Fear of Falling in a Younger Adult: Integrated CBT and Physiotherapy in a 4-Year Follow-up Case Study

Fear of falling (FOF) is well documented among older adults but has received little attention in younger populations. This case report describes the assessment and treatment of Angela, a 37-year-old woman with obesity who developed a phobic FOF. Her fear resulted in panic symptoms and extensive avoidance, which led to impaired mobility including dependency on mobility aids and compromised her engagement in physiotherapy. Body size appeared to contribute to the content of the patient’s catastrophic fears, particularly concerns regarding her ability to recover independently following a fall. Treatment involved values-guided graded cue exposure with response prevention alongside physiotherapy targeting balance and mobility. Functional impairment and phobic avoidance decreased substantially, with gains maintained at 1-month follow-up and remaining evident 4 years later. Unlike many interventions for older adults with FOF, which often require cautious progression because of frailty and fall risk, treatment for Angela progressed relatively quickly through exposure and rehabilitation tasks. Her younger age and the absence of age-related physical decline may have allowed a more rapid approach to rehabilitation. This case describes the application of integrated CBT-based exposure and physiotherapy in a younger adult whose FOF appeared to be maintained primarily by fear-related avoidance and addresses a gap in a literature focused predominantly on older adults.