A journey can become difficult long before you leave home. You may be thinking about the airport queue, the doors closing on the plane, feeling sick on the ferry or waking in a hotel room far from familiar help. Then there is another worry: “What if my panic ruins the trip for everyone?”
When I had panic disorder, I almost did not get on a plane to go home to my family. I was sweating and counting my heartbeats in the airport. I have written about that in my personal account of panic attacks. I understand why advice to relax and enjoy your holiday can feel completely out of reach.
This guide looks at preparing for a trip, getting through the journey and deciding what to do if you have a panic attack while you are away. My main panic attacks guide explains the symptoms and treatment in more detail.
What worries you about travelling?
Try completing this sentence: “The part of travelling I am most frightened of is…” Be as specific as you can. You might fear fainting in the queue, needing help when you are abroad, being unable to leave the aircraft, or feeling nauseous on a ferry.
Those concerns need different responses. If your worry is about getting medical help abroad, find out how to access care where you are going. If you are frightened of what happens in your body during panic, it can help to understand those sensations and what you fear they mean. If difficulty escaping or being far from home is restricting ordinary journeys too, my article about agoraphobia and public transport may be useful.
Preparing for a trip when you have panic attacks
Make the arrangements you would normally need for the trip. These might include:
- Travel documents, appropriate insurance and an EHIC where it applies. An EHIC does not replace travel insurance.
- Your prescribed medicines and any medical supplies you need. Ask your pharmacist about storage, timing or travel requirements if you are unsure.
- A realistic plan for transport, meals and rest, including any disability or access arrangements you need.
- Knowing how to get medical help at your destination and discussing new symptoms or travel-related health concerns with your GP beforehand.
The distinction I would make is between finding information and repeatedly asking for certainty. Checking your departure time is useful. Checking your pulse and asking the same “Will I be okay?” question throughout the evening may leave you more focused on panic without resolving the worry.
You can write down what remains to be arranged, deal with those items and return to other things. If the itinerary changes, of course you may need to check it again. Once you have made the arrangements you need, try to get on with the rest of your day.
At the airport or ferry terminal
If you become anxious in a queue, focus on the next thing you need to do: have your passport ready, put your bag on the tray or listen for the boarding announcement. You do not need to complete a complicated calming routine as well as navigate the terminal.
If you need assistance, ask. You can tell a member of staff that you are feeling unwell or anxious and ask what help is available. Support with boarding, accessibility or a health condition should not be withheld as a way of testing yourself.
If you recognise your usual panic symptoms, you might be able to carry on with the next part of the journey while they ease. You can also ask for help or take a break if you need one.
On the plane or ferry
Once the journey begins, the thought “I cannot get off immediately” may feel very strong. You do not have to argue with that fact. Try to focus on what you can do now: sit comfortably where permitted, let your breathing settle gently or have a quiet conversation.
A book, a familiar recording or something to look at outside can give your attention somewhere else to go. It can help pass the time. You do not have to keep doing it to prevent an attack. If you notice yourself checking every heartbeat, gently return to what you were doing.
Follow crew instructions, including seat-belt and movement restrictions. If you feel unwell or something feels different from your usual panic, tell the crew so they can help.
Hotels and unfamiliar places
A change in routine, tiredness and the pressure to enjoy your holiday can make the first evening difficult. Keep some familiar routines where you can: have something to eat, take a shower or read before bed.
If you wake with familiar panic, allow some time before deciding what the whole trip means. A difficult night can leave you tired the next day, so adjust the plan if you need to. My explanation of panic attacks at night may help if waking in panic is part of your usual pattern.
Travelling with others
It can help to talk before the trip about the support you would welcome. For example: “If I start to panic, could you stay with me for a few minutes? Just talk to me as you normally would. If I say something feels different or I need medical help, please take that seriously.”
Your companion does not have to persuade you that every sensation is harmless or decide on treatment for you. They can help with an ordinary task, listen, or ask what you need. Later, if you want to become more independent with journeys, agree how their support can change gradually. Do not ask them to withdraw help unexpectedly during an attack. The guide to helping someone having a panic attack may be useful to share before you travel.
After a panic episode on holiday
You may feel disappointed or embarrassed, particularly if everyone else seems to be enjoying themselves. Try to separate what happened from the conclusion that the rest of the holiday is lost. “I had an attack at dinner” gives you something specific to respond to; “I cannot go anywhere” is a much larger conclusion.
When you are rested and otherwise well, decide what you would like to do next. It could be eating a meal, taking a short walk or returning to an activity with support. Returning to a place associated with panic can be part of treatment, but there is no deadline to repeat the experience that day. Do not ignore illness, exhaustion or medical advice to complete an exposure task.
Should you take medication for travel panic?
Discuss this with your GP or prescribing clinician before travelling. Ask about the purpose of the medicine, how to take it, possible side effects and interactions with alcohol or other medicines. Your pharmacist can also advise on travel and storage questions.
Continue prescribed treatment as directed. Do not skip it, share someone else’s medicine or alter a dose to prove that you can cope without help. Appropriate medication and psychological treatment can both have a place in a plan. If you will be driving at your destination, ask specifically about effects on alertness and driving.
Getting ready to travel again
If fear is repeatedly deciding whether you travel, consider getting help before booking another demanding trip. CBT for panic attacks can help you understand why the sensations frighten you and work on the journeys you have started avoiding. A plan should fit the difficulty you identified: being away overnight, waiting in a terminal or travelling without constant reassurance may require different practice.
You could start with a visit to someone you know or a night away, depending on what has become difficult. Afterwards, look at what you were able to do and what you would need help with next time. The trip does not have to be free of anxiety.
Sources and further information
- HSE: Panic attacks — symptoms, coping and longer-term support.
- HSE: Using an EHIC abroad — access to healthcare and why an EHIC does not replace insurance.
- NICE: Treatment for panic disorder — discussing psychological treatment, medication and self-help.