No-Pills Anxiety Buster

By Dr. David H. Rosmarin

All phobias involve marked and persistent fear or avoidance of specific objects or situations. Common focal points include spiders, dogs, enclosed spaces, darkness, thunderstorms, flying, spiders, snakes, injections, dentists, and–you guessed it–heights.

Like other phobias, acrophobia often causes limited impairment. Phobic individuals generally function very well day-to-day and are highly accomplished. What’s their trick? They find ways to avoid facing their fears–for example, they might always ask for a room on a low floor in a hotel, follow detours around bridges, not look out windows, avoid balconies, or opt for stairs instead of elevators. However, phobias can limit a person’s choices in life such as where to live or take a job, and they can also interfere in subtle ways in relationships. Occasionally, it is not possible to avoid one’s fears (e.g., all the low-floor hotel rooms may be booked) and the phobic individual is “stuck.” Plus, in some cases, functioning can be severely impaired. One recent patient had such severe acrophobia that he would drive two to three hours out of his way to avoid traversing any overpasses!

The first-line treatment for acrophobia as well as all other specific phobias is called “exposure therapy.” In a nutshell, the patient builds a rank-ordered list of situations in which he or she will experience anxiety and fear, and then “exposes” himself or herself to each of them one-by-one until the anxiety subsides. No truly dangerous situations are ever faced–we don’t dangle people outside a high-floor window by a rope! We might challenge a patient to press their face up against the glass of a skyscraper window. Exposure therapy teaches the patient that their fears are not grounded in reality and there is truly nothing to be scared of. Heights don’t kill people as long as you follow certain basic rules. As Mary Baker Eddie is reputed to have said, “FEAR is an acronym for False Evidence Appearing Real.”

Recent research has established the efficacy of intensive exposure programs in which specific phobias are treated in as little as three hours. Imagine that just half of one day could make the difference! v

David H. Rosmarin, Ph.D., is an instructor in the Department of Psychiatry at Harvard Medical School and Director of the Center for Anxiety in Manhattan, a clinical-research facility with a focus on the Jewish community. He can be reached at


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