Acrophobia

Acrophobia is a persistent and excessive fear of heights. People with acrophobia may experience panic attacks when they are at the top of a building, on a cliff, or in a helicopter. Read on to learn more about this phobia and how you can deal with it.

What Is Acrophobia?

Acrophobia, derived from the Greek word “ákron” meaning peak and “phóbos” meaning fear, is an irrational and persisting fear of heights. Studies [mfn] Donker, T., Van Esveld, S., Fischer, N., & Van Straten, A. (2018). 0Phobia – towards a virtual cure for acrophobia: study protocol for a randomized controlled trial. Trials, 19(1), 433. https://doi.org/10.1186/s13063-018-2704-6 [/mfn] have shown that Acrophobia is the most common of all specific phobia subtypes. Approximately 5% of the global population [mfn] Misiewicz, Z., Hiekkalinna, T., Paunio, T., Varilo, T., Terwilliger, J. D., Partonen, T., & Hovatta, I. (2016). A genome-wide screen for acrophobia susceptibility loci in a Finnish isolate. Scientific reports, 6, 39345. https://doi.org/10.1038/srep39345 [/mfn] suffers from this phobia with more women affected by it than men.

Most of us tend to have a natural fear of heights – which is mainly for the sake of survival. However, people with acrophobia experience severe anxiety and in some cases, even full-blown panic attacks when they are at a height above the ground.

This can affect their ability to control their thoughts and emotions and get down safely. Acrophobia symptoms can also be triggered simply by thinking about heights, even when a person is at ground level.

A person with acrophobia may intentionally avoid experiences or circumstances that expose them to heights, like stepping on a balcony, bridge, plane, or ladder.

When anticipating or experiencing heights, Acrophobics may trigger their sympathetic nervous system [mfn] Lanese, N., & Dutfield, S. (2019, May 9). Fight or Flight: The Sympathetic Nervous System. Livescience.com; Live Science. Available from: https://www.livescience.com/65446-sympathetic-nervous-system.html [/mfn] to prepare their mind and body for danger or an emergency. This in turn triggers their fight-or-flight response to either face or escape the threatening situation.

This can make them experience nausea, shortness of breath, an upset stomach, increased heart rate, trembling, sweating and anxiety even when there is no actual threat or danger present.

Read More About Anxiety Here

Acrophobia Vs. Vertigo

Although the term “vertigo” is sometimes used to describe the fear of heights, the two are actually unrelated. Vertigo refers to an unpleasant spinning sensation that happens due to a physiological reason.

When the feeling of vertigo is triggered by heights, it is known as height vertigo [mfn] Bles, W., Kapteyn, T. S., Brandt, T., & Arnold, F. (1980). The mechanism of physiological height vertigo. II. Posturography. Acta oto-laryngologica, 89(5-6), 534–540. https://doi.org/10.3109/00016488009127171 [/mfn]. This is usually a result of struggle between vision, the somatosensory sense and the vestibular sense. This struggle [mfn] Redfern, M. S., Yardley, L., & Bronstein, A. M. (2001). Visual influences on balance. Journal of anxiety disorders, 15(1-2), 81–94. https://doi.org/10.1016/s0887-6185(00)00043-8 [/mfn] between the senses can affect balance and result in anxiety and motion sickness.

Case Example

When she was 5 years old, Resma visited her aunt for the first time, who happened to live on the 10th floor of a building. Having lived in a two-storey house since her birth, this was the first time Resma was stepping into a building as tall as this.

As she looked down her aunt’s balcony, seeing the ground so far beneath her instantly made her dizzy and she threw up. Since then, Resma had always had a fear of heights that continued into her adulthood. Traveling on planes made her extremely anxious so she could never travel alone.

Resma would never take the window seat on a flight or look down a window when she was inside a tall building as it would make her nauseous and breathless. Even looking at pictures taken from a big height would make her uncomfortable.

Case Analysis

From the excerpt above, it is apparent that Resma had been suffering from an intense and extreme fear, also known as a phobia. In her case, it was the fear of heights or acrophobia.

Whenever she was in a situation where the ground was far below her or there was a suggestion of height (such as in pictures), it would cause her physical and emotional distress.

Symptoms Of Acrophobia

There are many physical and emotional symptoms associated with acrophobia. Some of these acrophobia symptoms are mentioned below.

Psychological Symptoms

Phobias mainly stem from cognitive and emotional components. Here are the major psychological signs of Acrophobia:

• Intense & irrational fear of heights
• Enduring heights with extreme difficulty
• The urge to escape from high places
• Purposefully avoiding heights

Physiological Symptoms

An acrophobic person may exhibit the following physical symptoms when they are exposed to heights, either directly or indirectly.

• Nausea
• Sweating
• Shortness of breath
• Feeling sick or lightheaded
• Heart palpitations
• Dry mouth
• Increased heartbeat
• Headaches and dizziness
• Chest pain or tightness
• Shaking and trembling

What Causes Acrophobia?

Generally, it is believed that acrophobia can develop from traumatic experience or conditioning. But studies [mfn] Coelho, C. M., Waters, A. M., Hine, T. J., & Wallis, G. (2009). The use of virtual reality in acrophobia research and treatment. Journal of Anxiety Disorders, 23(5), 563–574. https://doi.org/10.1016/j.janxdis.2009.01.014 [/mfn] have found that people suffering from this particular phobia may often lack traumatic experiences [mfn] Menzies, R. G., & Clarke, J. C. (1995). The etiology of acrophobia and its relationship to severity and individual response patterns. Behaviour research and therapy, 33(7), 795–803. https://doi.org/10.1016/0005-7967(95)00023-q [/mfn].

While research on acrophobia causes is still underway, some of the risk factors for acrophobia are outlined below.

Evolutionary Theories

Evolution plays a great role in the development of most phobias. As our fear of falling is an instinctive feeling, acrophobia can be an extreme version of an evolutionary survival mechanism.

The Evolved Navigation Theory [mfn] Jackson, R. E., & Cormack, L. K. (2007). Evolved navigation theory and the descent illusion. Perception & psychophysics, 69(3), 353–362. https://doi.org/10.3758/bf03193756 [/mfn] proposes that specific processes, like the perception of height, have evolved and developed through natural selection.

By perceiving the height from a point greater than it actually is, we reduce the risk of falling and increase our chances of survival. However, this can also be a reason why some of us suffer from acrophobia more than others.

Behaviorist Theories

According to behaviorists, we often develop fears and phobias through our interactions and experiences with our surrounding environment. This may be develop due to

• Observation: Having a parent or caregiver who also suffers from acrophobia or a similar phobia.
• Trauma: Witnessing another person having a terrible or fatal experience with heights.
• Classical Conditioning: If someone has fallen from a height and has been injured in the past, they will unconsciously and automatically associate heights with danger. This is a conditioned response [mfn] Rehman, I., Mahabadi, N., Sanvictores, T., & Rehman, C. I. (2022). Classical Conditioning. In StatPearls. StatPearls Publishing. Available from: https://pubmed.ncbi.nlm.nih.gov/29262194/ [/mfn] to a specific stimuli, which in this case is height. Due to the learned association between falling from a height and danger, a person may become afraid of heights and avoid similar encounters in future.

Diagnosing Acrophobia

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [mfn] Substance Abuse and Mental Health Services Administration. (2016, June). Table 3.11, DSM-IV to DSM-5 Specific Phobia Comparison. Nih.gov; Substance Abuse and Mental Health Services Administration (US). Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t11/ [/mfn], the fear of heights is considered a “natural environment type” of specific phobia. To be diagnosed with acrophobia, an individual needs to experience the symptoms for at least 6 months, according to the DSM-5 [mfn] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Diagnostic and Statistical Manual of Mental Disorders, 5(5). https://doi.org/10.1176/appi.books.9780890425596 [/mfn].

Various tests and questionnaires like Behavioural Avoidance Tests (BAT), Acrophobia Questionnaire (AQ), Height Interpretation Questionnaire (HIQ) and The Attitude Towards Heights Questionnaire (ATHQ) may be used to assess the condition.

Mental health professionals, like certified psychiatrists, psychologists, and counselors are trained to diagnose and treat acrophobia after a detailed intake of history. If you or someone you know is suffering from this phobia, then it is best to consult a mental health professional immediately.

How To Treat Acrophobia

Although there is no established method to prevent acrophobia, treatment can help someone suffering from Acrophobia to gain better control of their daily lives, especially if they have to encounter heights on a regular basis. Along with dedication and patience, treatment from a mental health professional can greatly help overcoming acrophobia.

Here are a few Acrophobia treatment options.

1. Exposure therapy

Controlled exposure to heights can be a highly effective solution for treating Acrophobia. Exposure therapy [mfn] American Psychological Association. (2017). What Is Exposure Therapy? Https://Www.apa.org. Available from: https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy [/mfn] requires the patient to slowly expose [mfn] Raeder, F., Merz, C. J., Margraf, J., & Zlomuzica, A. (2020). The association between fear extinction, the ability to accomplish exposure and exposure therapy outcome in specific phobia. Scientific reports, 10(1), 4288. https://doi.org/10.1038/s41598-020-61004-3 [/mfn] themselves to the object or situation resulting in their phobia, under the supervision of a therapist. This allows the patient to gradually adapt to it and eventually confront what they are afraid of.

For acrophobia, you may begin by viewing images and videos of tall buildings or people standing at a height. According to a 2014 study [mfn] Bouchard, S., Wiederhold, B. K., & Bossé, J. (2014). Fear of heights (acrophobia): Efficacy and lessons learned from psychophysiological data. In B. K. Wiederhold & S. Bouchard (Eds.), Advances in virtual reality and anxiety disorders (pp. 119–144). Springer Science + Business Media. https://doi.org/10.1007/978-1-4899-8023-6_6 [/mfn], 3-4 sessions of virtual reality therapy [mfn] North, M. M., North, S. M., & Coble, J. R. (1997). Virtual reality therapy: an effective treatment for psychological disorders. Studies in health technology and informatics, 44, 59–70. [/mfn] can also help patients overcome Acrophobia. VR exposure [mfn] Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017). Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review. Current psychiatry reports, 19(7), 42. https://doi.org/10.1007/s11920-017-0788-4 [/mfn] enables people to encounter heights without actually putting themselves in any actual danger. Eventually, the patient may start climbing up a ladder or stepping onto the balcony to face their fear.

Read More About Fear Here

2. Cognitive behavioral therapy (CBT)

CBT or Cognitive-behavioral therapy [mfn] American Psychological Association. (2017). What Is Exposure Therapy? Https://Www.apa.org. Available from: https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy [/mfn] is a type of psychological treatment that is widely used for specific phobias and mental disorders. It requires the patient to work with a psychologist or a therapist to understand how changing their perception and thoughts can help them overcome their fear of heights. Behavioral techniques like systematic desensitization [mfn] McGlynn, F. D. (2010). Systematic Desensitization – an overview | ScienceDirect Topics. Sciencedirect.com. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/systematic-desensitization [/mfn] and flooding [mfn] American Psychological Association. (2020). APA Dictionary of Psychology. Dictionary.apa.org. Available from: https://dictionary.apa.org/flooding [/mfn] are commonly used by professionals. CBT enables sufferers to become aware and identify their irrational fears. This enables them to utilize strategic techniques to replace negative thoughts and emotions with positive and accurate thoughts.

CBT is best suited for individuals who are reluctant about exposure therapy. It also empowers patients to reframe their mindset and attitude towards height, regulate their stress response and gain emotional control.

Read More About CBT Here

3. Hypnotherapy

Hypnosis [mfn] Hypnosis. Https://Www.apa.org. Available from: https://www.apa.org/topics/hypnosis [/mfn] or hypnotherapy is a therapeutic technique wherein a deep state of relaxation is induced. A hypnotist then uses suggestive techniques and guided visualization and imagery to help the patient cope with their fear response to heights. Although adequate evidence suggests that hypnosis can be effective in treating Acrophobia, further scientific research is required.

4. Medication

There are no specific medications for the treatment of specific phobias. However, certain medications may help with the symptomatic treatment of Acrophobia. Some of these medications include

• Beta-blockers [mfn] Felman, A. (2021, February 17). Beta-blockers: Types, side effects, and interactions. Www.medicalnewstoday.com. Available from: https://www.medicalnewstoday.com/articles/173068 [/mfn] or sedatives: These medicines temporarily reduce our ‘fight-or-flight’ response and reduce stress. Beta-blockers also decrease the risk of heart attacks, lower blood pressure and relieve panic & anxiety.
• D-cycloserine (DCS) [mfn] Hofmann S. G. (2014). D-cycloserine for treating anxiety disorders: making good exposures better and bad exposures worse. Depression and anxiety, 31(3), 175–177. https://doi.org/10.1002/da.22257 [/mfn]: This drug can be specifically helpful in exposure therapy. According to 22 studies [mfn] Mataix-Cols, D., Fernández de la Cruz, L., Monzani, B., Rosenfield, D., Andersson, E., Pérez-Vigil, A., Frumento, P., de Kleine, R. A., Difede, J., Dunlop, B. W., Farrell, L. J., Geller, D., Gerardi, M., Guastella, A. J., Hofmann, S. G., Hendriks, G. J., Kushner, M. G., Lee, F. S., Lenze, E. J., Levinson, C. A., … Thuras, P. (2017). D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data. JAMA psychiatry, 74(5), 501–510. https://doi.org/10.1001/jamapsychiatry.2016.3955 [/mfn], DCS has improved the impact of exposure therapy in people coping with various anxiety-related conditions. A 2012 study [mfn] Bontempo, A., Panza, K. E., & Bloch, M. H. (2012). D-cycloserine augmentation of behavioral therapy for the treatment of anxiety disorders: a meta-analysis. The Journal of clinical psychiatry, 73(4), 533–537. https://doi.org/10.4088/JCP.11r07356 [/mfn] also found that this medication along with CBT can notably improve results in patients.
• Benzodiazepines [mfn] Benzodiazepines: Uses, Side Effects, and Types. (2015, August 5). Healthline. Available from: https://www.healthline.com/health/bipolar-disorder/benzodiazepines [/mfn]: These are also sedatives which help to reduce symptoms related to anxiety.

Coping With Acrophobia

Along with professional treatment, certain self help strategies can also help to deal with phobias.

So how to overcome acrophobia? Here are some techniques that can help.

• Learning about the fear of heights. The first step to tackling any phobia is acknowledging that your fear is out of proportion to the actual threat. Reading about Acrophobia and understanding the condition can help you to a great extent.
• Getting enough sleep. Being in a fight-or-flight mode when encountered with an actual or imagined threat can drain our energy and tire us. Thus it is important to take rest.
• Practicing relaxation exercises. Techniques like yoga, meditation, tai chi, qi gong, breathing exercises, and progressive muscle relaxation can also prove to be helpful in coping with the anxiety related to Acrophobia [mfn] Saeed, S. A., Cunningham, K., & Bloch, R. M. (2019). Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. American family physician, 99(10), 620–627. [/mfn].
• Confiding in someone you trust. When it gets too overwhelming, it may help to talk to a friend or family member.
• Joining a support group. Sharing your feelings and learning from the experiences of others in a similar situation can also act as support and encouragement.
• Being mindful. Mindfulness allows us to focus on the present moment and acknowledge that there is no imminent threat.

Takeaway

Acrophobia, or the fear of heights, is a common phobia that can be effectively treated with therapy and medications. Seeking help from a mental health professional can provide guidance on the right treatment plan. Additionally, seeking support from friends and family can assist in managing symptoms and overcoming fear.

At A Glance

1. Acrophobia is a persistent and excessive fear of heights.
2. Although the term “vertigo” is widely used to describe the fear of heights, it is actually incorrect.
3. Acrophobia may develop during childhood or may lack any clear reason for development.
4. Treatment can help someone suffering from Acrophobia and enable them to gain control of their daily lives, especially if they have to encounter heights on a regular basis.
5. The fear of heights is one of the most common phobias.