Exposure therapy for fear of flying: how it works

• Exposure therapy can be effective for some people in treating their fear of flying
• It works by gradually exposing the person to their fear in a safe and structured way
• The best outcomes happen when people work with a trained professional

When facing a fear can help you conquer it

Exposure therapy can be an effective psychological treatment for fear of flying. It works by providing a structured way to gradually confront the fear in a safe, structured way. This can help to break the cycle of avoidance, teaching the brain that flying, and specific triggers like takeoff, landing and turbulence are safe and normal.

In this article, we explore the theory, practice, and long-term implications of exposure therapy. We’ll also look at how virtual reality exposure therapy (VRET) is making exposure therapy a cost-effective way for fearful flyers to get some extra calm and confidence.

What causes fear of flying?

Before we look at what exposure therapy is and how it can help reduce fear of flying, it’s worth understanding what causes aviophobia.

Fear of flying (aviophobia) can take many forms. For some, it’s the claustrophobic feeling of a pressured aircraft cabin. Others may have a fear of heights, or fear of losing control. Turbulence, too, is a specific and real fear for many.

Symptoms of fear of flying can include:

• Intrusive catastrophic thoughts (“What if the plane crashes?”)
• Physical symptoms (racing heart, sweating, nausea)
• Panic attacks before or during flights
• Avoidance behaviours (refusing to fly, cancelling trips, or needing heavy sedation to board)

Fear of flying is a real and recognized phobia with both mental and physical health impacts. Some people are able to face their fears and get on a plane. Others may find that they can’t (or won’t) fly. This is called avoidance.

In the short term, avoidance reduces anxiety. Refusing to board a plane gives a quick release of anxiety. Over the long term, it reinforces the phobia. Each time you avoid flying, your brain “learns” (or believes) that avoiding the trigger kept you safe. This strengthens the fear pathway, making it even harder to fly.

As fearful flyers, we need to find a way to avoid avoidance – and exposure therapy can help.

The theories behind exposure therapy

Exposure therapy is a form of cognitive behavioural therapy (CBT) where patients are gradually and systematically exposed to the object or situation they fear. 

CBT doesn’t try to rid you of fears. Instead, it’s a structured way to retrain the brain through repeated experiences.

The idea is that, by facing a specific fear in a safe and structured way, the brain learns that the thing that triggers anxiety (flying, in this case) isn’t anything to be afraid of. 

Instead of catastrophic thinking, exposure therapy can help you develop a calmer outlook and approach.

The psychology of exposure

The process of exposure therapy works through two key mechanisms:

1. Habituation: Through repeated exposure to a stressful situation, you can reduce the intensity of the anxiety response.
2. Cognitive reappraisal: The person learns new information that contradicts catastrophic beliefs. You may start by thinking turbulence is a danger to passengers, pilots, and the plane, bt through exposure appreciate that planes can handle turbulence safely.

Over time, the fear you experience is replaced with calmness and confidence.

It sounds great, but does exposure therapy work?

Exposure therapy has decades of research supporting its effectiveness in treating phobias, says the British Psychological Society. Meta-analyses show significant reductions in avoidance behaviour and anxiety severity. 

However, exposure therapy has some drawbacks. It’s not cheap and convenient when your fear is flying. 

More importantly, it can be distressing as exposure therapy creates stress and anxiety when it’s not needed.

We’re not medical experts and can’t advise you on whether exposure therapy will work for you. What we can do is to outline the principles and the process. You can then explore whether it’ll work for you.

Exposure therapy is something you would work on with a professional therapist.

How exposure therapy works in practice

Exposure therapy for fear of flying typically follows a graded hierarchy. This is a step-by-step approach where each stage is slightly more challenging than the last. 

Here is how an exposure therapy programme for fear of flying could work. 

Step 1: Psychoeducation

Before exposure begins, patients learn about anxiety, phobias, and quite how safe flying is. This knowledge provides an intellectual foundation for reframing thoughts during exposure. 

By recognising you have a phobia you’re in a positive place to tackle it.

Step 2: Creating a fear hierarchy

Each individual is different, so treatment must be tailored. During phase 2, the therapist and patient will map out a ladder of situations, from least to most anxiety-provoking. 

This enables the expert to understand the causes of fear and the situations that exacerbate it. This could be the closing of the cabin doors, the noise during takeoff, or the first bumps of turbulence.

For example:

• Looking at photos of planes
• Listening to airport sounds
• Visiting an airport terminal
• Sitting in a stationary aircraft (sometimes offered by airlines)
• Short-haul flight with support
• Long-haul flight independently

Each step becomes a target for exposure, building on the last one. The idea is that you work up through the levels.

Step 3: Gradual exposure

As you’d expect, exposure starts at the lower levels of the hierarchy, repeating until anxiety reduces. 

Imagine you have a fear of spiders. Holding a spider may cause acute distress, but seeing a picture is easier to manage. This principle is applied to fear of flying.

Over time, you’ll work up to more difficult stages – culminating in a flight.

Step 4: In-flight exposure

For many, the final step is taking a real flight. This is done after repeated practice at lower stages, so anxiety is reduced and kept at manageable levels. 

Many fear of flying courses offer short flights which can be a great way to expose yourself to flying in a supportive way.

Step 5: Maintenance and relapse prevention

Exposure therapy doesn’t end after one flight. 

The progress made must be consolidated through repeated practice and follow-up. This can reduce the risk of relapse, where you fall back into your fears and once again seek to avoid flying.

VRET and simulated exposure

Some of the biggest challenges in exposure therapy for flying are cost, accessibility, and time. 

People can’t always book flights just for therapy. They may not have the time or skill to work through the stages and it can be hugely expensive. 

There are two options that could help you: virtual reality exposure therapy (VRET) and airline-led fear of flying programmes. 

Here is a basic outline of what they are and how they can help you:

Virtual reality exposure therapy enables patients to experience simulated flights, including boarding, takeoff, turbulence, landing and all from a therapist’s office. Studies show VR exposure is nearly as effective as real-flight exposure for reducing fear. It’s important to work with a virtual reality provider that has therapeutic qualifications and credentials.

Airline-led fear of flying programmes typically combine psychoeducation, exposure (visiting aircraft), and supported short flights. These courses are popular and blend therapeutic exposure with real-world aviation knowledge. Stats show that these programmes can be hugely positive with most phobic-flyers experiencing the short flights. It’s less clear whether this post-flight high results in a long-term reduction in flying fears.

What it feels like from the flyer’s point of view

Exposure therapy deliberately triggers anxiety, and that can cause distress, but in a safe and controlled environment.

The point of this is to prove that anxiety peaks and then falls. You may have felt this on a long-haul flight when anxiety reduces because it’s simply impossible to maintain such a heightened state of arousal for hours on end.

At first, exposure therapy can feel difficult, even daunting. Evidence shows that most patients begin to feel empowered as they realise their catastrophic thoughts don’t match reality. 

The hope is that each step reduces avoidance, increases confidence, and builds momentum, in the end meaning you can fly with less fear.

Exposure therapy is all about following a process, which is why it’s important to work with a qualified therapist. They can define a plan and a process that’s personalised to you.

Can you face your fears?

Exposure therapy offers a proven, structured way to face the fear, retrain your brain, and break the cycle of avoidance. 

The principle of exposure therapy is, by gradually confronting anxiety, learning the facts about flying, and experiencing flights in a safe and supported way, you can move from avoidance to empowerment. That’s the theory, anyway.

Exposure therapy is about reducing anxiety and intrusive thoughts with the rational knowledge that flying is safe. Sometimes facing your fears is the most effective way of overcoming them.

You can learn more about fear of flying and support in our Help Desk. You can download our Calm Flight Toolkit for some tools and techniques to help you stay in control.

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