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(15.04.2025) Fear of heights is one of the most common specific phobias - cognitive behavioral therapy at the University Medical Center Freiburg shows how those affected can overcome their fear.

"Anxiety disorders can be treated very effectively - especially with the help of modern methods such as virtual reality (VR)," says Jasmin Peifer, a psychologist in the Experimental Psychiatry and Psychotherapy working group at the Department of Psychiatry and Psychotherapy at the Freiburg University Medical Center. "VR enables a realistic but logistically feasible confrontation with the anxiety-inducing situation - for example with height, without actually having to climb a tower." Studies show that confrontation in VR achieves comparable effects to those in a real environment. But how exactly does this form of therapy work? And what experiences do patients have with it?

A platform against anxiety

A central component of cognitive behavioral therapy is exposure: the targeted confrontation with the fear-inducing situation. "In the case of fear of heights, this means gradually exposing yourself to the height," explains Peifer. This is exactly where the innovative VR application comes in. In VR, you move through three different virtual scenarios - a meadow, a city and a mountain landscape. Patients stand on a virtual platform that gradually moves upwards. Depending on individual anxiety levels, the height can be up to 75 meters. The special feature: Patients can set their own pace and have the opportunity to familiarize themselves with the situation at each height level before the platform rises further. "How far up the platform goes depends on the individual's level of anxiety - so the confrontation can be flexibly adapted to the patient's needs," says study director PD Dr. Miriam Schiele, Head Psychologist at the Department of Psychiatry and Psychotherapy.

Scientifically sound, implemented in practice

The therapy is embedded in a structured setting. It begins with three information sessions in which the basics of cognitive behavioral therapy are explained and individual fears are classified. This is followed by six so-called exposure sessions with a final reflection session. The entire study therapy lasts around six weeks. "Each session lasts one to two hours. This leaves enough time to deal with the anxiety in peace," explains Peifer.

The advantage: VR technology creates situations that would be difficult or impossible to reproduce in reality - such as hovering over a city or standing on a narrow platform at a lofty height. At the same time, classic elements of behavioral therapy such as thought protocols and emotion analyses are integrated.

Concrete help for everyday life

In addition to the actual confrontation with heights, patients receive well-founded information on physiological reactions and the psychological mechanisms of fear of heights. Cognitive restructuring is also part of the sessions - i.e. the targeted questioning and re-evaluation of fear-inducing thoughts. "The aim is for those affected to be able to deal with heights more confidently, not only in VR but also in everyday life," emphasizes Peifer. VR therapy is offered as part of a research project for interested patients.

Anyone with a fear of heights can find more information about the study and the online screening at the following link:https://stuz-redcap.ukl.uni-freiburg.de/surveys/?s=PT343CL7JK77CNAC

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