I’m a pilot, attached to the sky. Taking off, I happily enter another realm, thrilled to be airborne. My friend Cindy, however, has to force herself to set foot on an airplane. She’ll do it, but leaving terra firma is an ordeal. “It’s that loss of control,” she says. “Totally wigs me out.”

If you’re among the millions who are afraid of flying, you might find aspects of her routine familiar. “The day I have to fly, I get kind of sullen and quiet,” she says. “I go about my business, make sure I have my Valium prepared. I get to the airport, go through security, don’t talk a lot. I make sure to go to the restroom before we board because I do not like to stand up in a plane.”

She also insists on a window seat. “If I sit on the aisle,” she explains, “I feel like every bump, grind, whistle, and noise of that plane is exacerbated. If I sit near the window—preferably near the wing—I can see the horizon line. And if my eyes can lock onto the horizon, I can talk myself into saying, ‘O.K., it’s not that bad.’”

Though estimates vary, 10 to 40% of adults are said to find flying troublesome. It’s enough of a problem that some airlines have offered treatment programs and a number of airports—including those in San Francisco, Los Angeles, and Miami—have therapy dogs available to soothe travelers’ preflight jitters. It’s a global matter too: The International Civil Aviation Organization has held several conferences on fear of flying.

Sometimes known as aviophobia, it’s more complicated than it appears. For one thing, there’s considerable variation in the extent to which it affects a person’s ability to travel by air. There are those who avoid airplanes entirely, like Aretha Franklin, who goes from gig to gig on her own customized bus, and John Madden, the sports commentator, who cruises coast to coast in his. Some people will take a flight only if they deem it really necessary. Untold numbers of others fly regularly but suffer through it, gritting teeth, gripping armrests, popping pills, downing booze, or zoning out to block their percolating anxiety.

Fear of flying may have the hallmarks of a phobia, but that’s not necessarily a clear-cut definition of what it is. According to the DSM IV, the bible for diagnosis of mental health disorders currently in use, a key criterion for phobia is that “the avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships.” Researchers have noted, however, that fear of flying may be a manifestation of a broader underlying phobia, like agoraphobia or claustrophobia, and possibly more than one.

Dr. Robert Bor, a British aviation psychologist, sees it as a symptom of “a more specific primary fear”—of heights, for example, or separation, enclosure, death, or control. As he and his co-author Margaret Oakes note in their 2010 review of current psychological perspectives on the subject, in the journal Travel Medicine and Infectious Disease, “fear of flying is a heterogeneous phenomenon which is acquired under the influence of complex psychological, social and physiological factors unique to each affected individual.”

Cindy’s fear developed over time, in association with stressful events, starting with a flight she took as a child with her divorced mom for a court appearance concerning her estranged father. “The weather was awful,” she says. “I don’t recall if the flight had an issue, but we had a lot of anxiety. My mother was a nervous flyer and she was very keyed up, and that had to have had an effect on me.” A few years later, when Cindy had to fly alone for the first time because of a family emergency, she was “completely filled with worry.” After that, she says, “the fear settled in.” Eventually, she got a prescription for Valium because, as she put it, “I can’t not fly. I wanted to see friends and family.”

As any pilot will tell you, flying is not without risk. So is driving, along with plenty of other activities. But, although the media frenzy over aircraft mishaps might suggest otherwise, the reality is that flying is extremely safe. Arnold Barnett, an MIT statistics professor and expert on aviation safety, has calculated that your chance of dying on an airplane (prop- or jet-powered) in a First World nation is 1 in 45 million—meaning you could fly every day for 38,000 years before being in a fatal crash.

While such facts usually aren’t enough to persuade the fearful, they can be helpful, along with explanations of how airplanes are engineered for safety and how they stay aloft. This kind of information is often used in fear-of-flying treatment programs, along with exposure to airplanes and airports, real or virtual. Several studies have found that virtual reality can be as effective as real-life exposure to flight-related anxiety triggers, like the sounds of an airplane. There’s also been research, with some positive results reported, on the use of Eye Movement Desensitization and Reprocessing (EMDR) therapy.

Lots of studies, plenty of debate—in short, there’s no solid consensus on the best way to address flight fright. Most approaches, though, involve managing anxiety, using breath, relaxation/mindfulness exercises, and other techniques; variations of cognitive behavioral therapy (CBT) are also commonly deployed.

However, Tom Bunn, a therapist and airline pilot who offers his own program called SOAR, argues that trying to change conscious thinking—left-brain activity—isn’t sufficient to combat fear of flying. “To the degree that CBT is based on sequential/semantic logic, it cannot relieve anxiety produced by right-brain intuitive/visual logic,” he says in an article in Psychology Today. The key, he maintains, is to alter automatic and unconscious mental processes by appealing to the right brain—whose amygdala produces the stress hormones that create anxious feelings—through “visually based interventions.” (His Jello Exercise for explaining how planes stay up in the air is one example.) Bunn’s program also includes mindfulness training and exposure, including an actual flight.

Cindy says that reflecting on the relative safety of air travel can help her “beyond or before the moment of anxiety.” And she believes she’d be less anxious if she were in the cockpit, “seeing where I’m going, what I’m about to encounter.”

Given that she cites loss of control as her major issue, could she perhaps benefit from going up in an airplane with a flight instructor? “It’s not on my radar—no pun intended—because the thought of electing to be on a plane is fear-inducing,” she says. “But if I were to push myself to do that and were able to conquer the initial flight, it probably could be very liberating and would go a long way toward allaying most of my fears.”

Cindy and her family have listened to me enthuse about flying for years. After hearing the details of her fear of flight, I wonder what that’s been like for her. “I see your joie de vivre attached to it, and it makes me happy to see you happy like that,” she says. A good friend indeed.

Tips for Fearful Flyers

Some suggestions from experts that can help ease your way through a flight:

Think about the good reasons for your trip. Are you going to see friends or family? Are you going on a wonderful vacation? Look forward, or remember the positive moments you’ve experienced.

Take your mind somewhere else. Watch a movie, listen to music, read a book or magazine, play a game. Or chat with a fellow traveler.

Let the crew know you’re a nervous flyer. Flight attendants can offer reassurance to those who find flying a nerve-wracking experience.

Stay hydrated and eat to maintain energy. Avoid alcohol and caffeine. Small amounts of food eaten regularly help keep up blood sugar levels to keep you on an even keel.

Try deep-breathing and relaxation exercises. Tom Bunn recommends the simple 5-4-3-2-1 exercise. Dr. Andrew Weill offers deep-breathing instructions, as do Yoga Journal and others. Before your trip, find the one that’s right for you and practice.