Claustrophobia

Claustrophobia (from Latin claustrum "a shut in place" and Greek , phbos, "fear") is the fear of having no escape and being closed in small spaces or rooms (opposite: claustrophilia). It is typically classified as an anxiety disorder and often results in panic attack, and can be the result of many situations orstimuli, including elevators crowded to capacity, windowless rooms, and even tight-necked clothing[1]. 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. One study indicates that anywhere from 57% 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.[2]

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, airplanes and crowded areas. Additionally, the fear of restriction can cause some claustrophobics to fear trivial matters such as sitting in a barbers 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 an 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. Many claustrophobics remove clothing during attacks, believing it will relieve the symptoms. 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 is the fear of having no escape, and being closed in. It is typically classified as an anxiety disorder and often results in a rather severe panic attack. One study conducted by University of Wisconsin-Madisons neurology department revealed that anywhere from 2-5% 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. Claustrophobia develops as the mind makes the association that small spaces psychologically translate to some imminent danger. This typically occurs as a result of a traumatic past experience (such as being trapped in a dark, small space and thinking that there is no way out because the mind is not fully developed enough to realize there is a way out) or from another unpleasant experience occurring later on in life involving confined spaces. These two causes of claustrophobia both reject the common misconception that claustrophobia is a genetic disorder. In fact claustrophobia is a conditioned response to a stimulus. It results from when an individual associates a tremendous amount of anxiety and a panic attack with a confined space. That event, the confined space, serves as a trigger or the stimulus, which is programmed into the brain. Because that stimulus is programmed into the brain, so is the response, which in this case, is a tremendous amount of anxiety. As a result, the confined space consistently triggers the same anxious response. [edit]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] [edit]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.[3] [edit]Causes of claustrophobia The fear of enclosed spaces is an irrational fear. Most claustrophobic people who find themselves in a room without windows consciously know that they arent in danger, yet these same people will be afraid, possibly terrified to the point of incapacitation, and many do not know why. The exact cause of claustrophobia is unknown, but there are many theories [4].

Amygdala The amygdala is one of the smallest structures in the brain, but by far one of the most powerful. The amygdala is needed for the conditioning of fear, or the creation of a fight-or-flight response. A fight-or-flight response is created, when a stimulus is associated with a grievous situation [5]. A phobias roots are in this fight-or-flight response. In generating a fight-or-flight response, the amygdala acts in the following way: The amygdalas anterior nuclei associated with fear communicate with each other. Nuclei send out impulses to other nuclei, which influence respiratory rate, physical arousal, the release of adrenaline, blood pressure, heart rate, behavioral fear response, and defensive responses, which may include freezing up. These reactions constitute an autonomic failure in a panic attack [6]. A study done by Fumi Hayano found that the right amygdala was smaller in patients who suffered from panic disorders. The reduction of size occurred in a structure known as the corticomedial nuclear group which the CE nucleus belongs to. This causes interference, which in turn causes abnormal reactions to aversive stimuli in those with panic disorders. In claustrophobic people, this translates as panicking or overreacting to a situation in which the person finds themselves physically confined.

[edit]Classical Conditioning Claustrophobia develops as the mind makes the association that small spaces psychologically translate to some imminent danger [7]. It often comes as a consequence of a traumatic childhood experience [8], although the onset can come at any point in an individuals life. Such an experience can occur multiple times, or only once, to make a permanent impression on the mind [9]. The majority of claustrophobic participants in an experiment done by Lars-Gran st reported that their phobia had been acquired as a result of a conditioning experience [10]." In most cases, claustrophobia seems to be the result of past experiences. Conditioning experiences A few examples of common experiences that could result in the onset of claustrophobia in children (or adults) are as follows:

     

A child (or, less commonly, an adult) is shut into a pitch-black room and cannot find the door or the light-switch. A child gets shut into a box. A child falls into a deep pool and cannot swim. A child gets separated from their parents in a large crowd and gets lost. A child sticks their head between the bars of a fence and then cannot get back out. A child crawls into a hole and gets stuck, or cannot find their way back.

The term past experiences, according to one author, can extend to the moment of birth. In John A. Speyrers Claustrophobia and the Fear of Death and Dying, the reader is brought to the conclusion that claustrophobias high frequency is due to birth trauma, about which he says is one of the most horrendous experiences we can have during our lifetime, and it is in this helpless moment that the infant develops claustrophobia [11]. Magnetic resonance imaging, or the MRI, has been attributed to the onset of claustrophobia. Since a patient has to be put into the center of a magnet to optimize imaging, the patient finds themselves in a narrow tube for an extended period of time. In a study involving claustrophobia and the MRI, it was reported that 13% of patients experienced a panic attack during the procedure. The procedure has been linked not only to the triggering of preexisting claustrophobia, but also to the onset in some people [12]. These panic attacks during the procedure make it so the patient is unable to adjust to the situation, and therefore the fear remains [13]. S.J. Rachman tells of an extreme example is found in the experience of 21 miners in the Claustrophobia section of Phobias: A Handbook of Theory, Research, and Treatment. These miners were trapped underground for 14 days, during which six of the miners died of suffocation. After their rescue, ten of the miners were studied for ten years. All but one were greatly changed by the experience, and six of those developed phobias, phobias that involved confining or limiting situations. The only miner who did not develop any noticeable symptoms was the one who acted as leader [14]. Another factor that could cause the onset of claustrophobia is information received [15]. As Aureau Walding states in Causes of Claustrophobia, many people, especially children, learn who and what to fear by watching parents or peers. This method does not only apply to observing a teacher, but also observing victims. Vicarious classical conditioning also includes when a person sees another person exposed directly to an especially unpleasant situation[16]. This would be analogous to observing someone getting stuck in a tight space, suffocated, or any of the other examples that were listed above. [edit]Prepared phobia There is research that suggests that claustrophobia isnt entirely a classically conditioned or learned phobia. It is not necessarily an inborn fear, but it is very likely what is called a 'prepared phobia.' As Erin Gersley says in Phobias: Causes and Treatments, humans are genetically predisposed to become afraid of things that are dangerous to them. Claustrophobia may fall under this category because of its wide distribution early onset and seeming easy acquisition, and its non-cognitive features [17]. The acquisition of claustrophobia may be part of a vestigial evolutionary survival mechanism [18], a dormant fear of entrapment and/or suffocation that was once important for the survival of humanity and could be easily awakened at any time [19]. Hostile environments in the past would have made this kind of preprogrammed fear necessary, and so the human mind developed the capacity for efficient fear conditioning to certain classes of dangerous stimuli [20]. Rachman provides a very strong argument for this theory in his article: Phobias. He agrees with the statement that phobias generally concern objects that constitute a direct threat to human survival, and that many of these phobias are quickly acquired because of an inherited biological preparedness [21]. This brings about a prepared phobia, which is not quite innate, but is widely and easily learned. As Rachman explains in the article: The main features of prepared phobias are that they are very easily acquired, selective, stable, biologically significant, and probably [non-cognitive]. Selective and biologically significant mean that they only relate to things that directly threaten the health, safety, or survival of an individual. Non-cognitive suggests that these fears are acquired unconsciously. Both factors point to the theory that claustrophobia is a prepared phobia that is already pre-programmed into the mind of a human being. [edit]Treatment [edit]Cognitive therapy Cognitive therapy is a widely accepted form of treatment for most anxiety disorders.[22] It is also thought to be particularly effective in combating disorders where the patient doesnt actually fear a situation but, rather, fears what could result from being in said situation.[22] 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.[22] 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.[2] [edit]In vivo exposure This method forces patients to face their fears by complete exposure to whatever fear they are experiencing. [22] This is usually done in a progressive manner starting with lesser exposures and moving upward towards severe exposures. [22] 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.[22] 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.[2] Of the methods he tested in this particular study, this was by far the most significant reduction.[2]

[edit]Interoceptive exposure 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. [22] This was the final method of treatment tested by S.J. Rachman in his 1992 study. [2] It lowered fear and negative thoughts/connotations by about 25%.[2] These numbers did not quite match those of in vivo exposure or cognitive therapy, but still resulted in significant reductions.[2] 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 betablockers, which help to relieve the heart-pounding symptoms often associated with anxiety attacks.

The fear of being closed in Claustrophobia is usually described as a fear of enclosed places. A more accurate description might be 'a fear of not having an easy escape route' because for anyone who experiences this phobia this is the predominating feature - you feel a need to be able to get out or get home, quickly. Let's get something quite clear at the outset - this is not an illness and it can be eradicated. A 'learned response' Claustrophobia is a learned response to being in certain situations. A response that is powerful, uncomfortable, embarrassing, inconvenient, debilitating at times, perhaps even seriously debilitating - but still a learned response. And just as you can learn to have a particular response you can un-learn it. What's more, it's likely that you can do this for yourself without professional help. Good professional help is likely to make things easier and a lot quicker but, for most people, it is not essential. Yes, this is a sweeping statement - that you, yourself, can resolve your fear. But, as you'll read below, the 'mechanics' of the condition are relatively straightforward and once you have recognised these in yourself you can begin changing them and dissolving the fear. So how do we 'learn' to fear not having an escape route? There are many different ways in which we can learn to have this concern - the following are a few examples: Many people develop the condition as a result of being 'trapped' in an uncomfortable situation such as a stalled lift (elevator), an uncomfortable or frightening airplane journey, an overcrowded room, etc. Some, additionally, were experiencing panic attacks at the time when they were trapped - which added to their fear. Some people who go through a period of having panic attacks begin to become very focussed on the need to be able to get home quickly so they begin avoiding any situation where the route home will not be quick and easy.

What's it like to have this fear? It's a constant search for escape routes... On entering a room, hallway, lift (elevator), etc. you first scan for the escape routes and will usually position yourself as near to this as possible. Air travel becomes difficult or impossible - you dread that moment when the doors 'clunk' shot and you're 'trapped' for the duration of the journey. Car journeys can be difficult, particularly if they require you to travel on a motorway or even dual carriageway since it is not as easy to 'escape' from these. Similarly you may start to avoid travelling at busy times so that you do not get trapped in a traffic jam. Hospital checks involving scans where you are slowly moved through the scanning machine may only possible with sedative medication. If you live or work on an upper floor you get plenty of exercise because you are unable to take the lift (elevator). And even if you are able to travel in lifts it is done with difficulty and you'll likely wait if the lift appears crowded. And it's not just small rooms - even a large room, if filled with people, will pose a threat unless you can position yourself near a doorway. So meetings and parties are avoided.

In extremes you cannot be in a room unless the door is left ajar. It is often linked with conditions which have a strong physical element, such as Irritable Bowel Syndrome (IBS), where there is a realistic need to be able to escape quickly to get to a toilet. In such cases, even if the condition subsides, the fear of not having an escape route may continue because you now have 'learned' the claustrophobic response. If you experience panic attacks or social phobia these will usually have a strong claustrophobia element since you fear that is you have a 'funny turn' everybody will notice you and this could lead to you losing control of yourself.

OK, I get the point - now what can I do about it??? Right, you have to deal with this on three fronts: 1. Believe that you can eradicate this learned response. If you believe it is possible then it is. If you believe you have to 'learn to live with it' then that will be true for you. (It's the old rule - whether you believe you can or believe you can't - you're right!) So decide you are going to deal with this energetically and systematically - and are going to free yourself from claustrophobia for good. However long it takes. Whatever it takes in terms of effort, determination, etc. You decide that you're not going to be a patient patient any longer! 2. Tools for Claustrophobia First of all, forget about trying to analyse the cause - it is not particularly relevant to getting rid of the condition. Then approach the issue systematically. You need to believe in yourself and your ability to free yourself from the claustrophobia response. Remind yourself frequently that it is a learned response - one that you accidentally 'picked up' - and that what has been learned can be un-learned. (1) Tools to use when not in claustrophobic situations Examine how you usually 'do' the claustrophobia behaviour. Yes, I know you don't do it deliberately but you do do it - even though the process occurs automatically. It is your brain, your body, and your emotions that are involved in this. A typical fear-cycle Once the trigger is encountered you rapidly go through a series of steps. These vary from person to person but will typically involve an escalating cycle such as: think of or see trigger - remember past moments of being uncomfortable in similar situations, begin awfulising self-talk, imagine a disaster movie of what is likely to happen, feel awful, wonder if people are noticing your distress, imagine what they might think and do if you lost control, etc. Then you probably re-run this sequence a number of times faster and faster - and feel terrible. And it all happens automatically! The mechanics of your fear-cycle Remember you are studying the 'mechanics' of your fear. You are examining how and not why you do it. It usually involves lots of fearful anticipating - thinking ahead about all the awful things that could or might occur! What if I got a panic attack and couldn't get out of this room quickly - I might lose control completely etc. So you talk to yourself about what might happen and/or mentally visualise such events. This self talk and imaging then activates the body's fear-handling process - the 'fight or flight response' - and you're on your way to feeling really uncomfortable. Have you noticed how you do it? Great! You are on your way to eradicating the response. (Keep reminding yourself that it is just a learned response and not an illness.) Pin-point the trigger(s) The next step is easy because you're probably an expert in this area. How do you knowwhen to start the claustrophobic mechanism? To be claustrophobic you have to 'know' when to have the fear. There has to be a trigger that alerts your mind-body that it is time to start the feelings and thoughts. The trigger can be approaching a threatening situation or can even be thinking about a past or forthcoming situation involving a lack of escape route.

So, for you, what is the first thing you see or hear before the whole series of physical and mental mechanisms kick in? (Do remember, it is not what do you first feel - the feeling is just the result of the rapid self-talk and visualising activity.) The question is what you see or hear that results in the fearful feeling! Is it the sight of the crowded lift? Or the moment when the cabin staff start pushing the door of the plane closed? Or when the meeting room goes silent just before the speaker begins? Most people will have more than one trigger. One person I worked had a whole list - dozens of them. If you do have quite a few simply pick the trigger you most commonly encounter. Arrange the triggers in a sequence You have now established the manner in which your fear cycle starts and then spirals upwards into a panic. You have also established the various triggers and arranged these in order of intensity. Desensitise yourself Next begin using this 'hierarchy' of triggers to desensitise yourself to these situations. This means using a method called Systematic Desensitisation to eradicate your fearful response to the situations that cause you fear. It is called 'systematic' because you do it in a very methodical manner. You first work on the least threatening situation. Then, and only when you can remain in this situation with full comfort, you move to the next most threatening. Only when you are fully at ease withthis situation you go on to the next one. Systematic Desensitisation is s-l-o-w Very slow. But it is thorough and it does work. And when you think how long you have had the phobia and how much difficulty it causes you - well, what's the hurry if you can get rid of it 'systematically'? These is a full explanation of this method here. Patiently un-learn your way to freedom Once they know they can get rid of the condition many people spoil their chances of success through impatience. They want to get rid of all of their fears NOW! Even with the assistance of a skilled professional it is likely to take a number of sessions to eradicate the claustrophobic response if you have had it for some time. After all, you've been 'practising' for months or years. So allow a realistic amount of time - a few hours with the assistance of a professional and up to a couple of months if you are doing it yourself and doing a little practise every day. And, once again, what's your hurry? Either way you're just a short few steps away from freedom! Believe in yourself! Finally, as I mentioned on the first page on claustrophobia, it is critically important that you do believe you can overcome this. There really is no point in trying things! You must decide that you can and you will eradicate this fear from your life and begin living a normal life again. Just trying techniques or doing the rounds of therapists is wasting your time and possibly your money. This requires full commitment - full dedication. Believing it means you can literally visualise a realistic end-result - of you living normally and feeling quite at ease in the situations that currently cause you anxiety. Begin creating this image today - and use it as a beacon to draw you forward through the normal ups and the downs of releasing yourself from a phobic habit. (Incidentally, because it is so slow, Systematic Desensitisation is not the method I would use when working with someone. But it is ideal if you are working on your own without professional assistance. If you are looking for professional assistance there are many types of therapy for claustrophobia. And I would suggest that you begin by seeking a therapist who, in addition to her or his professional qualifications, has at least Master Practitioner Certification in NLP. The NLP + therapy method can be quick. ) (2) Tools and tips for emergencies These are some 'symptom management' methods to use while you are progressing with your desensitisation. The range of symptoms is extensive so it is only possible to give a few general tips and techniques here.

Breathing If you tend to get breathless or to hold your breath develop some skill in using breathing methods to calm yourself and feel more in charge of your mood.

Claustrophobia (Fear of Enclosed Spaces)

Claustrophobia is defined as a fear of enclosed spaces. Like any phobia, the severity of claustrophobia can vary widely from person to person. Sufferers may experience symptoms in small rooms, crawl spaces, crowds and many other situations. Some people with claustrophobia are uncomfortable on amusement park rides such as roller coasters that use secure restraints. MRI chambers and other medical testing can also be difficult or impossible for people who suffer from claustrophobia. Symptoms of Claustrophobia If you have claustrophobia, you may feel panicked when you are in a small space. You may sweat, shake or experience heart palpitations. You may cry or yell. You might attempt to get out of the situation by any means possible. Some people with claustrophobia find it difficult to breathe. Some say that it feels like the walls are closing in on them. Eventually, you may begin to dread activities that could cause you to feel closed in. You might skip crowded parties or other events, avoid rides that use shoulder restraints, leave the door open when you enter small rooms or make many other concessions to your fear. Traveling With Claustrophobia Claustrophobia can be a challenge when traveling, turning a well-deserved vacation into a nightmare. Flying gets the trip over with quickly, but forces you to confine yourself to a small seat surrounded by strangers. Train travel provides large comfortable seats, and allows you to walk around, but takes a long time. Driving can feel confining, but gives you the ability to stop for stretch breaks whenever you like. Dangers of Claustrophobia Claustrophobia can severely limit your life, causing you to miss out on things you would otherwise enjoy. Medically, claustrophobia can be dangerous because it could cause you to avoid having necessary MRI tests. Many people discover the severity of their claustrophobia for the first time when undergoing MRI scans. Causes of Claustrophobia Researchers are not yet certain what factors may cause claustrophobia. Many speculate that it may be rooted in a bad childhood experiences. Others believe that it may be a warping of an evolutionary survival mechanism. Either way, it appears that a history of being nervous in enclosed spaces may eventually lead to full-blown claustrophobia. Managing Claustrophobia Psychotherapy, particularly cognitive-behavioral therapy (CBT) has been shown to be quite successful in treating claustrophobia. Your doctor may also prescribe anti-anxiety medications or antidepressants to help manage your symptoms. Behavioral techniques such as systematic desensitization and flooding are often used in conjunction with cognitive methods such as theStop! Technique. The methods work together to help change both your behaviors and your feelings of fear. A 2007 study, published in CyberPsychology and Behavior, showed that immersive virtual reality may be effective in helping those who suffer from claustrophobia get through a fear-inducing event. Researchers found that virtual reality was more successful than distraction with music in helping sufferers successfully complete an MRI scan. Only two clients, both of whom were diagnosed with claustrophobia, were involved in the study. Both attempted 10-minute mock MRI scans, but reported high levels of anxiety and asked to terminate the scans early. For a second attempt, one was distracted with music, while the other was immersed in a virtual reality world. The client who listened to music reported high anxiety and asked to terminate the scan. The client immersed in virtual reality was able to successfully complete the scan, reporting low anxiety and a high feeling of self-efficacy. This research is relatively new, and involved only two clients. More studies will need to be performed in order to determine whether this is true in all or most situations. Some people find relief through hypnosis and other alternative forms of treatment. Others find that self-help methods such as visualization can help them through claustrophobia attacks. If you decide to try alternative methods of treatment, be sure to get the approval of your mental health professional. Claustrophobia can be debilitating if not treated. However, treatment is usually successful. If you are experiencing any symptoms of claustrophobia, it is important to contact a mental health professional or your family doctor as soon as possible.