One of my oldest memories survives from an unknown year in the early 1980s, when I was 6 or 7, and takes place near the top of a long-since-forgotten mountain in Acadia National Park. I had been following my parents as usual when we stepped out from the canopied shelter of the trail onto a broad, sloping slab of Maine granite. The view was quintessential Acadia: lush forest, rocky coast, and vast ocean far below. But instead of continuing along the trail, I froze—my legs unsteady, my sense of balance gone. I felt, irrationally, as though one stumble or the lightest gust of wind would send me toppling off the mountain.
That memory endures because those sensations still return. Crossing a bridge, climbing a fire tower, on other mountain summits and ridges: Any elevated, open space leaves me uneasy on my feet. I’ll reach for something to hold—a railing, a tree, a shoulder—and try to keep my eyes away from the edge. I move like I’m navigating a dark room. I hold my arms out and step with painful delicacy in an effort to avoid any hazards, real or imagined. Balance ceases to be an unconscious function as I find my mind grappling with how to maintain it.
To be clear, mine isn’t a debilitating phobia. I don’t need to avoid staircases or elevators or other everyday obstacles that people with a severe fear of heights, known as acrophobia, might find insurmountable. On a questionnaire that quantifies the fear of heights, I scored a 63 out of 120; a tally in the 70 to 80 range and above is suggestive of acrophobia.
I still go many places I know will trigger a certain amount of anxiety and only sometimes regret it. Even so, I can’t imagine ever traversing Katahdin’s Knife Edge or descending into the Grand Canyon. Would I prefer a different reality? Sure. But until I began writing this story, I had never thought about this phobia as something I could address—or even eliminate.
Fear is a natural reaction to danger, a survival instinct without which we would struggle to stay alive. Studies have shown that human babies fear falling and loud noises even before they’ve learned the dangers of either. Other fears develop through experience. A phobia is one of those fears taken to an irrational extreme. I particularly like Merriam-Webster’s definition of phobia: abnormal dread. It’s a fight-or-flight reaction when neither fight nor flight is necessary.
The amygdala, a pair of small, almond-shaped clusters of nuclei in the brain, triggers our reactions to fear. When these clusters sense danger they alert a nearby portion of the brain, the hypothalamus, which in turn launches a series of anxiety-related responses in the body. These can include the release of adrenaline, an increased heart rate, rapid breathing, and sweating. “The amygdala is designed, essentially, to keep us alive, to keep us safe,” says Todd Farchione, Ph.D., a clinical psychologist, teacher, and researcher at the Center for Anxiety & Related Disorders (CARD) at Boston University.
Each of us has unique wiring and, in some cases, past experiences or even traumas that dictate the level of our fear responses. That means two people sharing an experience might feel very different levels of fear. If you imagine sensitivity to heights existing on a spectrum, extreme acrophobia would occupy one end. For these people, “The warning mechanism is sort of overfunctioning,” says Cynthia Jones, a therapist at Duke University. “[It’s] like a fire alarm that doesn’t turn off.”
At the opposite end of the spectrum, you would find people like the rock climber Alex Honnold, whose fame comes from, among other things, climbing Yosemite National Park’s Half Dome without ropes. This trait is called “high sensation seeking.” In 2016, neuroscientists scanned Honnold’s brain while showing him a battery of images considered stimulating or stressful to the average person, ranging from dramatic climbing scenes to gruesome corpses. The scan showed very little activity in his amygdala. (The writer J.B. MacKinnon chronicled Honnold’s brain scan for Nautilus magazine last year.) In other words, Honnold needs to go to extremes to stimulate his amygdala. He could climb a sheer cliff without ropes and not experience the anxiety I feel when I step out above treeline on a perfectly safe trail.
So, where do I land on the spectrum? On a phone call with Jones, I describe the very specific conditions that trigger my fear of heights. “Our brains are confused a lot of the time,” she says. “Phobias and heightened fear responses are because you haven’t had a chance to practice and work it out.” It’s true I don’t often experience the factors that trigger my fear. That’s good news for my day-to-day life, but it also means it’s much easier for me to avoid charged situations than it is to test myself in them.
For years, I called my fear of heights “vertigo” because I didn’t know better. But I don’t suffer from dizziness, migraines, or, really, any of the classic vertigo symptoms. At some point I picked up the term acrophobia, and that was that—a reality I dealt with any time a trail crept too close to the edge of a ravine and then put aside as soon as I returned to a lower elevation. Then, five years ago, I flew to Montana to join an AMC group for a week in Glacier National Park. I don’t recall thinking about heights at all before the trip, but almost immediately upon entering the park, my internal alarm went off.
Our first hike began at Logan Pass, near the visitor center that sits on the Continental Divide, more than 6,600 feet in elevation. Extending northwest above a deep valley is the Highline: a flat, easy trail traversed by scores of people every day. We saw backpackers, families with little kids, and tourists walking in blue jeans and sandals. Minutes into the hike, we reached a sheer cliff, our route crossing a shelf cut into the mountainside. My heartbeat quickened, and my hands started sweating. I felt a familiar dread as adrenaline surged into my veins.
As usual in these situations, I grew hyperaware of my environment, everything around me a potential hazard. The ledge was covered in gravel, so I imagined an errant step sending me sliding toward the rim. With each stride, I lifted my foot higher than necessary, even though there wasn’t anything I could possibly trip on. The only safety measure was a cable bolted into the cliff and covered by lengths of green garden hose—a peculiar detail that has stuck in my mind because I grasped it tightly in my right hand. Focusing my eyes on the backpack directly in front of me, I inched forward. Eventually the drop-off to our left eased in pitch, and my brain began to settle down.
This anxiety is exhausting, and I couldn’t get to our midhike snack break fast enough. Once seated, no longer needing to move or balance, no longer bombarded by perceived danger, I relaxed. When we began hiking out the way we had come, I noticed something peculiar: I wasn’t as uncomfortable. This pattern played out the rest of the week as we crisscrossed the park. Any time the left side of my body faced the downslope, the familiar anxiety flooded back, but when my right side was facing out, I felt significantly more secure, if not exactly comfortable. This, I thought, was a significant clue.
In the years since, I’ve mentioned this experience to friends, family, and, for this story, therapists. Their theories run the gamut: something to do with peripheral vision? An inner ear condition? Being right-handed? Then I read about something called “visual height intolerance,” which can occur in open spaces where we lack the typical visual cues we use for balance. Rather than getting closer to understanding, I felt more confused than ever.
The definition of a phobia—that is, an irrational fear—seems so simple. But what is “rational,” especially given the real dangers of the outdoors? Experiencing fear while standing on the top floor of a skyscraper behind thick glass panels seems irrational to me, but I’d argue that standing at the same height on a narrow trail involves actual peril. Risk is an ever-present reality on any trail or mountain—all the more so for someone uneasy in that setting. So, if this is my reality but I love hiking, how do I approach treating such a nebulous concept?
“The treatment that we do is very exposure-based,” says CARD’s Todd Farchione. Through controlled exposures to the circumstances that trigger acrophobia, Farchione helps patients confront and deconstruct their fear. This has included taking patients out onto the fire escape near his office and venturing to a nearby hotel, where multiple floors look down on an open lobby. Some therapists, including Cynthia Jones at Duke, use the same approaches with virtual reality instead of real-life exposure.
Remarkably, exposure therapy sessions can have nearly immediate impacts. “[In] anywhere from one to two days, you can see some pretty significant gains,” Farchione says. Jones agrees, saying that a motivated patient might conclude therapy after five one-hour sessions. For results to endure, though, patients must continue to expose themselves to their fear. “[The brain] is the equivalent of any other muscle,” Jones says. “If you don’t keep it up, it will default to the old ways.”
Mindfulness exercises are another major component of dealing with a phobia. Jones tells me she helps patients develop breathing, relaxation, and imagination techniques they can then use to moderate their nervous systems.
A few weeks after speaking with Farchione, I visited CARD to undergo a full psychological assessment. A therapist, Michelle Bourgeois, led me to a small room and sat down across from me. She held a neat stack of paper, maybe 30 pages thick, containing a detailed questionnaire. She began on page one and slowly worked through questions about general anxiety, worries, fears, family, substance abuse. It would take us nearly four hours to complete the entire packet.
She eventually arrived at the first heights-related question: Does driving across bridges make me nervous? Sometimes, I said, especially if I’m in a lane near the edge. I thought hard about how I feel in these circumstances: acute awareness of the lane lines, my hands gripping the wheel tighter.
“What are you afraid will happen?” she asked. I paused. I’d never considered this. I suppose it involves driving off the bridge, although I can’t recall ever thinking about that exact scenario. She returned to this question—what are you afraid will happen?—again and again.
Bourgeois picked up on some themes: social anxiety and a tendency toward self-preservation. Once she’d worked through the standard questions, she began focusing more specifically on my fear of heights. I described the anxiety I feel in high, exposed areas: the lack of control, the hyperawareness. I was as specific as possible, hoping some detail might provide the missing clue she needed to explain what’s going on in my head.
I should’ve known better. “You’re probably never going to get the 100-percent answer you’re looking for,” she says. “So we have to operate with some uncertainty.” What emerges from our conversation is that other anxieties—minor but always present—are related to my very specific fear of heights. This fits CARD’s treatment approach, known as the Unified Protocol for the Treatment of Emotional Disorders. That’s a long name for a simple concept: CARD therapists see individual anxieties and fears not as isolated issues but as part of a complex whole, which they treat as one.
A week later after our appointment, Bourgeois calls me. She has reviewed my assessment with her colleagues and has a diagnosis. Three of them, actually, all on the mild side, but all tied together in my brain: a fear of heights, social anxiety, and something she calls “other specified anxiety disorder,” which, in my case, is basically a tendency to worry.
Bourgeois recommends therapy to address all three. Will I do it? I’m not sure—something else to worry about.
LEARN MORE: ANXIETY AND PHOBIA RESOURCES
Center for Anxiety and Related Disorders at Boston University (CARD)
CARD staff conducts research and provides treatment for a wide range of conditions. They also refer patients to therapists worldwide.
Anxiety and Depression Association of America
Visit this nonprofit website for disorder fact sheets, blogs, self-help book recommendations, therapy advice, a therapist database, and more. adaa.org
Association for Behavioral and Cognitive Therapies
The website of this professional therapists association provides FAQs, self-help book recommendations, disorder fact sheets, a therapist database, and more.