Conquer your fear of falling with cognitive behavioural therapy

The Bottom Line

  • Many older adults experience fear of falling, which can stop them from participating in activities and can lower their quality of life.
  • Cognitive behavioural therapy is a type of therapy that focuses on changing negative thoughts.
  • Cognitive behavioural therapy can reduce the fear of falling right after therapy, with results lasting for up to 6-12 months.

You’re watering your plants or retrieving the newspaper from the front step when you suddenly find yourself flat on the ground. This unexpected turn of events can leave you with more than just bruises. A fall can also have lasting psychological effects, manifesting into a fear of falling again.

For Canadian seniors, falls remain the leading cause of injury-related hospitalizations (1), so a fear of falling is not unfounded. In Canada, 34% of older adults report being concerned about falling (2), and this fear is most common in those who have hit the ground recently (3).

A fear of falling can lead people to play it safe – older adults will often go out less often and participate in fewer activities (3), leading to less social interaction and a lower quality of life (4;5). A fear of falling can also lead to poor balance (5), and may even change the way a person walks (6). The irony is that playing it safe creates a circular problem in which a fear of falling becomes a risk factor for future falls (4).

Many studies have examined ways to ease the fear of falling, with interventions such as fall-related programs that focus on multiple components and risk factors, tai chi, and exercise, in particular, showing promise (7).

More recently, studies have examined whether cognitive behavioural therapy (CBT) reduces fear of falling in older adults. CBT aims to change how a person thinks (“cognitive”) and acts (“behavior”), which can markedly improve how they feel. This approach can help people overcome their fear of falling by shifting their focus from pessimistic thoughts to things they can do – such as exercise – to lower their risk of falling. This shift in focus encourages people to safely increase their daily activity level (8).

What the research tells us

A recent systematic review and meta analysis looked at CBT delivered in groups or privately, either in person or over the phone. CBT sessions lasted between 4 and 20 weeks and included goal-setting and promoting physical activity.

This review found that CBT may lower the risk of falling and improve balance by small amounts in people 60 years of age or over who live at home. For risk of falling, effects began immediately after therapy ended and lasted for 6-12 months, while for balance effects were not immediate and only seen within 6 months of treatment ending. It also appears that individual CBT may produce stronger effects than CBT done in groups. These findings suggest that CBT is a promising strategy for addressing fear of falling among older adults. But despite the positive results, more research is needed owing to the small number of studies included, exclusion of older adults with certain health conditions, and variability among the CBTs used in the different studies (8).

If past falls have filled your mind with worries, CBT may be a useful technique to help you quell these doubts, and encourage you to move around with confidence once again!

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Author Details


  1. Public Health Agency of Canada. Senior’s falls in Canada [Internet]. Public Health Agency of Canada, 2014. Available from 
  2. Statistics Canada. Canadian community health survey – Healthy aging. Ottawa: Statistics Canada, 2010. Report No.: 5146. Available from 
  3. Gaxette C, Nguyen T, Chourabi F, et al. Fear of falling as seen in the multidisciplinary falls consultation. Ann Phys Rehabil Med. 2011; 54(4):248-258. doi: 10.1016/  
  4. Scheffer AC, Schuurmans MJ, van Dijk N, et al. Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age Aging. 2008; 37(1):19-24. doi: 10.1093/ageing/afm169. 
  5. Li F, Fisher KS, Harmer P, et al. Fear of falling in elderly persons: Association with falls, functional ability, and quality of life. J Gerontol B Psychol Sci Soc Sci. 2003; 58(5):P283-290. 
  6. Ayoubi F, Launay CP, Annweiler C, et al. Fear of falling and gait variability in older adults: A systematic review and meta-analysis. J Am Med Dir Assoc. 2015; 16(1):14-19. doi: 10.1016/j.jamda/2014/06/2020.
  7. Zijlstra GA, van Haastregt JC, can Rossum E, et al. Interventions to reduce fear of falling in community-living older people: A systematic review. J Am Geriatr Soc. 2007; 55(4):603-615. doi: 10.1111/j.1532-5415.2007.01148.x.  
  8. Liu TW, Ng GYF, Chung RCK, et al. Cognitive behavioural therapy for fear of falling and balance among older people: A systematic review and meta-analysis. Age Ageing. 2018. doi: 10.1093/ageaging/afy010. 

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.