What to do
Recognise and understand the symptoms of anxiety
The human anxiety response is a natural part of healthy functioning. When we detect a threat, our sympathetic nervous system activates and starts preparing our body for action. This is known as the fight-or-flight response, and it works to protect us. Many of the unpleasant symptoms of anxiety arise because our body is trying to pump more blood towards our muscles, to prepare us to fight or run away. For example, our heart beats faster and we breathe more quickly to get more oxygen to our muscles, and we get a dry mouth and ‘butterflies’ in our stomach as energy and blood are diverted away from these regions towards our muscles.
Hyperawareness and misinterpretation of these bodily sensations is a common problem in many anxiety disorders, including phobias. In acrophobia, for example, a person who feels nauseous and dizzy when up high might believe that these are signs of an imminent catastrophic fall. This can exacerbate anxiety, because the fear of falling will likely make the physical symptoms even worse.
To avoid misinterpretation and to help you tolerate the anxiety, try to familiarise yourself with the physical symptoms of anxiety. This will help you to see your symptoms for what they are: nothing more than your body’s natural fight-or-flight response. Although we can’t simply decide to switch off this system, the anxiety response doesn’t last forever. Remember: the anxiety will always pass.
Gradually build your tolerance of these symptoms around heights
Graded exposure therapy makes use of the transient nature of anxiety, helping you to tolerate and ride out your body’s anxiety response. The idea is to gradually expose yourself to the thing you fear, starting small and slowly working up to more difficult situations. You practise each step until your anxiety subsides, and this helps you create new memories of experiencing the feared object or situation without feeling anxious. As you practise and become more confident, you overwrite your association between the stimulus and fear in your mind. In time, the once-feared scenario begins to evoke less anxiety.
To start, make a list of situations that trigger your phobia and put them in order from least to most anxiety-provoking. For the easiest steps, you could begin with looking at pictures of heights, or creating mental images of heights. The important thing is to start with things that provoke a small but manageable level of anxiety. You could then move on to include standing near heights (such as an escalator in a shopping centre), then actually using an escalator, and then visiting a tall building.
Try out the easiest situation you have chosen, and stay in that situation until your anxiety subsides and you feel more comfortable. Try to stay focused on the features of the situation or image, engaging with the surroundings rather than focusing on your anxiety. For example, if you’re standing in front of a tall building, how many floors does it have? What colours and textures can you see? Remember that any physical sensations are just the body’s natural response and don’t necessarily mean that you’re in danger. For each step, you might find it helpful to rate your anxiety out of 10 in the first minute, and notice how the rating drops over time. Practise this several times until your anxiety for that particular situation has reduced. You can then try the next step on your list.
Practising relaxation exercises before, during and after exposure can be helpful. For example, try using mindfulness or counting your breath. More information on these can be found in the resources section.
Every individual will vary in the exact scenarios they find most challenging, and how quickly they can move between steps. Try to take small steps that are challenging but manageable. Take your time: leaving the situation before your anxiety has subsided might be counterproductive as you will continue to associate that situation with fear.
For a lot of people with a fear of heights, you can try these principles on your own or with the help of a friend. However, if this is too difficult or your fear is particularly severe, you should attempt these principles only with the support of a trained therapist.
Understand and then challenge your beliefs about heights
While exposure therapy focuses on reducing feelings of anxiety, cognitive therapy exercises focus on a person’s beliefs about heights. Many people with height phobia think something bad will happen when they are up high. For example, you might fear that you will fall over, that the structure will collapse, or that you might throw yourself off. In cognitive therapy, the goal is to help you learn that you are safer than you think, and that your feared outcome about heights won’t actually happen.
Ask yourself some questions. What do you believe might happen when you expose yourself to your fear? How likely do you think it is (on a scale of 1-10) that this would happen? What would be the outcome of it happening? For example, you might believe that if you go up a tall building the structure will collapse: you feel certain that this will happen, and that you would be seriously injured when it does.
Once you’ve answered the above questions about the likelihood of your fears manifesting themselves, you can try some ‘behavioural experiments’. These are a type of exposure activity where you test out your beliefs. For the above example, you could try a behavioural experiment where you go up high and see what happens: whether the structure indeed seems unstable, or whether you do indeed fall. Again, you can start small with your experiments, using relaxation exercises to help you. The idea is that, once you test out your fears, you see that the worst doesn’t actually happen – or that, if something difficult does happen, it’s not as bad as you feared.
Try to spot the ‘safety behaviours’ you use
During these experiments you might also want to identify any safety behaviours you resort to. These are behaviours that we use because we think they help to keep us safe. The most common safety behaviour is avoidance: simply not going anywhere that requires being up high. More subtle examples include closing your eyes, not looking down or over the edges, tightly holding on to something, or focusing your attention on repeating a certain phrase. While these can be helpful in the short term – for example, holding on tight to the railings makes us feel steadier – such behaviours actually act as barriers, preventing us from really engaging with the height. As a result, we’re unable to learn that we are, in fact, safe and able to cope without them. Holding on to the railing, for example, means that we don’t get to learn that we can stand, all on our own, without falling, and so our anxiety persists. Try to identify what defences you use, and then repeat the behavioural experiments without using them.
It is important to note that safety behaviours are very different from helpful coping mechanisms. The former get in the way of us learning that we’re safe without them, while adaptive coping mechanisms (such as relaxation exercises) simply help us to face the difficult situation and to tolerate our anxiety.
Following each behavioural experiment, think about what you’ve learnt. The following questions might be helpful: what happened? Did any of your anticipated fears that you wrote down beforehand happen? What happened instead? What went through your mind – and was that accurate? What happened when you did or didn’t use your defences? What can you learn from this experience? What does it mean for the future?
As with the graded exposure exercise, these exercises can be attempted on your own or with the support of a friend. However, if your fear is severe or you’re struggling to identify your beliefs about heights or the defences that you use, then having the support of a trained therapist is recommended.
