Fear of Flying by Dr Martin N. Seif, PhD

If you are afraid of flying, here are two facts to keep in mind: first, you are not alone. Recent estimates indicate that 20 to 25 per cent of all people have fears that significantly impact their flying.¹ Second, there is an excellent chance you can overcome this fear. Millions of people with fears just like yours have learned ways to overcome, manage and cope with their fears of flying, so they now fly with comfort, free of the worries that previously devilled them.

For twenty years, I ran the largest airport-based fear of flying program in the United States.² I’m going to share with you some of the most important points that I learned and help you start your journey towards less fearful plane travel.

Will it be easy? Probably not. Overcoming any serious phobia takes plenty of work and time. You need to learn about how your brain and body react when you are on a plane (especially before the flight when you are anticipating all the horrible things that can happen to you en route). It also takes courage. Even reading this chapter takes courage, because all phobias – in fact all anxieties – are driven by avoidance and want you to run away from your source of fear. However, as many of you already know, avoidance might make you feel more comfortable in the short te‘rm but empowers your anxiety in the long term.

“Courage isn’t the absence of fear, but rather the understanding that something else is even more important.”

Unknown

Working to overcome your own fear of flying is this definition of courage and I hope you can give yourself the credit that you deserve.

Most of you might ‘know’ and believe that flying is the safest way to get from point A to point B. Yet that knowledge doesn’t go very far in making you feel better about flying. So here is another simple fact: You can never reason away your fears, because your fears have nothing to do with reason, and originate in parts of the brain that lie outside the reasoning processes.

So, let’s get started. But I first want to be very specific. It is almost a misnomer to say ‘fear of flying’, because flight fright is really a confluence of many different fears and phobias. Think of an airplane as a perfect storm of intersecting factors that can set off your anxiety reaction.

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Step 1:
Nail down the triggers that set you off

Ask yourself, ‘what about the flight experience is particularly frightening to me?’ If you are claustrophobic, you might hate the idea that the plane is sealed and you can’t get out until it lands. If you are afraid of heights, imagining yourself flying at such a height can trigger intense anxiety. If you are somewhat agoraphobic (discomfort at being too far from home, outside of your comfort zone), then the plane goes too far, too fast. If you have panic disorder, you might be terrified that you will have a panic attack while on the plane and have no way to escape to safety.

If you have particular anxiety disorders, the list grows even more: people with OCD (obsessive compulsive disorder) can fear contamination on the plane (this used to be called germaphobia), those with social anxiety disorder (SAD) are terrified that others on the plane might notice their discomfort, and people with GAD (generalised anxiety disorder) can find just about anything to worry about; from the safety of the plane, to whether their checked luggage will be lost. I have seen several people with a form of OCD (intrusive thoughts) who are afraid that they will yell out ‘I’m a terrorist’ while on a plane.

The list is really very long. Here are some additional common triggers: turbulence, terrorism, the thought of the plane falling out of the sky, the thought of crashing while taking off, crashing while landing, inadequate maintenance, the sensations you feel when the plane banks, the fear of vomiting on the plane. In other words, you can be seated on an airplane next to someone who is just as afraid as you, but their triggers and fears might be entirely different!

Spend some time figuring out what frightens you and examine how your anxiety reaction is triggered. Remember that you probably have several triggers, so try to make your list as comprehensive as possible.

In reality, these triggers fall into three categories:

1. Frightening sensations: could I be having a stroke, a heart attack, fainting, throwing up?

2. Frightening thoughts: what if the plane crashes? What if the plane breaks apart from the turbulence?

3. Frightening memories: I panicked last time I was on the plane, what if it happens again?

These triggers initiate your fears, which quickly become intense because you are sensitised. Sensitisation is a word I use to describe the intense physical and emotional reaction you feel as a result of being triggered. Because of your history and genetics, you react strongly to these triggers, much as a person with hay fever reacts strongly to certain pollen.

At a neurological level, your particular triggers set off your alarm response, sometimes called the fight, flight, freeze reaction. The part of your brain that controls this reaction is your amygdala. Most people experience this alarm reaction as a ‘whoosh’ of fear.

Here is a diagram of the process.⁴

This reaction is outside of your conscious control, because your amygdala is wired to the non-conscious part of your brain. Here’s how you can think of it: imagine that someone sneaks up and yells ‘Boo!’ You will be startled and feel a ‘whoosh’ of fear. You can calm down as soon as you understand what happened to you, but you can’t stop that initial ‘whoosh’. You can read more about the fight, flight, freeze response in Chapter 2, Mind-Body Connections.

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Step 2:
Separate fear from danger

Anxiety is a huge trickster. It fools you into thinking that you are in danger when you are actually safe. The alarm centre in your brain, your amygdala, wants to keep you safe. Your fear of flying is triggered by an overactive amygdala that keeps sending false alarms. You feel all the feelings of being in terrible danger, when none really exists. Your goal is to expect, accept and allow your anxious feelings, but to label them as anxiety as opposed to danger.

It is often difficult to separate anxiety from danger because your body reacts in exactly the same way to both. When your amygdala sounds the alarm, the terror you feel from anxiety is exactly the same type of terror you feel when you are in actual danger. The difference is that the trigger to sound the alarm is not some external danger, but one (or more) of three internal terrors: (1) unusual sensations, (2) frightening thoughts and images and (3) disturbing memories.

You will experience a series of threatening images in your mind. You must label your fear as anxiety. Tell yourself that anxiety makes your frightening thoughts feel like they have a high probability of occurring. Remind yourself that feeling anxious doesn’t mean you are in danger. You are safe even when feeling intense anxiety. And you can’t stop the whoosh of fear that comes about when you encounter your triggers while flying. That understanding brings us to our third step.

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Step 3:
Tame that attitude

We all have the tendency to fight the feeling of anxiety we experience. Believe it or not, this is the worst way to cope with anxiety. Anxiety is paradoxical. Fighting anxiety makes it stronger. Think of the old saying, ‘what we resist, tends to persist.’ Effort works backwards.

An attitude change is a powerful tool for helping to rid yourself of flight fright. Instead of fighting the fear, make room for it. Don’t try to crowd it out. The essential components are summarised in three words: Expect, Accept, Allow.

• Expect to feel fearful on an airplane. Try not to be blindsided by the automatic reaction of your amygdala. Know that you are sensitised, and so try not to blame yourself, curse yourself (or fate, or the gods, or bad luck!) for having a sensitised reaction. Be gentle with yourself. Treat yourself as kindly as you would treat a good friend who tells you they are having a rough time.
• Accept those awful feelings. This is a very hard assignment. However, studies have shown that the effort to fight anxiety is what makes it worse.⁵ Trying to push them away just makes your brain more sensitised. Try not to beat yourself up because you are feeling anxious. You are not a failure, you are sensitised. This is not a measure of how good a person you are.
• Allow means to go about what you are doing; focusing on manageable tasks in the present while you are having these feelings. We talk a lot more about this in Chapter 10 – Anxiety, in Touring and Mental Health: the Music Industry Manual. See The Fourteen Best Anxiety Management Techniques in that chapter to learn about what to do when you are feeling frightened.

Try not to run away from the feelings or fight them off. Try to be tender to yourself. When you are feeling phobic anxiety, try to be as kind to yourself as you would to a good friend. Remember, you are allowing the feelings to be, but fighting what the feelings are telling you to do:

• Fight the behaviour of avoidance and escape. Try not to flee. Try not to avoid.
• Allow yourself to feel the anxious feelings. As Goldstein and Chambless used to say, after giving the example of someone pushing on my hands, ‘Resistance creates Persistence’.⁶
• Anxiety is maintained by avoidance. To overcome anxiety, try to move towards the area of greater discomfort.

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Step 4:
Understand that common sense makes no sense with anxiety

Anxiety has a knack for bluffing your common sense and tricking you into taking the wrong actions to make it better. Common sense tells us that the best course is to use our gut feelings to guide our actions, but this is not always true, and it is never true when dealing with the fear of flying.

Anxiety is reinforced by avoidance. It will always tell you to avoid, and – if you follow your gut feelings – you will always be reinforcing it. We are back to the truism that ‘what you resist will tend to persist’ and efforts to avoid, fight and run away from anxiety will work backwards. However, you can learn to outsmart anxious feelings. Here’s how.

You need to learn not to follow what anxiety tells you to do. As a rule, aim to do the opposite of what your anxious feelings are telling you to do. Fight what anxiety is telling you to do but embrace the feelings (and that means discomfort) that it engenders. If it is telling you to stay in your seat and grip the armrests, then open your hands, get up and move around. If you feel like you need to walk around, try to stay in your seat.

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Step 5:
Step on the airplane with knowledge

“I researched how planes work and as soon as I read the fact that once a plane reaches 300 miles an hour, it cannot stay on the ground. It has to lift off. I was just like, that’s pretty cool, as long as the engines are still on, you’ve got a chance and then even if the engine is switched off, you’re going to glide down or whatever. I just thought, okay I get it now.”

Erol Alkan
DJ / Producer. ⁷, ⁸

When you are dealing with anxiety, ignorance is not bliss. In fact, the opposite is true; anxiety thrives on ignorance. To combat this, learn about the airline industry, how pilots are trained, turbulence and anything else that frightens you. Are you concerned that the pilots might both get food poisoning and be unable to fly the plane over the Atlantic? Did you know that the pilot and co-pilot eat food brought in by separate catering establishments? If you can think of a potential problem, people in the industry have already thought about it and worked out a remedy.

Does this mean you can be absolutely, positively certain about things? No! There is nothing in life that is risk-free. There is a risk in walking across the street, riding in a car, or even sitting in your living room. But these risks, like flying, are so low that it makes sense to ignore them and proceed with the assurance of safety. When fearful fliers start a question with, ‘Is it possible that … ?’ I always answer, ‘Yes!’ Just about anything is possible. When you start a question that way, you aren’t asking for facts, you are asking for reassurance. That question is about anxiety, and not about facts.

Your anxiety is fed by ‘what if?’ catastrophic thoughts. When you don’t know about a subject, you make up scenarios based on your imagination, and these thoughts are limited only by your creativity. Once you become knowledgeable, your ‘what if?’ thoughts will be limited by the facts. Become familiar with the facts. They will not eliminate your anxiety, but will help to keep it more manageable.

A special note about things that go bump on the flight.

No one likes turbulence, but bumpiness while flying is a fact of life. The more you learn about turbulence, chop, noise abatement manoeuvres and the movements, sounds and sensations they produce, the more you are able to cope with them. Understand how the aircraft is designed to cope with turbulent stresses; try to figure out what constitutes your central fears about bumpy flights. These can include crashing, sensations in your body, vomiting, others observing you, or a fear of the fear itself. Focus on managing your anxiety rather than when the turbulence will end, or how severe it might get. Stay as close to the present as you can. Remind yourself that you are safe.

When I fly with patients, I often try a little experiment. I grab their seat and shake it as hard as I can, simulating the feelings of flying through turbulence. I’m always told to stop, and the most common reason is that s/he can’t distinguish this shaking from real turbulence. This lets me know that the fear isn’t of a bumpy ride: the real fear is the frightening ‘what if?’ thoughts that are triggered by the bumpy ride.

Remember that knowledge is power. In the resources section, you can find a list of common sounds that are produced during a normal flight.⁹

Things That Go Bump On The Flight

Phase of Flight	Noises	Sensations
Entering Aircraft	• Air conditioning • Jet engine sound from Aux. Power Unit • Whine from hydraulic pumps	None
Engine Start	• Air conditioning noise stops • Jet engine noise begins to rise in pitch	Vibration in seats near engines
Pushback	Engines starting	Rearward motion, perhaps jerky
Power Back (Aircraft backs up using reverse thrust)	Very loud engine noise	Rearward motion
Taxi	• Engine noise varies, sometimes loud  • Sounds of flap motors in seats near wings	• Forward motion • Possible bumbs • Abrupt turns and stops
Take-off	• Engine noise very loud which decreases as speed builds up  • Air noise begins (rushing sound), bangs from nose wheel as strut bottoms out, and as wheel goes over recessed runway lights  • Jet engine sound from Aux. Power Unit  • Whine from hydraulic pumps	• Forward motion, with a powerful acceleration if aircraft is light in weight  • Bumps in runway  • Bumps going over runway lights
Rotation	Possible bang sound from nose wheel as strut extends	• Nose goes up • Seat seems to tilt back
Liftoff	• Runway bump noises stop  • Air noise increases	• Possible vibration as tires spin down  • Increase in deck angle
Landing Gear Retraction	• Seats over wing may experience loud bumps as gear doors open and wheels retract  • Air noise may increase while gear doors are open	Vibrations and thuds as wheels retract
Wing Flap Retraction	• Possible whining sound in wing area as flap motors actuate  • Air noise increases as speed increases	• Possible slight sinking sensation as aircraft accelerates  • Less vibration after flaps are retracted
Departure Manoeuvring	• No special noises • Engine noises may vary as thrust settings are changed for manoeuvres	• Low altitude turns may cause tilting sensations  • Pitch (deck angle) may change for level offs  • If thrust is reduced, possible deceleration effect
Enroute Climb	• As speed increases, most of the noise becomes air noise  • Engines heard only in seats near them  • About 5 minutes into the flight, air noise will increase as aircraft reaches 10,000 feet and accelerates to full climb speed	• Generally, enroute manoeuvring is very gentle  • If you are looking out of the window you will see the banking for turns  • Light turbulence will produce a “rough road” effect
Cruise	Air noise	• Probably few to none  • Gentle turns
Descent	• Engine thrust is reduced for people sitting next to the engines  • On some aircraft, the air condition noise changes as thrust is reduced	• Possible slight downward deck angle, depending on the steepness of descent  • Gentle turns
Initial Approach	• As aircraft descends below 10,000 feet speed is reduced and air noise diminishes substantially  • If temporary level off is necessary engine noise will increase	• On some aircraft thrust changes produce acceleration and deceleration effects  • Deck angle changes for level offs
Flap Extension	• Air noise decreases as speed decreases  • Possible whine near wings as flap motors actuate  • As flaps extend, air noise becomes deeper in pitch	• Possible lifting sensation as flaps extend  • Ride, even in smooth air, becomes a little rough due to flap effects on airflow
Landing Gear Extension	• Air noise increases as gear doors open  • Some thuds and bangs as wheels extend, lock and doors close	• Some bumps and thuds  • Manoeuvring at low speeds  generally seems more intense  than during cruise  • Possible tilting sensation with  larger bank angles
Final Approach	Engine noise will vary as thrust is altered to maintain approach speed	For the first time you will feel the pilot handling the aircraft by banking and changing deck angles rapidly to maintain the exact glide path
Flare	Engine noise will vary as thrust is altered to maintain approach speed	Deck angle will increase as pilot reduces descent rate for touchdown
Touchdown	• Engine thrust and noise reduce abruptly  • If landing is firm, possible noise of touchdown such as a loud thud	• Depending on the type of landing anything from a skipping squeak to a full-scale thud  • Possible sideways motion as pilot tracks runway centre line  • Seat seems to tilt back
Landing Rollout	• Engine noise increases rapidly as thrust is reversed  • Runway noises again  • Bangs and bumps	• Depending on the length of the runway, either a mild or a major breaking effect  • Runway bumps and bangs  • Seat seems to tilt back
Taxi In	• Normal taxi noises • Engine thrust varies • One or more engines may be shut off altogether to save fuel	Turns and stops may be abrupt

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Step 6:
Anticipate your anticipatory anxiety

This is a big one. You will do best if you are prepared to be anxious: anticipatory anxiety is the anxiety we experience in anticipation of something we fear. The experience of flying is a perfect incubator for anticipatory anxiety. This is often the most intense anxiety you will experience regarding flying. It usually starts way before your flight, and your worries run all over the place. (Should I fly night or day? Is this the right flight to choose? i.e. will it not crash, be free of turbulence, take off during a hurricane, etc.) A fearful flier may start to worry weeks or even months before a flight; it can make you anxious, irritable, interfere with sleep and make you (and anyone close to you!) feel entirely miserable.

Anticipatory anxiety is so intense that the vast majority of aerophobes I fly with say the same thing after the flight. ‘Dr Seif,’ they say,’ When I was walking through the jetport onto the plane, I genuinely felt like I was walking to my own funeral.’ I always respond, ‘What courage!’ Anticipatory anxiety increases with your indecision (i.e. should I take the flight or not?) and starts to level off when you commit yourself to an action. It is a pervasive and complicated psychological phenomenon and feels like a predictor of how worried you will be on the flight.

Here’s a typical example: You schedule yourself to fly in a week. When you imagine yourself flying, you think catastrophic thoughts about the flight, and your anticipatory anxiety soars. You think, ‘Here I am a week before the flight, and just thinking about the flight in the comfort of my living room brings my anxiety up to a near panic. If I am that anxious just thinking about the flight, imagine how freaked out I am going to be when I am actually on the airplane. I have to cancel the flight.’

But this is all wrong. In truth, most of us experience the majority of our anxiety before and close to the beginning of the flight, when you first encounter the triggers that set you off. However, if you can stay in that situation past that surge of anxiety, utilising your newfound attitude of Expect, Accept and Allow, your anxiety will start to moderate soon after. If you have a good understanding of the phobic process and some solid tools for coping with your anxiety (these are available in Chapter 10, Anxiety), and practise applying them in the right way, you will most likely have experienced much of your anxiety by the time the plane reaches cruising altitude.

Here is another fact about anticipatory anxiety: it increases with your indecision. AA becomes more pervasive as we get close to the feared activity and as we find it hard to just ‘put off’ thinking about it. Our anxiety makes us waiver in our determination to pursue the activity. But when you commit yourself to either coming or going, you will start to experience some relief.

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Step 7:
Educate fellow on fliers how to help you

Other fliers need to know what frightens you, along with what helps you most to cope with anxiety during flight. If you ask, pilots can speak with you as you board.

Flight attendants will give you additional attention if you let them know what you need. Family, friends and other passengers can help you monitor your anxiety, keep you focused on the present, and help you steer clear of catastrophic mental imagery. Steer clear of ‘frenemies’ who relate their own frightening flights. They might think they’re funny, but they will more likely trigger you.

Your task is to be clear about your triggers and specifically ask for what you find most useful.

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Step 8:
Value each flight

Exposure is the active ingredient in overcoming your phobia, and so every flight provides you with the opportunity to make the next one easier.

Maximise the benefits of exposure in two ways: first, record your anxiety levels during the flight. You will be surprised at how short a time you are highly anxious during the flight. Next, search out and eliminate the many ‘mini-avoidances’ you go through to make your discomfort seem more manageable. Do you insist on a certain seat? Avoid specific airports? Grip your seat in terror until the ‘fasten seat belt’ light goes off? Focus on the flight attendants to reassure yourself that all is going well? Avoidances like these prolong your anxiety and work against the therapeutic effects of exposure.

Remember that your goal is to retrain your brain to become less sensitised to triggers that set you off.

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How to Help Fearful Fliers in Flight:
A Handbook for Flight Companions

General Principles for Companions

Frightened fliers feel calmer when they sense their companions observing and sensitively responding to their fears. Fearful fliers tell us that they feel more grounded, less self-conscious, and more in control when they feel their fears are noted and understood. Reducing anxiety makes the flight easier for everyone aboard the plane

Remind Fearful Fliers that:

• Flying is safe
• They are in a safe place
• It is all right to feel anxious
• Anxiety is uncomfortable, but not dangerous
• They won’t suffer any harm from anxiety
• Their thoughts are frightening them, not the airplane. They have control over their thoughts even though they are not controlling the airplane
• They will do better if they try to stay in the here and now. Suggest that they touch and feel things, look around, smell and taste andactivate the senses
• Try to stay with ‘what is’, as opposed to ‘what if’
• Flying may feel dangerous, but it is not dangerous

Try not to:

• Yell or get annoyed
• Tell stories about your own fearful/turbulent/delayed flights
• Demand that they should: Calm down! Relax! Control yourself!

Avoid statements of the kind:

• Don’t be anxious
• Don’t make a spectacle of yourself
• Don’t embarrass me or my crew
• You are being ridiculous
• What’s the big deal? A lot of people get anxious all the time
• Take a pill
• Shut up!

Suggestions for Helping each Type of Fearful Flier

The phobic flier will be concerned about safety related aspects of flight. Remember that this flier is obsessively locked into a continuous re-run of terrifying thoughts about flight catastrophes.

• Reassure them that flying is very safe. Movement of the airplane as it flies is just as safe and normal as cars bouncing a bit on the road.
• Point out that their thoughts are making them afraid, not the airplane or the flying experience.
• Remind them that feelings are not facts, and while they may feel like the flying experience is dangerous, the facts show that flying is safe.
• Suggest that they pay more attention to comforting realities of the flight and focus on manageable tasks in the present.
• Reiterate that they have control of their thoughts even though they have chosen to give control of the airplane to the pilots.
• Remember that it does no good to try to talk someone out of their fear.

Panic fliers are frightened that they will experience a panic attack on the flight. They may complain of physical symptoms, seem overly concerned with possible flight delays, or talk directly about feeling panicky.

• Ask what they need to feel more comfortable.
• Re-assure them that it is okay to feel anxious.
• Explain that the energy used in trying to fight the anxiety goes right into making the anxiety worse.
• Tell them that they don’t have to exit the plane in order to feel comfortable. They can recover in the phobic situation if they can reduce their ‘what if’ thoughts.
• Let them know that panics cannot hurt them, although they are very uncomfortable.
• Inform them that panics are self-limiting – they cannot panic forever. (As they sometimes may fear.)
• Tell them that you will make an effort to monitor them and to talk when possible.

The agoraphobic flier, who is fearful of panicking away from their ‘safe place,’ will often be accompanied by a safety person.

• Ask whether it is best to talk with the safety person or the agoraphobic flier. Sometimes it is best to speak with both.
• Re-assure both the safety person and the agoraphobic flier that they are not alone and there are people around who can be helpful to them.
• Remind the agoraphobic flier that he can carry his own safe space, no matter where he is physically located.
• Encourage the safety person to engage the agoraphobic flier on breathing (long, slow out-breaths), distractions and safe self-talk (i.e., the plane is flying straight and level).
• Give support to the safety person, especially if that person begins to feel frustrated, exhausted, or overwhelmed.
• Encourage the safety person to reinforce the recommendations discussed under helping the panic flier.

Specific phobias fliers have pre-existing fears or phobias that are encountered during ordinary flight. They are not afraid of flying, but rather the triggers they might encounter while in flight.

• This type of fearful flier will usually be able to identify their particular trigger. The most common are heights, deep water, darkness and lack of control.
• Give accurate information in a neutral voice about the triggers they fear. (i.e. ‘We are cruising at 37,000 feet’, or ‘We will be flying over water for the next 2 hours,’ or ‘Our Captain is a highly trained, highly experienced flight specialist.’)
• Encourage them to find a safe place in their body that they can move to find some calming.
• Then ask them to create a safe place in their mind around that area of the body and to visualise it.
• Encourage them to go between the ‘unsafe,’ anxious areas of the body and the safe place – the anxiety will then often recede.
• Many techniques are helpful in reducing the anxiety of specific phobias. Relaxation, distraction (counting backwards from 100 by three’s, doing work or number puzzles, listening to favourite music), diaphragmatic breathing.

Socially phobic fliers are approached differently from other types of fearful fliers, since the attention of flight personnel and other passengers can accentuate their phobic concerns and result in increased anxiety.

• These anxious fliers are hypersensitive to real or imagined criticism.
• They are sometimes identified by facial flushing or remaining frozenin their seat for the entire flight.
• Before proceeding, ask if they would like attention, since they dreadexposing their fear to others.
• Keep questions away from describing their internal experience. Instead, ask – if possible – if they would like to move to a morecomfortable (less visible or separated from another passenger) place.
• Remind them that they are far less visible than they think, and that they might imagine themselves in a protective bubble that no oneelse can penetrate.
• Tell them that others are self-involved and neither focused on, nor concerned about them.
• Ask them to focus on how other people appear to them, as opposed to how they imagine they appear to others.

Traumatised fliers are difficult and agitated fliers since they feel they are in a vulnerable situation. They therefore require great care.

• Ask them if they are concerned about safety on the plane.
• Remind them that every passenger has been screened for dangerous materials.
• Tell them that cargo has been X-rayed and examined carefully.
• Remind them that the flight crew strives to provide a safe flight.
• Your role is to provide safety first and then comfort.
• Rules and delays are in the service of flight safety: coping with them requires flexibility and patience.

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Looking back on this chapter about fear of flying:

You now have all the tools you need to understand and overcome your fears of flying. Remember that there are many different fears of flying, and you will do best when you understand the triggers that set you off.
Additionally, companions to fearful fliers have a guidebook to best help suggestions during actual flights.

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References

1. Oakes, M., & Bor, R. (2010). The Psychology of Fear of Flying (part I): A critical evaluation of current perspectives on the nature, prevalence and etiology of fear of flying. Travel medicine and infectious disease, 8(6), 327-338.
2. Freedom to Fly, at White Plains Hospital Anxiety and Phobia Treatment Center
3. Attributed to Franklin D. Roosevelt, Ambrose Redmoon, Meg Cabot or Nelson Mandela– depending on who you ask, or indeed which meme you choose!
4. Seif, M. N., & Winston, S. (2014). What every therapist needs to know about anxietydisorders: Key concepts, insights, and interventions. Routledge.
5. Seif, M. N., & Winston, S. (2014). What every therapist needs to know about anxietydisorders: Key concepts, insights, and interventions. Routledge.
6. Goldstein, A. J., & Chambless, D. L. (1978). A reanalysis of agoraphobia. Behaviortherapy.
7. Tamsin Embleton interview with Erol Alkan, 19 July 2021.
8. According to Wikipedia, ‘Typical take-off air speeds for jetliners are in the range of240–285 km/h (130–154 kn; 149–177 mph)’.
9. From my website, www.drmartinseif.com