Q: I have a serious fear of flying. I'm not afraid because of being in the sky, but I have terrible claustrophobia and am so afraid of how I will feel once I'm in the plane and can't get off. I haven't flown in 25 years because of this. Is there anywhere I can go to get help where I can actually get on a plane to see how I would feel on a flight and maybe get some counseling? I want to travel so badly, but I’m held back because of my fear. Any help would be appreciated.

–Nancy Restaino, Nutley, N.J.

A: Nancy, you may want to tackle your claustrophobia with the help of a psychiatrist who can both offer counseling and perhaps medication to combat the symptoms. You can search for someone in your area that specializes in claustrophobia on the American Psychological Association's website.

Although it would be a bit of the drive for you, the Tufts University Medical Center has one of the best facilities for treating claustrophobia in the country. TMC specializes in cognitive behavioral therapy, which would teach you how to control your anxiety in fear-triggering situations. Some cognitive behavioral specialists will go so far as to take you on an airplane once treatment has progressed to that level.

Believe it or not, claustrophobia is the root of many people's fear of flying and based on the concern that they might have a panic attack while in the air. There are several courses and clinics that focus on the fear of flying. For example, the Anxiety and Stress Disorders Institute of Maryland (ASDI) is an independent treatment center in Baltimore that's been operating since 1992. Classes usually involve several weeks of group therapy and culminate in a short flight to employ the coping techniques. In Westchester County, N.Y., the six-session Freedom to Fly workshop includes individual meetings with a counselor and ends with a flight from New York to Boston and back.

There are also things you can do on your own: Educate yourself on the mechanics of airplanes and the effects of weather. The more you know about strange noises and movements, the less uncomfortable you'll be. Arrive early to avoid last-minute stress that can increase your chances of a panic attack. Avoid caffeine and other stimulants that can make you jittery while on the plane.

Once you're able to travel by plane, you should create a flying routine that minimizes fear triggers. Try flying with noise-canceling headphones and a laptop or video iPod that will drown out engine noise and help you forget that you're on a plane.

It's also a good idea to sit in the front few rows of the plane. If you sit in the front, you won’t have to look down a long tunnel of cabin seats and be constantly reminded that you’re on a plane. Aisle seats also provide more room because you’ll be able to lean into the middle passage.  

Consider taking a bus trip that lasts more than a few hours so you can adjust to being in a cabin-like setting. When you first start flying, take short trips and then try to progress to longer and longer flights.

Nancy, you're not alone. A lot of people have a fear of flying, but a lot of people have also gotten over their fears. The hardest thing you'll have to do once you've conquered your claustrophobia is deciding where to go first.