Understanding Acrophobia, or Fear of Heights

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.

This can lead to a range of physical and psychological symptoms.

Physical symptoms of acrophobia include:

• increased sweating, chest pain or tightness, and increased heartbeat at the sight or thought of high places
• feeling sick or lightheaded when you see or think about heights
• shaking and trembling when faced with heights
• feeling dizzy or like you’re falling or losing your balance when you look up at a high place or down from a height
• going out of your way to avoid heights, even if it makes daily life more difficult

Psychological symptoms can include:

• experiencing panic when seeing high places or thinking about having to go up to a high place
• having extreme fear of being trapped somewhere high up
• experiencing extreme anxiety and fear when you have to climb stairs, look out a window, or drive along an overpass
• worrying excessively about encountering heights in the future

Acrophobia sometimes develops in response to a traumatic experience involving heights, such as:

• falling from a high place
• watching someone else fall from a high place
• having a panic attack or other negative experience while in a high place

But phobias, including acrophobia, can also develop without a known cause. In these cases, genetics or environmental factors may play a role.

For example, you may be more likely to have acrophobia if someone else in your family does. Or you learned to fear heights from watching the behavior of your caregivers as a child.

Evolved navigation theory

Something called evolved navigation theory may also explain why some people develop acrophobia.

According to this theory, certain human processes, including perception of height, have adapted through natural selection. Perceiving something as being taller than it actually is can reduce your risk for dangerous falls, increasing the likelihood that you’ll live to thus reproduce.

Phobias, including acrophobia, can only be diagnosed by a mental health professional. You can ask your healthcare provider for a referral to a psychiatrist. They can help with the diagnosis.

They’ll likely start by asking you to describe what happens when you find yourself faced with heights. Be sure to mention any other mental health symptoms you’ve experienced as well as how long you’ve had this fear.

Generally, acrophobia is diagnosed if you:

• actively avoid heights
• spend a lot of time worrying about encountering heights
• find that this time spent worrying starts to affect your daily life
• react with immediate fear and anxiety when encountering heights
• have these symptoms for more than six months

Phobias don’t always require treatment. For some, avoiding the feared object is relatively easy and doesn’t have a big impact on their daily activities.

But if you find that your fears are holding you back from doing things you want or need to do — such as visiting a friend who lives on the top floor of a building — treatment can help.

Exposure therapy

Exposure therapy is considered to be one of the most effective treatments for specific phobias. In this type of therapy, you’ll work with a therapist to slowly expose yourself to what you’re afraid of.

For acrophobia, you might start by looking at pictures from the point of view of someone inside a tall building. You might watch video clips of people crossing tightropes, climbing, or crossing narrow bridges.

Eventually, you might go out onto a balcony or use a stepladder. By this point, you’ll have learned relaxation techniques to help you conquer your fear in these moments.

Cognitive behavioral therapy (CBT)

CBT may help if you don’t feel ready to try exposure therapy. In CBT, you’ll work with a therapist to challenge and reframe negative thoughts about heights.

This approach may still include a bit of exposure to heights, but this is generally only done within the safe setting of a therapy session.

HOW TO FIND A THERAPIST

Finding a therapist can feel daunting, but it doesn’t have to be. Start by asking yourself a few basic questions:

• What issues do you want to address? These can be specific or vague.
• Are there any specific traits you’d like in a therapist? For example, are you more comfortable with someone who shares your gender?
• How much can you afford to spend per session? Do you want someone who offers sliding-scale prices or payment plans?
• Where will therapy fit into your schedule? Do you need someone who can see you at a certain time? Or would you prefer online sessions?

Next, start making a list of therapists in your area. If you live in the United States, head over to the American Psychological Association’s therapist locator.

Concerned about the cost? Our guide to affordable therapy can help.

Medication

There aren’t any medications designed to treat phobias.

However, some medications can help with symptoms of panic and anxiety, such as:

• Beta-blockers. These medications help by keeping your blood pressure and heart rate at a steady rate and reducing other physical symptoms of anxiety.
• Benzodiazepines. These drugs are sedatives. They can help reduce anxiety symptoms, but they’re typically only prescribed for a short time or for occasional use, as they can be addictive.
• D-cycloserine (DCS). This drug may increase the benefits of exposure therapy. According to a 2017 literature review of 22 studies involving people who lived with various anxiety-related conditions, DCS seemed to help enhance the effects of exposure therapy.

Virtual reality

In recent years, some experts have turned their attention to virtual reality (VR) as a potential method for treating phobias.

An immersive VR experience can provide exposure to what you’re afraid of in a safe setting. Using computer software gives you the option to stop right away if things feel overwhelming.

A 2018 study looked at the effects of VR on 100 people with acrophobia. Participants only experienced low levels of discomfort during VR sessions. Many reported that VR therapy was helpful.

While the study authors noted that more research is needed in the field, they concluded that VR may be an easily accessible, affordable treatment option since it can be done at home.

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.

A therapist can help you develop tools that will allow you to overcome your fear and prevent it from affecting your daily life.