Panic attack on a plane: what to do in your seat, and how to fly calmer

The doors close, the plane starts to taxi, and suddenly your heart is pounding. Your chest is tight, your hands are tingling, and one thought fills your head: I can’t get off.

Panic attacks on planes are common, and they’re frightening precisely because there’s no escape. But a panic attack follows the same pattern in the air as on the ground: it peaks and it passes. Here’s exactly what to do, and how to make the next flight easier.

Why planes can trigger panic

• You can’t leave. Feeling trapped is one of panic’s strongest triggers.
• Enclosed space. Narrow aisles, small seats and closed doors can set off claustrophobia.
• Loss of control. Someone else is flying, and you can’t choose when to stop.
• Unusual body sensations. Take-off pressure, ear popping, turbulence and dry air all create sensations an anxious brain might read as danger.
• Slightly thinner air. Cabins are pressurised to the equivalent of being up a mountain, up to about 8,000 feet. Healthy people barely notice, but you might feel slightly more breathless if you walk up the aisle.
• The build-up. Early starts, queues, crowds, caffeine and rushing leave many people on edge before they even board.

What to do if panic hits in your seat

1. Name it. “This is a panic attack. It feels terrible, but it can’t hurt me. It will peak and pass, here just like anywhere else.”
2. Breathe out slowly. In through your nose for 4, out through your mouth for 6. Don’t gulp air.
3. Press your feet into the floor and your back into the seat. Feel the plane holding you up.
4. Ground yourself. Name 5 things you can see, 4 you can feel, 3 you can hear.
5. Cool down. Open the air vent above you, sip cold water or hold a cold drink to your wrists.
6. Relax your grip. Unclench your hands and jaw and drop your shoulders.
7. Let the wave pass. Don’t fight it or check your watch. Most panic attacks peak within about 10 minutes.
8. Keep your mind busy once the peak passes: a film, music, a game or counting backwards from 100 in 7s.

Involving a flight attendant

It’s completely okay to press the call button or speak to the crew. You could say:

“I’m having a panic attack. I’ll be okay, but could I have some water and maybe check on me in a few minutes?”

Flight attendants deal with anxious passengers often. They can bring water, help you move to an aisle seat if one is free, stand somewhere you can see them, or simply reassure you.

Panic or a medical emergency?

Panic causes chest tightness, a racing heart and breathlessness, but so can medical problems. Press the call button and tell the crew it might be medical if you have:

• chest pain or pressure that spreads to your arm, back, neck or jaw
• severe difficulty breathing, or lips turning blue or grey
• fainting, or feeling like you’re about to pass out
• sudden weakness, a drooping face or slurred speech
• symptoms that feel different from your usual panic

Cabin crew are trained in first aid and can get advice from medical experts on the ground, and there’s often a doctor or nurse on board. Nobody will be annoyed if it turns out to be panic.

Before your next flight

• Talk to your doctor first if you have a heart or lung condition, are pregnant, or are thinking about medicine for flying.
• Choose your seat. An aisle seat means you can get up and stretch. Seats over the wings feel turbulence least.
• Arrive early so you’re not rushing.
• Go easy on caffeine and alcohol before and during the flight.
• Eat something before you board.
• Pack a calm kit: headphones, downloaded films or music, a cold drink bought after security, mints and a card with your coping steps.
• Tell the crew when you board that you’re a nervous flyer, if you think it would help.
• Practise slow breathing in the days before you fly.

Our post on turbulence anxiety explains what turbulence is and what to do when it’s bumpy.

What about medicine for flying?

Some people are prescribed a sedative for flights. Talk to your doctor, and never mix sedatives with alcohol. One study found that people with a fear of flying who took alprazolam on their first flight felt calmer at the time, but were much more anxious, and had far more panic attacks, on a second flight a week later without it. The medicine seemed to stop them learning they could cope. Being very drowsy on a long flight also means moving less, which raises the risk of blood clots.

Afterwards

When you land, give yourself credit. You got through a panic attack in one of the hardest places to have one. That’s real evidence that you can cope, and it’s worth remembering before your next flight.

If panic on planes keeps happening, or you’re avoiding flying, cognitive behavioural therapy (CBT) with gradual exposure helps most people. In one study, people treated with CBT for fear of flying kept their progress more than two years later.

Frequently asked questions

Can you have a panic attack on a plane?

Yes, and it’s common. Feeling trapped, enclosed spaces and unusual sensations like turbulence and ear popping all make planes a frequent trigger. A panic attack on a plane isn’t dangerous, and it passes like any other.

What should I do if I panic during take-off?

Take-off is loud and powerful, which can feel alarming. Press your feet into the floor, breathe out slowly and name the normal sounds: the engines getting louder, the wheels lifting, a thud as the landing gear folds away. The steepest part is over within a few minutes.

Can I ask to get off the plane if I panic?

Before the doors close, you can tell the crew you need to get off, though it may delay the flight. Once you’re moving, you’ll need to stay until landing. Most people find that knowing the panic will pass, and getting support from the crew, helps them stay.

How can I stop panic attacks on planes for good?

CBT with gradual exposure is the most effective treatment for fear of flying and panic. Some airlines and airports run fear-of-flying courses too. Practising slow breathing and grounding between flights also helps.

How Breatheasy can help

Breatheasy works without internet, so it’s there in airplane mode. When panic starts, tap “I’m feeling anxious” and Luma walks you through it: rate how strong it feels, breathe slowly as your phone pulses gently in your hand, ground yourself with 5-4-3-2-1, then see how far the anxiety came down. Breatheasy is coming soon to iPhone and Android.

Sources

• Claustrophobia, NHS
• Panic disorder, NHS
• Turbulence: staying safe, Federal Aviation Administration
• Acute and delayed effects of alprazolam on flight phobics during exposure, Wilhelm and Roth, Behaviour Research and Therapy, 1997
• Cognitive behavior therapy for fear of flying: sustainability of treatment gains after September 11, Anderson and others, Behavior Therapy, 2006