What causes a fear of heights?


Some people really overestimate the danger: they think they’re going to fall, throw themselves off (‘the call of the void’) or that a building might collapse. That causes anxiety, it causes people to avoid heights and it can impact on day-to-day life: they can’t walk or drive across bridges, or go to meetings high-up in office blocks. About 1 in 20 people have it at the level of phobia, when you’ve had it for at least six months. Vertigo is something different, a balance issue.

Why treat it with virtual reality?

There are some good psychological treatments for mental health problems and if you see a skilled therapist, you can do really well. But it can be hard to find a therapist, so we’re trying to help people via automated virtual reality. The fear of heights programme was our first test.

Could our brains be fooled by virtual reality? © iStock

What did the treatment involve?

People came to the offices of [university spinout company] Oxford VR. We screened them for at least a moderate fear of heights and had 49 randomised to the VR treatment and 51 to the control condition. They received the treatment, which consisted of about five VR sessions of 30 minutes each, over the course of two weeks.

In the VR package we’ve been using, you meet the therapist, who’s called Nick, in a virtual office. She explains what causes a fear of heights and how to overcome it, then takes you into the atrium of an office block and asks, “Which of the 10 floors do you want to start off with?”. You go up to whichever floor you selected and carry out a range of tasks: it might be just standing by the edge, rescuing a cat from a tree, or traversing a rickety walkway. In this way you can learn that your fears are inaccurate and misguiding your behaviour, because actually nothing bad happens.

How did you measure improvement?

It’s a series of questions on clinical assessments – all these questionnaires are validated against performance at real heights. People’s fears came down on average by two-thirds, and 69 per cent no longer met the trial entry criteria. It’s not a direct comparison, but compared to other trials that use face-to-face therapy, the effects are almost double. I was surprised the results were even better than expected. There’s no reason why it shouldn’t help people with a milder fear of heights.

More like this

One of the beautiful things about VR is you know it’s not real, so you try things you would never do. Then when you come up against much more mundane heights in day-to-day life, you have the confidence that you can deal with it.

When will VR treatments be available?
Over the next couple of months, we’re piloting this treatment in NHS psychological services, putting the VR kit into clinics. In future years, people could do the treatments at home, but at the moment they don’t have the equipment.

Oxford VR is employing people from the games industry to make these sorts of treatments much more fun and engaging. We think we can learn a lot from the computer games industry in terms of making mental health treatment much more appealing to people.

This is an extract from issue 326 of BBC Focus magazine.

Subscribe and get the full article delivered to your door, or download the BBC Focus app to read it on your smartphone or tablet. Find out more


Follow Science Focus on Twitter, Facebook, Instagram and Flipboard


Jason Goodyer
Jason GoodyerCommissioning editor, BBC Science Focus

Jason is the commissioning editor for BBC Science Focus. He holds an MSc in physics and was named Section Editor of the Year by the British Society of Magazine Editors in 2019. He has been reporting on science and technology for more than a decade. During this time, he's walked the tunnels of the Large Hadron Collider, watched Stephen Hawking deliver his Reith Lecture on Black Holes and reported on everything from simulation universes to dancing cockatoos. He looks after the magazine’s and website’s news sections and makes regular appearances on the Instant Genius Podcast.