A flying phobia affects more than 25 million Americans. Here’s how to manage it

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When air travel accidents such as the fatal midair collision near Washington, DC, occur, the consequences can reach much further than those directly affected by the tragedy. It can also give rise or increase people’s fear of flying, also known as aerophobia or aviophobia.

Many people have sat through plane delays due to mechanical issues, weather or other reasons, perhaps a bit concerned at the holdup but not terrified of what could happen.

“Almost every person has had some thought of, ‘Oh, my plane is delayed. I hope everything’s safe and fine,’” said Dr. Gail Saltz, clinical associate professor of psychiatry at Weill Cornell Medical College in New York City.

But it’s not that simple for everyone.

“Some people have a tendency to have a thought become what’s called sticky or obsessive,” Saltz added. “They don’t like the thought, but it sticks in their mind, and they can’t really get it out. This kind of event is a typical trigger for people to have some increase in anxiety about flying or a true aerophobia.”

As one of the most common phobias, aerophobia affects more than 25 million adults in the United States, according to the Cleveland Clinic. It most commonly affects people between ages 17 and 34 — “a time in life when significant changes occur, such as graduation, marriage or childbirth,” the clinic website notes. “People may be scared that flying jeopardizes their life at such an important time.”

In light of Wednesday night’s tragic collision, Saltz discussed aerophobia’s symptoms and how people can manage the phobia to help themselves recover rather than limit their lives.

This conversation has been lightly edited and condensed for clarity.

CNN: What’s the difference between flight anxiety and a flying phobia?

Dr. Gail Saltz: Flight anxiety is just anxiety about flying. But diagnostically, there is a definition of aerophobia, and people with it have sets of symptoms. There are physical symptoms of that fear — fast heartbeat, sweating, trembling, dizziness, nausea, shortness of breath, chest pain or vomiting. They have emotional symptoms, so they feel panicky and worried. There might be behavioral symptoms that make someone cancel a flight at the last minute because of their panic or decide to take a train for an obscene number of hours to avoid flying. They might choose to not go on vacations or business trips and repeatedly seek reassurance about travel safety from other people.

Those symptoms can occur even the week before the flight or at any point when they’re on the plane. For flight anxiety to be considered a flying phobia, these symptoms need to have been the case for six months or more. It needs to be interfering with their life in some way. People who seek treatment usually have a debilitating phobia.

CNN: What causes aerophobia?

Saltz: There’s not one thing that causes any phobia, including fear of flying. But you’re more likely to experience aerophobia if you already have high anxiety. Another factor is trauma, like a natural disaster experience or a terrible car accident — something where your life felt at risk. Kids who have a parent with a fear of flying can acquire it from them.

CNN: What factors may worry someone with aerophobia?

Saltz: Sometimes it’s not even the flying per se. Sometimes it’s a fear of being in an enclosed thing in the air and not being able to get out. It could be a fear of heights, of becoming motion sick and vomiting, of contagious illness or of takeoff, landing, thunderstorms or turbulence. Everybody thinks that you’re terrified that the plane will crash, but that’s only a small number of flying phobias.

CNN: What ways of coping with aerophobia are unhelpful?

Saltz: When you avoid or cancel a flight, you feel this great sense of relief. That relief provides positive reinforcement to your brain, saying, “This was a good thing. I avoided the danger. I feel better now.”

However, your world just shrunk a little smaller, and your fear, being reinforced by this, gets larger. The one thing you don’t want to do is avoid, and as hard as that is, it will help you diminish your fear. Also, avoid drinking or taking sleeping pills or other drugs (to deal with your phobia) unless prescribed by a doctor. That can be dangerous and cause dependence, and it won’t give you the therapeutic benefit of exposing yourself to the flight and moving in the direction of recovery.

CNN: How can someone manage or overcome a fear of flying?

Saltz: Phobias in general are one of the most common mental health conditions, and they’re very treatable. The treatment is exposure and response prevention — you have to expose yourself in some way to that feared situation and prevent your usual responses, which only make the phobia worse. That’s (done) by having a therapist guide you through and teach you all these relaxation and therapeutic techniques to manage your anxiety as it comes. Over time, you essentially become desensitized to those triggers. Virtual reality treatment guided by a therapist can also help.

See what you can do along the way to make flying the least unpleasant. When you’re feeling panicked, meditation, progressive muscle relaxation and 10 minutes of paced deep breathing can help. You’re inhaling through your nose to a count of five, holding it for a second or two, then exhaling through pursed lips to a count of seven. Watching or listening to something that relaxes you can distract you from anxious thoughts. If you’re traveling with someone, discuss your thoughts with them.

For many people, their fear is based on flying just seeming like an impossible feat. Educating themselves on the mechanics of aerodynamics is helpful. It’s called intellectualizing as a defense mechanism.

CNN: Some people may think, “Although plane accidents are rare, I never know if I’m going to be on one of those flights that end in disaster.” How can they cope with that awareness?

Saltz: While I said these are irrational fears, of course any fear can have a kernel of truth to it, and most of these do. One thing experts do is educate patients about the statistics to put things into perspective — like how you are much more likely to die in a car accident, get hit by a car while crossing the street or even be struck by lightning than you are to die in a plane crash. And you get in your car or cross the street every day.

There’s very little in life that truly has zero risk. Every day we walk around accepting a certain amount of risk to live our lives. And luckily, most of us don’t go around and think, “I better not cross the street because I could get hit by a bus.” Most people can think thoughts that allow them to go, such as “I’m going to look both ways, then cross the street” or “I’m going to book with a known airline.”

CNN: How can parents talk to kids about plane accidents without fostering a phobia?

Saltz: Your tone is important. If you sound alarmist, it doesn’t even matter what the content is — your child will be alarmed. If you can’t talk about it calmly because you’re freaked out, go away (and) return when you’re calmer.

Try to keep news and social media from your child. You understand you’re seeing the same event posted over and over again, but for your kid, it feels like the event is happening over and over again. Say you’ll answer any questions the best you can, and that the incident was an incredibly rare one and that millions of safe flights happen all the time. Reassure them you would not take them on something you’re concerned isn’t safe.

CNN: How long does overcoming aerophobia take?

Saltz: It can be different for every person, but some people really do get better in eight or 10 weekly therapy sessions. Some people’s phobia is resistant, so recovery can take longer and be very difficult. But many people do respond in a shorter time period.

Therapy may keep the phobia at bay for years or, for some people, permanently. Others might need to come back in and re-engage in treatment. It’s hard — if you’ve got a phobia and you think the most terrorizing thing that could possibly happen to you is to be exposed to this thing which makes you terrified, then you have to have a certain amount of faith and trust in the system and belief that this (treatment) can help you.

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