Last Updated on March 12, 2023 by Mike Robinson

w  What is acrophobia the acrophobia or fear of heights is a phobia or irrational fear of heights. People who experience it experience panic attacks in high places and shake to try to get safe.

It usually affects recreational activities, although in some cases it can affect daily life. For example: avoid railings, elevators and stairs, avoid going to high floors, avoid going through bridges…

Between 2 and 5% of the population suffers from this disorder, with twice as many women as men.

The word “vertigo” is often used as a synonym for this phobia. However, vertigo refers to a feeling of dizziness or that the environment revolves when the person does not actually turn.

Vertigo can be caused by:

• Look down from a high place.
• Look for a high place.
• Movements such as getting up, sitting…
• Changes in the visual perspective: going up or down stairs, looking out the window of a car or a moving train…

When dizziness occurs by heights, it is called “vertigo to the heights”.

Symptoms of Acrophobia

To be acrophobic, the fear of heights must be excessive and not realistic. Therefore, the symptoms should be exaggerated compared to the situation in which they appear.

As in other types of phobias, acrophobia is associated with three major types of responses: anxiety, fear, and panic.

Although they are used to use interchangeably, anxiety, panic and fear are different:

• Anxiety: it is an emotion centered on a possible danger in the future. It is associated with the tendency to worry and to anticipate possible dangers. The physical symptoms are muscle tension, tachycardia, headache, dizziness…
• Fear: it is a basic emotion that you feel when you interpret a situation as threatening. The physical symptoms are tremors, tachycardia, sweating, nausea, and feeling out of reality…
• Panic: it is a wave of fear that grows rapidly. Your symptoms may be fear of death, fear of losing control, dizziness, shortness of breath, tachycardia…

Depending on the situation, a person may experience from average levels of anxiety or fear to a complete panic attack.

In addition to anxiety, panic and fear, several physiological responses can be generated:

• Muscle tension.
• Headaches.
• Palpitations.
• Dizziness.
• Shortness of breath.
• Lots of control.

Changes in Behavior 

The emotion of fear is usually accompanied by some kind of behavior that reduces the feeling of fear. In most cases that response is escape or avoidance.

People with fear of heights often avoid being in tall buildings, balconies, high seats in theaters or sports arenas. Other people can avoid even looking at people who are in high places or looking at high places.

If someone with acrophobia is in a high place, usually perform security behaviors such as: avoid looking down, avoid approaching windows or balconies, and prevent anyone from approaching them…

Causes of Acrophobia

It seems that the fear of most people with acrophobia is not related to conditioning based on previous experiences. Evolutionary theory asserts that fear of heights is a natural adaptation to a context in which falling can result in death or in great danger.

From this theory all humans are afraid to be at great heights. The degree of fear varies between each person and the term phobia is reserved for irrational fear.

On the other hand, according to a study published in the journal Psychological Science, acrophobia depends on the peripheral vision that we have when we move.

Previous experiences

In some cases, the fear of heights can be developed by going through direct, vicarious (observing) or informative (counted) experiences.

• Direct: passing a traumatic or stressful experience in a high place. For example, if a person suffers a panic attack on a balcony, he may associate that attack with being in a high place.
• Vicarious experiences (observe): someone may develop acrophobia by observing that another person is afraid at a high altitude or that person has a bad experience. For example, if a child observes that his father is always afraid of heights, the child can develop it too.
• Information: Someone can develop fear at a high altitude because they have read or been told that it is very dangerous to be in high altitude. For example, parents with fear can tell their child to be careful of heights.

Negative thoughts

Fear of heights tends to be associated with phobic thinking or negative thoughts about the dangers of being in high places. If you are sure that you are safe in a high place, you will not be afraid. However, if you think a place is unsafe and likely to fall, it is normal to experience anxiety or fear.

The thoughts that accompany fear can be so fast and automatic that you are not aware of them.

Some normal examples in acrophobia are:

• I will lose my balance and fall.
• The bridge is unsafe.
• The elevator is unsafe and can fall.
• If I go too close to the balcony, someone will push me.
• If I am in a high place, I will approach the edge and fall.

Consequences of fear of heights

In some cases, this phobia is not a problem in life. For example, if a person is afraid of climbing mountains and does not do mountaineering, nothing happens.

However, in other cases it can influence and have negative consequences in daily life.

For example, someone with acrophobia can live in a city and be constantly avoiding elevators, tall buildings, bridges or stairs.

In the latter case, the phobia could affect the type of work that is sought, the activities that are performed or the places to which it is sought.

Treatment Options

Cognitive-behavioral therapy

The cognitive behavioral therapy is the main treatment to treat specific phobias. Behavioral techniques are used that expose the patient to the feared situation gradually (systematic desensitization, exposure) or rapidly (flooding).

Virtual reality

One of the first applications of virtual reality in Clinical Psychology has been in acrophobia. In 1995 the scientist Rothbaum et al. published the first study; the patient managed to overcome the fear of heights by exposing himself in a virtual scenario.

How to overcome fear of heights

In this section I will explain specifically the technique of exposure, which is usually used in cognitive-behavioral therapy.

With the exposure, the person with fear of heights faces this situation progressively and with various activities. For this purpose, a hierarchy will work.  The goal is desensitization that is to say that the person feels less and less to the heights.

This therapy consists of:

• Forget the association between heights and the response of fear, anxiety or panic.
• Become accustomed to heights.
• Free-associate the heights feelings of relaxation and tranquility.

Creating a hierarchy

Create a scale from minor to major, rating the situation less feared to the most feared.

That hierarchy will mean the steps that will bring you to the maximum feared situation, for example being on a balcony or going up and down floors with an elevator.

In this way, the first step will cause minimal anxiety and the latter will cause maximum anxiety. It is recommended that the hierarchy consist of 10 to 20 steps.

On the other hand, if the person with phobia has an excessive fear of heights, a person can accompany him to carry out the steps.

Example with an elevator:

1. Observe how people rise and fall in elevators.
2. Enter an elevator standing next to someone.
3. Enter an elevator standing alone.
4. Raise or lower a floor next to someone.
5. Raise or lower a floor by itself.
6. Go up or down three floors with someone.
7. Go up or down three floors together alone.
8. Increase the number of floors next to someone.
9. Increase the number of floors alone.

In this case, if you are afraid of heights when using elevators, you would have to do those steps several times a week until the fear or anxiety has almost completely subsided.

Ideally, practice 3-5 times a week. Longer sessions tend to produce better results than short sessions.

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It is recommended that you withdraw from the situation if the anxiety you feel worsens. That is, you feel dizzy, heart rate acceleration, muscle tension, fear of losing control…

If you feel uncomfortable but feel that you are in control, you can continue to expose yourself to the situation.

Imaginary desensitization

It is important that you overcome your fear and expose yourself to real situations. However, to start you can expose yourself in imagination.

It is that you visualize the situations that you have put in the hierarchy, although in the imagination.

Tips for coping with resistance

There is usually a resistance to exposure to situations that cause anxiety.

To overcome this resistance:

• See if you are delaying the exposure sessions.
• Recognize that it is normal to experience strong emotions during exposure to feared situations.
• Avoid negative thoughts like “you will never overcome fear”, “it is dangerous”.
• Look at therapy as an opportunity for improvement.
• Think of the rewards of overcoming fear.
• Recognizing that feeling bad about exposure is the way to overcome fear.
• Do not oversaturate: if you feel excessive anxiety, withdraw momentarily or repeat the next day.
• Preparing solutions: for example, as a precaution of a possible stop of an elevator, you can carry an emergency telephone.
• Reward yourself for small successes.