Although these fears can overlap, identifying what is driving the fear of flying is important because the most effective treatment approaches can be quite different.

Fear of Flying or Aviophobia, classified in the DSM 5 as a Specific Phobia, is characterized by “excessive and persistent fear of air travel” related to fear of mechanical failure and/or accident causing the plane to crash is the number one reason for fear of air travel. Fear of flying is also one of the most common specific phobias. Research indicates that roughly one-quarter to one-third of adults experience significant anxiety about flying. However, in 6–10% of the population fear of air travel is severe, often interfering with travel, work and family life.

Individuals who struggle with severe fear of flying so embed themselves in the possibility of a fatal outcome that the flight becomes contaminated with idea of premature death. This perspective colors the person’s entire reaction to the idea of flying. Individuals in this group focus on every and anything related to the functioning of the aircraft and accident.

As a result, they have selective, biased memory for aviation accidents, reports of pilot error or irresponsible behavior. Aviation statistics mean nothing to them: 2.5 incidents per million aviation hours. 1 fatality per 5 million flights or 1 death per 850 passenger journeys, all discounted: “Someone has to go down, why not me”. “It is unnatural for this much metal to be in the air”. As with most phobias and obsessions, the perception of risk does not align with what is real or plausible, as they have a broken relationship with possibility. Some examples of fears in Fear of Flying include:

In fear of flying, as with other anxiety disorders, the go-to reaction is avoidance. Those who do fly rely heavily on a combination of sedative medications and Safety Behaviors, which are responses or actions that allow them to feel safer or 'protected'. Common Safety Behaviors people rely on when flying include:

Whilst fear of accident or crash is the most common reason for fear of flying, a significant minority, between 20-30% people who fear and avoid air travel owing to fear of panic attack. For these individuals, the primary fear is not necessarily that the aircraft will crash, rather, it is the fear of being trapped during panic, thousands of meters in the air, where "escape" is literally not possible. They rely on safety behaviors relevant to the to the context of air travel in addition to the classic safety behaviors associated with panic disorder.

CBT is the treatment of choice for both fear of panic and fear of accident during air travel. The core fears of each is different, and, consequently, the focus of cognitive methods varies accordingly. Nonetheless, the fundamentals of CBT are applicable to the treatment of both. Briefly, steps in the approach I use to treat of flying

Given the central role of Panic in this form of fear of flying, Panic Control Therapy and Progressive Exposure, as described on the Transport Anxiety page, is also the primary approach I use to treat Fear of Panic during air travel. Here, instead of trains, buses or cars, the aircraft is the agoraphobic trigger. As with Fear of Flying- Phobia, I also use the OvRome Virtual Reality platform for an enhanced immersive exposure experience.