Abstract
Acrophobia, or the fear of heights, is a phobic anxiety disorder that falls under the category of specific (isolated) phobia in the International Classification of Diseases-10 (ICD-10) and is classified as a specific phobia in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). It is characterized by an irrational fear of heights, resulting in the avoidance of such situations or enduring the situations with marked distress. Acrophobics avoid a large range of stimuli, from climbing ladders to walking stairwells, getting close to windows in high-rise buildings, crossing bridges, sitting in the balcony section at the theater, etc. Acrophobia is different from physiological height vertigo, with the former being related to excessive fear of falling despite objective risks and avoidance while physiological height vertigo is the whirling sensation and visual destabilization of posture caused when the distance between the observer and the closest stationary visible object becomes critically large.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abelson, J. L., & Curtis, G. C. (1989). Cardiac and neuroendocrine responses to exposure therapy in height phobics: Desynchrony with the “physiological response system”. Behaviour Research and Therapy, 27, 556–561.
American Psychiatric Association: APA. (2000). Diagnostic and statistical manual of mental disorders fourth edition text revision. Washington, DC: American Psychiatric Association.
Antony, M. M., & Barlow, D. H. (2002). Specific phobias. In D. H. Barlow (Ed.), Anxiety and its disorders (2nd ed., pp. 380–417). New York: Guilford.
Bauman (2007). Physiology during anxiety-provoking VR simulations. Oral presentation at the 12th Annual CyberTherapy Conference 2007, Washington, DC, 11–14 June.
Bouchard, S., St-Jacques, J., Robillard, G., Côté, S., & Renaud, P. (2003). Efficacité de l’exposition en réalité virtuelle pour l’acrophobie: Une étude préliminaire. Journal de Thérapie Comportementale et Cognitive, 13(3), 107–112.
Bouchard, S., Robillard, G., Larouche, S., & Loranger, C. (2012). Description of a treatment manual for in virtuo exposure with specific phobia. In C. Eichenberg (Ed.) Virtual reality in psychological, medical and pedagogical applications (Chap. 4, pp. 82–108). Rijeka (Croatia): InTech.
Bourque, P., & Ladouceur, R. (1980). An investigation of various performance-based treatments with acrophobics. Behavior Research & Therapy, 18, 161–170.
Brandt, T. (2003). Vertigo: Its multisensory syndromes (2nd ed.). New York: Springer.
Brandt, T., Arnold, F., Bless, W., & Kapteyn, T. S. (1980). The mechanism of physiological height vertigo, I: Theoretical approach and psychophysics. Acta Otolaryngologica, 89, 513–523.
Bullinger, A. H. (2005). Treating acrophobia in a virtual environment. Oral presentation at the 10th Annual CyberTherapy Conference 2005, Basel (Switzerland), 6–10 June.
Choi, Y. H., Jang, D. P., Ku, J. H., Shin, M. B., & Kim, S. I. (2001). Short-term treatment of acrophobia with virtual reality therapy (VRT): A case report. Cyberpsychology & Behavior, 4(3), 349–354.
Coelho, C. M., & Wallis, G. (2010). Deconstructing acrophobia: physiological and psychological precursors to developing a fear of heights. Depression and Anxiety, 27, 864–870.
Cohen, D. C. (1977). Comparison of self-report and behavioral procedures for assessing acrophobia. Behavior Therapy, 8, 17–23.
Curtis, G. C., Magee, W. J., Eaton, W. W., Wittchen, H.-U., & Kessler, R. C. (1998). Specific fears and phobias: Epidemiology and classification. British Journal of Psychiatry, 173, 212–217.
De Quervain, D. J. F., Bentz, D., Michael, T., Bolt, O. C., Wiederhold, B. K., Margraf, J., & Wilhelm, F. H. (2011). Glucocorticoids enhance extinction-based psychotherapy. Proceedings of the National Academy of Sciences, 108(16), 6621–6625.
Depla, M. F. I. A., ten Have, M. L., van Balkom, A. J. L. M., & de Graaf, R. (2008). Specific fears and phobias in the general population: Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology, 43, 200.
Emmelkamp, P. M. G., Bruynzeel, M., Drost, L., & van der Mast, C. A. P. G. (2001). Virtual reality treatment in acrophobia: A comparison with exposure in vivo. Cyberpsychology & Behavior, 4(3), 335–340.
Emmelkamp, P. M. G., Krijn, M., Hulsbosch, L., de Vries, S., Schuemie, M. J., & van der Mast, C. A. P. G. (2002). Virtual reality treatment versus exposure in vivo: A comparative evaluation in acrophobia. Behaviour Research and Therapy, 40(5), 25–32.
Fowles, D. C. (1988). Psychophysiology and psychopathology: A motivational approach. Psychophysiology, 25(4), 373–391.
Fredrickson, M., Annas, P., Fischer, H., & Wik, G. (1996). Gender and age differences in the prevalence of specific fears and phobias. Behaviour Research & Therapy, 26, 241–244.
Gray, J. A. (1975). Elements of a two-process theory of learning. New York: Academic.
Hodges, L. F., Kooper, R., Rothbaum, B. O., Opdyke, D., de Graaff, J. J., Williford, J. S., & North, M. M. (1995). Virtual environments for treating the fear of heights. Computer Innovative Technology for Computer Professionals, 28(7), 27–34.
Huang, M. P., Himle, J., & Alessi, N. E. (2000). Vivid visualization in the experience of phobia in virtual environments: Preliminary results. Cyberpsychology & Behavior, 3(3), 321–326.
Jang, D. P., Ku, J. H., Choi, Y. H., Wiederhold, B. K., Nam, S. W., Kim, I. Y., & Kim, S. I. (2002). The development of virtual reality therapy (VRT) system for the treatment of acrophobia and therapeutic case. IEEE Transactions on Information Technology and Medicine, 6(3), 213–217.
Juan, M. C., & Pérez, D. (2009). Comparison of the levels of presence and anxiety in an acrophobic environment viewed via HMD or CAVE. Presence, 18(3), 232–248.
Juan, M. C., & Pérez, D. (2010). Using augmented and virtual reality for the development of acrophobic scenarios. Comparison of the levels of presence and anxiety. Computers & Graphics, 34, 756–766.
Krijn, M., Emmelkamp, P. M. G., Biemond, R., de Wilde de Ligny, C., Schuemie, M. J., & van der Mast, C. A. P. G. (2004). Treatment of acrophobia in virtual reality: The role of immersion and presence. Behaviour Research and Therapy, 42, 229–239.
Krijn, M., Emmelkamp, P. M. G., Ólafsson, R. P., Schuemie, M. J., & Van Der Mast, A. P. G. (2007). Do self-statements enhance the effectiveness of virtual reality exposure therapy? A comparative evaluation in acrophobia. Cyberpsychology & Behavior, 10(3), 362–370.
Kuntze, M. F., Störmer, R., Mager, R., Müller-Spahn, F., & Bullinger, A. (2003). Die behandlung der Höhenangst in einer virtuellen umgebung, Nervenarzt, 74, 428–435.
Lamson, R. J. (1997). Virtual therapy. Montreal: Polytechnic International Press.
Marshall, W. L. (1985). The effects of variable exposure in flooding therapy. Behavior Therapy, 16, 117–135.
McNally, R. J. (2007). Mechanisms of exposure therapy: How neuroscience can improve psychological treatments for anxiety disorders. Clinical Psychology Review, 27(6), 750–759.
Meehan, M. (2001). Physiological reaction as an objective measure of presence in virtual environments. Doctoral dissertation, University of North Carolina at Chapel Hill.
Meehan, M., Insko, B., Whitton, M. C., & Brooks, F. P. (2002). Physiological measures of presence in stressful virtual environments. Proceedings of the 29th Annual Conference on Computer graphics and interactive techniques, San Antonio, Texas, pp. 645–652.
Meehan, M., Razzaque, S., Whitton, M. C., & Brooks, F. P. (2003). Effect of latency on presence in stressful virtual environments. Proceedings of the IEEE Virtual Reality 2003.
Meehan, M., Razzaque, S., Insko, B., Whitton, M. C., & Brooks, F. P. (2005). Review of four studies on the use of physiological reaction as a measure of presence in stressful virtual environments. Applied Psychophysiology and Biofeedback, 30(3), 239–258.
Menzies, R. (1997). Height phobia. In G. C. L. Davey (Ed.), Phobias: A handbook of theory, research and practice (pp. 139–151), Chichester: Wiley.
Meyerbroeker, K., Powers, M. B., van Stegeren, A., & Emmelkamp, P. M. G. (2012). Does yohimbine hydrochloride facilitate fear extinction in virtual reality treatment of fear of flying? A randomized placebo-controlled trial. Psychotherapy and Psychosomatics, 81(1), 29–37.
North, M. M., North, S. M., & Coble, J. R. (1996). Virtual reality therapy. An innovative paradigm. Colorado Springs: IPI.
Öst, L.-G. (1997). Rapid treatment of specific phobias. In G. C. L. Davey (Ed.), Phobias: A handbook of theory, research and treatment (pp. 227–246). Chichester: Wiley.
Poulton, R., Waldie, K. E., Menzies, R. G., Craske, M. G., & Silva, P. A. (2001). Failure to overcome “innate” fear: A developmental test of the non-associative model of fear acquisition. Behaviour Research and Therapy, 39, 29–43.
Rachman, S. J. (1990). Fear and courage (2nd ed.). New York: Freeman.
Regenbrecht, H. T., Schubert, T. W., & Friedmann, F. (1998). Measuring the sense of presence and its relations to fear of heights in virtual environments. International Journal of Human-Computer Interaction, 10(3), 233–249.
Ressler, K.J., Rothbaum, B.O., Tannenbaum, L., Anderson, P., Graap, K., Zimand, E., Hodges, L., Davis, M. (2004). Cognitive enhancers as adjuncts to psychotherapy: Use of D-cycloserine in phobic individuals to facilitate extinction of fear. Archives of General Psychiatry, 61(11), 1136–1144.
Richards, D. C. S., Lauterbach, D., & Gloster, A. T. (2006). Description, mechanisms of action, and assessment. In D. C. S. Richards & D. L. Lauterbach (Eds.), Handbook of exposure therapies (pp. 1–28). Burlington: Academic.
Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., Williford, J. S., & North, M. (1995a). Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. American Journal of Psychiatry, 152, 626–628.
Rothbaum, B. O., Hodges. L. F., Kooper. R., Opdyke. D., Williford, J. S., & North, M. (1995b). Virtual reality graded exposure in the treatment of acrophobia: A case report. Behavior Therapy, 26, 547–554.
Schuemie, M. J., Bruynzeel, M., Drost, L., Brinkman, M., de Haan, G., Emmelkamp, P. M. G., & van der Mast, C. A. P. G. (2000).Treatment of Acrophobia in VR: A pilot study. In F. Brockx & L. Pauwels (Eds.) Conference Proceedings Euromedia 2000, 8–10 May 2000, Antwerp Belgium, pp. 271–275.
Sik-Lányi, C., Laky, V., Tilinger, Á., Pataky, I., Simon, L., Kiss, B., et al. (2004). Developing multimedia software and virtual reality worlds and their use in rehabilitation and psychology. In M. Duplaga et al. (Eds.), Transformation of health care with information technologies (pp. 273–284). Amsterdam: IOS Press.
Sirbu, C., Ruscio, A. M., & Ollendick, T. H. (2004). Virtual reality versus in vivo one session treatment for acrophobia. Poster presented at the 38th Annual Convention of the Association for Advancement of Behavior Therapy, New Orleans, 18–21 November.
Slater, M., Usoh, M., & Steed, A. (1995). Taking steps: The influence of a walking technique on presence in virtual reality. ACM Transactions Computer-Human Interactions, 2, 201–219.
Smits, J.A.J., Rosenfield, D., Otto, M.W., Powers, M.B., Hofmann, S. G., Telch, M.J., Pollack, M.H., & Tart, C.D. (2013). D-cycloserine enhancement of fear extinction is specific to successful exposure sessions: Evidence from the treatment of height phobia. Biological Psychiatry, 73(11), 1054–1058.
Stinson, F. S., Dawson, D. A., Chou, S. P., Smith, S., Goldstein, R. B., Ruan, W. J., & Grant, B. F. (2007). The epidemiology of DSM-IV specific phobia in the USA: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 37, 1047–1059.
Vale, H. M. C., Oliveira, C., Sena, D. C., & Porto, A. J. V. (2010). Construction of immersive multi-projection environments for treatment of phobia of heights. In P. Bartolo et al. (Eds.), Innovative Developments in Design and Manufacturing (pp. 619–624), London: CRC.
Walker, D.L., Ressler, K.J., Lu, K.-T., Davis, M. (2002). Facilitation of conditioned fear extinction by systemic administration or intra-amygdala infusions of D-cycloserine as assessed with fearpotentiated startle in rats. Journal of Neuroscience, 22(6), 2343–2351.
Whitney, S. L., Jacob, R. G., Sparto, P. J., Olshansky, E. F., Detweiler-Shostak, G., Brown, E. L., & Furman, J. M. (2005). Acrophobia and pathological height vertigo: Indications for vestibular physical therapy? Physical Therapy, 85(5), 443–458.
Wilhelm, F. H., Pfaltz, M. C., Gross, J. J., Mauss, I. B., Kim S. I., & Wiederhold, B. K. (2005). Mechanisms of virtual reality exposure therapy: The role of the Behavioral activation and behavioural inhibition systems. Applied Psychophysiology and Biofeedback, 30(3), 271–284.
Williams, S. L., Dooseman, G., & Kleifeld, E. (1984). Comparative effectiveness of guided mastery and exposure treatments for intractable phobics. Journal of Consulting and Clinical Psychology, 52, 505–518.
Williams, S. L., Turner, S. M., & Peer, D. F. (1985). Guided mastery and performance desensitization treatments for severe acrophobia. Journal of Consulting and Clinical Psychology, 53, 237–247.
World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders. Geneva: WHO.
Zimmons, P. M. (2004). The influence of lighting quality on presence and task performance in virtual environments. Doctoral dissertation, University of North Carolina at Chapel Hill.
Zimmons, P. M., & Panter, A. (2003). The influence of rendering quality on presence and task performance in a virtual environment. Proceedings of the IEEE Virtual Reality 2003.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Wiederhold, B., Bouchard, S. (2014). Fear of Heights (Acrophobia): Efficacy and Lessons Learned from Psychophysiological Data. In: Advances in Virtual Reality and Anxiety Disorders. Series in Anxiety and Related Disorders. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-8023-6_6
Download citation
DOI: https://doi.org/10.1007/978-1-4899-8023-6_6
Published:
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4899-8022-9
Online ISBN: 978-1-4899-8023-6
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)