Q: I am a 50 years old male having a fear of heights. I live on the eighth floor and am afraid of standing in the balcony of the flat. Due to my fear, I am unable to travel in an aeroplane. How can it be managed?

A:You seem to be suffering from fear of heights. Phobias are quite common problems that we encounter in our clinical practice. The good thing is that they are treatable. Phobias originate out of irrational fears of a particular situation, in your case heights. Phobias, being situation specific, the affected people try to avoid such situation and the very thought / anticipation of such situation generates significant anxiety. As a result the affected person starts experiencing anticipatory anxiety and displays avoidance behaviours, resulting in restrictions in lifestyle. I suggest the following:

• Detailed psychiatric evaluation including childhood history, relationship with parents, significant others
• Blood thyroid evaluation
• Yoga (pranayam), meditation, relaxation sessions can help
• Please make a hierarchical list (based on the intensity of anxiety generated) of all such situations that you are fearful of. First try to expose yourself to situations that are less anxiety provoking. Having mastered such situations and overcoming the fears associated with them, try to move on to the next level of situations that generate more anxiety. Systematic desensitization helps in gaining confidence and overcoming irrational fears.
• Try to challenge negative thoughts (the negative consequences that are blown out of proportion in your thoughts) by more positive / healthier alternative thoughts. For e.g., to counter the avoidance of air travel, you could perhaps encourage thoughts like: 'So many people travel by air. Even small children are able to enjoy their journey by air. Air accidents are not that frequent. The cabin crew is there to help even if the need arises (as the remotest of possibility) etc.
• Certain psychiatric medications are very helpful. Serotonin specific re-uptake inhibitors are quite helpful in dealing with anticipatory anxiety. Certain anti-anxiety medications are found to be quite helpful. Psychiatric medications should be properly guided and supervised by the treating psychiatrist.
• Avoid alcohol or other intoxicants.