Claustrophobia
Claustrophobia is a fear of confined spaces. It is triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.
For other uses, see Claustrophobia (disambiguation).Claustrophobia
One study indicates that anywhere from five to ten percent 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.
The term claustrophobia comes from Latin claustrum "a shut in place" and Greek φόβος, phóbos, "fear".
Claustrophobia is classified as an anxiety disorder. Symptoms generally develop during childhood or adolescence.[1] Claustrophobia is typically thought to have one key symptom: fear of suffocation. In at least one, if not several, of the following areas: small rooms, MRI or CAT scan apparatus, cars, buses, airplanes, trains, tunnels, underwater caves, cellars, elevators and caves.
Being enclosed or thinking about being enclosed in a confined space can trigger fears of not being able to breathe properly, and running out of oxygen. It is not always the small space that triggers these emotions, but it's more the fear of the possibilities of what could happen while confined to that area.[1] When anxiety levels start to reach a certain level, the person may start to experience:
Symptoms depend on how severe your phobia is.
Treatment[edit]
Cognitive therapy[edit]
Cognitive therapy is a widely accepted form of treatment for most anxiety disorders.[15] 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 such a situation.[15] 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.[15] 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 shows that cognitive therapy decreased fear and negative thoughts/connotations by an average of around 30% in claustrophobic patients tested, proving it to be a reasonably effective method.[16]
In vivo exposure[edit]
This method forces patients to face their fears by complete exposure to whatever fear they are experiencing.[15] This is usually done in a progressive manner starting with lesser exposures and moving upward towards severe exposures.[15] 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.[15] 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.[16] Of the methods he tested in this particular study, this was by far the most significant reduction.[16]
Interoceptive exposure[edit]
This method attempts to recreate internal physical sensations within a patient in a controlled environment and 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%.[16] These numbers did not quite match those of in vivo exposure or cognitive therapy, but still resulted in significant reductions.[16]
Other forms of treatment that have also been shown to be reasonably effective are psychoeducation, counter-conditioning, regressive hypnotherapy and breathing re-training. Medications often prescribed to help treat claustrophobia include anti-depressants and beta-blockers, which help to relieve the heart-pounding symptoms often associated with anxiety attacks.
Studies[edit]
MRI procedure[edit]
Because they can produce a fear of both suffocation, MRI scans often prove difficult for claustrophobic patients.[17] In fact, estimates say that anywhere from 4–20% of patients refuse to go through with the scan for precisely this reason.[18] One study estimates that this percentage could be as high as 37% of all MRI recipients.[17] 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.[17]
Use of virtual reality distraction to reduce claustrophobia[edit]
The present case series with two patients explored whether virtual reality (VR) distraction could reduce claustrophobia symptoms during a mock magnetic resonance imaging (MRI) brain scan. Two patients who met DSM-IV criteria for specific phobia, situational type (i.e., claustrophobia) reported high levels of anxiety during a mock 10-min MRI procedure with no VR, and asked to terminate the scan early. The patients were randomly assigned to receive either VR or music distraction for their second scan attempt. When immersed in an illusory three-dimensional (3D) virtual world named SnowWorld, patient 1 was able to complete a 10-min mock scan with low anxiety and reported an increase in self-efficacy afterwards. Patient 2 received "music only" distraction during her second scan but was still not able to complete a 10-min scan and asked to terminate her second scan early. These results suggest that immersive VR may prove effective at temporarily reducing claustrophobia symptoms during MRI scans and music may prove less effective.[19]
Another case study investigated the effectiveness of virtual reality subjection in the case of a patient who was diagnosed with two particular phobias (claustrophobia and storms). Participant met DSM-IV criteria for two specific phobias, situational type (claustrophobia) and natural environment type (storms). She suffered from fear of closed spaces, such as buses, elevators, crowds, and planes, which began after a crowd trampled her in a shopping mall 12 years prior. In response to this event, she developed the specific phobia, natural environment type (storms) because the cause of the stampede was the racket of a big storm. Participant was assigned to two individual VR environments to distinguish the levels of difficulty in a "claustrophobic" environment, with one setting being a house and the other being an elevator. There was a total of eight sessions that were carried out over the span of 30 days, with each session lasting between 35 and 45 minutes. The results from this treatment proved to be successful in reducing the fear of enclosed spaces and additionally improved over the course of 3 months.[20]
Separating the fear of restriction and fear of suffocation[edit]
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 MRIs.
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.[18]
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.[21]
Probability ratings in claustrophobic patients and non-claustrophobics[edit]
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 because 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.[22]