Claustrophobia

Claustrophobia is the fear of being shut in in an enclosed, limiting space.  Psychologists typically class it as an anxiety disorder, and the symptoms, which may range from mild discomfort to the severity of a full panic attack, normally has a cognitive component in which the sufferer fears being crushed or abandoned or helpless and unable to escape.

Studies of the number of people afflicted with severe claustrophobia range from two to five percent of the global population, but the number affected to the degree that they are unable to function in normal society is considerably less.  It is fair to say that most people have experienced or may experience very mild claustrophobic symptoms to some degree:  being confined in stiflingly tight circumstances is not normally regarded as pleasurable by most people.  Severe claustrophobia is a far more intense experience emotionally, yet only a small percentage of sufferers are estimated to receive treatment for the disorder.

Claustrophobia is very much an environmentally triggered disorder.  The claustrophobic will experience discomfort ranging from the mild to the extreme in locked room, closets, elevators, cellars, subway trains, caves, crowded buses or planes, caves, even cars.

Subjective Experience
Self-reports of the subjective experience indicate that claustrophobics are, with rare exceptions, not averse to the areas themselves, but rather swiftly elaborate scenarios in which the harm may come to them as a result of the restriction of space and movement.  Entering a closet, they will fear that they may encounter insects or rats, or be locked in by accident and left for days and even be forgotten.  Confined to an enclosed space, they fear a lack of air will lead to asphyxiation, or that structural weakness will lead to collapse and lead to harrowing physical injury and even death.  Suffocation is perhaps the most common subjective leitmotivs among victims of the disorder.  Scenarios such as burial while alive may be among a victim’s recurring thoughts or on occasion dreams.  The vividly imagined elaboration of such dire consequences may result in severe panic, and so the condition is linked to panic disorder as well.

Behavioral Attributes
Behaviorally, however, the main deficits of claustrophobia are more prosaic.  Most sufferers from the disorder take necessary and even excessive precautions to avoid situations that trigger the onset of feelings of discomfort and panic.  The severe reaction is not experienced, but the strategy of avoidance may lead to considerable inconvenience and many lost opportunities in terms of socializing, career advancement, and, not least, proper medical care. Estimates say that anywhere from four percent to twenty percent of patients needing MRI scans refuse to do so for reasons relating to claustrophobic reactions. One study, in fact, estimated the percentage at 37% of all patients recommended to undergo MRI scanning.  The procedure, which takes place in a receptacle that is both enclosed and restricted, requires very nearly an hour to complete, more than enough time to evoke severe panic reactions in severely claustrophobic patients.

Claustrophobia is normally assessed by the use of the Claustrophobia Scale, a questionnaire first originated in 1979 that consists of twenty questions exploring indicators of anxiety and avoidance.  An alternative questionnaire-based analytic tool was developed by Rachman and Taylor in 1993 that isolates symptoms related to fear of suffocation and fear of restriction.

Treatment Options
The most widely accepted treatment for claustrophobia, and for the anxiety disorders in general, is cognitive therapy.  Cognitive therapy places conscious perceptible thoughts at the forefront of psychological adjustment or maladjustment, and the modification of distorted or maladaptive thoughts are normally the goal of therapies with a cognitive orientation.  While environmental factors may trigger the maladaptive thinking, it is the thoughts themselves, argue cognitive therapists, which trigger the negative emotions and reactions characteristic of claustrophobia.  Modify the thoughts and the negative reactions will not follow.

Cognitive therapeutic treatment, therefore, often tends toward the cerebral and consists of patient-therapist dialogue in which the maladaptive thoughts are examined, criticized, and deconstructed.  Cognitive therapists may point out to a claustrophobic patient that the number of people suffocated annually while riding elevators or standing in line for a bus is virtually nil, or that being locked in a closet for days is not very likely, given that few closets are locked.

Therapists with more psychoanalytic orientations feel the roots of the disorder stem from deeper layers of the mind, but a study conducted by Rachman confirms that cognitive therapy effectively decreases negative thoughts and emotions in claustrophobic patients by roughly thirty percent.

The most effective method employed to date, however, remains the behaviorist procedure developed in 1958 by South African behavioral psychologist Joseph Wolpe and known as systematic desensitization.  Systematic desensitization involves having a client go through a set of practices leading to a deep, thoroughly relaxed state, at which point the patient is asked to imagine each of a series of carefully graded scenes or stimuli geared to provoke anxiety.  When the client proves capable of entertaining the mildest imaginings without negative result, he moves on to the next, slightly more anxiety-provoking scene until he or she acclimates, without the resultant anxiety.

Gradually the claustrophobic sufferer moves up the scale, progressing from milder exposures to more powerful ones, till even those are experienced as the completely relaxed state is maintained.  Eventually relaxation and the triggering stimulus become associated, and the anxiety-causing stimulus provokes calm rather than upset.

Numerous studies have shown this to be an effective approach in dealing with phobics.  Rachman, in the course of testing the effectiveness of several methods of treating claustrophobia, found that it decreased and negative thoughts and emotions in his patients by an average of nearly 75% — the largest reduction of all the methods tested in his study.

There is some reason to believe that claustrophobia may well be a remainder from our evolutionary heritage.  Evolutionary psychologists argue that many apparently maladaptive psychological traits are only so construed because the social world humans are now being asked to adapt to is so very different from the pre-technological and pre-cultural world to which humanity was genetically fitted.  Certainly there is no great leap of imagination to understand why primitive peoples might fear enclosed, restricted spaces such as caves.  If so, it may well be that claustrophobia is an inherent, if latent, predisposition in us all.

And there is some reason to believe that that is the case:  in a famous study of MRI scanning experience as it relates to claustrophobia, test subjects, the majority of who had reported never having had claustrophobic sensations at all up to that point, underwent MRI scanning.  Nearly twenty-five percent reported feelings of anxiety during the scan, and thirty percent of the forty-eight patients responding claimed that that their claustrophobic feelings had elevated since the scan.

While it is clear, then, that claustrophobia can be induced, it is also clear that it can be very effectively reduced.  Numerous techniques, most notably systematic desensitization, have a remarkably high rate of effectiveness.  Victims of claustrophobia may feel hemmed in, but they need not be hemmed in by the feeling that effective sources of care and cure are not available. They are.

Phobias: A Handbook of Theory, Research, and Treatment. Chichester New York: Wiley, 1997.
Wolpe, Joseph.
Öst, Lars-Göran. “The Claustrophobia Scale: A Psychometric Evaluation.” Behaviour Research and Therapy 45.5 (2007): 1053-64.
McIsaac, Heather K., et al. “Claustrophobia and the Magnetic Resonance Imaging Procedure.” Journal of Behavioral Medicine 21.3 (1998): 255-68.

Harris, Lynne M., and John Robinson. “Evidence for Fear of Restriction and Fear of Suffocation as Components of Claustrophobia.” Behaviour Research & Therapy 37.2 (1999): 155.
Valentiner, David P., and Michael J. Telch. “Cognitive Mechanisms in Claustrophobia: An Examination of Reiss and McNally’s Expectancy Model and Bandura’s Self-Efficacy Theory.” Cognitive Therapy & Research 20.6 (1996): 593-612.

Are you a victim of frequent anxiety attacks? We found a quite remarkable program developed by Barry Joe Mc Donagh, who suffered from debilitating anxiety despite trying a variety of allopathic and alternative techniques. The program provides practical techniques that you can start implementing immediately, as well as straightforward guidance. Click here to get the Panic Away program. Alternatively, click here for our review of the Panic Away program.