“Expect and accept that possibility, and prepare with some coping skills,” said Reid Wilson, PhD, an international authority on the fear of flying, a founding fellow of the Anxiety and Depression Association of America (ADAA) and director of the Anxiety Disorders Treatment Center in Chapel Hill, N.C.

Flying-related anxiety is widespread, with experts estimating that up to 40 percent of people have issues of varying severity. Only a small percentage of people actually suffer from clinical aviophobia. The rest of that 40 percent have different reasons for white-knuckling the armrests or avoiding flying altogether. Other phobias — fears of enclosed spaces, heights, germs, crashing and more — or underlying mental health issues such as generalized anxiety disorder, obsessive-compulsive disorder or post-traumatic stress disorder can fuel the fear.

There’s no universal path to navigating the emotional turbulence; different tools can help travelers handle the bumps, from planning the trip to nailing the landing. But anxiety can start early, so use your downtime to get ready for that trip you’ve been dreaming of — or dreading.

“Many people who have fear of flying are already anxious even if they’re planning a flight six months or a year away,” said Stephnie Thomas, a licensed clinical professional counselor at the Anxiety and Stress Disorders Institute of Maryland (ASDI) who has been treating fearful fliers for more than 15 years.

Connect with your motivation for taking that trip, Thomas suggested. Are you visiting family you haven’t seen in more than a year? Taking that covid-postponed honeymoon? The positive association can give you the determination to confront your fear.

Understanding that you may address the fear but continue to experience some degree of panic or anxiety on a flight is also important. “People can still have anxiety, but effective treatment is learning that just because I’m anxious, I can continue to fly or the do things that are important to me no matter how I’m feeling,” Thomas said. “A completed flight is a successful flight.”

Fliers who have learned to manage their fear share a few common traits, said Cornelia Tietke, a psychotherapist at the Center for Travel Anxiety in Washington and Bethesda. They accept their fear, no matter how irrational it is. They comfort themselves physically and mentally. They distinguish between whether something is frightening or truly dangerous. And they accept whatever needs arise from facing their fears — even little accommodations such as upgrading to a larger seat can provide a greater sense of control.

Here’s a roundup of tools to help get you down that runway once we’re cleared for departure.

Therapy

Individual or group therapy can help clients desensitize their brains to triggers and regulate their physical sensations. Most therapists will be informed by cognitive, behavioral and psychodynamic theories and may incorporate techniques such as hypnosis or eye movement desensitization and reprocessing (EMDR). Any approach will include exposure to feared thoughts and feelings.

The most important factor? The strength of the therapist-client relationship. For people considering therapy, Tietke advised, “find someone who specializes in treating fears and phobias, who has experience treating fear of flying and whom you like.”

Thomas has found group therapy to be one of the most effective approaches. In her sessions at ASDI, participants share camaraderie and support — and can test their anxiety management skills together on a practice flight from Baltimore-Washington International Marshall Airport.

Classes and coaching

From Boston to Los Angeles and online, a handful of classes offer help for nervous fliers, some using simulations, virtual reality and actual flights. Since 1982, Capt. Tom Bunn has assisted thousands of fearful fliers with his SOAR program, available online. Capt. Ron Nielsen runs Fearless Flight clinics in Phoenix, Los Angeles and online. Both of these former pilots are licensed therapists who have written books and offer individual phone coaching.

Some nonprofit organizations such as the Fear of Flying Clinic in Santa Clara, Calif., host weekend workshops, normally in person but online during the pandemic.

Mindfulness

Relaxation, breathing exercises and meditation can ground you at 36,000 feet; if you can calm the body, the mind follows, and vice versa. Long, deep breaths can clear unwanted thoughts and calm your body, Wilson said. But when anxiety is high, he noted, breathing and meditation can be difficult — and struggling against anxiety only increases physical symptoms.

Another strategy? Actively redirect focus to something else. “We don’t want to turn our attention away out of fear, but we can acknowledge anxiety and finish our book,” he said.

Medication

Patients with underlying mental health conditions might take daily medications, while physicians sometimes prescribe a limited number of benzodiazepines for flustered fliers to take before or during a flight. Sometimes, just having them along as an option is enough.

This as-needed medication can cap anxiety’s strength and give patients space to learn coping skills, Wilson said: “It’s a crutch, but we can use crutches to heal ourselves.”

Books

Whether flying-specific or geared for general anxiety, books can help readers understand and cope with fear. Written by fear of flying and anxiety disorder expert David Carbonell, who also teaches a fear-of-flying workshop in Chicago, the “Fear of Flying Workbook” gives readers specific steps to overcome fear. And Wilson’s “Stopping the Noise in Your Head: the New Way to Overcome Anxiety and Worry” and “Don’t Panic: Taking Control of Anxiety Attacks” are mental health classics.

Videos

While anyone with anxiety can relate to Wilson’s entire six-part “The Noise in Your Head” series (available on YouTube), Episode 3 discusses the fear of flying. Try a commanding view at PilotsEYE.tv; cockpit videos can help viewers move toward, rather than avoid, their fear by learning about planes, their mechanics and what keeps them in the air.

Whether via video or other methods, self-education can be crucial. “No self-help skills will assist you in your goal unless you choose to feel safe on commercial flights,” Wilson said. Learning statistics — the probability vs. the possibility of a problem — can help with reassurance, along with information about air travel and normal flight experiences.

Apps and websites

Bring Capt. Bunn along for the ride with the SOAR app, which offers videos, turbulence forecasts and a G-force meter (iOS) that can reassure you that the plane isn’t as bouncy as it seems. Meditation apps, including Headspace and Calm, can guide breathing exercises.

Wilson has a fear-of-flying section on his site at anxieties.com, and ADAA’s site has comprehensive anxiety information.

Supportive actions

Fearful fliers should give themselves permission to meet their needs in whatever ways will help them, said Tietke. That might mean exercising before a flight, arriving at the airport three hours early, watching their favorite comedy videos or simply hydrating.

Wilson also recommended a carry-on pastime bag containing a book, puzzles, music and other activities.

Whether covid has grounded you or you have avoided flying for even longer, lifting off can take time — and feel like a big lift.

“It takes an enormous amount of bravery to face your fear,” Thomas said. “The people I work with are the most courageous people I know.”

Original at The Washington Post.