Fear of Flying: Treatment That Works

Fear of flying can get louder when a trip home means a plane, or a hard decision about not going. People who have it are often handed safety statistics, and then feel foolish when the numbers don’t help.

They’re far from alone. Estimates run from 2.5% to 40% of people, mostly depending on whether a study counted a diagnosable phobia or anyone who says they’re afraid. The best-studied treatment is exposure-based therapy. It doesn’t help everyone, and some people stay nervous even once they’re flying again, but the research behind it is solid.

What People Are Actually Afraid Of

You may have read that fear of flying is never really about the plane. The research doesn’t go that far. For many people, a crash is exactly what they fear. A review of flying phobia research describes a mix of concerns, and one person can have several:

• Something going wrong with the plane: a crash, mechanical trouble, bad weather or turbulence.
• Panic on board: the physical symptoms of anxiety, and what they might lead to, somewhere you can’t simply walk out.
• Losing control: of your own emotions, or of the situation, with someone else flying and no way to get off.
• Being watched: other passengers noticing, judging or thinking something is wrong with you.
• Closed-in spaces or heights: some people’s fears look more like claustrophobia or a fear of heights.

For many people, the weeks of dread before the trip are a large part of it too. Our post on anticipatory anxiety explains that dread. Which fear sits on top matters, because it changes what treatment should focus on.

Why Knowing the Numbers Rarely Settles It

Most people with this fear don’t need to be told flying is safe. In one study described in that review, people with a flying phobia estimated the odds of a crash about the same as people without one, though those questions were general, not the personal “this wing could snap off” thoughts that come mid-flight.

A likely explanation, though the research is thin, is that fear in the moment doesn’t run on averages. Rechecking safety information can also work like reassurance: short relief, then back for more.

Specific information does have a place. Fear of flying programs generally pair an information component with a test flight. Reading alone may not be enough, though. In one trial, a self-help book without a therapist worked less well than virtual reality exposure or CBT.

What the Treatment Research Shows

Exposure therapy is a form of cognitive behavioral therapy (CBT) in which you face a fear gradually and repeatedly. For flying, the list might start with a photo of a plane, then driving past an airport, then walking into one with no plan to board.

For phobias in general, this is well supported. A meta-analysis of 33 randomized studies found large effects compared with no treatment, and exposure also beat placebo and other kinds of therapy, though not by such large margins.

Flying has its own trials. In one study of 83 people, 76% of those who received anxiety-management training plus exposure agreed to fly on a test flight afterward, compared with 20% of those not yet treated, and more than 70% of those who answered later said they were still flying up to a year on.

There are limits too. A review describes what keeps this fear going as poorly understood, and notes that many people who complete multiple flights stay distressed, so simply forcing yourself onto planes may not be the whole answer. Courses also vary: an older international review found little information on how well they worked, so it’s fair to ask what a program includes and who runs it. A 2020 study from Germany, an international study of a one-day group course with a real flight, found 71% of 138 people fully or partly in remission six months later, though it had no comparison group.

Virtual Reality: Promising, With Caveats

A simulated cabin spares you the airports and tickets, and the evidence is encouraging. A 2019 meta-analysis of 30 randomized trials across anxiety conditions found virtual reality exposure clearly beat no treatment and didn’t differ significantly from real-life exposure. In the earlier phobia meta-analysis, real-life exposure did better than other forms, including virtual reality, right after treatment, though not at follow-up.

Not every result is so clean:

• In one flying trial of people who had refused to fly at screening, 65% of the virtual reality group flew afterward, but so did 57% of a group that met for therapy without exposure. Participants included people with agoraphobia or panic disorder with agoraphobia. By six months, most differences on fear measures were gone.
• In a small 2025 trial of 26 people, virtual reality was no better than ordinary video exposure, and both groups kept their gains two years later.

The fair reading is that virtual reality is a reasonable way to do exposure, not a breakthrough beyond it. When a therapist isn’t available, self-guided options exist: in a Dutch trial of 153 people, an international study, a fully automated smartphone virtual reality program worked well compared with a waitlist, and gains held a year later. Some of the program’s developers were among the study’s authors.

When the Fear Is Really About Panic

Flying and panic often overlap. Many people with a flying phobia have panic attacks on flights, and the distress can sometimes reflect another anxiety condition. Airplanes are also a common example in agoraphobia, where the issue is being somewhere that’s hard to leave.

So it’s worth asking whether the fear stops at the airport. If you also have panic attacks elsewhere, or you avoid highways, theaters or long lines, tell whoever evaluates you.

The answer can change treatment. CBT for panic may include interoceptive exposure, which means practicing with the body’s sensations of panic, guided by a therapist. Flying programs don’t always include the elements considered fundamental in treating panic disorder. Our panic disorder page explains how we help.

Small Comforts: Do They Help or Hold You Back?

Most fearful flyers have rituals: the aisle seat, gripping the armrest, watching the crew’s faces, tracking the route on a phone. Therapists call these safety behaviors, and the traditional advice is to drop them, because you may end up crediting the habit for getting you through. One experiment in panic disorder with agoraphobia supported that.

This is debated, however. A 2016 meta-analysis couldn’t find compelling evidence for either removing or allowing them during exposure, and there’s little research on flying specifically. Some studies suggest small comforts used sparingly, especially early on, don’t seem to block progress. So a small comfort that gets you on the plane isn’t a failure. It’s simply worth noticing which habits you feel you can’t fly without.

Alcohol deserves its own mention, since many people with this fear report using it. It can make it harder to think clearly, and anxiety and broken sleep can follow it. In a small German lab study of healthy people, an international study, alcohol at simulated cabin pressure lowered blood oxygen, raised heart rate and cut deep sleep.

Where Medication Fits

Medication isn’t the main treatment for a flying phobia on its own, and the evidence is limited. Merck describes exposure as often the only therapy needed. Pilot trials of SSRIs for specific phobia involved 11 and 13 people: promising, but too small to rely on.

It’s a different picture when the fear is part of panic disorder or another anxiety disorder. SSRIs and SNRIs can help panic disorder symptoms, though they may take several weeks to start working, so they aren’t a fix for next week’s flight. SSRIs can also cause jitteriness or more anxiety at first, which is one reason they’re often started at a lower dose for panic and raised gradually.

Two other kinds of medication come up around flights:

• Beta-blockers such as propranolol can ease physical symptoms like a racing heart and tremors, and Merck mentions them for situations that can’t be avoided. But a systematic review, with only two small specific phobia studies, found the evidence too weak to support routine use in anxiety disorders, a 2025 review found no good evidence that beta-blockers help anxiety disorders, and in a small Dutch trial, adding propranolol to virtual reality exposure didn’t help people afraid of flying or heights. Beta-blockers aren’t right for everyone: the propranolol label says not to use it with asthma, a slow heart rate or certain heart rhythm problems.
• Benzodiazepines are sedating anti-anxiety medications such as lorazepam. Merck notes that short-term use can help when a feared situation can’t be avoided. Whether they get in the way of what exposure teaches is debated.

On that debate, the evidence points in different directions. In a trial of 28 women with flying phobia, alprazolam eased anxiety on a first flight, but on a second flight a week later that group was more anxious than the placebo group and had more panic attacks. Yet in a larger study of dental injection phobia, adding alprazolam to gradual exposure gave no advantage, and fear fell about the same either way. The concern rests on more than one small trial, though: in a larger trial in panic disorder with agoraphobia, an international study, adding alprazolam to exposure helped slightly during treatment but held back improvement afterward.

So the concern is real, but it isn’t settled. Benzodiazepines carry an FDA boxed warning: they can lead to misuse and addiction, and taking them steadily for several days to weeks, even as prescribed, can cause physical dependence, so stopping suddenly can bring dangerous withdrawal. Combined with opioids, they can cause profound sedation, slowed breathing, coma and death, and alcohol makes their sedating effects worse. For travel, CDC guidance advises avoiding sedative medicines with long-lasting effects, the lorazepam label notes that sedation and unsteadiness become more common with age, and sitting still for long stretches on a flight raises the risk of blood clots, mainly for people who already have other risk factors. If your provider prescribes a medication for flying, try it at home first, never for the first time on a flight. Whether any medication fits your situation is a conversation to have with a provider who knows your history. Controlled medications are considered only case by case (see our FAQ).

If You’ve Stopped Flying Altogether

Many people with this fear avoid flying entirely, and the cost can touch both work and relationships: the trip turned down, the wedding watched in photos.

Not having flown in years doesn’t rule out treatment. No study can promise what will happen for you, but in the trial above where everyone had refused to fly at screening, 65% of those treated flew on a test flight afterward, as did 57% of the comparison group.

How We Can Help

For adults in Mount Laurel and across New Jersey, our board-certified psychiatric nurse practitioners can help sort out what’s driving the fear: a phobia of flying, panic, agoraphobia or a wider anxiety pattern. When anxiety underneath is part of the picture, we can talk through medication options. Depending on your clinician, visits may draw on supportive, motivational interviewing, CBT-based, or DBT-based skills.

Exposure therapy for flying isn’t something we offer. We don’t offer standalone weekly therapy, but we’re happy to help you find a therapist and, with your permission, we’ll coordinate with them.

Frequently Asked Questions

How do you get over a fear of flying?

The best-studied approach is exposure-based CBT, which means facing flying gradually and repeatedly with a therapist, in real life or virtual reality. Many people in studies go on to fly, though not everyone does, and some stay nervous. If panic is part of it, treating the panic matters too.

Is fear of flying a phobia or panic disorder?

It can be either, or both. Flying is a recognized specific phobia. It can also be one of several situations in panic disorder or agoraphobia. An evaluation can help sort this out.

Does virtual reality therapy work for fear of flying?

Trials support it, and it has generally matched real-life exposure in research. It isn’t clearly better than other exposure, though, and one small trial found ordinary video did as well.

Why doesn’t knowing flying is safe help my fear?

Because most people with this fear already know the numbers, and fear in the moment doesn’t seem to run on averages. Your fear may also be about panic, being stuck or losing control, which crash statistics don’t touch.

I have a flight coming up. What can I do?

Treatment takes time, so it may not be finished before this trip. Cleveland Clinic says deep breathing or meditation during takeoff, landing or turbulence can ease anxiety symptoms, and the UK’s National Health Service suggests being careful about looking things up online. If you’re wondering about medication for a flight, talk with the provider who knows your history well before the trip, and don’t take anyone else’s. Controlled medications are considered only case by case (see our FAQ).

If fear of flying is shaping your work or your family life, a psychiatric evaluation can sort out what’s driving it, and medication management can help when anxiety underneath is part of the picture. Our anxiety guide covers the bigger picture.

This article is for general educational purposes only. It does not constitute medical advice, does not establish a provider-patient relationship, and is not a substitute for individual evaluation, diagnosis, or treatment by a qualified clinician. If you’re in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.