As both a pilot and a licensed therapist, I have specialized in the treatment of flight phobia since 1980. In the 1990s, Brain scan technology was developed that made it possible to understand much more about how the mind works.

A part of the brain, the amygdala, monitors what is going on. It divides everything into "routine" or "non-routine." If things are routine, the amygdala does nothing. But, if it senses something non-routine, it releases stress hormones to make you notice the situation and determine whether action is called for.

On a plane, stress hormones are released when there is an unexpected noise or movement. If seated in the cockpit, there would be no problem. A glance at the captain's face would assure you that nothing is amiss.

But in the cabin, that is not possible. Safety depends upon a person whose face you cannot read. At this point, your history with others who were in control becomes important. Were they trustworthy? Did they reliably insure your physical safety?

Didi they consistently provide emotional safety? Were people in control attuned and responsive? Could you consistently rely on them to care about what you were feeling?

When we were young, everything in our lives depended upon others who were in control. Now as adults, events from our childhood play out again on a plane. Dependency on others is just as real in the air as when we were subjected to the tender mercies of others during childhood. Again, others are in control. How safe we feel now as a passenger is determined to a great extent by how secure we felt when we were young.

Whether on the ground or in the air, when stress hormones are released, they trigger an urge to escape. If our early experience was profoundly secure, we automatically override the urge and look to see what is going on. If we see nothing wrong, we drop the matter.

But some of us do not drop matters so easily. Even if no danger is visible, we still have to deal with what is "visible" to the mind's eye: our imagination that the sound or the motion means something is wrong. The physical feelings—rapid heartbeat, rapid breathing, tension in the body, sweatiness—are all signs, we believe, of danger. How could these feelings be present if there were no danger? What can we do to control the situation? If we were on the ground, we might be able to control the situation. Otherwise, we could escape.

When driving, for example, if another car drifts into your lane, the amygdala releases stress hormones which activate high level thinking called executive function which initiates a three-step (ABC to make it easy to remember) process.

A. Assessment. Executive function assess the car as a danger.

B. Build A Plan. Executive function plans what to do, perhaps hitting the brakes and turning the wheel.

C. Commitment To Carry Out The Plan. At the moment executive function commits to a plan, it stops stress hormone release.

But, in the passenger cabin, you have no way to accomplish the ABC process that can end the release of stress hormones. You cannot assess the situation as safe. You cannot be sure your original plan—to sit and fly to the destination—is sound. Doubt undermines your committed to the plan. Without commitment, executive function cannot stop stress hormone release.

As hormones build up, so does the urgency to escape. With escape impossible, claustrophobia may result. As hormones build up, it becomes difficult—perhaps impossible—to think clearly. It becomes all too easy to believe that what is feared is about to happen. Panic may result.

This is the problem therapists run into when attempted to treat flight anxiety using CBT. If executive function cannot reach commitment, stress hormones cannot be controlled. Thus, the solution is to prevent the release of stress hormones.

On the ground, we all read the facial expression and body language of others. When the signals indicate the person is completely trustworthy, the brain either prevents the release of stress hormones or overrides the effect of stress hormones.

In the method I have developed, I show anxious fliers how to identify an experience when another person's signals protected them from anxiety and allowed them to feel completely comfortable. Once we find a suitable moment, the client links each anxiety-producing moment of the flight to memory of an anxiety-protective moment. Once the things that happen during flight are linked to a protected moment, the feelings they previously had in flight can no longer develop.

Also helpful is an app that explains how flying works, provides relaxation exercises, and measures in-flight turbulence to prove the plane is not in danger. The app is available free at 

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