Pilots can get counseling and therapy without automatically losing their medical certificate. Current FAA guidance says psychotherapy is compatible with both an unrestricted medical certificate and a special issuance. What matters is the underlying condition and how it affects your functioning, not the fact that you sought help. Stress, fatigue and time away from home are real pressures in aviation, and getting support early is safer than waiting. Delta Air Lines and other employers offer confidential therapy through Spring Health.
Article summary
- The FAA’s guidance, updated in 2026, says psychotherapy is compatible with an unrestricted medical certificate and with special issuance.
- Visits to licensed counselors generally must be reported on MedXPress, with exceptions the FAA lists. Reporting therapy is not by itself disqualifying.
- Fatigue, schedule disruption, commuting and time away from family affect pilots at every career stage.
- Delta Air Lines names Spring Health as its employee mental health provider.
Why pilots have hesitated to get help
For years, many pilots avoided counseling because they feared it would cost them their medical certificate, and with it their career. In 2026 the FAA updated its guidance to encourage pilots and air traffic controllers to seek help through counseling, psychotherapy and peer-support programs when appropriate (NBAA, 2026). The FAA’s own FAQ states that psychotherapy is compatible with both an unrestricted medical certificate and special issuance (FAA, 2026).
What current FAA guidance says
- Visits to licensed providers, including counselors and therapists, generally must be reported on your MedXPress application. The FAQ lists exceptions, such as educational and religious counseling, and couples counseling unless you were referred for individual therapy.
- Whether you keep an unrestricted certificate depends on your diagnosis, symptom severity and risk factors, not on whether you went to therapy. Your AME may issue the certificate or refer the case to the FAA.
- If the FAA asks for documentation, it’s usually a brief summary from your therapist rather than your full records.
- You still need to ground yourself if symptoms affect your ability to fly safely, as 14 CFR 61.53 requires.
Rules can change, so check the current FAA guidance and talk with your AME about your own situation. This article is general information, not legal or aeromedical advice. With your written consent, Proactive Wellness can provide the brief summary the FAA may request.
Getting help early is safer than waiting until symptoms affect your flying.
Common pressures in aviation
- Fatigue from early report times, red-eyes and time-zone changes
- Reserve schedules and short-notice trips
- Commuting to base and nights away from home
- Checkrides, training events and career uncertainty
- Missed birthdays, holidays and school events
- The responsibility of carrying passengers and crew safely
Signs to take seriously
- Poor sleep on layovers that doesn’t recover on days off
- Dreading trips you used to enjoy
- Worry about checkrides that crowds out everything else
- Irritability or distance at home
- Drinking more on layovers or days off
- Feeling flat, hopeless or unlike yourself for more than two weeks
Different seats, different pressures
First officers and newer pilots
Training costs, reserve lines, commuting and seniority can make the early years especially stressful.
Captains and check airmen
You carry final authority for the flight and often mentor others, which can make it harder to admit you’re struggling.
Chief pilots and flight operations leaders
You manage people, schedules and safety culture, often while still flying.
Families
Partners and children live with the schedule too. Our guide on how work stress affects marriage, parenting and family relationships may help.
Have EAP benefits through work?
Proactive Wellness participates with Spring Health, Lyra Health and BHS/Revive. Complete our intake form first. Our office coordinates eligibility with your program, then schedules your first session by secure video in New York, New Jersey, Georgia or Massachusetts.
Practical steps you can try this week
- Protect sleep on layovers. A dark, cool room, a consistent wind-down routine and a plan for caffeine help your body adjust.
- Talk with your AME early. Ask how reporting works for your situation before your next exam, not at the exam.
- Give your therapist the FAA’s information sheet. The FAA recommends sharing “Information for Psychotherapists Treating Pilots and ATCS” at your first visit.
- Use peer support. Many airlines and pilot unions run confidential peer-support programs staffed by pilots who understand the job.
- Plan connection while you’re away. A scheduled call home on each trip helps families feel included.
- Check your benefits. Search your benefits portal for “Spring Health,” “EAP” or “mental health.”
If fatigue comes from scheduling patterns, report it through your airline’s fatigue reporting process. Fatigue is a safety issue for the whole system, not a personal weakness.
Evidence-based approaches
Therapy at Proactive Wellness is confidential and held by secure video. Approaches with strong research support include:
- Cognitive behavioral therapy (CBT) for stress, anxiety, irritability and low mood. The American Psychological Association’s depression guideline recommends CBT and related therapies for adults (APA).
- CBT for insomnia (CBT-I) for sleep that shift work or worry keeps breaking up. The American College of Physicians recommends it as the first treatment for chronic insomnia (ACP, 2016).
- Acceptance and commitment therapy (ACT) for staying grounded in what matters to you when stress you can’t control stays high. In workplace studies, ACT-based programs reduced psychological distress, especially for people who started out highly stressed (Reeve et al., 2018).
- Problem-solving therapy, which breaks work and life problems into concrete, testable steps. A meta-analysis found it is probably an effective treatment for depression, with results comparable to other therapies (Cuijpers et al., 2018).
- Motivational interviewing if you want to look honestly at drinking or other substance use, without judgment (SAMHSA TIP 35).
- If you are in crisis or thinking about harming yourself, call or text 988 any time.
Airline employers that offer Spring Health
Delta Air Lines’ 2025 wellness report names Spring Health as the provider of its employee mental health counseling (Delta, 2025). Delta has major operations in Atlanta, New York and Boston, so pilots who are based in Georgia, New York or Massachusetts may have access to confidential therapy through Spring Health.
Eligibility depends on your employing company and plan. Employees of regional carriers, ground-handling contractors and staffing agencies usually have their own benefits. Check your benefits portal or ask HR. Proactive Wellness also participates with Lyra Health and BHS/Revive.
If you have had a drug or alcohol test violation
A DOT drug or alcohol violation starts a separate federal process with a Substance Abuse Professional (SAP). Voluntary therapy doesn’t replace it, and completing the SAP process doesn’t restore an FAA medical certificate on its own. Read FAA drug and alcohol violations: understanding the DOT SAP process.
Keep reading
- Flight Attendant Burnout: Emotional Labor, Travel and Family Life
- Airport Ground Crew and Maintenance Worker Mental Health
- Working Rotating Shifts: Sleep, Mood and Family Relationships
- Online therapy and telehealth: how video sessions work and where you need to be
Frequently asked questions
Will seeing a therapist cost me my medical certificate?
Not automatically. Current FAA guidance says psychotherapy is compatible with both an unrestricted medical certificate and special issuance. The outcome depends on the condition and its severity, so talk with your AME about your situation.
Do I have to report therapy on MedXPress?
Generally yes, for visits to licensed providers such as counselors and therapists. The FAA’s FAQ lists exceptions, including educational and religious counseling and some couples counseling. Check the FAQ and ask your AME.
Can you provide the summary the FAA asks for?
Yes. With your written consent, we can provide the brief summary the FAA may request, which usually covers diagnosis, severity and how you’re functioning.
Will my airline know I’m in therapy?
Your employer isn’t told what you discuss. We don’t share clinical information with your employer without your written permission, except in rare situations the law requires.
Does Delta offer Spring Health?
Delta’s 2025 wellness report names Spring Health as its employee mental health provider. Eligibility depends on your employer and plan. Complete our intake and we’ll help verify your benefit.
Can I have a session during a layover?
You need to be physically in New York, New Jersey, Georgia or Massachusetts during each session, so sessions can’t take place from a layover in another state.
What if I’ve had a drug or alcohol test violation?
That’s a separate DOT Substance Abuse Professional process. See our guide to the FAA SAP process or start our DOT SAP intake.
References
- Federal Aviation Administration. (2026). Therapy, Psychotherapy, and Counseling FAQs for Pilots and ATCS (updated May 27, 2026).
- National Business Aviation Association. (2026, June 8). NBAA champions new FAA mental wellness policy supporting counseling.
- American Psychological Association. (2019). Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts.
- Qaseem, A., et al. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133.
- Reeve, A., Tickle, A., & Moghaddam, N. (2018). Are acceptance and commitment therapy-based interventions effective for reducing burnout in direct-care staff? A systematic review and meta-analysis. Mental Health Review Journal, 23(3), 131–155.
- Cuijpers, P., de Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. D. (2018). Problem-solving therapy for adult depression: An updated meta-analysis. European Psychiatry, 48, 27–37.
- SAMHSA. (2019). TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment.
- Delta Air Lines. (2025). Wellness: 2025 ESG Report, checked October 2026.
Check your EAP eligibility
Proactive Wellness participates with Spring Health, Lyra Health and BHS/Revive. Complete our intake form first. Our office reviews it, coordinates eligibility and any authorization with your program, and then schedules your first session.
Have Spring Health through work? You don’t need to find us in the Spring Health directory first. After you complete our intake, our office works with Spring Health Care Navigation to confirm eligibility and add you to our caseload.
Eligibility and family coverage vary by employer, so coverage isn’t confirmed until we verify it. Therapy is by secure video for people located in New York, New Jersey, Georgia or Massachusetts. Please don’t send health details by email or in comments.
New to work mental health benefits? Read how trucking employees check their benefits.
