Travel and Anxiety

Feelings of anxiety, nervousness, or tension are common everyday responses to events or tasks that make you feel alert and energetic. However, experiencing constant or extreme anxiety can disrupt your travel plans.

Even if you have no prior history of anxiety, the stress of travel or a triggering event may cause you to suddenly develop symptoms related to anxiety. Experiencing anxiety in a foreign country can be very frightening – not being able to communicate your distress in a different language or knowing why you’re experiencing anxiety increases stress levels and worsens symptoms. In addition to managing stress, recognizing the warning signs of extreme anxiety and knowing where to get help abroad are key to a safe trip.

What is an anxiety disorder?

Anxiety is a feeling of intense and overwhelming worry, distress, or fear. Anxiety disorders are a group of mental illnesses characterized by feelings of anxiety. The distress caused by anxiety disorders can keep you from participating in or enjoying normal activities and can affect your physical health and wellbeing.

Panic attacks

A panic attack is a sudden and short-lived response (typically lasting 10-30 minutes) to psychological stress. It can occur without warning and can be triggered by new or ongoing stressful events, extreme physical activity such as adventure travel, or psychoactive substance misuse. A panic attack can be a reaction to a stressful situation or it can be related to another anxiety disorder.

Panic attack symptoms mimic cardiac arrest, asthma, pulmonary embolism, or pneumonia. Feeling an overwhelming sense of dread, a traveller experiencing a panic attack may be convinced that they will die, be in an accident, or become ill.

Signs of a panic attack include:

Shortness of breath, gasping for air, dry mouth, choking
Rapid heartrate, chest pain
Sweating, muscle tension, trembling, chills
General weakness, dizziness, nausea
Feelings of dread, immense fear

Phobias

Phobias are persistent fears that cause extreme avoidance of objects, places, people, or activities and severely impair the enjoyment of daily life. In some cases, a phobia can lead to a full scale panic attack. Phobias such as fear of flying (aviophobia), being in a confined space (claustrophobia), or crowded areas (agoraphobia) can pose problems for travellers.

Obsessive Compulsive Disorder

Travellers with Obsessive Compulsive Disorder (OCD) have trouble controlling or ignoring intrusive thoughts, urges, and images that constantly appear in their mind. Obsessions may include fear of touching contaminated surfaces, fear or being in confined spaces for long periods of time, and fear of overcrowding. Compulsions may include obsessive hand washing, cleaning, focusing on exactness and order, double checking, hoarding, and counting or repeating mantras and words. Individuals with OCD often suffer from muscle tension and discomfort.

Post-Traumatic Stress Disorder

Travel can also affect individuals with Post-Traumatic Stress Disorder (PTSD). Survivors of traumatic events such as abuse, rape, disappearance, torture, bombings, displacement, and natural disasters may end up mentally reliving the event. Sounds, smells, images, people, and events in an unfamiliar environment can trigger suppressed or unwanted memories and emotions.

Returning to the place where the trauma occurred can trigger PTSD symptoms including nightmares, depression, anxiety, phobias, panic attacks, and sudden anger and mood changes.

How can I manage my anxiety disorder while travelling?

Travellers who are actively managing and controlling an anxiety disorder can travel safely. Consult your doctor to determine if travel is an appropriate activity for you. If required, stay in touch with your mental healthcare practitioner or find a qualified doctor at your destination in case of an emergency. Make sure you have effective coping strategies in place. Bring calming items (e.g. a book or journal) and participate in activities (e.g. running, meditation, yoga) that help distract you from anxious feelings and minimize stress.

Plan ahead: Choose a low stress destination, map out your itinerary in detail, take direct flights or routes, allow for plenty of time to arrive and leave, and consider travelling with a trusted relative, friend, or professional travel companion. Recognize stress factors and warning signs leading to an anxiety attack and seek medical attention as soon as possible to avoid emergency hospitalization and possible evacuation. Keep in mind that substance misuse can aggravate anxiety.

Know before you go

Experiencing anxiety during travel may force you to abandon your original plans and could lead you to feel isolated and more anxious. Treatment during travel tends to focus on administering anti-anxiety medication to relieve symptoms, and hospitalization with possible evacuation. When travelling with a mental health condition, it's important to know and prepare for factors that can influence your ability to access healthcare abroad.

Cultural perceptions of mental health

Social and cultural acceptance of mental health in your destination country determines the type of psychiatric care you will receive. Forced admission (where voluntary consent is not the norm), substandard psychiatric facilities (unhygienic living conditions), questionable treatment (isolated confinement, lack of appropriate medicines), and difficulty finding mental healthcare professionals that speak your language should be taken into account when planning your trip. For example, you may discover that anxiety disorders are not recognized as a legitimate medical condition by some health professionals, which can make it difficult to get proper treatment.

In some countries, disturbing the peace, uttering threats, or exhibiting strange behaviour can lead to arrest, criminal charges, imprisonment, or forced admission to a hospital or mental health facility.

Travel health insurance coverage

Standard travel health insurance plans do not cover mental health conditions. As a result, you may be responsible for the full cost of medical expenses if you require psychiatric care abroad. Look for travel health insurance plans that cover psychiatric care – an independent broker can help.

Get coverage from a company that specializes in emergency evacuation and repatriation. This service generally covers patients who have managed their illness and are being hospitalized abroad. Check the fine print for restrictions and exclusions. Last-minute evacuation insurance is extremely expensive (starting in the tens of thousands of dollars) and may be refused on the basis of the patient’s mental health condition.

Travelling with medication

If you are travelling with any medication, be aware that your destination may place restrictions on the amount or type of medication you can import. Substances that are legal or available over-the-counter in one country may be illegal or require a prescription for importation in others. The importation of medication that contains controlled substances – drugs that are classified as having a high potential for abuse or addition such as narcotic and psychotropic medication – is highly regulated around the world.

Country-specific regulations regarding the import of controlled substances can vary widely. In most cases, travellers are permitted to bring a 30-day maximum supply of medication containing controlled substances, but some countries place stricter regulations or require specific documentation.

You can learn more about travelling with medication here:

Helping a family member or friend

If you are accompanying a traveller with an anxiety disorder, it can be challenging at times. A person’s anxiety disorder may cause them to need to act a certain way or avoid particular situations, which can be frustrating for others. However, you can be supportive by being patient and listening without judgement. It’s also important to not forget about your own health. Know how to recognize signs of psychological stress and avoid being isolated. You may want to hire a professional companion traveller to help during all or parts of the trip.

If you suspect someone is experiencing extreme anxiety and requires medical assistance, contact a mental health professional that speaks your language. Contact the person's embassy or consulate for emergency assistance.

Travel and mental health checklist

Before you leave

Consult your healthcare practitioner to discuss if the type of travel you are planning is right for you. Get advice on how to stay healthy and cope with the effects of travel stress and jet lag. Ask if you can stay in touch with your health professional during your trip.
Find a reputable health or mental health professional at your destination who speaks your language. You may want to contact them prior to your trip to ensure continuity of care.
Familiarize yourself with the psychiatric healthcare system of your destination country. Know what steps you need to take in case of an emergency.
Book the most direct route possible to your destination; avoid layovers and long hours in transit.
Travel with a trusted friend, family member, or professional travel companion. If you are travelling alone, set up regular check-in times to reach a family member or friend.
Register with your embassy or consulate in case you need their assistance during an emergency abroad.
Make sure to pack enough medication for the duration of your trip. Check whether your medication is regulated or restricted at your destination.

During your trip

Give yourself plenty of time to arrive and go through security checks. Note that airports, train stations, bus depots generally have medical facilities.
Establish a routine that sets the tone for your trip. Familiarize yourself with your surroundings and if you can, integrate some activities that you are used to doing back home or bring you a sense of comfort.
Bring a calming item (a book, listening to music on your iPod), memento, or journal that provides comfort during stressful situations.
Know your mental and physical limits. Regularly re-assess your original plans and change them to minimize stress levels.
Know when to stop a challenging situation from escalating. Find non-confrontational solutions.
Practice relaxing breathing exercises and integrate physical activity like walking and stretching to relieve stress. Get the appropriate amount of sleep, eat a healthy diet, and stay hydrated.

When you return

Book an extra day or two off after you return to mentally and physically recover from your trip. This will help you adjust from jet lag and help you get back into your daily routine.
Follow up with your healthcare practitioner if you needed emergency care abroad or to address any concerns you may have related to post-travel readjustment.