Acrophobia: understanding the fear of heights and finding your feet

You climb three steps of a stepladder and your legs start to shake. On a fifth-floor balcony, you stay pressed against the wall. On a walk, a slightly exposed stretch of path stops you dead while your friends stroll across without a thought. What you are going through has a name: acrophobia, the fear of heights.

I am a sophrologist, hypnotherapist and wellbeing coach in Bordeaux. The people who tell me about it are often a little embarrassed, as if they lacked courage. Courage has nothing to do with it. It is a body sounding the alarm too loudly, and that is something you can work on.

Here you will find what acrophobia is, how to tell it apart from vertigo, why the body freezes, what to do in the moment, what research shows about what helps, and when to see a doctor.

Acrophobia: what the fear of heights is

The word comes from the Greek akron, the summit. The MSD Manual, a medical reference, lists the fear of heights among the most common specific phobias. It describes them as a fear out of proportion to the real danger, present for at least six months, that leads to avoidance and gets in the way of social or working life. Whether that applies to you in the medical sense is for a doctor to say, not me.

A very common fear

A review from the University of Munich describes three levels. First, the slight unsteadiness everyone feels up high. Then a stronger unease that researchers call visual height intolerance. Acrophobia sits at the far end of that scale, when the fear takes over.

According to this Munich review, that unease affects 28% of adults at some point in their lives, slightly more women (32%) than men (25%). Acrophobia in the strict sense is thought to affect between 3 and 6.4% of people, depending on the studies the researchers looked at. So you are far from alone.

What it feels like

The sensations described by the NHS are those of intense fear: feeling dizzy and lightheaded, a racing heart, a tight chest, trembling, and the sense that you might faint or lose control. Many people add jelly legs and an overwhelming urge to kneel down or grab hold of something.

Vertigo or fear of heights: how to tell the difference

In everyday English, people often say "I get vertigo" when they mean a fear of heights. The two words describe different things.

Vertigo in the medical sense is a feeling that everything is spinning or that the floor is moving. It can happen anywhere, when you get out of bed or turn your head, with no height in sight. It often has a physical cause, particularly in the inner ear, and it is for a doctor to look for it.

A fear of heights is tied to the situation. It rises as you get near an edge, an open window or a ladder, and it settles once you are back on stable ground. The Munich researchers also note that it is more common in people who already have balance problems linked to the inner ear, or certain kinds of migraine: the two can overlap.

A simple rule of thumb: if you feel dizzy at ground level, see your doctor before anything else.

Why the body freezes up high

The Munich review describes exactly what happens. Faced with a drop, fear makes the muscles that keep us upright all tighten at once. The whole body stiffens, even the eyes: your gaze locks onto the horizon and you walk slowly, in small steps. The authors compare this to a very old reflex, playing dead.

The trouble is that a stiff body balances less well. You feel unsteady, which tells your brain the situation really is dangerous, and the fear climbs further. It is a loop, and it has nothing to do with a lack of willpower.

Where does the fear come from?

The NHS points out that phobias often start after a frightening experience, or are learned from watching someone close to you be afraid. With heights, it might be a fall, a scare on a fairground ride, or a parent who shouted "careful!" at every low wall.

A study based on a representative sample of the German population followed 574 people who felt uneasy at heights, 128 of whom had acrophobia. In that group, the fear was more often triggered by a traumatic event, and it spread more easily to other heights. Often, though, people remember nothing specific. You do not need to find the cause to move forward.

In children and in adults

In children, a fear of heights is common: the Munich researchers found it in 34% of children aged 8 to 10. The good news is that it usually fades on its own within a few years.

In adults, it is the other way round. In the German study, two thirds of people found their unease stayed the same or got worse, and very few looked for help. The more you avoid the situations that trigger it, the more the fear settles in.

What to do in the moment when fear rises

The Munich researchers gathered very practical advice for moments up high. I combine it with what I work on in sessions, because the body and the breath are at the heart of sophrology. These steps will not make the phobia disappear. They help you get through a moment without panicking.

1. Choose where to rest your eyes

Look at the horizon, or at something close and still: a railing, a rock, the wall beside you. Avoid following moving clouds or cars below, which give a false sense of movement. If you look down, keep a fixed object in the corner of your eye.

2. Lower your centre of gravity

Sit down, or lean against a wall, hold onto a rail. According to the Munich review, the sensations are strongest when standing and weakest when lying down. Sitting on a step is not silly at all: it is exactly what your body is asking for.

3. Stop walking

Fear increases when you walk at height. Pause, with both feet firmly planted. Feel the soles of your shoes on the ground and the weight of your body settling into your legs.

4. Lengthen the out-breath

Breathe in through your nose for a count of four, and out through your mouth for a count of six. As you breathe out, let your shoulders and jaw soften. The NHS lists breathing exercises among the things you can do yourself to cope with a phobia. If you like a precise structure, heart coherence breathing works on the same principle.

5. Give your mind a job

Hand your brain a small task: name fruits, towns beginning with B, the first names of your relatives. The Munich researchers showed that a mental task like this eases fear and improves balance. It sounds too simple. Try it anyway.

One last piece of advice, the hardest one: try not to run away every time. Each time you avoid, the fear gains ground.

What helps in the longer term, according to research

The most studied approach is gradual exposure. The MSD Manual explains the idea: you draw up a list of situations, from the least frightening to the hardest, and face them one by one, using relaxation and breathing techniques. With heights, that might start with looking at photos taken from a summit, then going up to the first floor of a building and looking out of the window.

Virtual reality

A trial led by the University of Oxford split 100 adults with a fear of heights into two groups. Half of them had about six 30-minute virtual reality sessions over two weeks, guided by an animated coach. Their fear dropped sharply, and the improvement was still there four weeks later. The study was partly funded by the company that develops the programme, which is a reason for some caution.

Results that take patience

An analysis of 17 trials involving 946 people confirms that guided virtual reality and real-life exposure do better than no support at all. The authors admit, however, that the evidence is still limited.

Another review of 16 studies adds an important nuance: exposure and desensitisation help in the short term, but a lasting effect of real-life exposure has not been shown. I mention it because it is the honest picture. Easing a fear is often ongoing work, with top-ups, rather than a single breakthrough.

What sophrology and hypnosis can offer

There is no solid research on sophrology for acrophobia. What I offer draws on what helps with fear in general. The MSD Manual itself lists relaxation, breathing and hypnosis among the tools that support exposure.

In sophrology, you learn to notice tension as soon as it starts, in your calves, shoulders or stomach, and to let it go. We also rehearse the situations you dread by picturing them calmly: the restaurant terrace, the chairlift, the ridge path. Your body practises the scene in a relaxed state before you live it for real.

And hypnosis?

With hypnosis as I practise it, you approach height in your imagination, in a state of deep relaxation. The MSD Manual describes this approach: feeling calm by picturing a comfortable place, then gradually changing the way you see the situation you fear. After that, we move on to small real-life steps, at your pace.

How I work

At my practice, we start from your own list: what you avoid, what you miss most. Getting back to the mountains, climbing a ladder to change a light bulb, enjoying a balcony on holiday. We move forward in small steps, never forcing anything. If this fear reminds you of other phobias, such as the fear of vomiting, the approach is similar.

When to see a doctor and how to get started

Sophrology and hypnosis do not replace medical advice. See your doctor if:

• you feel dizzy or lose your balance even at ground level, or you have had a fall;
• the fear stops you working, travelling or going on holiday;
• you have frequent panic attacks, or you have been feeling low for several weeks.

The NHS advises seeing a GP as soon as a phobia affects your life. Your doctor can look for a physical cause and refer you to a professional trained in gradual exposure. I work alongside medical care, never instead of it.

To start today, practise the long out-breath when you are calm, three minutes a day, before you need it up high. If you would like support, you can book a sophrology session, by video call or at my practice, or a hypnosis session for adults, at my practice on rue Ducau only. I also work with children from the age of 8 through hypnosis for children. I see clients as a hypnotherapist in Bordeaux, and you can read about my background on the about page.