Pharmacologic Treatment of the Fear of Flying: Should It Be Avoided?

Aerophobia is the extreme fear of flying and may affect as many as 25 million Americans. One traditional treatment method is the use of prescription medications to reduce anxiety during the flight. However, is this a good treatment option?

Key takeaways:
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    Pharmacologic treatment does not help to overcome the fear of flying.
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    Benzodiazepines have addictive properties and can lead to withdrawal and thus should only be used in certain situations.
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    The long-term use of medications can worsen one’s fear of flying.
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    Cognitive behavioral therapy and exposure therapy are the most effective treatment strategies to manage the fear of flying.
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    Talk with your doctor about your symptoms to determine the treatment strategy that is right for you.

What is aerophobia?

Aerophobia is the extreme fear of flying in an airplane and can provoke significant anxiety before and during a flight. Although the affected person may know their fear is irrational, they are unable to control their anxiety.

The fear of flying can cause significant stress in one’s life as one navigates ways to avoid traveling by air for work or pleasure. If your fear of flying is affecting your quality of life talk with your healthcare provider to see if treatment is right for you.

Non-pharmacologic treatment of the fear of flying

The most common non-pharmacologic treatment is cognitive behavioral therapy (CBT). This type of therapy works to change the way you view flying. Often administered by a therapist, they will teach you ways to manage your stress and anxiety.

Meditation and deep-breathing techniques are common techniques to help reduce anxiety during the flight. Additionally, avoiding stimulants like caffeine and high-sugar snacks can help reduce your anxiety. Talking or traveling with a supportive person (friend or family member) can help overcome some of the fears associated with flying.

Exposure therapy can also be used which is the gradual exposure to thoughts, places, and situations related to flying. The use of virtual reality tools can help provide low-risk simulations to help overcome your fears.

Overall, these methods have been shown to be very effective in overcoming aerophobia. Additionally, these methods are preferred over the use of medications.

Pharmacologic management of the fear of flying

There are a number of medications used to help treat the anxiety associated with flying.

Benzodiazepines — Xanax or Valium are medications that work quickly to reduce anxiety and can last for the duration of the flight.

Dramamine — this over-the-counter medication typically used for nausea has a sedative effect that can help reduce anxiety during flights.

Melatonin — a natural alternative that can induce sleep and produce a calming effect that can be used on overnight flights.

Gamma-aminobutyric acid (GABA) supplements — studies have shown GABA supplements to be effective in reducing anxiety and inducing relaxation.

Are medications really the answer?

The use of pharmacologic treatments for the management of aerophobia is not recommended. Medications such as Xanax and Dramamine are sedatives that can induce sleep, alter consciousness, and impair your ability to react promptly. This can lead to altered behaviors that can result in problems during the flight and thus are not recommended.

In addition, benzodiazepine medications can be addictive and lead to dependency and withdrawal issues. These risks oftentimes outweigh the benefits of their use and thus are not recommended.

Finally, and most importantly, these medications do not work to overcome the fear of flying. Rather they just temporarily produce a sedative effect that allows you to complete the flight. They can even worsen anxiety symptoms in the long run and can gradually worsen symptoms.

However, in situations where you fly on a very limited basis (a couple of times a year) or experience anxiety and not a true fear of flying, medications can be helpful. Benzodiazepines can be used successfully in these situations but should only be used under the guidance of your physician.

In the rare circumstances that CBT therapy does not work, pharmacologic treatments can be helpful if flying is unavoidable. Dramamine and GABA supplements can benefit those who wish to avoid benzodiazepines. However, the use of medications like benzodiazepines is considered the most effective in managing acute anxiety symptoms.

Overall, the most effective treatment for the fear of flying is cognitive behavior and exposure therapy. The use of medications can have adverse effects and even worsen your fear of flying. However, short-term use of medications can be used but talk with your health care provider to see which medication is right for you.

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