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The use of virtual reality in acrophobia research and treatment
Abstract
Acrophobia, or fear of heights, is a widespread and debilitating anxiety disorder affecting perhaps 1 in 20 adults. Virtual reality (VR) technology has been used in the psychological treatment of acrophobia since 1995, and has come to dominate the treatment of numerous anxiety disorders. It is now known that virtual reality exposure therapy (VRET) regimens are highly effective for acrophobia treatment. This paper reviews current theoretical understanding of acrophobia as well as the evolution of its common treatments from the traditional exposure therapies to the most recent virtually guided ones. In particular, the review focuses on recent innovations in the use of VR technology and discusses the benefits it may offer for examining the underlying causes of the disorder, allowing for the systematic assessment of interrelated factors such as the visual, vestibular and postural control systems.
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“iVR has been extensively researched beyond specific phobias, and reports have validated a panoramic impact on both stress-related and chronic anxiety disorders [24,25].”
From SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia (2024) · cites this paper as [25]
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“Emotional and physical responses to height exposure are so similar in VR compared to real life that it can and has been used as a tool for exposure therapy for treatment of acrophobia (e.g., Coelho et al., 2009).”
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Virtual Reality, Visual Cliffs, and Movement Disorders
Kaur, R., Lin, X., Layton, A., Hernandez, M. E., & Sowers, R. B. (2018) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2018.8512246 · Cited by 6
“Virtual reality (VR) technologies can provide realistic visual feedback of cliff scenarios, allowing for a range of studies of acrophobic responses [11], [12], [13], [14], [15], [16], [17], [18], particularly those which are ocular [19], [20], [21], [22], [23], [24].”
BackgroundAltered brain function in patients with acrophobia: A voxel-wise degree centrality analysis
Guo, M., Zhong, Y., Xu, J., Zhang, G., Xu, A., Kong, J., Wang, Q., Hang, Y., Xie, Y., Wu, Z., et al. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.05.058 · Cited by 7
Virtual Reality in Evidence-Based Psychotherapy
Szentgotai, A., Opri, D., & Davi, D. (2010) · InTech eBooks · doi:10.5772/13130 · Cited by 6
“…pointed out that motion combined with simulated height, rather that height per se, lead to the phobic response (Coelho et al., 2006; Coelho et al., 2008), suggesting the need to also explore visuo-vestibular and motion mechanisms as possible diathesis factors in this disorder (Coelho et al., 2009).”
BackgroundCrawford, M. T., Maymon, C., Miles, N. L., Blackburne, K., Tooley, M., & Grimshaw, G. M. (2024) · Cognition & Emotion · doi:10.1080/02699931.2023.2300748 · Cited by 5
“The evidence that participants were experiencing realistic fear is further supported by studies that use similar height-based VR simulations (Cle-worth et al., 2012; Coelho et al., 2009; El Basbasse et al., 2023; Gromer et al., 2019; Kisker et al., 2019; Nielsen et al., 2022).”
ResultCaravas, P., Kritikos, I., Alevizopoulos, G., & Koutsouris, D. (2021) · Lecture notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering · doi:10.1007/978-3-030-76066-3_13 · Cited by 5
HRV-Based Detection of Fear of Heights in a VR Environment
Arpaïa, P., Barbato, S., D’Errico, G., Mastrati, G., Moccaldi, N., Robbio, R., & Wriessnegger, S. C. (2023) · Lecture notes in computer science · doi:10.1007/978-3-031-43401-3_33 · Cited by 5
Healing anxiety disorders with glucocorticoids
Sandi, C. (2011) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1103410108 · Cited by 5
“These observations support the popularity, since its outset in 1995, of virtual reality exposure over other behavioral therapies for the treatment of height phobia (10).”
BackgroundThe Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation
Chander, H., Freeman, H. R., Hill, C. M., Hudson, C. R., Arachchige, S. N. K. K., Turner, A. J., Jones, J. A., & Knight, A. C. (2022) · Clinical and Translational Neuroscience · doi:10.3390/ctn6020015 · Cited by 5
“VR has also been used successfully as a rehabilitation and intervention tool for Acrophobia through the virtual reality exposure therapy (VERT) [34].”
MethodA New Experimental Paradigm to Manipulate Risk in Human-Automation Research
Hoesterey, S., & Onnasch, L. (2022) · Human Factors The Journal of the Human Factors and Ergonomics Society · doi:10.1177/00187208221133878 · Cited by 4
“The emotional and physical responses to altitude exposure in VR are similar enough to real life that it has been used as a tool for exposure therapy for the treatment of acro-phobia (e.g., Coelho et al., 2009).”
MethodVirtual Reality Exposure Therapy
Turman, M. L., Olden, M., Emrich, M., & Difede, J. (2024) · CBT: science into practice · doi:10.1007/978-3-031-72720-7_4 · Cited by 5
Implementation of the MOTEK CAREN system in behavioural therapy for patients with anxiety disorders.
Krysta, K., Wilczyński, K. M., Paliga, J., Szczęsna, A., Wojciechowska, M., Martyniak, E., & Krzystanek, M. (2016) · PubMed · Cited by 4
The role of different sensory stimuli in an at height simulation
Shah, D., & Lawson, G. (2025) · Applied Ergonomics · doi:10.1016/j.apergo.2025.104559 · Cited by 3
Gutekunst, M., Geuss, M. N., Rauhoeft, G., Stefanucci, J. K., Kloos, U., & Mohler, B. J. (2014) · Reutlingen University Academic Bibliography (Reutlingen University) · doi:10.2312/ve.20141358 · Cited by 3
Is a Combination of Pharmacotherapy and Psychotherapy Superior to Each Alone?
Choi, K., & Kim, Y. (2017) · Springer eBooks · doi:10.1007/978-981-10-6577-4_21 · Cited by 4
Hyperion : A Simulation of High Places in the Form of Virtual Reality for Acrophobia Sufferers
Lengkong, O. H., & Bororing, J. (2020) · International Conference on Cybernetics and Intelligent System (ICORIS) · doi:10.1109/icoris50180.2020.9320824 · Cited by 3
“…by trauma, parenting styles as well as one's mindset with symptoms in the form of great anxiety when anticipating heights, immediate reactions when at a height such as kneeling, hiking, or looking for something to hold on to, include stair, elevator, plane travel, also can lead to vertigo[1][2][3].”
BackgroundApplications of the Metaverse in Medicine and Healthcare
Mittal, V., Upadhyay, P., & Sharma, A. (2024) · Information systems engineering and management · doi:10.1007/978-3-031-72418-3_7 · Cited by 3
Exposure Based Therapy pada Fobia Ketinggian
Bahanan, F., & Yulianti, E. (2020) · Jurnal Psikiatri Surabaya · doi:10.20473/jps.v8i1.15865 · Cited by 3
Fish, M. T. (2011) · The Scholarship East Carolina University's Institutional Repository (East Carolina University) · Cited by 3
Badeja, D., Schier, F., McGinity, M., & Hoyer, J. (2026) · Psychotherapy Research · doi:10.1080/10503307.2025.2534978 · Cited by 2
“While VR has been demonstrated to be effective in inducing and treating fear of heights (Coelho et al., 2009), MR’s validity and practicability in this particular context has not yet been explored.”
VR for Specific Phobias: a Perspective on Adaptive and Physiological Feedback-Based Exposure Therapy
Ciurlia, M., Paiano, M., Rubino, M., D’Errico, G., Pellegrino, G., Barba, M. C., & Paolis, L. T. D. (2025) · Lecture notes in computer science · doi:10.1007/978-3-031-97763-3_20 · Cited by 2
Playful User-Generated Treatment
Volkmar, G., Alexandrovsky, D., Smeddinck, J. D., Herrlich, M., & Malaka, R. (2020) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3383668.3419893 · Cited by 2
“The immersive characteristics of reality-altering technologies such as virtual reality ( VR ) open avenues for novel modes of treatment and facilitate the democratization of therapy [6, 18, 22, 28].”
BackgroundCognitive Behavior Therapy of Urinary Incontinence Phobia: A Case Report
Tan, T., & Lim, L. E. C. (2015) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2015.51009 · Cited by 2
“Although treatment has been adapted to target a wide variety of phobic conditions [11]-[14], the literature is sparse on treatment success with the phobia of urinary incontinence.”
BackgroundTowards Early Diagnosis of Dementia Using a Virtual Environment
Shamsuddin, S. N. W., Ugail, H., Lesk, V. E., & Walters, E. R. (2013) · Lecture notes in computer science · doi:10.1007/978-3-642-38803-3_13 · Cited by 2
La Video Game Therapy® Un approccio innovativo integrato
Bocci, F., & Girelli, A. (2024) · RIVISTA SPERIMENTALE DI FRENIATRIA · doi:10.3280/rsf2024-003006 · Cited by 1
VRSPi: towards a neuroadaptive VR exposure therapy system for spider phobia
Wriessnegger, S. C., Kiatthaveephong, S., Leitner, M., & Kostoglou, K. (2026) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2026.1717588 · Cited by 1
“…have shown significant reductions in subjective fear and physiological arousal after repeated sessions (Francová et al., 2025), with VR sessions often achieving similar therapeutic gains in less time than real-world exposures (Coelho et al., 2009; Balan et al., 2019; Azimisefat et al., 2022).”
RELACIÓN ENTRE LOS TRASTORNOS POR ANSIEDAD Y ALTERACIONES DEL OÍDO INTERNO
Urzola, C., & Chica-Urzola, H. L. (2010) · Cited by 1
Virtual reality can help to develop a new reality
Brakoulias, V. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412455852 · Cited by 1
“In a study where VRET was used to treat acrophobia, it was found that anxiety arose not only in the context of height, but as a result of the combined effect of height with motion (Coelho et al., 2009).”
BackgroundExploring Virtual Reality for Neural Rehabilitation and Phobia Treatment
Vargas-Herrera, D., Oropeza-Ramos, L. A., Cabrera, O., Caldelas, I., Brambila-Paz, F., & Montúfar‐Chaveznava, R. (2019) · Communications in computer and information science · doi:10.1007/978-3-030-16785-1_4 · Cited by 1
“About 5% of the general population suffer from acro-phobia [19].”
BackgroundVirtual Reality in the Treatment of Acrophobia
Maravalhas, V., Marques, A. J., de Sousa, S., Monteiro, P. R. R., & de Almeida, R. S. (2021) · Advances in intelligent systems and computing · doi:10.1007/978-3-030-72657-7_53 · Cited by 1
MRI examination teaching system by using virtual reality (VR)
Lu, T.-C., Li, W., You, M.-R., Chen, C. C., Chai, J., & Wu, Y.-Y. (2021) · International Journal of Applied Science and Engineering · doi:10.6703/ijase.202109_18(5).011 · Cited by 1
“In the past research, it has been confirmed that virtual reality can cause acrophobia of patients in high-rise situations (Coelho et al., 1995).”
BackgroundInfluentialWhen Fear Overshadows Perceived Plausibility: The Influence of Incongruencies on Acrophobia in VR
Brübach, L., Celikhan, D., Rüffert, L., Westermeier, F., Latoschik, M. E., & Wienrich, C. (2025) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr59515.2025.00089 · Cited by 1
“Acrophobia, affecting about 1 in 20 adults [8], was chosen to evoke fear even in a non-clinical sample [12, 18].”
Metadata
- Authors
- Coelho, C. M., Waters, A. M., Hine, T. J., & Wallis, G.
- Affiliations
- The University of Queensland (AU)
- Griffith University (AU)
- Corresponding author
- Coelho, Carlos M.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2009-06
- Volume
- 23
- Issue
- 5
- Pages
- 563-574
- ISSN
- 0887-6185 (ISSN-L)
- OpenAlex
- W2148405318
- Cited by
- 127
- References
- 161
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 12 · 2023: 9 · 2022: 5 · 2021: 12 · 2020: 17 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 6 · 2015: 6 · 2014: 5 · 2013: 9 · 2012: 2
- FWCI
- 0.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- acrophobia, virtual reality exposure therapy, fear of heights, anxiety disorders, exposure therapy, virtual reality, vestibular system, postural control, visual perception, treatment efficacy
- MeSH terms
- Fear, Humans, Locomotion, Motion Perception, Phobic Disorders, Photic Stimulation, Posture, User-Computer Interface, Vestibule, Labyrinth, Visual Perception, Cognitive Behavioral Therapy, Self Efficacy
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