Fear of heights in virtual reality saturates 20 to 40 m above ground

  • Wuehr MaxEmail author
  • Breitkopf Katharina
  • Decker Julian
  • Ibarra Gerardo
  • Huppert Doreen
  • Brandt Thomas
Original Communication


Recent epidemiological studies indicate that about one-third of the general population suffers from a more or less disabling height intolerance, with a relevant impact on quality of life in many of them. Acrophobia, the most severe form of visual height intolerance, has a life-time prevalence of around 5%. Although it is commonly believed that fear of heights should continuously aggravate with increasing elevation, this issue has not been systematically investigated yet. Here, we examined this topic using immersive virtual reality, an established tool in therapy for fear of heights, that allows to flexibly manipulate height stimuli. In a comprehensive cohort (including insusceptible subjects as well as subjects with height intolerance up to acrophobia) height intolerance severity was graded by an established metric scale (vHISS). Participants were randomly exposed to different virtual elevations using a head-mounted display. Behavioral responses to virtual height exposure were analogous to exposure in vivo. Participants exhibited increased anxiety and musculoskeletal stiffening with enhanced high-frequency body sway, to an extend that corresponded to the individual subjective height intolerance rating. For all behavioral responses, we observed a saturation above a certain altitude. Body sway and musculoskeletal stiffening became maximal at 20 m above ground, whereas anxiety saturated above 40 m. These results suggest that fear of heights is characterized by a nonlinear stimulus–response relationship and a dissociation between visual-height-induced bodily and emotional reactions.


Fear of heights Acrophobia Virtual reality Body sway Muscle activity 



This work was supported by the German Federal Ministry of Education and Research (01EO1401).

Author contributions

All of the authors have taken part in the preparation of this manuscript, have reviewed the results, and have approved the final version of this manuscript. M.W., D.H., and T.B. conceptualized and designed the study. M.W., K.B., J.D., G.I., D.H., and T.B. collected, analyzed, and interpreted the data. M.W and K.B wrote the paper.

Compliance with ethical standards

Conflicts of interest

M.W.: no conflicts of interest to be disclosed. K.B.: no conflicts of interest to be disclosed. J.D.: no conflicts of interest to be disclosed. G.I.: no conflicts of interest to be disclosed. D.H.: no conflicts of interest to be disclosed. T.B.: no conflicts of interest to be disclosed.

Ethical standards

TThe study protocol was approved by the Ethics Committee of the University of Munich and was conducted in conformity with the Declaration of Helsinki.

Supplementary material

415_2019_9370_MOESM1_ESM.docx (15 kb)
Supplementary file1 (DOCX 14 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Wuehr Max
    • 1
    Email author
  • Breitkopf Katharina
    • 1
  • Decker Julian
    • 1
  • Ibarra Gerardo
    • 1
  • Huppert Doreen
    • 1
    • 2
    • 3
  • Brandt Thomas
    • 1
    • 2
  1. 1.German Center for Vertigo and Balance DisordersLudwig-Maximilians-University, University HospitalMunichGermany
  2. 2.Institute for Clinical NeurosciencesLudwig-Maximilians-University, University HospitalMunichGermany
  3. 3.Department of NeurologyLudwig-Maximilians-University, University HospitalMunichGermany

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