To begin with, acrophobia can be defined as an intense fear of heights experienced by many people in the world. The established system of personal beliefs usually causes this fear and, therefore, may be treated. Moreover, acrophobia may cause anxiety and panic attacks, which is why people should deal with this phobia before any circumstances occur, for instance, with the help of cognitive behavior therapy (CBT).
CBT aims to treat fears by changing the belief system and the thinking process. According to Sharf (2012), “cognitive therapy, a system developed by Aaron Beck, stresses the importance of belief systems and thinking in determining behavior and feelings” (p. 370). In other words, to treat an intense fear, such as acrophobia, people’s unconscious thoughts and beliefs should be uncovered and altered. Moreover, therapists help their clients realize the hidden thoughts and past experiences that cause them to fear heights. That is why, while treating acrophobia, a cognitive therapist may suggest alternative ways of dealing with the client’s problems. Specialists try to change the way patients live in order for them to get rid of their fear.
However, CBT can be applied in modern apps and virtual reality games, targeting people having acrophobia. For instance, Donker et al. (2020) conducted research concerning the efficiency of a self-guided virtual reality app based on CBT aimed at helping people with acrophobia. The results have shown that the “participants were engaged with ZeroPhobia, as can be seen by the majority of them advancing through all VR exposure levels” (Donker et al., 2020, p. 11). Therefore, one can conclude that practicing different virtual reality (VR) games may help people treat their fears (Maskey et al., 2019). Thus, acrophobia can be treated by changing thoughts and beliefs, which are altered through VR apps with the help of CBT.
Theory of the Cognitive Behavior Therapy
When discussing cognitive behavior therapy, some key theorists should be mentioned. As it is said by Sharf (2012), “although several theories of psychotherapy emphasize cognitive aspects of treatment, cognitive therapy is associated with the work of Aaron Beck” (p. 370). Aaron Beck, as a psychoanalyst, was highly interested in what people say to themselves and the way they monitor their internal communication (Sharf, 2012). Then, one can highlight the impact of Alfred Adler, a scholar who emphasized the cognitive nature of persons and their internal beliefs. Moreover, Albert Ellis is also significant to this discussion because he used different approaches to confront irrational beliefs in his works. Interestingly enough, Ellis and Beck tried to change their clients’ beliefs through the interaction: they were sure that patients would overcome psychological disorders by altering misguiding assumptions.
Firstly, in a discussion about cognitive behavior therapy, the concept of automatic thoughts should be pointed out. Beck realized that his patients were unaware of some thoughts followed by the negative experience of which they were aware (Sharf, 2012). Thus, Beck came up with the concept of automatic thoughts, which can be compared with Freud’s concept of “preconscious” (Sharf, 2012). Secondly, according to Sharf (2012), Beck concluded his analysis of automatic thoughts with a new concept, negative cognitive shift, “in which individuals ignore much positive information relevant to themselves and focus instead on negative information about themselves” (p. 371). In other words, with the help of therapy, patients can shift their cognitive focus to the positive side to concentrate on the positive information, which will help them overcome different fears, such as acrophobia.
Finally, Beck developed two other concepts: distorted beliefs and cognitive schemas, which are essential in studying phobias. Beck came up with the conclusion that most of the negative thoughts were “developed into beliefs about worthlessness, being unlovable, and so forth” (Sharf, 2012, p. 371). This means that depressed people were unaware of these automatic thoughts because they were transformed into distorted beliefs. Moreover, these distorted beliefs were created in childhood and were developed into cognitive schemas (Sharf, 2012). Interestingly enough, these cognitive schemas exist despite facts that contradict them.
The central goal of cognitive behavior therapy lies in removing distorted beliefs and thoughts so that a patient can overcome disorders. According to Sharf (2012), during therapies, “patients’ cognitive distortions are challenged, tested, and discussed to bring about more positive feelings, behaviors, and thinking” (p. 379). Therefore, one can claim that removing cognitive schemas containing distorted beliefs is the central therapeutic goal of this approach to treatment.
Evaluation of Cognitive Behavior Therapy in Treating Acrophobia
As it was argued in the paragraphs above, CBT aims at changing distorted beliefs into a more positive side, removing established cognitive schemas. Emotions are connected to thoughts, meaning that people tend to give meaning to their emotions (Cunliffe & Hemmings, 2016). Moreover, thoughts and, caused by them, behaviors are usually not connected from the patients’ points of view; however, there is a strong connection between these two variables (Cunliffe & Hemmings, 2016). Thus, removing distorted beliefs and suggesting alternative ways of dealing with patients’ daily situations. For instance, therapists succeeded in altering the cognitive schemas of a tennis player, helping her realize the negative thoughts and suggesting alternative ways of addressing triggers (Cunliffe & Hemmings, 2016). Therefore, it can be concluded that CBT as a method treat some psychological disorders is a very successful one.
Moreover, by applying this approach to acrophobia, one can realize that the scheme of the therapy is the same and, therefore, cannot be ineffective. For instance, the research made on the effectiveness of virtual reality apps in treating acrophobia was concluded to be effective (Donker et al., 2020). This app, called “ZeroPhobia-Acrophobia” consists of six modules that provide people with background information and explain key concepts about acrophobia. An interesting fact is that there is an animated virtual therapist, who explains the origins of the fear of heights and “how to deal with it, setting goals, exercises, getting through difficult moments, cognitive behavioral therapy to deal with negative thoughts and practicing with challenging situations” (Donker et al., 2020, p. 3). Therefore, this app represents actual therapeutic sessions and is proven to be efficient in treating acrophobia.
However, treating acrophobia with CBT may have some weaknesses. For instance, in order for a person to trigger the phobia so that a therapist can analyze the appeared thought of a patient, sometimes it may be insufficient to tell a story from the past or see photos taken from the heights. Thus, a person may need to go somewhere to see something from the heights to experience alternative ways of dealing with fear. That is why this approach to treatment may be complex in terms of realization at the final stages of treatment.
Applying the Therapy to a Multicultural Context
Understanding how cognitive behavior therapy can be applied to the multicultural context is crucial. The concepts of distorted beliefs and cognitive schemas are created in personal development, meaning that the cultural context is essential because of its impact on establishing those cognitive models (Young, 2009). Young (2009) claimed: “core beliefs about the self illustrate how culture is relevant to the practice of cognitive psychotherapy, and also how the therapeutic approach incorporates people’s different cultural models” (p. 411). Therefore, CBT should be applied to multicultural contexts very accurately, having a solid understanding of individual cultural models of behavior so that a therapist would be able to predict patients’ emotional reactions.
For instance, the treatment of acrophobia with the help of CBT should be considered in the context of South Africa. Applying this approach to the South African context, one can claim that the most efficient disorders treated by therapy are social phobia and post-traumatic stress disorder (Young, 2009). According to Young (2009), “The cognitive model and treatment of social phobia shares some features with many of the other anxiety disorders …, including the therapeutic tasks of challenging threat beliefs and appraisals” (p. 410). Therefore, one can hypothesize that acrophobia treatment, having common features with social phobia, will also be efficient in South Africa; however, more deliberate research should be made.
In conclusion, it is necessary to state that cognitive behavior therapy aims to remove distorted beliefs and thoughts so that a patient will be able to overcome disorders. Treating acrophobia is proven to be efficient with the help of a virtual reality app based on CBT. This approach provides patients with alternative ways of addressing the triggers, which allows people to change their cognitive schemas and become free from the established negative beliefs and automatic thoughts. Based on the research on the efficiency of the cognitive behavioral approach in treating social phobia and post-traumatic stress disorder. Thus, one can hypothesize that the treatment of acrophobia will also be efficient in South Africa; however, more deliberate research should be conducted.
Cunliffe, M., & Hemmings, B. (2016). Case study 4: A case study of cognitive behavior therapy in tennis. Sport & Exercise Psychology Review, 12(2), 48-55.
Donker, T., Van Klaveren, C., Cornelisz, I., Kok, R. N., & Van Gelder, J. L. (2020). Analysis of usage data from a self-guided app-based virtual reality cognitive behavior therapy for acrophobia: A randomized controlled trial. Journal of Clinical Medicine, 9(6), 1-13. DOI: 10.3390/jcm9061614
Maskey, M., Rodgers, J., Ingham, B., Freeston, M., Evans, G., Labus, M., & Parr, J. R. (2019). Using virtual reality environments to augment cognitive behavioral therapy for fears and phobias in autistic adults. Autism in Adulthood, 1(2), 134-145. DOI: 10.1089/aut.2018.0019
Sharf, R. (2012). Cognitive therapy. In Theories of psychotherapy and counseling: Concepts and cases. (pp. 369-415). Brooks/Cole Cengage Learning.
Young, C. (2009). The transportability and utility of cognitive therapy in South African contexts: A review. Journal of Psychology in Africa, 19(3), 407-414. DOI: 10.1080/14330237.2009.10820309