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Thomas Brandt – One of the best experts on this subject based on the ideXlab platform.

  • Acrophobia and visual height intolerance: advances in epidemiology and mechanisms
    Journal of Neurology, 2020
    Co-Authors: Doreen Huppert, Max Wuehr, Thomas Brandt

    Abstract:

    Historical descriptions of fear at heights date back to Chinese and Roman antiquity. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and Acrophobia at the severest end of the spectrum. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including Acrophobia in 28% of adults (32% in women; 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. A high comorbidity was found with psychiatric disorders (e.g. anxiety and depressive syndromes) and other vertigo syndromes (e.g. vestibular migraine, Menière’s disease), but not with bilateral vestibulopathy. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. Visual exploration is preferably reduced to fixation of the horizon. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Anxiety is the critical factor in visual height intolerance and Acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy.

  • Acrophobia and visual height intolerance: advances in epidemiology and mechanisms.
    Journal of neurology, 2020
    Co-Authors: Doreen Huppert, Max Wuehr, Thomas Brandt

    Abstract:

    Historical descriptions of fear at heights date back to Chinese and Roman antiquity. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and Acrophobia at the severest end of the spectrum. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including Acrophobia in 28% of adults (32% in women; 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. A high comorbidity was found with psychiatric disorders (e.g. anxiety and depressive syndromes) and other vertigo syndromes (e.g. vestibular migraine, Meniere’s disease), but not with bilateral vestibulopathy. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. Visual exploration is preferably reduced to fixation of the horizon. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Anxiety is the critical factor in visual height intolerance and Acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy.

  • A New Questionnaire for Estimating the Severity of Visual Height Intolerance and Acrophobia by a Metric Interval Scale
    Frontiers in neurology, 2017
    Co-Authors: Doreen Huppert, Eva Grill, Thomas Brandt

    Abstract:

    Aims: To construct and validate a short scale for assessment of the severity of visual height intolerance and Acrophobia. Methods: The questionnaire was developed from two earlier representative epidemiological studies (n=5,529). Items were applied in a telephone survey of a representative population-based sample. Results: A total of 1,960 persons were included. The life-time prevalence of visual height intolerance was 32.7% (f: 36.1%; m: 28.4%); 12% of these persons fulfilled the psychiatric criteria of Acrophobia. Rasch analysis of 11 items on severity, symptoms, and triggers resulted in an 8- item scale with good fit to the model. The score differentiated well between persons with and without Acrophobia. The distribution of the scores on the metric scale of the questionnaires of those individuals with Acrophobia is separate and distinct from that of susceptibles without Acrophobia, although there is some overlap. Conclusions: Our proposed short questionnaire (vHISS, see appendix) allows a continuous quantification of the severity of visual height intolerance within a metric interval scale from 0 to 13. The diagnosis of Acrophobia can be established by including two additional questions.

Doreen Huppert – One of the best experts on this subject based on the ideXlab platform.

  • Acrophobia and visual height intolerance: advances in epidemiology and mechanisms
    Journal of Neurology, 2020
    Co-Authors: Doreen Huppert, Max Wuehr, Thomas Brandt

    Abstract:

    Historical descriptions of fear at heights date back to Chinese and Roman antiquity. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and Acrophobia at the severest end of the spectrum. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including Acrophobia in 28% of adults (32% in women; 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. A high comorbidity was found with psychiatric disorders (e.g. anxiety and depressive syndromes) and other vertigo syndromes (e.g. vestibular migraine, Menière’s disease), but not with bilateral vestibulopathy. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. Visual exploration is preferably reduced to fixation of the horizon. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Anxiety is the critical factor in visual height intolerance and Acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy.

  • Acrophobia and visual height intolerance: advances in epidemiology and mechanisms.
    Journal of neurology, 2020
    Co-Authors: Doreen Huppert, Max Wuehr, Thomas Brandt

    Abstract:

    Historical descriptions of fear at heights date back to Chinese and Roman antiquity. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and Acrophobia at the severest end of the spectrum. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including Acrophobia in 28% of adults (32% in women; 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. A high comorbidity was found with psychiatric disorders (e.g. anxiety and depressive syndromes) and other vertigo syndromes (e.g. vestibular migraine, Meniere’s disease), but not with bilateral vestibulopathy. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. Visual exploration is preferably reduced to fixation of the horizon. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Anxiety is the critical factor in visual height intolerance and Acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy.

  • A New Questionnaire for Estimating the Severity of Visual Height Intolerance and Acrophobia by a Metric Interval Scale
    Frontiers in neurology, 2017
    Co-Authors: Doreen Huppert, Eva Grill, Thomas Brandt

    Abstract:

    Aims: To construct and validate a short scale for assessment of the severity of visual height intolerance and Acrophobia. Methods: The questionnaire was developed from two earlier representative epidemiological studies (n=5,529). Items were applied in a telephone survey of a representative population-based sample. Results: A total of 1,960 persons were included. The life-time prevalence of visual height intolerance was 32.7% (f: 36.1%; m: 28.4%); 12% of these persons fulfilled the psychiatric criteria of Acrophobia. Rasch analysis of 11 items on severity, symptoms, and triggers resulted in an 8- item scale with good fit to the model. The score differentiated well between persons with and without Acrophobia. The distribution of the scores on the metric scale of the questionnaires of those individuals with Acrophobia is separate and distinct from that of susceptibles without Acrophobia, although there is some overlap. Conclusions: Our proposed short questionnaire (vHISS, see appendix) allows a continuous quantification of the severity of visual height intolerance within a metric interval scale from 0 to 13. The diagnosis of Acrophobia can be established by including two additional questions.

Guy Wallis – One of the best experts on this subject based on the ideXlab platform.

  • Rapid Communication The Role of Self-Motion in Acrophobia Treatment
    , 2015
    Co-Authors: Carlos M Coelho, Guy Wallis, Jorge A. Santos, Jennifer Tichon, Ph. D, Carlos Silva

    Abstract:

    Acrophobia is a chronic, highly debilitating disorder preventing sufferers from engaging with high places. Its etiology is linked to the development of mobility during infancy. We evaluated the efficacy of various types of movement in the treatment of this disorder within a virtual reality (VR) environment. Four men and four women who were diagnosed with Acrophobia were tested in a virtual environment reproducing the balcony of a ho-tel. Anxiety and behavioral avoidance measures were taken as participants climbed outdoor stairs, moved side-ways on balconies, or stood still. This took place in both real and virtual environments as part of a treatment evaluation study. Participants experienced an elevated level of anxiety not only to increases in height but also when required to move laterally at a fixed height. These anxiety levels were significantly higher than those elicited by viewing the fear-invoking scene without movement. We have demonstrated a direct link between any type of movement at a height and the triggering of Acrophobia in line with earlier developmental studies. We suggest that recalibration of the action-perception system, aided by VR, can be an important adjunct to standard psychotherapy. 72

  • deconstructing Acrophobia physiological and psychological precursors to developing a fear of heights
    Depression and Anxiety, 2010
    Co-Authors: Carlos M Coelho, Guy Wallis

    Abstract:

    Background: Acrophobia is one of the most prevalent phobias, affecting as many as 1 in 20 individuals. Of course, heights often evoke fear in the general population too, and this suggests that Acrophobia might actually represent the hypersensitive manifestation of an everyday, rational fear. In this study, we assessed the role of sensory and cognitive variables in Acrophobia. Methods: Forty-five participants (Mean age 25.07 years, 71% female) were assessed using a booklet with self-reports as well as several behavioral measures. The data analysis consisted in multivariate linear regression using fear of heights as the outcome variable. Results: The regression analyses found that visual field dependence (measured with the rod and frame test), postural control (measured with the Sharpened Romberg Test), space and motion discomfort (measured with the Situational Characteristics Questionnaire), and bodily symptoms (measured with the Bodily Sensation Questionnaire) all serve as strong predictors for fear of heights (Adjusted r(2) =.697, P <.0001). Trait anxiety (measured with the State Trait Anxiety Inventory Form Y-2) was not related with fear of heights, suggesting that this higher order vulnerability factor is not necessary for explaining this particular specific phobia in a large number of individuals. Conclusion: The findings reveal that fear of heights is an expression of a largely sensory phenomena, which can produce strong feelings of discomfort and fear in the otherwise calm individuals. We propose a theory that embraces all these factors and provides new insight into the aetiology and treatment of this prevalent and debilitating fear. Depression and Anxiety 27:864-870, 2010. (C) 2010 Wiley-Liss, Inc.

  • Deconstructing Acrophobia: physiological and psychological precursors to developing a fear of heights
    Depression and Anxiety, 2010
    Co-Authors: Carlos M Coelho, Guy Wallis

    Abstract:

    Background: Acrophobia is one of the most prevalent phobias, affecting as many as 1 in 20 individuals. Of course, heights often evoke fear in the general population too, and this suggests that Acrophobia might actually represent the hypersensitive manifestation of an everyday, rational fear. In this study, we assessed the role of sensory and cognitive variables in Acrophobia. Methods: Forty-five participants (Mean age 25.07 years, 71% female) were assessed using a booklet with self-reports as well as several behavioral measures. The data analysis consisted in multivariate linear regression using fear of heights as the outcome variable. Results: The regression analyses found that visual field dependence (measured with the rod and frame test), postural control (measured with the Sharpened Romberg Test), space and motion discomfort (measured with the Situational Characteristics Questionnaire), and bodily symptoms (measured with the Bodily Sensation Questionnaire) all serve as strong predictors for fear of heights (Adjusted r(2) =.697, P