Coping with Fear of Heights

Coping with Fear of Heights

Most people are wary of heights—a normal response to a potentially dangerous situation. But when the wariness turns into extreme and irrational fear, it becomes a real problem. As many as one in 20 people suffers from acrophobia, the psychiatric term for fear of heights that comes from the Greek words akros (meaning peak or summit) and phobos (meaning fear).

They will do everything possible to avoid heights, including tall buildings, bleachers, balconies, and bridges—and if forced to confront such situations, they will become markedly distressed and panicky.

Even more people have what’s called visual height intolerance, in which the visual stimulus of a high place causes unpleasant feelings or sensations like fear of losing balance or falling. Also called height vertigo, it is a less-recognized and less-treated condition that varies in severity. It typically occurs when gazing down from a height, but also, in some people, when looking upward at a vertical surface.

Not surprisingly, having problems with heights can interfere with many everyday activities, with some people finding even such commonplace activities as hanging curtains and cleaning windows distressful.

In a German study in the Journal of Neurology, nearly one in three people described having visual height intolerance, most often starting in their twenties. The condition was also found to be more common in women and in people with a family history of it, as well as in those who had migraines, anxiety disorders, or a susceptibility to motion sickness.

The most commonly reported precipitating situations included climbing a tower or a ladder, hiking, crossing a bridge, and looking out a window from a high floor, with a resulting sense of vertigo, lightheadedness, sweating, instability, trembling, and a queasy feeling in the stomach. Often there is a feeling of being pulled down into an abyss.

Visual height intolerance and acrophobia actually fall along a continuum, with symptoms ranging from minor distress to the panic of a severe phobia. Though the two conditions are commonly set off by the same triggers, the distinction is that visual height intolerance does not meet the diagnostic criteria of a specific phobia, as defined by the Diagnostic and Statistical Manual of Mental Disorders (the “bible” of psychiatric disorders).

An ancient fear

You may think that the modern world, with its skyscrapers, soaring bridges, elevators, and airplanes, is to blame for acrophobia. But according to German researchers who have published several papers on the topic—including a review in Current Opinion in Neurology—both the fear of heights and visual height intolerance likely date back to at least ancient Greek times. In one description, a notable Athenian was unable to cross over a bridge or ditch without physical symptoms, including a feeling of uneasiness, a worsening of eyesight, and the sensation that his muscles had all gone slack.

The condition is also alluded to in early Chinese medical books, Roman historical texts, and Roman mythology. For instance, in his epic, the Metamorphoses, the Roman poet Ovid describes Phaeton (mortal son of the sun god Phoebus) as turning pale and trembling when looking down to earth as he drives his father’s sun chariot, with darkness enveloping him despite the brightness from the sun. Scholars conjecture that this may be a projection of Ovid’s own fear of heights.

In more recent times, many famous people—from Goethe to Woody Allen—have reportedly been plagued by acrophobia.

Overcoming fear of heights

Acrophobia calls for psychological treatment, though people with visual height intolerance may also benefit from some kind of therapy or support if they find it is holding them back from activities they otherwise enjoy. Treatment varies depending on the causes of the condition—which can include some kind of vestibular (inner ear) dysfunction, an anxiety disorder, cognitive problems, or a combination of these.

Without treatment, both acrophobia and visual height intolerance tend to persist over a lifetime and generalize to additional height-related situations. Here are some options:

Make your posture more stable to help minimize symptoms of visual height intolerance. For example, lean or hold onto something or sit or crouch down, when possible. Avoid tilting your head to keep your vestibular system (which contributes to your sense of balance) stable.

Also try to keep stationary objects in your peripheral vision and avoid looking at moving clouds; this will give you more of a visual sense of stability.

Exposure therapy involves exposing people to fearful height stimuli in a controlled setting until the fear or anxiety declines. Typically done under the guidance of a therapist, who brings the patient to locations of varying heights, it is often combined with relaxation techniques, including breathing exercises.

This type of behavior therapy may be done through a graduated approach (that is, exposure to the stimulus by degrees) or with flooding (all-out exposure). It can also be done using the imagination (imaginal exposure) rather than real-life experience.

Virtual reality therapy is a type of exposure therapy that uses computer-generated visual, auditory, and tactile sensory inputs to immerse the patient in a 3D environment that realistically simulates the feared stimulus. Advantages are that it can be done in a safe office setting, and the patient has control to turn off the stimulus as needed.

Some research has found it to be as effective as real-life exposure therapy for reducing anxiety and avoidance in people with acrophobia.

Cognitive therapy involves helping patients reinterpret perceived harmful stimuli as less threatening. In a study in the Journal of Consulting and Clinical Psychology, cognitive therapy (in which people associated positive words with sentences dealing with height) reduced symptoms of acrophobia as much as exposure therapy.

Drug therapy for acrophobia may include anti-anxiety drugs, antidepressants, and beta-blockers. These all have side effects, however, and do not “cure” the phobia. Interestingly, some research suggests that oral doses of the hormone cortisol (which is released during stress) can improve the results of exposure therapy.

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