Fear of heights: cognitive performance and postural control

IntroductionFear of heights, or acrophobia, is one of the most frequent subtypes of specific phobia frequently associated to depression and other anxiety disorders. Previous evidence suggests a correlation between acrophobia and abnormalities in balance control, particularly involving the use of visual information to keep postural stability. This study investigates the hypotheses that (1) abnormalities in balance control are more frequent in individuals with acrophobia even when not exposed to heights, that (2) acrophobic symptoms are associated to abnormalities in visual perception of movement; and that (3) individuals with acrophobia are more sensitive to balance-cognition interactions.MethodThirty-one individuals with specific phobia of heights and thirty one non-phobic controls were compared using dynamic posturography and a manual tracking task.ResultsAcrophobics had poorer performance in both tasks, especially when carried out simultaneously. Previously described interference between posture control and cognitive activity seems to play a major role in these individuals.DiscussionThe presence of physiologic abnormalities is compatible with the hypothesis of a non-associative acquisition of fear of heights, i.e., not associated to previous traumatic events or other learning experiences. Clinically, this preliminary study corroborates the hypothesis that vestibular physical therapy can be particularly useful in treating individuals with fear of heights.

[1]  S. Mineka,et al.  Born to fear: non-associative vs associative factors in the etiology of phobias. , 2002, Behaviour research and therapy.

[2]  Mark G Carpenter,et al.  Task-specific measures of balance efficacy, anxiety, and stability and their relationship to clinical balance performance. , 2008, Gait & posture.

[3]  A. Fyer,et al.  Treatment of specific phobia in adults. , 2007, Clinical psychology review.

[4]  J Duysens,et al.  Postural control and cognitive task performance in healthy participants while balancing on different support-surface configurations. , 2001, Gait & posture.

[5]  R. Poulton,et al.  Fears born and bred: toward a more inclusive theory of fear acquisition. , 2002, Behaviour research and therapy.

[6]  Patrick J Sparto,et al.  Acrophobia and pathological height vertigo: indications for vestibular physical therapy? , 2005, Physical therapy.

[7]  M. Woollacott,et al.  The effects of two types of cognitive tasks on postural stability in older adults with and without a history of falls. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[8]  R. McCrea,et al.  Role of the cerebellar flocculus region in the coordination of eye and head movements during gaze pursuit. , 2000, Journal of neurophysiology.

[9]  W Bles,et al.  The mechanism of physiological height vertigo. , 1978, Transactions of the American Neurological Association.

[10]  S. Rachman.  Fears born and bred: non-associative fear acquisition? , 2002, Behaviour research and therapy.

[11]  R. Poulton,et al.  Non-associative fear acquisition: a review of the evidence from retrospective and longitudinal research. , 2002, Behaviour research and therapy.

[12]  M. Woollacott,et al.  Cognitive influence on postural stability: a neuromuscular analysis in young and older adults. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[13]  R. J. Thompson,et al.  Epidemiology and Classification , 2020, The Management of Meniscal Pathology.

[14]  H Hsiao,et al.  Preventing falls from roofs: a critical review , 2001, Ergonomics.

[15]  R. Poulton,et al.  Failure to overcome 'innate' fear: a developmental test of the non-associative model of fear acquisition. , 2001, Behaviour research and therapy.

[16]  D. Clark,et al.  Balance complaints and panic disorder: A clinical study of panic symptoms in members of a self-help group for balance disorders , 1992 .

[17]  Mark G. Carpenter,et al.  Fear of falling modifies anticipatory postural control , 2002, Experimental Brain Research.

[18]  M G Carpenter,et al.  Postural control is scaled to level of postural threat. , 2000, Gait & posture.

[19]  Normand Teasdale,et al.  Effects of a reaction time task on postural control in humans , 2000, Neuroscience Letters.

[20]  M. Redfern,et al.  Postural prioritization defines the interaction between a reaction time task and postural perturbations , 2007, Experimental Brain Research.

[21]  P. Baltes,et al.  Adaptive task prioritization in aging: selective resource allocation to postural control is preserved in Alzheimer disease. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[22]  R. Miall,et al.  The cerebellum coordinates eye and hand tracking movements , 2001, Nature Neuroscience.

[23]  Mark S. Redfern,et al.  Optic flow-induced sway in anxiety disorders associated with space and motion discomfort , 1995 .

[24]  Alan M. Wing,et al.  Effects of spatial and nonspatial cognitive activity on postural stability. , 2001, British journal of psychology.

[25]  Sheila R. Woody,et al.  Discomfort with space and motion: A possible marker of vestibular dysfunction assessed by the situational characteristics questionnaire , 1993 .

[26]  E. L. Keller,et al.  Generation of smooth-pursuit eye movements: neuronal mechanisms and pathways , 1991, Neuroscience Research.

[27]  M. Woollacott,et al.  Attentional demands and postural control: the effect of sensory context. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[28]  Subhobrata Mitra,et al.  Methodological and interpretive issues in posture-cognition dual-tasking in upright stance. , 2008, Gait & posture.

[29]  J. F. Soechting,et al.  Similarity in the response of smooth pursuit and manual tracking to a change in the direction of target motion. , 2000, Journal of neurophysiology.

[30]  W Bles,et al.  The mechanism of physiological height vertigo. II. Posturography. , 1980, Acta oto-laryngologica.

[31]  S. Takemori,et al.  Influence of Height on the Spatial Orientation and Equilibrium of the Body , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[32]  W Bles,et al.  The mechanism of physiological height vertigo. I. Theoretical approach and psychophysics. , 1980, Acta oto-laryngologica.

[33]  Jefferson E. Roy,et al.  Brain stem pursuit pathways: dissociating visual, vestibular, and proprioceptive inputs during combined eye-head gaze tracking. , 2003, Journal of neurophysiology.

[34]  Michael E Talkowski,et al.  Cognitive influences in postural control of patients with unilateral vestibular loss. , 2004, Gait & posture.

[35]  J. Frank,et al.  Influence of a visuo-spatial, verbal and central executive working memory task on postural control. , 2001, Gait & posture.

[36]  J. Furman,et al.  Surface Dependence: A Balance Control Strategy in Panic Disorder with Agoraphobia , 1997, Psychosomatic medicine.

[37]  J. Langley,et al.  Evidence for a non-associative model of the acquisition of a fear of heights. , 1998, Behaviour research and therapy.

[38]  G C Curtis,et al.  Specific fears and phobias. Epidemiology and classification. , 1998, The British journal of psychiatry : the journal of mental science.