Ask Doctor K

Cognitive Behavioral Therapy Can Overcome Fear of Flying

DEAR DOCTOR K: When I am forced to fly, I sweat and shake and feel like I'm going to faint. I've been avoiding work-related travel, and I'm holding my family back from taking long-distance vacations. What can I do to get over my fear?

DEAR READER: You suffer from a type of anxiety disorder called flight phobia or, in medicalese, "aviophobia." A phobia is an extreme fear of something that poses little or no real danger. Fear of flying, heights, animals, insects and the like are all phobias.

Fear of flying is actually pretty common -- and it can affect quite powerful people. For example, the founding dictator of North Korea, Kim Il-sung, allegedly suffered from flight phobia, as does the son to whom his mantle of dictatorship was passed, Kim Jong-il. Of course, the isolation of their country from the world didn't require them to fly to many other places. Indeed, flying to many countries would have been quite inadvisable.

Even the most powerful person in the world for eight years, President Ronald Reagan, allegedly had flight phobia. Before becoming a politician, he traveled by train whenever possible. After entering politics, he just gritted his teeth and accepted the inevitable.

It sounds as though your phobia triggers a panic attack. If so, you may also have other symptoms, such as chest discomfort, shortness of breath or palpitations. You may feel that you are losing control.

Cognitive behavioral therapy (CBT) is the leading form of therapy for anxiety. It aims to correct ingrained patterns of negative thoughts and behaviors. As the name suggests, it has two parts. Cognitive therapy helps people change patterns of thinking that prevent them from overcoming their fears. Behavioral therapy works to change their reactions in situations that trigger anxiety.

A form of CBT called desensitization (also called exposure) can be particularly effective for phobias and panic disorders.

Exposure therapy involves having people face their fears directly. This can be done in several ways. One is through role-playing. Another is by having a person imagine frightening situations and describing them.

Yet another strategy is to actually put people in real-life situations that spark anxiety. The reasoning is that avoiding anxiety-causing situations reinforces fears or false beliefs. In real-life situations, people can recognize inaccurate or negative thoughts and substitute realistic ones. With repeated exposure, people eventually become desensitized to fear-provoking situations.

You may not need ongoing treatment if you encounter the thing you are afraid of only occasionally and predictably, as it tends to be with air travel. In such a case, anti-anxiety drugs such as lorazepam and clonazepam can help. You can take them only when needed. The goal is to find a dose that reduces symptoms enough so that you can get on the plane and stay calm enough while en route.

Given the intensity you describe, it is probably a good idea for you to explore therapy and medication. Most people find that anti-anxiety medicine plus a simple relaxation technique, such as deep breathing, is enough to make air travel bearable.

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