Overcoming Flight Anxiety: How a Structured, Data-Driven Approach Works

Flight anxiety is one of the most common fears I encounter in my practice. For some, it shows up as mild worry at the thought of turbulence or boarding a plane. For others, the physiological responses are so intense that travel feels impossible. Today, I want to share the story of a client who came to me with flight anxiety and how, through a deliberate and structured plan, we resolved their fear in just seven sessions.

This is not a “quick fix” story. It is a demonstration of how my system, rooted in data, exposure principles, and EMDR (Eye Movement Desensitization and Reprocessing), works when client commitment and targeted interventions align.

The Starting Point: Assessments and Clarity

Every client I work with begins with a full battery of assessments. From there, there are key areas of focus on assessments, for this client, that meant the GAD-7, PHQ-9, DASS-21, and a specific phobia severity measure. Interestingly, their scores were not clinically “high.” On paper, they did not look like someone in crisis. Yet their subjective experience told a different story: intense physiological arousal while flying, ie, racing heart, sweating, muscle tension, that interfered with their ability to travel for work and family.

This is why assessments matter. They provide baseline data, but the real picture emerges when we combine numbers with the client’s lived experience. Their situation illustrates that distress is not always captured by cut-off scores.

Building the Foundation: Sessions 1–3

The first three sessions were dedicated to relationship building, utilization of the Untangling Anxiety workbook, and preparation for EMDR. This included identifying the negative cognition (NC)—the internalized belief fueling their fear—and the positive cognition (PC)—the adaptive belief we would strengthen through processing. For example, an NC might sound like, “I am not safe,” while a PC might be, “I can handle this.”

During this phase, I also introduced them to the structure of my system, including SUDS ratings (Subjective Units of Distress Scale). This is a 0–100 scale clients use to rate their level of distress in the moment. By tracking SUDS across sessions, we could measure progress in real time, not just through reassessment at the end.

Turning Up the Heat: Session 4

When we began EMDR in session four, I paired it with intentional exposure strategies. To simulate the physical sensations of flying, I asked them to drink coffee beforehand (to mimic jitteriness and a racing heart) and I turned up the heat in my office (to simulate discomfort and sweating).

Why? Because anxiety is often fueled by the fear of bodily sensations themselves. By recreating those sensations in a controlled environment, we “turned up the volume” on the fear response. This allowed us to target not just the idea of flying but the experience of what his body went through while flying.

Breakthrough: Sessions 5–6

What followed was a dramatic shift. Within two EMDR sessions, we saw a significant reduction in SUDS ratings. By session six, they reported an almost complete inability to generate distress during our exposure exercises. The fear that had once hijacked their system was losing its power.

At this point, we created a fear hierarchy to guide their practice between sessions. Together, we outlined steps for both in vivo exposure (real-world practice, such as sitting in a parked car or visiting an airport terminal) and imaginal exposure (mentally rehearsing challenging scenarios). This multi-layered approach prepared them not just cognitively but physiologically for their next flight.

The Real Test: Session 7

When they returned after their flight, the results were undeniable: little to no anxiety. For the first time in years, they traveled without the overwhelming distress that had held them back. What had begun as a nine-session treatment plan concluded successfully in just seven.

Why This Matters

It’s important to be clear: not every case looks like this. Some clients need the full treatment timeline, and others require more extended work. But this case demonstrates two key principles of my system:

1. Data-Driven Structure – Assessments (GAD-7, PHQ-9, DASS-21, phobia measures, SUDS tracking) ensure we aren’t guessing. We can see progress unfold in real numbers.

2. Targeted Interventions – Pairing EMDR with exposure, physiological activation, and workbook-guided practice creates faster, more durable change than talk therapy alone.

   
   

Therapy That Actually Works

The chart above illustrates how we measured the client’s SUDS (Subjective Units of Distress) ratings across sessions. At the start, distress levels peaked above 60. By mid-treatment, they dropped by more than half, and by the final session, they were nearly eliminated. This visual reinforces what the client reported: a dramatic decrease in physiological reactivity and a regained sense of control.

The Data Matters

This is why I deliberately track progress with every client. Data gives us more than numbers; it provides clarity, accountability, and evidence of change. Clients don’t just leave with a subjective sense of feeling “better”; they see measurable proof of their growth. In this case, the steady decline in SUDS aligned with his ability to successfully complete a flight without distress.

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