Evidence suggests that a fear of heights that begins in childhood usually improves within a few years, but adult-onset acrophobia often persists through life. The condition also frequently co-occurs alongside other psychiatric conditions, including anxiety and depression.

If you have acrophobia, even thinking about crossing a bridge or seeing a photograph of a mountain and surrounding valley may trigger fear and anxiety. This distress is generally strong enough to affect your daily life.


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The main symptom of acrophobia is an intense fear of heights marked by panic and anxiety. For some people, extreme heights triggers this fear. Others may fear any kind of height, including small stepladders or stools.

Acrophobia is one of the most common phobias. If you have a fear of heights and find yourself avoiding certain situations or spending a lot of time worrying about how to avoid them, it may be worth reaching out to a therapist.

Acrophobia is an extreme or irrational fear or phobia of heights, especially when one is not particularly high up. It belongs to a category of specific phobias, called space and motion discomfort, that share similar causes and options for treatment.

Most people experience a degree of natural fear when exposed to heights, known as the fear of falling. On the other hand, those who have little fear of such exposure are said to have a head for heights. A head for heights is advantageous for hiking or climbing in mountainous terrain and also in certain jobs such as steeplejacks or wind turbine mechanics.

"Vertigo" is often used to describe a fear of heights, but it is more accurately a spinning sensation that occurs when one is not actually spinning. It can be triggered by looking down from a high place, by looking straight up at a high place or tall object, or even by watching something (i.e. a car or a bird) go past at high speed, but this alone does not describe vertigo. True vertigo can be triggered by almost any type of movement (e.g. standing up, sitting down, walking) or change in visual perspective (e.g. squatting down, walking up or down stairs, looking out of the window of a moving car or train). Vertigo is called height vertigo when the sensation of vertigo is triggered by heights.

Traditionally, acrophobia has been attributed, like other phobias, to conditioning or a traumatic experience. Recent studies have cast doubt on this explanation.[7][5] Individuals with acrophobia are found to be lacking in traumatic experiences. Nevertheless, this may be due to the failure to recall the experiences, as memory fades as time passes.[8] To address the problems of self report and memory, a large cohort study with 1000 participants was conducted from birth; the results showed that participants with less fear of heights had more injuries because of falling.[9][5] Psychologists Richie Poulton, Simon Davies, Ross G. Menzies, John D. Langley, and Phil A. Silva sampled subjects from the Dunedin Multidisciplinary Health and Development Study who had been injured in a fall between the ages of 5 and 9, compared them to children who had no similar injury, and found that at age 18, acrophobia was present in only 2 percent of the subjects who had an injurious fall but was present among 7 percent of subjects who had no injurious fall (with the same sample finding that typical basophobia was 7 times less common in subjects at age 18 who had injurious falls as children than subjects that did not).[10]

More studies have suggested a possible explanation for acrophobia is that it emerges through accumulation of non-traumatic experiences of falling that are not memorable but can influence behaviours in the future. Also, fear of heights may be acquired when infants learn to crawl. If they fell, they would learn the concepts about surfaces, posture, balance, and movement.[5] Cognitive factors may also contribute to the development of acrophobia. People tend to wrongly interpret visuo-vestibular discrepancies as dizziness and nausea and associate them with a forthcoming fall.[11] A traumatic conditional event of falling may not be necessary at this point.

A fear of falling, along with a fear of loud noises, is one of the most commonly suggested inborn or "non-associative" fears. The newer non-association theory is that a fear of heights is an evolved adaptation to a world where falls posed a significant danger. If this fear is inherited, it is possible that people can get rid of it by frequent exposure of heights in habituation. In other words, acrophobia could be attributed to the lack of exposure in early times.[12] The degree of fear varies and the term phobia is reserved for those at the extreme end of the spectrum. Researchers have argued that a fear of heights is an instinct found in many mammals, including domestic animals and humans. Experiments using visual cliffs have shown human infants and toddlers, as well as other animals of various ages, to be reluctant in venturing onto a glass floor with a view of a few meters of apparent fall-space below it.[13] Although human infants initially experienced fear when crawling on the visual cliff, most of them overcame the fear through practice, exposure and mastery and retained a level of healthy cautiousness.[14] While an innate cautiousness around heights is helpful for survival, extreme fear can interfere with the activities of everyday life, such as standing on a ladder or chair, or even walking up a flight of stairs. Still, it is uncertain if acrophobia is related to the failure to reach a certain developmental stage. Besides associative accounts, a diathetic-stress model is also very appealing for considering both vicarious learning and hereditary factors such as personality traits (i.e., neuroticism).

A recombinant model of the development of acrophobia is very possible, in which learning factors, cognitive factors (e.g. interpretations), perceptual factors (e.g. visual dependence), and biological factors (e.g. heredity) interact to provoke fear or habituation.[5]

Many different types of medications are used in the treatment of phobias like fear of heights, including traditional anti-anxiety drugs such as benzodiazepines, and newer options such as antidepressants and beta-blockers.[37]

A related, milder form of visually triggered fear or anxiety is called visual height intolerance (vHI).[40] Up to one-third of people may have some level of visual height intolerance.[40] Pure vHI usually has smaller impact on individuals compared to acrophobia, in terms of intensity of symptoms load, social life, and overall life quality. However, few people with visual height intolerance seek professional help.[41]

Many of the symptoms of acrophobia, to use the technical term, are shared with other anxiety disorders. These include physical symptoms such as shaking, sweating, a racing heart, difficulty breathing, nausea and a dry mouth. Individuals with acrophobia typically feel intense fear and distress around heights, and tend to avoid them as a result. There are also symptoms more unique to acrophobia, including vertigo and the desire to drop to the knees or clutch on to something.

Hyperawareness and misinterpretation of these bodily sensations is a common problem in many anxiety disorders, including phobias. In acrophobia, for example, a person who feels nauseous and dizzy when up high might believe that these are signs of an imminent catastrophic fall. This can exacerbate anxiety, because the fear of falling will likely make the physical symptoms even worse.

To start, make a list of situations that trigger your phobia and put them in order from least to most anxiety-provoking. For the easiest steps, you could begin with looking at pictures of heights, or creating mental images of heights. The important thing is to start with things that provoke a small but manageable level of anxiety. You could then move on to include standing near heights (such as an escalator in a shopping centre), then actually using an escalator, and then visiting a tall building.

Every individual will vary in the exact scenarios they find most challenging, and how quickly they can move between steps. Try to take small steps that are challenging but manageable. Take your time: leaving the situation before your anxiety has subsided might be counterproductive as you will continue to associate that situation with fear.

For a lot of people with a fear of heights, you can try these principles on your own or with the help of a friend. However, if this is too difficult or your fear is particularly severe, you should attempt these principles only with the support of a trained therapist.

Ask yourself some questions. What do you believe might happen when you expose yourself to your fear? How likely do you think it is (on a scale of 1-10) that this would happen? What would be the outcome of it happening? For example, you might believe that if you go up a tall building the structure will collapse: you feel certain that this will happen, and that you would be seriously injured when it does.

I was one of a team of researchers who recently tested the effectiveness of VR therapy for height phobia. In the study, 100 participants diagnosed with fear of heights were randomly allocated to receive either VR therapy (delivered in six 30-minute sessions over a two-week period) or to receive no therapy. In the VR therapy, an automated virtual character called Nic guided the individuals to try out different tasks, such as looking over a balcony or helping a cat down from a tree. During the tasks, Nic encouraged participants to test out their beliefs concerning heights, and to try dropping their defence behaviours.

Those who received VR therapy experienced significant reductions in their fear of heights, compared with those who received no intervention. These benefits were maintained when the participants were tested again four weeks after the end of the treatment. In the UK where I work, VR therapy for height phobia is now available in some NHS services, and might become available in other countries in the near future. 006ab0faaa

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