Claustrophobia is the fear of being in a small space, room, or confined area and unable to escape.
It can be triggered by many situations or stimuli, including elevators crowded to capacity, windowless rooms, hotel rooms with closed doors and sealed windows, even bedrooms with a lock on the outside, small cars, and tight-necked clothing.
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.
One study indicates that anywhere from 5-10% 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 is classified as an anxiety disorder. Symptoms generally develop during childhood or adolescence.
Claustrophobia is typically thought to have two key symptoms: fear of restriction and fear of suffocation.
A typical claustrophobe will fear restriction in at least one, if not several, of the following areas: small rooms, locked rooms, MRI or CAT scan apparatus, cars, buses, airplanes, trains, tunnels, underwater caves, cellars, elevators, and caves.
Additionally, the fear of restriction can cause some claustrophobes to fear trivial matters such as sitting in a barber’s chair or waiting in a queue at a shop simply out of a fear of confinement to a single space. Another possible site for claustrophobic attacks is a dentist’s chair, particularly during dental surgery; in that scenario, the fear is not of pain, but of being confined.
Being enclosed or thinking about being enclosed a confined space can trigger fears of not being able to breathe properly, running out of oxygen, and anxiety of being restricted.
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. When anxiety levels start to reach a certain level, the person may start to experience:
- sweating and/or chills
- accelerated heart rate and a rise in blood pressure
- dizziness, fainting spells, and lightheadedness
- dry mouth
- hot flashes
- shaking or trembling and a sense of “butterflies” in the stomach
- a choking sensation
- tightness in the chest/chest pain and difficulty breathing
- an urge to use the bathroom
- confusion or disorientation
- fear of harm or illness
The fears of enclosed spaces is an irrational fear. Most claustrophobic people who find themselves in a room without windows consciously know that they aren’t in danger, yet these same people will be afraid, possibly terrified to the point of incapacitation, and many do not know why.
The amygdala is one of the smallest structures in the brain, but also 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. Cheng believes that a phobia’s roots are in this fight-or-flight response.
In generating a fight-or-flight response, the amygdala acts in the following way: The amygdala’s anterior nuclei associated with fear of 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.
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.
Claustrophobia results as the mind come to connect confinement with danger. It often comes as a consequence of a traumatic childhood experience, although the onset can come at any point in an individual’s life.
Such an experience can occur multiple times, or only once, to make a permanent impression on the mind. The majority of claustrophobic participants in an experiment done by Lars-Göran Öst reported that their phobia had been “acquired as a result of a conditioning experience.” In most cases, claustrophobia seems to be the result of past experiences.
Cognitive therapy is a widely accepted form of treatment for most anxiety disorders. 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.
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.
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.
In vivo exposure
This method forces patients to face their fears by complete exposure to whatever fear they are experiencing. This is usually done in a progressive manner starting with lesser exposures and moving upward towards severe exposures.
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.
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. Of the methods he tested in this particular study, this was by far the most significant reduction.
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.
This was the final method of treatment tested by S.J. Rachman in his 1992 study. It lowered fear and negative thoughts/connotations by about 25%. These numbers did not quite match those of in vivo exposure or cognitive therapy, but still resulted in significant reductions.
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.
Tips for managing claustrophobia
Take deep breaths, one to three times. Then, focus on safe things like the time on your watch. Remind yourself repeatedly that your fears and anxieties will pass.
It’s irrational to challenge what triggers your attack by repeating the fear. Imagine and focus on a place or moment that calms you down.