Friday, June 6, 2014

What is Acrophobia and how to treat it?

Acrophobia is an extreme irrational fear and anxiety of heights. According to the DSM IV diagnostic guidelines Acrophobia is categorized as a specific phobia.

What are the clinical features?

Acrophobia is characterized by extreme anxiety in heights. People with acrophobia get panic attacks in a heights and wants to quickly go down.  In addition they fear, that they will fall from the height. However they behave perfectly normally when not on heights.  In addition they may have features of anxiety. Anxiety symptoms are classified as physical and psychological.

Psychological symptoms

People with acrophobia can get fearful anticipation or extreme anxiety, when they go to a height. Some people may get the anxiety even for the idea of going to a height.
During an episode they can get increased sensitivity to noise, irritability, restlessness and get poor concentration.

Physical symptoms

People who are afraid of heights may get dry mouth, difficulty in swallowing, felling of constriction of their chest and difficulty in inhaling. In addition they may get cardiovascular symptoms such as palpitations (subjective feeling of their own heart beat) and awareness of missed beats. Other than that they may get tremors, headache especially when they stay too long and muscle aching. Sometimes people with acrophobia may develop hyperventilation and get dizziness, tingling sensation in fingers /toes and subjective feeling of breathlessness.

These anxiety symptoms cause the patient to avoid such situations and it maintains the problem. Therapy is targeted to expose the person into the anxiety provoking situation and desensitize him/her.

How to treat Acrophobia?

Acrophobia is treated mainly with psychological methods. In addition some people may need specific medications such as benzodiazepines. Psychological methods include cognitive behavioral therapy. Cognitive behavioral therapy method used in Acrophobia includes systemized desensitization, relaxation training and graded exposure.

Systemized desensitization

Here patient need to construct, a list made of situations that provoke increased degrees of anxiety. If the patient has minimal anxiety, when seeing a photo of a height, then he/she may write it down at the top. Then the patient is asked to write down next anxiety provoking situation. E.g. seeing a video of a height. The list should continue until the patient write down the most anxiety provoking situation. E.g. Standing on one foot in a unstable bridge.

Relaxation training

Once the list is formulated, patient is taught how to control anxiety by way of relaxation therapy. In relaxation therapy patient is trained to relax, first individual muscles then the whole body. This method should be practiced regularly during sessions.

Graded exposure

Here patient is entered into least anxiety provoking situation. E.g. If the least anxiety provokimg situation is seeing an photo of a height, he/she may be asked to look at it and imagine that he/she is in a height. This is done until the anxiety is diminished. Then the patient is entered into the next scenario. Like that, it is carried out until the patient is not anxious to the previously most anxiety provoking situation. Here a patient can send to a bridge that is unstable but safe, and ask him/her to stand on one foot.

During the therapy the patient is asked to practice relaxations methods to relieve anxiety. Sometimes drugs may be needed to relax patients.


Acrophobia is a specific phobic disorder that can be troublesome for the sufferer. But it can be treated with various psychotherapies.

Oxford short textbook of Psychiatry

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