A fear of heights is very common and a true phobia of heights is much rarer: in a German telephone survey of 2,012 people, 28.5% had experienced visual height intolerance, the everyday version, while 6.4% had acrophobia, the phobia. [kapfhammer-2015] Exposure-based therapy treats it, and in one trial of 100 adults a two-week course of automated virtual reality (VR) therapy cut fear-of-heights scores by 24.5 points against 1.2 for usual care. [freeman-2018] This guide covers how common it is, when it starts, what treats it, where the evidence stops and a safe first step. Our guide to phobias covers the wider picture.
How common is a fear of heights?
Unease at heights is common, and a diagnosable phobia is a small part of it. In a representative German telephone survey of 2,012 people aged 14 and over, the lifetime prevalence of visual height intolerance, the survey’s term for the everyday version, was 28.5%. The lifetime prevalence of acrophobia was 6.4%, and the point prevalence, the share affected when the survey was done, was 2.0%. [kapfhammer-2015]
| Group | Visual height intolerance (lifetime) | Acrophobia (lifetime) | Acrophobia (at the time) |
|---|---|---|---|
| All | 28.5% | 6.4% | 2.0% |
| Women | 32.4% | 8.6% | 2.8% |
| Men | 24.5% | 4.1% | 1.1% |
Most people who feel uneasy on a balcony never reach the phobia. Both conditions were more common in women, and the figures come from one country’s telephone survey, so they may differ elsewhere. The survey also found that symptoms and the social impairment they caused formed a continuum from mild to seriously distressing, so the data show a gradient and not a sharp line. [kapfhammer-2015]
When does a fear of heights start, and does it go away on its own?
It most often starts in the teenage years, and in this survey it tended to persist rather than fade. The first attacks came most often in the second decade of life, 36% of them, so most people began at another age. The survey observed a chronic course with at least moderate impairment, and a rapid spread to other height situations. [kapfhammer-2015] A survey at one point in time cannot show what happens to any one person, but it gives no sign that the fear typically fades without help.
Panic and low mood often travel with it. Among people with visual height intolerance, 22.5% reacted with the intensity of a panic attack, and both it and acrophobia went with high rates of anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of earlier acrophobia. [kapfhammer-2015] Our guide to panic attacks covers what that reaction is.
What treats a fear of heights?
Gradual exposure to the feared situation is the standard treatment for phobias, and for heights one trial tested an automated version in virtual reality. A 2019 review calls in vivo exposure, meaning real-life exposure, the benchmark and gold standard for phobia treatment. [wechsler-2019] Our guide to exposure therapy covers how it works and why the steps are small.
In the VR trial, Freeman and colleagues recruited 100 adults through radio advertisements in Oxfordshire, UK. Each scored above 29 on the Heights Interpretation Questionnaire (HIQ), which runs from 16 to 80, with higher scores meaning more severe fear. They were randomly assigned to automated VR or to usual care. The VR course was roughly six 30-minute sessions over two weeks, guided by an avatar coach in the headset, and the researchers assessing people did not know who had which. [freeman-2018]
At the end of treatment, scores in the VR group had fallen by 24.5 points on average against 1.2 for usual care, an adjusted difference of 24.0 points (95% confidence interval 20.3 to 27.7). At four weeks the fall was 25.1 against 1.5. The number needed to treat to at least halve the fear of heights was 1.3, no adverse events were reported, and all 100 people completed the four-week follow-up. The VR group spent 124 minutes in the headset on average. [freeman-2018]
Average change scores reported in Freeman et al. (2018): 49 adults in the VR group and 51 in the usual care group. Higher scores meant more fear, so a bigger fall is more improvement.
The next question is whether VR holds up against real-life exposure. A 2019 meta-analysis pooled nine randomised trials, 371 people in all, that gave the same amount of exposure in VR and in real life. Four were on specific phobia, three on social phobia and two on agoraphobia. Both approaches had large, significant effects. The gap between them was small and not significant, leaning towards real-life exposure (g = −0.20), and for specific phobia it was −0.15, also not significant. The authors found no evidence that VR exposure is significantly less efficacious than real-life exposure in specific phobia and agoraphobia. [wechsler-2019]
What do the studies not show about fear of heights?
They do not show that VR beats real-life exposure, and they do not explain why some people develop the fear. The heights trial compared VR with usual care, not with real-life exposure or another therapy, so it shows the VR course beat no extra treatment, not that it beats the alternatives. [freeman-2018] Participants were adults who answered a radio advertisement and scored above a cut-off, not people referred to a clinic, and the results in the abstract run to four weeks. The abstract does not report who funded the trial or any competing interests, so read the paper’s own disclosures before weighing it.
The meta-analysis pooled several phobias, so its figures are not specific to heights, and nine trials is a small base. [wechsler-2019] The survey is a telephone survey in one country. [kapfhammer-2015] None of the abstracts reviewed here says why a fear of heights begins, so this guide does not guess. Whether a VR course is on offer near you is a question for a local clinician.
How do you take a first step on a fear of heights?
Pick a secure height just above your comfort level and stay there while the fear rises and settles. That is the first rung of a graded ladder, our adaptation of exposure therapy and not the programme tested in the trial. Safety comes first: use somewhere with a solid barrier or closed glazing, such as a first-floor window or a low stairwell railing, never an unprotected edge, and stop if the fear turns into panic you cannot ride out.
A five-minute first rung
Choose a secure spot only a little higher than feels comfortable, such as a first-floor window or a low stairwell railing with a solid barrier. Stand where you can see down, and rate the fear from 0 to 10 now. For the whole time, stay and keep looking, without gripping, bargaining with yourself or looking away. Rate the fear again when the timer ends.
5:00
The aim is to stay while the fear rises and settles, not to feel calm. If it does not settle, that is information and not failure: repeat the same rung another day.
Done. Compare the two ratings. If the second is lower, you have just watched the fear settle.
Repeat the same rung until it feels dull, then move to a slightly higher or more open spot. Avoiding the situation keeps the fear going, which our overview of phobias explains. If a fear of heights comes bundled with other travel fears, our guide to fear of flying covers a close cousin.
No screener on this site assesses phobias. The self-assessment hub lists the seven we do have.
When to seek help
Speak to a doctor or therapist if heights shape your choices, such as turning down work, travel or a home with a balcony, if the fear brings on panic attacks, or if low mood has come with it, since the survey found high rates of anxious and depressive conditions alongside. Our guide to depression covers that side. Dizziness that is new, or that is not tied to heights, deserves a medical check, because balance problems have other causes.
If you feel unable to keep yourself safe, contact your local emergency services or a crisis helpline.
How MyFreud can help
A graded ladder only works if you can see it moving. Daily mood tracking in MyFreud shows how your days go around the situations you avoid, and the notepad is somewhere to log each rung, the fear rating before and after, and what you noticed. It does not replace a therapist.
Download MyFreud and start today: App Store or Google Play.