fear and we don't avoid the situation, we usually find that it is less scary than we predicted. So much of fear about anything seems to be anticipatory, and it seems to be what I would call, "looking for a future catastrophe," and reacting as if the catastrophe is happening now and is real at this moment.

Every time I even think of flying I have nightmares about it--how can I stop this?

I think that you may not be able to stop it, but you may be able to understand that as you begin to change the way you think about flying, you will likely find that you have fewer nightmares, or they are less severe. A part of the nightmares may be an expression of the fears that you have during the day and the way you are thinking about flying. If you were to decide to think about it differently, or take steps to manage your anxiety about flying, I suspect the nightmares would decrease.

Am I nuts to hate to fly?

Of course not. There are many people who are uncomfortable about flying, and we would certainly not consider these people to be "nuts" or to have a mental disorder. We describe flying phobia as a mental disorder when the person takes extraordinary steps to avoid flying and the avoidance of flying has a serious impact on their life. There are many people who feel that not flying does not interfere with their lives and that not flying is a perfectly comfortable choice for them. If that were the case, we certainly would not diagnose that as a disorder. Generally the people who come to me for treatment want to overcome this fear because it is having a significant impact on their lives. Perhaps it is affecting the kinds of jobs they could get. In some cases, it is affecting family life because families may not be able to take a distant vacation in a short amount of time unless they fly. If not flying does not interfere with your life, there is certainly nothing wrong with you. If it is not interfering with your life or keeping you from doing things you would enjoy, there is probably no reason to change. Most of us do not change unless there is a very strong motivating force.

Is drinking alcohol to overcome the initial fear of taking off on the plane a bad idea?

We do not recommend that people use alcohol or drugs except in very small amounts because those, by themselves, can create other problems. These substances could also interferes with the sense of accomplishment or the sense of being able to deal with the experience. There was a pilot for one of the airlines who developed a fear-of-flying program a number of years ago and one of his comments was, for a small fear then a small drink. If it's more than that, you are trying to shut out the experience. When we work with people who are dealing with anxiety associated with flying or with any other situation, we are actually teaching that person to do something that we call "habituating." This means, "getting used to." What that means is learning to tolerate a certain level of anxiety, by not exaggerating the response to the anxiety. By not demanding that the anxiety go away immediately, you will find that this is what will help bring the anxiety down. When you use alcohol/drugs to block the anxiety, you cannot experience habituation.

Do you have suggestions on how to be able to fall asleep on a plane? I have trouble sleeping even on nighttime flights?

Different techniques, such as listening to soft music, may help people in falling asleep on a plane or relaxation tapes. People who are flying through several times zones, such as on international flights, may find it helpful to have their physician prescribe a mild sleeping pill. Obviously you need to talk to your own physician about what would be best. It is probably a good idea to try that medication at a time when you are not flying just to be sure you don't experience any adverse side effects. If you have a fairly relaxed attitude about sleeping on the plane--and what I mean is that you not demand that you be able to go to sleep--it may be easier for you to relax and sleep. There are a number of people who do not have a lot of anxiety associated with flying, but they find it difficult to sleep on a plane because it is not always the most comfortable position, other people may be up and around, the lights may be on or off and it may not be a restful environment, so you may simply have to accept that it is difficult to sleep on a plane.

Can hypnotherapy work for people who don't like to fly?

That can be very helpful. In the techniques that I use with anxious flyers, we do a great deal of relaxation and some hypnosis, including self-hypnosis. Many people can learn the technique of self-hypnosis, which can make them feel as though they have a great deal of control over their reaction.

What are some other techniques we can try?

There are a variety of relaxation techniques that can be very helpful. If you also are able to identify specific aspects of your anxiety about flying such as a fear of heights, for instance, you can work with someone who can help you to be more comfortable going up in an elevator or standing at the top of a building and looking out at the horizon. If the fear is related to being in an enclosed place, you can work on going to places that are more crowded, perhaps starting out by sitting close to the door and gradually moving forward and being able to sit in the middle of a row at a movie theatre. Certainly for some people, looking at issues about being away from home and finding ways to be more comfortable as you think about leaving home may be more helpful. It is really important to look at the associated fears that go along with flying.

For those with this phobia, do you recommend that they sit in a particular location on the airplane that is less anxiety producing?

This certainly can be helpful for people. You may have to experiment to decide what location is best for you. Many people find that if they sit in an aisle seat they have a sense of being able to get out of their seat more easily or are able to stretch their legs out more comfortably. Other people feel more comfortable sitting by a window. Again, it depends on the particular person. Generally speaking, sitting slightly forward or over the wings is a more comfortable place. If you sit back towards the tail section, you may have more of a sensation of motion and be more uncomfortable.

Can reading be a good idea as a distraction?

Another anxiety associated with flying is motion sickness. These people usually experience discomfort because of the motion, and it's not the flying itself that produces their discomfort. These people are equally uncomfortable in the back seat of a car or in a boat. People who have motion sickness will often report that trying to read while in a moving object makes them very uncomfortable. If you are not subject to motion sickness and are able to read, it can be extremely helpful, especially if it is something that is very compelling and interesting to you. You may find that you hardly notice that you're flying because you are so absorbed in what you are reading.

Can you give some tips on meditation or other relaxation techniques that can be used while in the seat on the plane?

I think those are excellent techniques to use. There are some commercially produced relaxation tapes that can be purchased. I think the secret is to practice with them faithfully for several weeks before you take your flight. This is true in general about meditation and relaxation. It is important to practice before you actually need it so that your body and mind respond automatically. If you get into a situation where you are experiencing extremely high anxiety, it may be more difficult to use the relaxation if you have not practiced at other times. What we are doing when we teach relaxation is that we are starting to change the connections. When you are anxious about flying, you associate feelings of anxiety with the flying experience. We are trying to re-associate feelings of relaxation with the flying experience. I mentioned earlier that perhaps the most prominent reason for the fear of flying is the feeling of loss of control. I would agree that as passengers, we are not in control in a plane the way we are if we are driving a car. While we cannot control what is going on in the cockpit, we can control how we think about the experience and by using relaxation techniques and thinking differently about the experience, we can control some of those disturbing sensations in our body, such as our heart beating rapidly, feeling shaky, or trembling. Some people will experience feelings of dizziness or sweating, any number of reactions associated with feelings of fear. The relaxation techniques help us to calm those feelings and give us something we can control. Some of the other things we do as part of our training to manage the anxiety associated with flying involve getting more accurate information about flying itself, such as how airplanes fly and what some of the noises are that disturb us. When we don't understand something, we tend to be afraid of it. One of the things that we do in helping overcome this fear is to have what I call "Ask a Pilot" sessions. If you are in a large city with airline service you might want to contact the airline to ask if they have any programs to help fearful flyers. They may be able to give you permission, for instance, to board a plane that is parked and just sit in a cabin and note that your feelings of anxiety will gradually subside as you sit there. There are some cassette tapes and books that also are helpful for self-help. That there are a number of things that people can do to help themselves, and there are therapists who are able to help people overcome their anxiety about flying.

It is important to emphasize that any fear is maintained by avoidance. As long as people continue to avoid fearful situations, they will find it very difficult to decrease their fear. On the other hand, one of the things we need to look at is the role of the media and the kind of publicity that is given to a plane crash which, in fact, is a very rare event, which is why it is newsworthy. We live in an age now where we have instant graphic pictures when any kind of disaster occurs. Those visual images are replayed over and over for days and days in excruciating detail. By constantly replaying them, it reinforces the idea that this is a very common event and that every time you get on a plane, you are in eminent danger of a disaster when, in fact, that is very far from the truth. As we said before, flying is extremely safe, particular in the United States, Canada, and Western Europe. Therefore, if you are flying on regularly scheduled airlines, you will find that airline safety is extremely high. It is also important to realize that the airlines have a great investment in making flying safe because when there is the rare accident, there is an immediate effect on the number of cancellations and the number of people who then decide not to fly. The effort to improve airline safety is an ongoing one. Pilots are very vigorously trained and aircraft are built to very high safety standards. There are over 40,000 flights per day in the world, and very, very few accidents.

By way of summary, we might talk about some other things that are helpful when you are planning a trip by air. I think it is important to optimize the possibility of a successful experience. Obviously, leaving yourself plenty of time is very important. If people are rushing around, trying to get to the airport, they are going to find themselves feeling more anxious and they are going to set themselves up for more distress. Plan carefully in advance so that you leave enough time for doing what you need to do at home before you leave, perhaps packing the car the night before or early the next morning, getting to the airport early and selecting a seat near the front where it will be quieter and smoother. It is important to eat appropriately, not going on an empty stomach but also avoiding a very heavy meal, which may make you uncomfortable if you are sitting for a long period on the plane. You may want to bring along a good book or magazine to read. You can distract yourself by watching other passengers at the airport and on the plane, observing people who seem to be relaxed. You may also enjoy bringing along a portable tape or CD player for the flight.

My husband fears flying, what shall he do?

Your husband needs to decide how important it is to overcome this fear. It may be helpful for him to look at the positive aspects of being able to fly. How would it make his life more enjoyable? He also may want to look at the things he is missing out on because he is not able to fly. Then, the next step is to look for a professional who has experience in helping people overcome their fear of flying and making an appointment to talk with that person. Sometimes people find it very helpful if they have a supportive friend/partner who goes to the fear-of-flying group with them and helps them in planning some ways to expose themselves to flying situations. Sometimes it is helpful to actually build what we call a hierarchy of situations associated with flying, starting out with the thing you fear most, which might be the flight itself, and then looking at some aspects that are less frightening, like buying a travel magazine or going to a travel agency and looking at possible trips. Another step would be driving to an airport and just watching the planes land and take off, just to get used to being in that environment. Another step would be sitting in the lobby at the airport, imagining yourself taking a flight and then using your relaxation training to help manage the anxiety as you think about that step. This is a common technique in relaxation in which we ask people to imagine themselves planning a trip, leaving home, arriving at the airport, and standing in line for their ticket and so forth. It would be very helpful if he books his ticket early and is assured of a window seat. If he can work with someone who will help him learn to relax, he may be able to control his physical reactions and he may also, with good information, be less likely to have such a strong thought that every time he gets in the airplane he will crash. We are really working in a number of areas when we are tackling a fear. We are working on our thoughts, which then affect the feelings we have, but most importantly, we are making a change in our behavior. As that behavior changes, we usually find that our thoughts and feelings will change as well. One of the comments I would like to make about the fear of flying, or the anxiety associated with flying, is to have realistic expectations. What I mean by that is being willing to accept some degree of anxiety associated with flying rather than believing you must be perfectly calm and relaxed or you have not been successful.

What I would like to say in closing is that the fear of flying is extremely common. It is estimated that 25 million people in the United States are so frightened they will not fly at all. An additional 50 million experience substantial anxiety whenever they do fly. However, we also know that a great number of people have been able to reduce their anxiety and to fly more comfortably and experience the benefits of being able to do the things they want to do. One of the people that I worked with found that as she began to overcome her fear of flying, she found that many other fears also decreased and her feelings of empowerment and confidence markedly increased. I will encourage all of those people who have joined us today to think about challenging their fear of flying because they may find many other benefits as well. I would like to thank all of those who have joined us today.