Claustrophobia is referred to as a type of specific phobia that involves a fear of tight or enclosed spaces. This can include an elevator, small room, very crowded space, airplane, subway train, tunnel, car wash, bathroom stall, and even in a Magnetic Resonance Imaging (MRI) machine.
Treatments can include exposure therapy, cognitive behavior therapy (CBT), virtual reality exposure therapy (VRET), medication, and relaxation skills. The length of treatment varies based on the severity of claustrophobia symptoms, but a good ballpark is between 6-18 weekly therapy sessions.1
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What Is Claustrophobia?
Claustrophobia is a specific phobia involving the irrational fear of small spaces, which can sometimes lead to a panic attack. A person with claustrophobia knows their fear is irrational, but even thinking about the fear causes anxiety. Many people will go out of their way to avoid the situation that causes anxiety (For example, taking the stairs instead of the elevator, or taking a car instead of the train).1
What Situations Can Trigger Claustrophobia?
Feelings of claustrophobia can be triggered by entering an elevator, a small windowless room, or even an airplane. Wearing tight-necked clothing may also cause feelings of claustrophobia in some people.
How Common Is a Fear of Small Spaces?
It is estimated that claustrophobia affects approximately 12.5% of people, and women are more frequently affected by this phobia than men.1 Moreover, it is extremely common for people to have multiple phobias. In fact, approximately 75% of people who have a specific phobia fear more than one object or situation.2
Symptoms of Claustrophobia
Claustrophobia is different for everyone. It can be intense anxiety or a full-blown panic attack. Symptom severity depends on how many situations cause anxiety, how long an individual has suffered from claustrophobia, and amount of treatment that was sought.
Symptoms of claustrophobia can include:1
- Shortness of breath
- Fast heartbeat
- Sweating
- Shaking
- Nausea
- Dizziness
- Dry mouth
- Difficulty breathing
- Ringing in ears
- Choking feeling
- Nausea
- Confusion
- Chest pain
When someone is having severe symptoms, these feelings can be very frightening, as they feel they will faint, are losing control or dying even if there is no life-threatening risk.
Symptoms of a Panic Attack
Panic attacks are intense and peak within a few minutes. Panic symptoms can include shortness of breath, sweating, chest pain and tightness. These symptoms are similar to a heart attack, and many people with claustrophobia may seek medical attention, only to find that there is no physical cause of these symptoms.1,4
What Causes Claustrophobia?
Research is unclear on the exact cause of claustrophobia. Some link it to genetics being passed down through a family, and others say it could be linked to a childhood history of bullying or another traumatic event). If someone suffers from another anxiety disorder they may be more likely to develop claustrophobia.4 Another factor may be a defect in a gene called GPM6A that some researchers believe makes an individual prone to claustrophobia.1
How to Overcome Claustrophobia
There are a wide range of coping strategies that you can use for self-help and better manage and overcome your claustrophobia.
Here are some self-help suggestions for dealing with claustrophobia:
- Use self-help books/podcasts: You can take an active role in your recovery by learning about claustrophobia while also gaining tools that you can practice during high anxiety situations.
- Reach out for help: Reach out to close friends, family and anyone who you know has your back and won’t judge you. This can be beneficial at times when you need to vent or talk about your struggles related to your phobia.
- Learn a grounding technique: There are a wide variety of grounding techniques that can reduce the panic triggered by the fear-inducing situation. One that’s simple and easy to remember is to look down and stare at your feet, which can divert your attention and literally ground you.
- Have a mantra: Find a mantra, affirmation, or anything that you can say to yourself to bring you peace when the panic starts to rise. You can try, ”I am not in danger, I am safe”, or, “This feeling is temporary and it will pass.”
- Incorporate relaxation strategies: Try setting time aside without interruptions and engage in breath work, meditation, mindfulness, and progressive muscle relaxation to calm your senses and decrease anxious feelings.
- Join a support group: When you join a support group you can connect with others who are dealing with similar struggles. This can help you feel less alone, and it can also feel rewarding to share your story and possibly help other people dealing with similar struggles.
- Have a healthy lifestyle: Focus on the basics like eating nutritiously, exercising, getting plentiful rest, tending to your mental health, and other forms of self-care. Having a balance between these things can help to build your resilience to cope with life stressors.
Why Avoidance Can Be a Bad Coping Strategy for Claustrophobia
Avoidance coping is the “go-to” coping strategy among people who battle anxiety and phobias including claustrophobia. This is because it serves as a temporary shield to control the anticipated panic and unwanted emotions associated with enclosed spaces. Although avoidance brings an immediate sense of relief, this maladaptive pattern only perpetuates the phobia. In the long run, the dread that originally led to the avoidance intensifies, and the brain learns that when the fear-provoking situation is dodged, the distress disappears. Consequently, sufferers remain stuck in this cycle which only worsens their condition in the long run.
How Is Claustrophobia Diagnosed?
The process for diagnosing claustrophobia starts with a thorough evaluation conducted by a medical or mental health professional. This examination includes a clinical interview, sometimes questionnaires, and other tools that will inquire about your current symptoms, recent stressors, how the fear impacts your daily life, as well as personal relationships and the possible presence of a mental/general medical disorder, or any other causes that may account for the condition. The objective is to determine if you are presenting with normal fear or with a phobia.1
To arrive at an accurate diagnosis, you must have all the following qualifications:2
- Fear or anxiety is specific to enclosed spaces like elevators, a small room, etc.
- Intense distress and fear that’s immediately triggered when you encounter a tight space or by thinking about the dreaded situation.
- You actively avoid the specific fear-producing situation or endure it with strong anxiety.
- You have an exaggerated dread that’s disproportionate to the actual threat the situation poses.
- Your symptoms have significantly disrupted daily activities, social interactions, and other important life domains.
- Excessive and uncontrollable fear of confined spaces for at least six months or more.
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Treatments for Claustrophobia
There are several treatment options for phobias that primarily revolve around cognitive behavioral therapy (CBT). This type of treatment focuses on a person’s thoughts and behaviors as they relate to developing the symptoms of claustrophobia. Medication may also be used to manage symptoms.
Cognitive Behavioral Therapy (CBT)
CBT is one of the most effective treatments for claustrophobia and usually lasts between 5-10 sessions. The person identifies situations that trigger undue anxiety, and arrange them in a hierarchy from most triggering to least triggering. This is sometimes referred to as a fear hierarchy.
They identify unhelpful thought patterns and work to replace them with more realistic, and positive ways of thinking about these situations. Identified fears are addressed from least triggering (like being in a car) to most triggering (like using an elevator), building confidence as they work up the hierarchy until they no longer fear enclosed spaces.1,5
Exposure Therapy
Exposure therapy exposes the client to the phobias that frighten them. It is believed that phobias are maintained because of avoidance of the phobic stimuli so that the individual does not realize that they can actually tolerate the fear. The fear will reduce without having to escape or avoid it, and the terror they fear will happen when in the feared space actually won’t come true.
Avoidance can occur, for example, by taking the stairs instead of the elevator, or drinking alcohol before a flight. Exposure therapy can be done in real life or in imagination, where you have the client imagine themselves in the feared situation (For example, imagining one is stepping into an elevator).5,6
Virtuality Reality Exposure Therapy (VRET)
VRET is an exposure technique in which a patient is put in a virtual environment that provokes anxiety. It is important that the virtual world produces the same fear and anxiety similar to real-world situations. This technique can greatly help therapists who don’t have the resources or time to work with patients outside the therapy office. It is also more helpful than to have the person imagine the situations in the therapy office.
VRET is not used by many therapists due to its costs, as equipment and hardware can be expensive. Researchers continue to find ways to make VRET more affordable and accessible.5,7
Medication
Medication is primarily prescribed by a psychiatrist or general practitioner (GP). If provided by a psychiatrist, your GP may need to send a referral for you to see a psychiatrist. It is important to check with your insurance provider on their policy.
Medications are often used in conjunction with psychotherapy but are not representative of a cure themselves. Medication can offer short-term relief but does not treat the underlying origin of the disorder. If utilized alone, when someone stops using the medication, claustrophobia symptoms may return.
- Selective Serotonin Reuptake Inhibitors (SSRIs) are used most frequently. Common types of SSRI medications include Zoloft, Paxil, and Lexapro.
- Benzodiazepines are medications that can be used to treat episodes of anxiety and can give relief quickly. They have the potential to be addictive, and are prescribed with caution. Common types of benzodiazepines include Xanax, Klonopin and Valium.9
Relaxation Skills
Relaxation skills are a great tool for managing anxiety. In essence, the therapist teaches relaxation skills to help the person cope with the panic and fear that accompanies claustrophobia. The most effective relaxation skills used are deep breathing, grounding, imagery, and progressive muscle relaxation.
Deep Breathing
Breathwork can seem unnatural for many people, as most people tend to take shallow breaths which can actually cause a sensation of being short of breath and anxious. When you take deep breaths, air fills your lungs and you can feel your lower belly rise. Deep breaths allow the lungs to get a full supply of oxygen and this benefit is reflected as the heart rate slows down and blood pressure stabilizes.9
Grounding
This technique involves being aware of your surroundings, turning your attention away from your anxiety and focusing instead on the world around you. This helps us relax more and be better able to focus on what we are doing.
One particular grounding technique is called “5-4-3-2-1,” in which you focus on:10
- 5 things you can see
- 4 things you can feel
- 3 things you can hear
- 2 things you can smell
- 1 thing you can taste
Imagery
This technique can vary by therapist, but involves having the person think about a peaceful situation in their past when they are not anxious (for example, a day at the beach or camping with family) and have them recreate this scene in detail. By thinking of this peaceful image, individuals can reduce anxious body reactions as they imagine what it felt like to be at peace in that moment.11
Progressive Muscle Relaxation
Progressive muscle relaxation involves tensing a muscle of your body while inhaling and then exhaling and relaxing the muscle (for example fists, shoulders, legs). A good rule of thumb is to tense as hard as you can for 5 to 10 seconds then relax your muscle(s). This technique is helpful in reducing tense feelings in the body during an anxious state or anxiety attack.
How to Prepare for an MRI When You Have Claustrophobia
If you are about to undergo an MRI test and have claustrophobia, make sure you tell your health provider during your consultation prior to the scan. They may prescribe a sedative that you can take shortly before your MRI scan to help ease your nerves.
You may also inquire about special accommodations depending on the area of your body being examined. Find out if the facility has an open MRI machine and if this can be available for you on the day of your test. Additionally, it is a good idea to contact the clinic before the day of your appointment to inform the attending staff about your claustrophobia.
Here are some things to know about getting an MRI:12
- You’ll be provided a headset to block out the noise or to listen to music during your scan.
- There will be a calming light breeze that will blow on your face.
- You’ll have a panic button if you feel uncomfortable and wish to be removed from the machine at any time.
- The technologist will be able to communicate with you and you with them throughout the scan.
Other tips to help you stay relaxed during the exam include:12
- Ask the technician how long the procedure will take and let them know you have claustrophobia.
- Right before entering the MRI machine, take a few deep, slow breaths.
- Keep your eyes closed throughout the entire time you’re lying down inside the scanner.
- While you are laying down, it can also help you to envision yourself in a cozy and peaceful place whatever that may be for you (a forest, the beach, etc.)
Dealing With a Claustrophobia-Induced Panic Attack
A panic attack begins abruptly when anxiety is triggered. If you feel a panic attack coming on, it is important to tune in to your breath, calm your body, and counter your negative or anxious thoughts. It is also helpful to have an encouraging support system. Panic attacks usually peak within 10 minutes and then reduce. Many people link panic attacks to having a heart attack, or heart defect, and will go to the hospital emergency room.
- Stay calm: To help control panic attacks, it’s important to calm your breath and relax your body. Utilizing some of the relaxation skills discussed previously can be very helpful. In addition, it’s important to remind yourself that you are physically fine and not dying, that this feeling will pass, and that you can overcome this.
- Take deep breaths: Tuning in to your breathing and surroundings is also beneficial.
- Reduce your stress levels: One way to do this is to counter any negative or anxious thoughts that come up throughout your day, not just during a panic attack. You should remind yourself that these thoughts are the anxious you, and write them down and challenge these inaccurate thoughts.
- Change your lifestyle: Lifestyle adjustments like physical activity, adequate sleep, yoga, and social support can also help to prevent panic attacks. This involves having a consistent walking or exercise schedule, making sure to get seven to nine hours of sleep a night, and eating a healthy diet.
- Have a support system in place: Having designated friends or loved ones to reach out to when you are stressed can help keep a calm atmosphere.
How to Get Help for Claustrophobia
If you or someone you care about is struggling with claustrophobia, getting treatment is recommended. If you have health insurance you can explore options for finding a therapist who accepts your insurance, and you would just need to pay a copay. Depending on where you live, paying a therapist’s full fee rate without insurance can cost anywhere between $85-$250 a session.
You can search for therapists in an online therapist directory and specify “Anxiety Issues,” “Exposure Response Prevention,” “Cognitive Behavioral Therapy,” as well as age group. In addition, anxiety disorder clinics or anxiety disorder treatment organizations are more likely to have experience treating claustrophobia.
Claustrophobia Infographics
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