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 treatmeant of numerous
anxiety disorder. It is now known that virtual reality exposure therapy (VRET) regimens are
highly effective for 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 undergoing causes of the disorder, allowing for the systematic
assessment of interrelated factors such as the visual, vestibular and postural control systems. The
present study intends to corroborate the successful treatment of fear of heights with VR systems,
and to find out if the therapeutic gains are maintained 1 year after treatment. This kind of long-
term follow-up has not been performed in previous studies. Also, it is our purpose to closely
examine the results attained by a partially sighted subject (totally bling in the left eye). The
participants of this study were individuals suffering from acrophobia who referred themselves for
treatment after publicity (internal e-mail and local newspaper) in the University Campus.
Nineteen subjects were submitted to a screening process. Seven were excluded for not fulfilling
the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria of
acrophobia. Another two subjects were not included in the study, because they presented fear in
the Behavioral Aviodance Test (BAT) but not in the VR environment. There was 10 subjects left
without heart or vestibular problems and with significant fear of heights. The diagnosis was only
attributed to subjects with a value of at least five subjective units of discomfort (SUD) in the last
step of the stairs in the BAT. Only two individuals were able to climb every step before the
treatment, with SUD values of five and eight. Among the 10 participants who included the study
were four men and six woman, with an age range of 18-66 years ( mean, 38.8 years). They
reported suffering from fear of heights for 10-55 years. Four of the participants reported fear of
heights since they ever remember. The average age of beginning was 8.7 years old. We also
highlight one of the participants of this study, J., a married 66 years old man, retired. He referred
as being afraid of and avoiding high places.

Warren W. Tryon, in Cognitive Neuroscience and Psychotherapy, 2014 Human Research

Ressler et al. (2004) extended the animal studies to the treatment of acrophobia in humans. This
study used a double-blind placebo controlled design for the administration of DCS to a group of
28 participants seeking treatment for acrophobia. Exposure treatment was administered using a
virtual reality software package for fear of heights. DCS was administered 2-4 hours prior to
participation in the exposure sessions, and administered in either 50 mg or 500 mg doses. There
was no significant difference in improvement due to dosage. Treatment effects were found to be
durable at 3-month follow-up. Futhermore, DCS did not have an effect on baseline anxiety. That
is, in the absence of exposure treatment, DCS had no effect on anxiety. Hofmann et al. (2006)
reported that DCS is effective as an adjunct tp exposure therapy for social anxiety disorder
(SAD). Twenty-seven participants enrolled in the study, all with SAD and prominent public-
speaking fear. Hofmann et al. used a double-blind design for administering DCS, in 50 mg doses.
Treatment look place over five sessions, in either individual or group form. This study showed
that participants taking DCS improved to a significantly greater extent than those who did not
receive the medication. While both groups continued to improve at 1 month follow-up, the group
who received DCS showed significantly greater improvement. Guastella et al. (2007) reported
DCS to be effective in the treatment of subclinical spider fear. Thhis study used a double-bling
design in the administration of 50 mg of DCS, compared to placebo. These investigators did not
find a significant effect for DCS in alleviating fear in their participants following a single session
of DCS plus exposure therapy for spiders. However, the authors noted that effectiveness of DCS
may not be obvious in non-clinical participants, or that a dose at the level (50 mg) may not be
significient to activate their NMDA receptor sites. Heresco-Levy et al. (2002) evaluated the
efficacy of DCS in the treatment of post-traumatic stress disorder (PTSD) using a double-blind
placebo controlled crossover design with 11 participants with a variety of traumatic reactions.
DCS where the medication is taken only immediately preceding the active therapy, typically 1-2
hours prior to treatment.