Your palms sweat as you board the plane. Searching for your seat twists your stomach into a giant knot of dread. And then you have an entire flight to endure. Fortunately, if you're one of the estimated 25 million frightened flyers in the United States, there are ways to cope.

Nigel S., a 29-year-old vice president of a San Francisco public relations firm, was once a tranquil flyer. But when he reached his early twenties, a few "incredibly turbulent" flights and one troubled landing propelled him into a tailspin of terror.

"My fear never kept me from flying," he says, "but from the moment I bought my tickets I'd lie awake at night dreading the plane trip as if it were my own execution." Since Nigel logs in 35,000-50,000 miles of airtime a year, those anxious sleepless hours added up.

Refusing to let panic control his life, Nigel enrolled in a course at Boston's Institute for Psychology of Air Travel. One evening a week for ten weeks, he practiced breathing exercises and acupressure techniques. A commercial pilot explained turbulence, flight sounds, and passenger sensations such as a dropping feeling as the plane levels in the air. Group members supported each other through sharing and mutual encouragement.

Was the course worth it? Nigel says it's one of the best things he's ever done for himself. "I'll always have some fear, but I've learned how to deal with it. It's really made a difference in my personal and professional life." He mentions his honeymoon, which concluded with a 14-hour flight home from Greece. "I was stressed but I could cope."

And those sleepless nights? "No longer a problem," he says.

Safety in Numbers?

The statistics are reassuring. According to Boeing, there have been fewer deaths in American commercial airplane accidents during the past 60 years than deaths from U.S. car accidents in a typical three-month period. Yet as many as one in six U.S. adults admits to fear of flying. The degree of fear covers a wide spectrum: some travelers are mildly uneasy during plane trips, whereas others are grounded by their desperate refusal to fly, despite profound professional and personal cost.

So what's the explanation for the soaring number of panicky passengers, despite statistics proving that flying is much safer than driving? Many phobia experts agree with Nigel when he explains that "statistics mean nothing to someone with an irrational fear."

What Causes Fear of Flying?

Recent tragedies, such as the crash of Egypt Air Flight 990 may turn even previously calm passengers timid. "Frequent flyers who could tolerate air travel in the past may now experience thoughts and fears about crashing...that they are unable to control, resulting in cancelled reservations and heightened anxiety for those who are forced to fly," says Los Angeles-based trauma psychologist Robert R. Butterworth, PhD.

Other scenarios might nudge a relaxed traveler into fearfulness. Like Nigel, a once-confident flyer may encounter an upsetting in-flight experience, such as prolonged turbulence or mechanical problems. Or boarding the plane may be just one stress too many for someone already overloaded with everyday tension, resulting in an anxiety episode. Worry over a repeat panic attack during future flights could trigger an ever-worsening spiral of fear.

No matter what causes the problem, experts agree that insight alone isn't treatment. Anxious flyers must take action to deal with their feelings.

Tips for the Just Plane Scared

For uneasy flyers, there are some simple methods that may soothe anxiety:

  • Eat a nutritious meal before boarding to keep blood sugar levels even.
  • Get to the airport early, since rushing can contribute to nervousness.
  • If possible, meet your flight crew.
  • Watch the safety demonstration and study the emergency instruction in your seat pocket.
  • Pack a light snack. Seattle-based flying phobia therapist Robin Fay-McNair, MS, recommends "foods that make you feel like you're taking care of yourself."
  • Confide in a friendly seatmate. "Strangers are amazingly compassionate," Nigel says. "They'll go out of their way to distract you or put you at ease."
  • Drink enough water to prevent dehydration.
  • Avoid caffeine, diet pills, and over-the-counter cold/allergy medications containing decongestants. All are stimulants, and may contribute to a pounding heart, shortness of breath and nervousness.
  • Avoid alcohol and sedatives, since they may contribute to feelings of loss of control. Effects are difficult to predict during flight because of changes in altitude pressure.
  • Stay busy. Listen to soothing music, watch the in-flight movie, read a great book, or work. If safety conditions allow, stroll around the cabin.
  • Practice deep breathing exercises and relaxation techniques.

If Tips Aren't Enough

But what if you can't even force yourself near an airport? What if the quality of your life is suffering because you absolutely cannot fly?

If it's time for professional assistance, there are various resources available, including clinics, airline-run self-help groups, private therapists, and even virtual-reality therapy. Most programs combine different elements, making them difficult to categorize, but generally speaking:

  • Clinics offer expert instruction combined with group support.
  • An airline-run self-help group may include an airport setting, pilot-led discussions, and even a group "graduation" flight.
  • Personal therapists offer privacy and individualization.
  • Virtual-reality therapy clinics, such as the program run by Brenda Wiederhold, PhD, Director of the Center for Advanced Multimedia Psychotherapy at the California School of Professional Psychology, allow clients to experience a computer-generated flight via a head-mounted display while the therapist teaches coping techniques.
  • While some doctors will agree to prescribe short-term anti-anxiety medications for use during a flight, some studies have shown that use of these medications increases a passengers risk for developing blood clots in their legs

The National Institute of Mental Health suggests consulting your family physician. Your doctor can rule out other medical conditions and refer you to a mental health professional.