claustrophobia

Claustrophobia (from Latin claustrum "a shut in place" and Greek φόβος, phóbos, "fear") is the fear of having no escape and being closed in. It is typically classified as an anxiety disorder and often results in panic attack. One study indicates that anywhere from 5-7% of the world population is affected by severe claustrophobia, but only a small percentage of these people receive some kind of treatment for the disorder.^[1]

Basic symptoms of claustrophobia

Claustrophobia is typically thought to have two key symptoms: fear of restriction and fear of suffocation. A typical claustrophobic will fear restriction in at least one, if not several, of the following areas: small rooms, locked rooms, cars , tunnels, cellars, elevators, subway trains, caves, and crowded areas. Additionally, the fear of restriction can cause some claustrophobics to fear trivial matters such as sitting in a barber’s chair or waiting in line at a grocery store simply out of a fear of confinement to a single space. However, claustrophobics are not necessarily afraid of these areas themselves, but, rather, they fear what could happen to them should they become confined to said area. Often, when confined to an area, claustrophobics begin to fear suffocation, believing that there may be a lack of air in the area to which they are confined. Any combination of the above symptoms can lead to severe panic attacks. However, most claustrophobics do everything in their power to avoid these situations.^[2]

Diagnosis

Claustrophobia scale

This method was developed in 1979 by interpreting the files of patients diagnosed with claustrophobia and by reading various scientific articles about the diagnosis of the disorder. Once an initial scale was developed, it was tested and sharpened by several experts in the field. Today, it consists of 20 questions that determine anxiety levels and desire to avoid certain situations. Several studies have proved this scale to be effective in claustrophobia diagnosis.^[3]

Claustrophobia questionnaire

This method was developed by Rachman and Taylor, two experts in the field, in 1993. This method is effective in distinguishing symptoms stemming from fear of suffocation and fear of restriction. In 2001, it was modified from 36 to 24 items by another group of field experts. This study has also been proved very effective by various studies.^[4]

Treatment

Cognitive therapy

Cognitive therapy is a widely accepted form of treatment for most anxiety disorders.^[5] It is also thought to be particularly effective in combating disorders where the patient doesn’t actually fear a situation but, rather, fears what could result from being in said situation.^[6] The ultimate goal of cognitive therapy is to modify distorted thoughts or misconceptions associated with whatever is being feared; the theory is that modifying these thoughts will decrease anxiety and avoidance of certain situations.^[7] For example, cognitive therapy would attempt to convince a claustrophobic patient that elevators are not dangerous but are, in fact, very useful in getting you where you would like to go faster. A study conducted by S.J. Rachman, an acclaimed expert in the field, shows that cognitive therapy decreased fear and negative thoughts/connotations by an average of around 30% in claustrophobic patients tested, proving it a very effective method.^[8]

In vivo exposure

This method forces patients to face their fears by complete exposure to whatever fear they are experiencing.^[9] This is usually done in a progressive manner starting with lesser exposures and moving upward towards severe exposures.^[10] For example, a claustrophobic patient would start by going into an elevator and work up to an MRI. Several studies have proven this to be an effective method in combating various phobias, claustrophobia included.^[11] S.J. Rachman has also tested the effectiveness of this method in treating claustrophobia and found it to decrease fear and negative thoughts/connotations by an average of nearly 75% in his patients.^[12] Of the methods he tested in this particular study, this was by far the most significant reduction.^[13]

Interoceptive exposure

This method attempts to recreate internal physical sensations within a patient in a controlled environment.^[14] In other words, it is a less intense version of in vivo exposure.^[15] This was the final method of treatment tested by S.J. Rachman in his 1992 study.^[16] It lowered fear and negative thoughts/connotations by about 25%.^[17] These numbers did not quite match those of in vivo exposure or cognitive therapy, but still resulted in significant reductions.^[18]

Studies

MRI procedure

Because they can produce a fear of both suffocation and restriction, MRI scans often prove difficult for claustrophobic patients.^[19] In fact, estimates say that anywhere from 4-20% of patients refuse to go through with the scan for precisely this reason.^[20] One study estimates that this percentage could be as high as 37% of all MRI recipients.^[21] The average MRI takes around 50 minutes; this is more than enough time to evoke extreme fear and anxiety in a severely claustrophobic patient. This study was conducted with three goals: 1. To discover the extent of anxiety during an MRI. 2. To find predictors for anxiety during an MRI. 3. To observe psychological factors of undergoing an MRI. Eighty patients were randomly chosen for this study and subjected to several diagnostic tests to rate their level of claustrophobic fear; none of these patients had previously been diagnosed with claustrophobia. They were also subjected to several of the same tests after their MRI to see if their anxiety levels had elevated. This experiment concludes that the primary component of anxiety experienced by patients was most closely connected to claustrophobia. This assertion stems from the high Claustrophobic Questionnaire results of those who reported anxiety during the scan. Almost 25% of the patients reported at least moderate feelings of anxiety during the scan and 3 were unable to complete the scan at all. When asked a month after their scan, 30% of patients (these numbers are taken of the 48 that responded a month later) reported that their claustrophobic feelings had elevated since the scan. The majority of these patients claimed to have never had claustrophobic sensations up to that point. This study concludes that the Claustrophobic Questionnaire (or an equivalent method of diagnosis) should be used before allowing someone to have an MRI.^[22]

Separating the fear of restriction and fear of suffocation

Many experts who have studied claustrophobia claim that it consists of two separable components: fear of suffocation and fear of restriction. In an effort to fully prove this assertion, a study was conducted by three experts in order to clearly prove a difference. The study was conducted by issuing a questionnaire to 78 patients who received MRI’s. The data was compiled into a “fear scale” of sorts with separate subscales for suffocation and confinement. Theoretically, these subscales would be different if the contributing factors are indeed separate. The study was successful in proving that the symptoms are separate. Therefore, according to this study, in order to effectively combat claustrophobia, it is necessary to attack both of these underlying causes. However, because this study only applied to people who were able to finish their MRI, those who were unable to complete the MRI were not included in the study. It is likely that many of these people dropped out because of a severe case of claustrophobia. Therefore, the absence of those who suffer the most from claustrophobia could have skewed these statistics.^[23]

A group of students attending the University of Texas at Austin were first given an initial diagnostic and then given a score between 1 and 5 based on their potential to have claustrophobia. Those who scored a 3 or higher were used in the study. The students were then asked how well they felt they could cope if forced to stay in a small chamber for an extended period of time. Concerns expressed in the questions asked were separated into suffocation concerns and entrapment concerns in order to distinguish between the two perceived causes of claustrophobia. The results of this study showed that the majority of students feared entrapment far more than suffocation. Because of this difference in type of fear, it can yet again be asserted that there is a clear difference in these two symptoms.^[24]

Probability ratings in claustrophobic patients and non-claustrophobics

This study was conducted on 98 people, 49 diagnosed claustrophobics and 49 "community controls" to find out if claustrophobics' minds are distorted by "anxiety-arousing" events (i.e. claustrophobic events) to the point that they believe those events are more likely to happen. Each person was given three events—a claustrophobic event, a generally negative event, and a generally positive event—and asked to rate how likely it was that this event would happen to them. As expected, the diagnosed claustrophobics gave the claustrophobic events a significantly higher likelihood of occurring than did the control group. There was no noticeable difference in either the positive or negative events. However, this study is also potentially flawed due to the fact that the claustrophobic people had already been diagnosed. Diagnosis of the disorder could likely bias one’s belief that claustrophobic events are more likely to occur to them.^[25]

See also

• List of phobias
• Anxiety disorder
• Premature burial
• Panic Attack

References