Are you afraid of heights? How afraid? Have you ever wondered if you have a phobia (i.e. an extreme or irrational fear)?

This article will explain the difference between a normal fear and a phobia of heights (sometimes called acrophobia), and end with a review of effective treatments for height phobia.

Is height phobia a normal fear or phobia?

Fear of heights is normal. Indeed, people who can say, parachute from a plane, climb steep mountains or work from heights (e.g., skyscraper window cleaners) are the exception, not the norm.

As an article in Clinical Psychology Review suggests, human beings have been “programmed” by evolution to fear heights. In fact, a lack of fear of heights would have been costly to our species because even a single fall from a very high place could be fatal.

If your fear of heights is excessive, however, it is likely that your fear is no longer adaptive.

For instance, if your fear is so severe that you avoid bridges, refuse to go on hikes, or are unable to even step out on the balcony, you might have a phobia of heights.

To know for certain, of course, you need to speak to a mental health professional. To determine if you have a phobia of heights, your doctor may consult the DSM-5, the diagnostic manual published by the American Psychiatric Association. According to the manual, the diagnostic criteria for height phobia include:

  • You experience severe fear of heights.
  • Your fear is excessive (disproportionate to the threat). 
  • Heights almost always elicit fear.
  • You go out of your way to avoid heights.
  • Your fear has lasted for six months or longer.
  • Your fear causes significant distress or impairment in functioning.

Treatment of Height Phobia

Treatments for height phobia include medications (e.g., anti-anxiety agents) and psychotherapy. Perhaps the most effective psychotherapy for height phobia is exposure therapy—including in vivo exposure and virtual reality exposure. These treatments are described below.

In vivo exposure refers to real-world confrontation with the phobic situation (in this case, heights). Patients with height phobia are initially asked to create a hierarchy of feared situations, from least to most anxiety-provoking. They then prepare and plan how and when to do the exposure exercises.

Patients usually begin exposure with only moderately difficult tasks; for example, going to the second floor of a nearby building and looking down from a balcony. During an exposure session, the patient will need to remain in the feared situation until the anxiety subsides.

Over time, the patient gradually progresses to more distressing items on their fear hierarchy. Eventually, they complete the most anxiety-provoking item (e.g., going to a skyscraper’s observation deck).

But what if in vivo exposure is not convenient or possible? In these cases, virtual reality exposure may be just as helpful.

Virtual reality exposure uses various technologies and props to create a sense of immersion in a virtual environment that simulates real-world feared situations.

The user interacts with the simulated world in real-time. For example, while standing in a (virtual) glass elevator, the user can push the button for the elevator to go up and can look around the virtual world as the elevator ascends.

The mechanisms of virtual reality exposure are similar to the mechanisms of in vivo exposure.

Specifically, repeated exposure to a virtual feared situation should reduce anxiety. And, like patients undergoing in vivo exposure, those experiencing virtual reality exposure can attempt more challenging exercises (e.g., higher floors in a virtual skyscraper) over time.

Research suggests both in vivo, and virtual exposure therapy are effective for the treatment of height phobia.