Data are presented from clinical interviews and psychological tests of a helicopter pilot who had survived a helicopter crash. Within a week, the pilot developed severe stress reactions after the crash, dominated by guilt feelings, nightmares and fear of not being able to fly. Helicopter-accident training simulating a helicopter crashing into the water was used as part of the treatment. The therapeutic value and limitations of this type of treatment are discussed. The main benefit seemed to be the extinction of traumatic helplessness and the reestablishment of a positive response-outcome expectancy. Existential conflicts were not covered by the simulator training.