Claustrophobia is referred to as a type of Specific Phobia categorized within the anxiety disorder cluster, and is a fear of tight or enclosed spaces. This can include an elevator, small room, very crowded space, airplane or subway train, tunnel, car wash, bathroom stall, and even in an 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
Signs of Claustrophobia
Anxiety in different areas of life can be common, as it is the most prevalent mental disorder in the U.S. What sets claustrophobia apart is that people have an irrational fear of small spaces, which can sometimes lead to a panic attack.
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 individuals. A person with claustrophobia knows the 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
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:4
- Shortness of breath
- Fast heartbeat
- Dry mouth
- Difficulty breathing
- Ringing in ears
- Choking feeling
- Chest pain
When an individual 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.
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.3,4
Causes of 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, particularly if the event includes being locked in enclosed spaces (for example, a closet or small locker). If an individual suffers from another anxiety disorder they may be more likely to develop claustrophobia.3
Panic attacks can accompany claustrophobia; a person may get panic attacks randomly, but in claustrophobia it will be because of a feared situation. When someone experiences a panic attack, they have the urge to leave the situation immediately, and this reinforces the need to avoid the feared situation.
Another factor may be a defect in a gene called GPM6A that some researchers believe makes an individual prone to claustrophobia.1
If someone has a traumatic experience such as bullying, abuse, or harsh punishment, they are more likely to develop stress related symptoms, which can include panic, sweating, and nausea when encountering the feared situation. When seeking help or considering one’s own symptoms, it is important to reflect on one’s childhood experiences to see if any major event may have triggered claustrophobic reactions.
Treatments for Claustrophobia
There are several treatment options for claustrophobia 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. Other common therapies include Exposure Therapy and Virtual Reality Exposure Therapy (VRET), and 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 individual 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 many times positive, ways of thinking about these situations. Identified fears are addressed from least triggering (for example, being in a car) to most triggering (for example, an elevator), building confidence as they work up the hierarchy until they no longer fear enclosed spaces.1,5
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 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.
The two types of medications prescribed for claustrophobia are antidepressants and antianxiety agents:
These medications can be beneficial when anxiety is relentless and unbearable. Selective Serotonin Reuptake Inhibitors (SSRIs) are used most frequently. Serotonin is a neurotransmitter in the brain that influences mood, and the purpose of SSRIs is to make serotonin more readily available in the brain, which can be helpful in reducing anxiety. Common types of SSRI medications include Zoloft, Paxil, and Lexapro.
Anti-anxiety medications reduce the physiological symptoms that come with anxiety. 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.8,9
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.
This technique 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 heart rate slows down and blood pressure stabilizes.10
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:
- 5 things you can see
- 4 things you can feel
- 3 things you can hear
- 2 things you can smell
- 1 thing you can taste11
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.12
Progressive Muscle Relaxation
This technique 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.13
Dealing With a Claustrophobia-Induced Panic Attack
A panic attack begins abruptly with a fear trigger. 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.
Typical symptoms of a panic attack can include:
- fast or pounding heart
- tightening throat
- Feeling hot or cold
- pins and needles sensation
- chest pain
- Short of breath
Panic attacks can produce emotional experiences like feelings of detachment, unreality, and feelings that one is dying. 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.
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.
Tuning in to your breathing and surroundings is also beneficial. In preventing panic attacks you must reduce your overall 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.
For example, if I have the thought “I will never overcome my anxiety,” a counter thought can be, “Am I 100% certain this is true, can I not think of one example where I was successful?” By countering these thoughts, you will begin to develop a habit of thinking more positively and realistically, thus calming your body.
Lastly, 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.
In addition, having designated friends or loved ones to reach out to when you are stressed can help keep a calm atmosphere. By engaging in these healthy activities you can significantly reduce the risk of panic attacks and severe anxiety when in a potentially anxiety-producing situation.14
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 find a therapist that 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.
If your insurance has “out of network benefits,” which allow you to see a therapist not covered by your plan, you would pay the full session fee and then get reimbursed by your insurance for a portion, or sometimes the whole fee. Calling the number on the back of your insurance card or going online to use the insurance company’s search tool will result in a list of providers close to you.
You can search for therapists in an online 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.
When searching Google, it is recommended you search for “anxiety treatment centers near me” to find a list of anxiety-focused clinics in your area. When finding the right therapist it is recommended that you call at least 10 providers in your area to ask questions, see if they are accepting new patients, see if their availability matches yours (for example, sessions during the evenings or on weekends), and whether they have specific experience in treating claustrophobia or specific phobias.15
Claustrophobia Tests, Quizzes, and Self-Assessment Tools
There are no formal quizzes or tests to determine whether an individual suffers from claustrophobia. Current online quizzes that may give you an idea whether you may have claustrophobia are: