You are strapped in to your seat in the aircraft, looking forward to your journey ahead.  The unpleasantness of the security checks and the bother of the check-in process is behind you, as well as the possibly tense traffic-jammed trip to the airport.

Over the next few minutes you inexplicably start to feel unease.  You experience some of the following sensations:

• Feeling faint or dizzy
• Your limbs tingle or go numb
• Tightness, discomfort or pain in your chest
• Your throat closes up and you can’t swallow
• You become fearful of dying
• Your heart speeds up, pounds or palpitate
• You start shaking
• Shortness of breath, or you feel there is not enough oxygen in the air
• You start sweating profusely
• You have a cold chill or a hot flush
• Your tummy feels disquieted
• You feel nauseous
• You become detached from yourself
• Things start feeling unreal

You could be suffering from a panic attack.  (You could also be having a heart attack.  If you are at all unsure, ask the cabin crew for help right away.  As with other medical conditions, panic attacks need to be properly diagnosed by a medical professional.)

Panic attacks are extremely unpleasant, scary and disturbing; and typically last from a few seconds to around half an hour.  They are triggered in part by the anxiety that one experiences in the build-up to the flight, which makes it a much bigger deal than it really ought to be.

The first bit of hope that we can give you is that, although you feel that you are going to die, one does not die from anxiety or panic attacks.  It will go away, and you will get over it, however you may feel when in the grips of one.  The physical symptoms you experience at the time make the psychological strains that much harder to bear.  Some admit to having prayed for death.

What can you do about panic attacks

For a number of people anxiety precedes the panic.  If you are able to reduce the anxiety, you may well be able to ward off the attack.

It is said that the writer Tolstoy and his brother claimed to be members of an exclusive club.  Membership was obtained by standing in a corner for half an hour and not thinking about anything white.  If you try it you will soon find that you are thinking of the word white and white things.  The brain cannot unthink any idea – it is made to think about something.

You can’t “fight” anxiety any more than you can concentrate on not-thinking about something white.  You have to replace you’re anxious thoughts with peaceful, calm and pleasant thoughts.  Or put another way, you must divert your attention elsewhere.

1. Medication.  Responsible physicians can prescribe non-habit-forming drugs that can provide support to alleviate the anxiety and panic, without impacting on your intellectual capacity or reducing you to a zombie-like state.  Anxiety can also be a side-effect of medication that you might be taking for other conditions, in which case your medical practitioner may try changing the prescription to alleviate the symptoms.  Diet pills and cold and flu medication can heighten anxiety.  You may also be advised to avoid certain foodstuffs, for instance caffeine, that can heighten anxiety in many people.  Certain anti-depressants may take a month before they are fully effective, and you would need to take them even when you are not experiencing an attack.

Benzodiazepines are not recommended by many medical practitioners.  They take 30 minutes to an hour to act, by which time the panic attack would have subsided by itself, and they are highly addictive.

2. “First-aid”.   Relax.  Options that you may have when on the ground, like going for a walk outside, are clearly not available to you when you are in the air, which can greatly heighten the tension of the experience.  If you feel the beginnings of a panic attack, close your eyes.  Breathe in and out deeply a few times.  Try to relax any areas of your body in which there is muscular tension.  If you are travelling with a loved one, get them to massage the back of your neck.  Physical contact is a deep-seated need in humans and appropriate physical contact can provide silent reassurance.  Hugging or grabbing the hands of strangers will create additional problems of a different kind.

3. Think positive thoughts.  Having a Polly-Anna outlook on life is not what we mean.  When you are experiencing a panic attack, imagine being in a happy, peaceful place.  What is important is that you must push your thoughts in a positive direction.  By thinking about something nice, you drive out the anxious thoughts, at least for a while.

4. Eliminate sources of anxiety.  This is something that you can only do before or after the attack, not during one.  In fact if you try address these causes during an attack you are likely to just make it worse.  If you are going through a crisis in your life then you probably need to get help with that rather than looking at the travel aspects – it is best to attend to root causes.  And you may need professional help with that.

If the source of anxiety is the travel itself then you are already doing something useful about it by reading DIY Travel Expert.  Understanding the symptoms is a good starting point.  We also have articles that explain what is happening during various stages of the flight and considerations as to how you can ensure your personal safety.  Knowledge about flight operations is one established way of fighting fear of flying.

Psychologists specialising in travel anxiety are likely to use two approaches: cognitive behavioural therapy or exposure therapy.  Cognitive behavioural therapy unpacks the thinking and behaviours that lead to the attack and help you to understand your fears in a realistic way.  Reading our series of articles on fear of flying and anxiety will provide much information that can assist with this.

Exposure therapy typically means taking a course in which you are shown around the aircraft, get to sit in it when it is not going to go anywhere and gradually desensitise yourself to your fears.  The good news is that this is not needed for most people.