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Thomas Brandt - One of the best experts on this subject based on the ideXlab platform.
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Acrophobia and visual height intolerance: advances in epidemiology and mechanisms
Journal of Neurology, 2020Co-Authors: Doreen Huppert, Max Wuehr, Thomas BrandtAbstract: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.
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Acrophobia and visual height intolerance: advances in epidemiology and mechanisms.
Journal of neurology, 2020Co-Authors: Doreen Huppert, Max Wuehr, Thomas BrandtAbstract: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.
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A New Questionnaire for Estimating the Severity of Visual Height Intolerance and Acrophobia by a Metric Interval Scale
Frontiers in neurology, 2017Co-Authors: Doreen Huppert, Eva Grill, Thomas BrandtAbstract: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.
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Visual height intolerance and Acrophobia: distressing partners for life
Journal of Neurology, 2016Co-Authors: Hans-peter Kapfhammer, Doreen Huppert, Eva Grill, Werner Fitz, Thomas BrandtAbstract:The course of illness, the degree of social impairment, and the rate of help-seeking behavior was evaluated in a sample of individuals with visual height intolerance (vHI) and Acrophobia. On the basis of a previously described epidemiological sample representative of the German general population, 574 individuals with vHI were identified, 128 fulfilled the DSM-5 diagnostic criteria of Acrophobia. The illness of the majority of all susceptible individuals with vHI ran a year-long chronic course. Two thirds were in the category “persistent/worse”, whereas only one third was in the category “improved/remitted”. Subjects with Acrophobia showed significantly more traumatic triggers of onset, more signs of generalization to other height stimuli, higher rates of increasing intensity of symptom load, higher grades of social impairment, and greater overall negative impact on the quality of life than those with pure vHI. An unfavorable course of illness in pure vHI was predicted by major depression, agoraphobia, social phobia, posttraumatic stress, initial traumatic trigger, and female sex; an unfavorable course in Acrophobia was predicted by major depression, chronic fatigue, panic attacks, initial traumatic trigger, social phobia, other specific phobic fears, and female sex. Help-seeking behavior was astonishingly low in the overall sample of individuals with vHI. The consequences of therapeutic interventions if complied with at all were quite modest. In adults pure vHI and even more so Acrophobia are by no means only transitionally distressing states. In contrast to their occurrence in children they are more often persisting and disabling conditions. Both the utilization of and adequacy of treatment of these illnesses pose major challenges within primary and secondary neurological and psychiatric medical care.
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Visual height intolerance and Acrophobia: clinical characteristics and comorbidity patterns
European Archives of Psychiatry and Clinical Neuroscience, 2015Co-Authors: Hans-peter Kapfhammer, Doreen Huppert, Eva Grill, Werner Fitz, Thomas BrandtAbstract:The purpose of this study was to estimate the general population lifetime and point prevalence of visual height intolerance and Acrophobia, to define their clinical characteristics, and to determine their anxious and depressive comorbidities. A case–control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above was selected. Defined neurological conditions (migraine, Menière’s disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and Acrophobia were assessed. The lifetime prevalence of vHI was 28.5 % (women 32.4 %, men 24.5 %). Initial attacks occurred predominantly (36 %) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. A total of 22.5 % of individuals with vHI experienced the intensity of panic attacks. The lifetime prevalence of Acrophobia was 6.4 % (women 8.6 %, men 4.1 %), and point prevalence was 2.0 % (women 2.8 %; men 1.1 %). VHI and even more Acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later Acrophobia and a significant consequence of previous Acrophobia. VHI affects nearly a third of the general population; in more than 20 % of these persons, vHI occasionally develops into panic attacks and in 6.4 %, it escalates to Acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.
Doreen Huppert - One of the best experts on this subject based on the ideXlab platform.
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Acrophobia and visual height intolerance: advances in epidemiology and mechanisms
Journal of Neurology, 2020Co-Authors: Doreen Huppert, Max Wuehr, Thomas BrandtAbstract: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.
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Acrophobia and visual height intolerance: advances in epidemiology and mechanisms.
Journal of neurology, 2020Co-Authors: Doreen Huppert, Max Wuehr, Thomas BrandtAbstract: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.
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A New Questionnaire for Estimating the Severity of Visual Height Intolerance and Acrophobia by a Metric Interval Scale
Frontiers in neurology, 2017Co-Authors: Doreen Huppert, Eva Grill, Thomas BrandtAbstract: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.
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Visual height intolerance and Acrophobia: distressing partners for life
Journal of Neurology, 2016Co-Authors: Hans-peter Kapfhammer, Doreen Huppert, Eva Grill, Werner Fitz, Thomas BrandtAbstract:The course of illness, the degree of social impairment, and the rate of help-seeking behavior was evaluated in a sample of individuals with visual height intolerance (vHI) and Acrophobia. On the basis of a previously described epidemiological sample representative of the German general population, 574 individuals with vHI were identified, 128 fulfilled the DSM-5 diagnostic criteria of Acrophobia. The illness of the majority of all susceptible individuals with vHI ran a year-long chronic course. Two thirds were in the category “persistent/worse”, whereas only one third was in the category “improved/remitted”. Subjects with Acrophobia showed significantly more traumatic triggers of onset, more signs of generalization to other height stimuli, higher rates of increasing intensity of symptom load, higher grades of social impairment, and greater overall negative impact on the quality of life than those with pure vHI. An unfavorable course of illness in pure vHI was predicted by major depression, agoraphobia, social phobia, posttraumatic stress, initial traumatic trigger, and female sex; an unfavorable course in Acrophobia was predicted by major depression, chronic fatigue, panic attacks, initial traumatic trigger, social phobia, other specific phobic fears, and female sex. Help-seeking behavior was astonishingly low in the overall sample of individuals with vHI. The consequences of therapeutic interventions if complied with at all were quite modest. In adults pure vHI and even more so Acrophobia are by no means only transitionally distressing states. In contrast to their occurrence in children they are more often persisting and disabling conditions. Both the utilization of and adequacy of treatment of these illnesses pose major challenges within primary and secondary neurological and psychiatric medical care.
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Visual height intolerance and Acrophobia: clinical characteristics and comorbidity patterns
European Archives of Psychiatry and Clinical Neuroscience, 2015Co-Authors: Hans-peter Kapfhammer, Doreen Huppert, Eva Grill, Werner Fitz, Thomas BrandtAbstract:The purpose of this study was to estimate the general population lifetime and point prevalence of visual height intolerance and Acrophobia, to define their clinical characteristics, and to determine their anxious and depressive comorbidities. A case–control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above was selected. Defined neurological conditions (migraine, Menière’s disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and Acrophobia were assessed. The lifetime prevalence of vHI was 28.5 % (women 32.4 %, men 24.5 %). Initial attacks occurred predominantly (36 %) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. A total of 22.5 % of individuals with vHI experienced the intensity of panic attacks. The lifetime prevalence of Acrophobia was 6.4 % (women 8.6 %, men 4.1 %), and point prevalence was 2.0 % (women 2.8 %; men 1.1 %). VHI and even more Acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later Acrophobia and a significant consequence of previous Acrophobia. VHI affects nearly a third of the general population; in more than 20 % of these persons, vHI occasionally develops into panic attacks and in 6.4 %, it escalates to Acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.
Guy Wallis - One of the best experts on this subject based on the ideXlab platform.
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Rapid Communication The Role of Self-Motion in Acrophobia Treatment
2015Co-Authors: Carlos M Coelho, Jennifer Tichon, Jorge A. Santos, Guy Wallis, Ph. D, Carlos SilvaAbstract: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
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deconstructing Acrophobia physiological and psychological precursors to developing a fear of heights
Depression and Anxiety, 2010Co-Authors: Carlos M Coelho, Guy WallisAbstract: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.
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Deconstructing Acrophobia: physiological and psychological precursors to developing a fear of heights
Depression and Anxiety, 2010Co-Authors: Carlos M Coelho, Guy WallisAbstract: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
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The use of virtual reality in Acrophobia research and treatment.
Journal of Anxiety Disorders, 2009Co-Authors: Carlos M Coelho, Trevor John Hine, Allison M. Waters, Guy WallisAbstract: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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Contrasting the effectiveness and efficiency of virtual reality and real environments in the treatment of Acrophobia
PsychNology Journal, 2008Co-Authors: Carlos M Coelho, Jennifer Tichon, Carlos F. Silva, Jorge A. Santos, Guy WallisAbstract:Previous studies reported good results in using virtual reality for the treatment of Acrophobia. Similarly this paper reports the use of a virtual environment for the treatment of Acrophobia. In the study, 10 subjects were exposed to three sessions of simulated heights in a virtual reality (VR) system, and 5 others were exposed to a real environment. Both groups revealed significant progress in a range of anxiety, avoidance and behaviour measurements when confronted with virtual as well as real height circumstances. Despite VR participants experiencing considerably shorter treatment times than the real-world subjects, significant improvements were recorded on the Behavioural Avoidance Test, the Attitudes Toward Heights Questionnaire and the Acrophobia Questionnaire. These results are suggestive of a possible higher effectiveness and efficiency of VR in treating Acrophobia.
Paul Pauli - One of the best experts on this subject based on the ideXlab platform.
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Height Simulation in a Virtual Reality CAVE System: Validity of Fear Responses and Effects of an Immersion Manipulation
Frontiers in Human Neuroscience, 2018Co-Authors: Daniel Gromer, Octávia Madeira, Philipp Gast, Markus Nehfischer, Michael Jost, Mathias Müller, Andreas Mühlberger, Paul PauliAbstract:Acrophobia is characterized by intense fear in height situations. Virtual reality (VR) can be used to trigger such phobic fear, and VR exposure therapy (VRET) has proven effective for treatment of phobias, although it remains important to further elucidate factors that modulate and mediate the fear responses triggered in VR. The present study assessed verbal and behavioral fear responses triggered by a height simulation in a 5-sided CAVE (Cave Automatic Virtual Environment) with visual and acoustic simulation and further investigated how fear responses are modulated by immersion, i.e. an additional wind simulation, and presence, i.e. the feeling to be present in the virtual environment. Results revealed a high validity for the CAVE virtual environment in provoking height related self-reported fear and avoidance behavior in accordance with a trait measure of acrophobic fear. Increasing immersion significantly increased fear responses in high height anxious participants, but did not affect presence. Nevertheless, presence was found to be an important predictor of fear responses. We conclude that a CAVE system can be used to elicit valid fear responses, which might be further enhanced by immersion manipulations independent from presence. These results may help to improve VRET efficacy and its transfer to real situations.
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Plasticity of Functional MAOA Gene Methylation in Acrophobia.
The international journal of neuropsychopharmacology, 2018Co-Authors: Miriam A. Schiele, Daniel Gromer, Paul Pauli, Christiane Ziegler, Leonie Kollert, Andrea Katzorke, Christoph Schartner, Yasmin Busch, Andreas Reif, Jürgen DeckertAbstract:Epigenetic mechanisms have been proposed to mediate fear extinction in animal models. Here, MAOA methylation was analyzed via direct sequencing of sodium bisulfite-treated DNA extracted from blood cells before and after a 2-week exposure therapy in a sample of n = 28 female patients with Acrophobia as well as in n = 28 matched healthy female controls. Clinical response was measured using the Acrophobia Questionnaire and the Attitude Towards Heights Questionnaire. The functional relevance of altered MAOA methylation was investigated by luciferase-based reporter gene assays. MAOA methylation was found to be significantly decreased in patients with Acrophobia compared with healthy controls. Furthermore, MAOA methylation levels were shown to significantly increase after treatment and correlate with treatment response as reflected by decreasing Acrophobia Questionnaire/Attitude Towards Heights Questionnaire scores. Functional analyses revealed decreased reporter gene activity in presence of methylated compared with unmethylated pCpGfree_MAOA reporter gene vector constructs. The present proof-of-concept psychotherapy-epigenetic study for the first time suggests functional MAOA methylation changes as a potential epigenetic correlate of treatment response in Acrophobia and fosters further investigation into the notion of epigenetic mechanisms underlying fear extinction.
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Height Simulation in a Virtual Reality CAVE System: Validity of Fear Responses and Effects of an Immersion Manipulation
Frontiers Media S.A., 2018Co-Authors: Daniel Gromer, Octávia Madeira, Philipp Gast, Markus Nehfischer, Michael Jost, Mathias Müller, Andreas Mühlberger, Paul PauliAbstract:Acrophobia is characterized by intense fear in height situations. Virtual reality (VR) can be used to trigger such phobic fear, and VR exposure therapy (VRET) has proven effective for treatment of phobias, although it remains important to further elucidate factors that modulate and mediate the fear responses triggered in VR. The present study assessed verbal and behavioral fear responses triggered by a height simulation in a 5-sided cave automatic virtual environment (CAVE) with visual and acoustic simulation and further investigated how fear responses are modulated by immersion, i.e., an additional wind simulation, and presence, i.e., the feeling to be present in the VE. Results revealed a high validity for the CAVE and VE in provoking height related self-reported fear and avoidance behavior in accordance with a trait measure of acrophobic fear. Increasing immersion significantly increased fear responses in high height anxious (HHA) participants, but did not affect presence. Nevertheless, presence was found to be an important predictor of fear responses. We conclude that a CAVE system can be used to elicit valid fear responses, which might be further enhanced by immersion manipulations independent from presence. These results may help to improve VRET efficacy and its transfer to real situations
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Medial prefrontal cortex stimulation accelerates therapy response of exposure therapy in Acrophobia.
Brain stimulation, 2016Co-Authors: Martin J. Herrmann, Daniel Gromer, Paul Pauli, Andrea Katzorke, Yasmin Busch, Thomas Polak, Jürgen DeckertAbstract:Abstract Background Animal as well as human research indicated that the ventral medial prefrontal cortex (vmPFC) is highly relevant for fear extinction learning. Recently, we showed that targeting the vmPFC with high-frequency repetitive transcranial magnetic stimulation (rTMS) in a placebo-controlled study with 45 healthy controls induced higher prefrontal activity during extinction of conditioned stimuli (CS+) in the active compared to the sham stimulated group and better extinction learning as indicated by ratings, fear potentiated startles and skin conductance responses. Objective In this study, we aimed to proof our concept of accelerating extinction learning using rTMS of the mPFC in a group of anxiety disorder patients. Methods To specifically evaluate the impact of rTMS on exposure-based therapy, we applied a sham-controlled protocol over the vmPFC (FPz) succeeded by a virtual reality exposure therapy (VRET) in n = 20 participants with Acrophobia and n = 19 controls. Results We found a significantly higher reduction in active compared to sham stimulated group for anxiety (t[37] = 2.33, p Conclusion This study provides first clinical evidence that high-frequency rTMS over the vmPFC improves exposure therapy response of Acrophobia symptoms.
Carlos M Coelho - One of the best experts on this subject based on the ideXlab platform.
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O TRATAMENTO DO MEDO DE ALTURAS
Psicologia Argumento, 2017Co-Authors: Carlos M Coelho, Margarida Pocinho, Carlos Fernandes Da SilvaAbstract:In this article, we mentioned the therapeutic strategies we deem appropriate to treat fear of heights. We compared several studies that used various techniques and refer to our clinical experience and research. We considered also the new treatments that use virtual reality environments for the treatment of Acrophobia. Currently, virtual reality (VR) is used by governments, industry, academia and individual researchers, by encouraging a multiplicity of possible products and applications in various areas. These systems also have numerous applications in the field of psychology, for example in the evaluation and treatment of eating disorders and various phobias such as fear of spiders, fear of flying and claustrophobia. We conclude that, until the present moment, the practice reinforced Leitenberg (1976) is the best-studied treatment for Acrophobia. The main purpose of treatment of phobias is the decrease of avoidance of feared situation or stimulus, the molding of behavior appropriate approach. The therapist provides the client with a gradual exposure to the target threatening and reinforces successive improvements in the clients' ability to interact with the target stimulus. The duration of exposure may be based on length of time or a number of presentations practices.
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Rapid Communication The Role of Self-Motion in Acrophobia Treatment
2015Co-Authors: Carlos M Coelho, Jennifer Tichon, Jorge A. Santos, Guy Wallis, Ph. D, Carlos SilvaAbstract: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
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deconstructing Acrophobia physiological and psychological precursors to developing a fear of heights
Depression and Anxiety, 2010Co-Authors: Carlos M Coelho, Guy WallisAbstract: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.
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Deconstructing Acrophobia: physiological and psychological precursors to developing a fear of heights
Depression and Anxiety, 2010Co-Authors: Carlos M Coelho, Guy WallisAbstract: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
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The use of virtual reality in Acrophobia research and treatment.
Journal of Anxiety Disorders, 2009Co-Authors: Carlos M Coelho, Trevor John Hine, Allison M. Waters, Guy WallisAbstract: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.