This article discusses the origins and treatment of the common phobia of claustrophobia. This will be of help to anyone who is suffering from claustrophobia who would like to suppress their symptoms and work out their own solution to the problem
- What causes claustrophobia?
- More than just lifts and tunnels
- Treatment options
Choosing your route out of your claustrophobia
- Do you want to suppress or relieve the symptoms of claustrophobia quickly, in the short term?
- Do you think or know that your claustrophobia was caused by a specific trauma, and that you might need help with that first?
- Do you have the sense that the way you are thinking about confined spaces or your own ability to tolerate fear is part of your problem?
- Would you like to work out your own solutions and strategies?
- Group A treatments
- Group B treatments
- Other therapies
Claustrophobia is the fear and avoidance of confined spaces. Specifically, it is being frightened of being trapped (in the confined space), and of either being unable to control or escape from whatever might happen whilst trapped, or of being forgotten and abandoned there. The phobia develops when an individual begins to avoid small and confined spaces, strongly believing that ‘something awful will happen’. If the person does have to face going into a small space, he or she experiences physical symptoms of panic such as dry mouth, sweaty palms, nausea, shaky legs, pressure in the head, feeling either very hot or cold. Thinking becomes scattered or is reduced to one pressing thought – ‘I’ve got to get out’. Emotionally, the person feels huge fear and trepidation, and has a sense of dread and doom.
As the phobia progresses, people who experience claustrophobia not only avoid small spaces but also pictures of them. The individual may get to the point where talking or even thinking about small spaces triggers anxiety. The phobia worsens in this way for the simple reason that, as with any phobia, the more we avoid a feared situation, the worse our anxiety becomes, the more irrational our beliefs become, and the less willing we are to test the reality of our fears.
Claustrophobia has rarely been highlighted in the phobia literature until recently, but this debilitating experience affects around 10% of the population. Whilst claustrophobia is not a disability, it can be experienced as profoundly disabling in terms of limiting work options, career development, leisure, access to buildings and forms of transport, and can also negatively affect both personal and professional relationships. Claustrophobic difficulties can lead to feelings of shame and depression, and undermine self-confidence and self-esteem.
There seem to be at least five different routes. Considering which seems most true for you can help you decide what treatment to go for.
Firstly, many people who experience claustrophobia can point to a single incident (getting trapped in a lift, being shut in a cupboard by a sibling etc) which triggered their anxiety. It is likely that the trauma they experienced overwhelmed their normal coping mechanisms and so remained locked in their awareness, rather like a splinter in a finger, instead of being forgotten or dealt with. They then notice that any new small or confined space makes them feel extremely anxious, and they start down the path of avoidance. Not everyone who experiences trauma develops a phobia, so other factors, such as stress or a lack of empathic and appropriate support, are likely to have also been present.
Secondly, some people have a sense that ‘It’s always been like this for me’, with no specific memory or association. Some therapists believe that birth trauma could trigger claustrophobia (for example difficulties with delivery, the cord being wrapped around the neck and so on) and thus be held as a ‘body memory’, that is, as a sensation and sensitivity, rather than as a normal memory in thoughts or pictures. An alternative explanation here is that if the person’s parents experienced claustrophobia, the baby and then the growing child learnt their anxiety from them. Certainly there are some people who clearly remember feeling helpless and scared when witnessing a parent’s anxiety or agitation. In future years, small spaces become associated with the hard-to-manage feelings they had as a child, as well as the ones they saw their parent having. The anxious parent may also prevent the child from testing the reality of the claustrophobic fear, giving the child less possibility to develop their own confidence.
Women often report experiencing claustrophobia for the first time after the birth of their children. This may be because as a care-giver, the mother may become highly sensitised to potential environmental dangers, and anxious not only about their child’s well-being but also what would happen to the child if anything happened to her.
A fourth group may have developed anxiety around the time that some other difficulty appeared in their lives, for example a bereavement, marital difficulties or redundancy and so on. If they confront their claustrophobic fear, it will become more apparent what other needs or conflicts they have, and if they resolve their other issues, the claustrophobia may disappear of its own accord.
Finally, people suffering a more generalised anxiety disorder may well experience claustrophobia if their major self-care strategy is avoidance.
The list of circumstances that people find claustrophobic is long and possibly growing. The increasing use of impersonal, electronic control in buildings, cars, buses, trains and even toilets, combined with the demands of a crowded and pressurised way of life has increased people’s fear and apprehension. Medical facilities such as conventional MRI scanners are also frequently cited as causing anxiety. In some unfortunate cases, going into a scanner actually triggered the first claustrophobic panic. Where this was not handled well by staff, patients’ panic has led to the scanning process being abandoned and their subsequent avoidance of other confined spaces. Services such as the London UprightMRI Scanner have been specifically developed to offer claustrophobic patients a genuine alternative. The patient is able to sit or stand in the open-fronted scanner and remain in visual and verbal contact with staff throughout the procedure. Any residual anxiety the patient may have is handled with sensitivity and respect.
Shame or lack of information about approaches may have prevented people who experience claustrophobia from seeking help, but with sensitive and appropriate assistance, it can be fully overcome. There are a wide range of therapy and self-help options: no single approach works for everyone. The work in any therapy will be to stop avoiding and to start dealing with claustrophobic fear, but not to convince yourself that life is totally safe or that you will never again experience fear. What you can look forward to is no longer being afraid of feeling frightened, and of being able to go into and through the small spaces that once terrified you, with ease.
The most likely indicators for a successful outcome of any therapy will be your motivation, how much you trust the therapist, how much support you have outside the therapy session and what other positive things are going on in your life. The more you can have enjoyable experiences and strengthen mutually supportive relationships with your family and friends, and the more you can develop your view of yourself as a resourceful, capable person able to access help and learn new ways of doing things, the more you are likely to find therapy productive.
The following questions may help you choose the right therapy for you*:
You may wish to ask your GP for medication to reduce anxiety specific to a particular situation, for example taking a flight. It is highly unlikely that medication would be prescribed for ongoing phobic anxiety.
You might want to try Eye Movement Desensitization and Reprocessing (EMDR) of Hypnotherapy
You might want to try Cognitive Behaviour Therapy (CBT) or Computer Assisted CBT (CACBT)
You might want to try Solution Focused therapy or one or more self-help strategies.
The single most important decision in deciding on treatment or a self-help strategy is to consider whether you want to learn to soothe your anxiety (Group A), or, by experiencing anxiety to its full-blown extent, learn to tolerate your fear through exposure (Group B)
The aim of hypnotherapy is to allow you to reach an altered state of consciousness through a process of deep relaxation. Within the hypnotic state or trance, your normal judgments and defences of suspicion and cynicism are suspended. Your sub-conscious mind becomes accessible to positive suggestions intended to mobilise your inner strength and resources, to deal with the problem issue. Your sub-conscious can be provided with alternative, helpful imagery about confined spaces, agreed beforehand by you and your therapist, reducing the anxiety-provoking effect of the feared situation once you are fully awake. You can practise the hypnotherapy techniques of relaxation and visualisation for yourself when going into or while you are in a confined space. It may be possible to release previous trauma without having to actively discuss it.
Some people who experience claustrophobia may fear the loss of control they imagine they will experience in this form of therapy, although the depth of relaxation and trance will depend on the strength of relationship the person forms with their therapist. Hypnotherapy is available both through the NHS and privately.
This form of therapy may be appropriate if you feel a specific incident triggered your claustrophobia. EMDR is recommended by NICE for dealing with the effects of trauma, and has been found to be highly effective. Within the context of a safe, supportive counselling relationship, EMDR therapists uses non-invasive bi-lateral stimulation of the brain (through sound, touch or by the patient watching a moving object) to enable you to slowly and safely process your memories of the original trauma without running the risk of re-traumatisation. The therapy will also help you to re-build the emotional and cognitive resources necessary to return to similar situations.
Referral to an EMDR specialist at a trauma clinic may be possible through your GP, and EMDR is also available privately. However, it is not as yet widespread through the UK, and waiting lists may be lengthy.
This therapy will help you identify how your thinking affects your behaviour and feelings. You may be encouraged to keep a thoughts-and-feelings diary, to uncover what kind of thinking is helping to maintain your anxiety, and what kind of alternative thinking would be more constructive. You will be encouraged to carry out real-life experiments to test out your beliefs on the assumption that you will find evidence to contradict doom-laden thoughts. You may be given information about what happens to your body when you experience anxiety and panic, to help you recognise the normal range of experience. You will be supported to gradually build confidence in your ability both to tolerate fear and make more accurate assessments of the kind of situations you want to be able to face. You will be encouraged to re-visit the situations you fear by progressing through a ‘fear hierarchy’ (from the least frightening situation to the most frightening situation). Where CBT is combined with exposure/desensitization work, you may be encouraged to stay in the situation that frightens you until your fear peaks and subsides, usually after about thirty to forty minutes, in order to learn that you will survive.
Recommended by NICE for anxiety and phobias, this therapy is most likely to be offered through the NHS for between six to eight sessions. One of its best advantages is that the therapist may go with you to the confined spaces that you fear, and support you to stay there until your anxiety subsides. CBT may be particularly useful for people who feel they have ‘learnt’ to be anxious or claustrophobic from a parent or other family member, or who have become claustrophobic after some other major life event (giving birth, bereavement, divorce etc). It may not be appropriate for people who have experienced trauma, or who have problems with personal organisation, motivation, memory, or who find transfer of learning difficult.
FearFighter is a NICE approved computer-aided therapy programme which guides the user through nine self-exposure-to-anxiety steps over 10 sessions. It is available through discussion with your GP. It is designed to be accessed over the internet via a password. The rationale for exposure therapy is explained, and you are supported to identify what your particular issues and goals are. Fearfighter encourages you to stay with fear, not to run from it, as a way of breaking the ‘addiction’ to avoidance. It outlines a programme of identifying anxiety triggers, setting goals to face the triggers and the fear they produce, and to practice each goal until the fear diminishes. There are homework diaries, feedback on progress and ‘trouble-shooting’ advice. Little or no experience of computers is needed. You may or may not be offered face-to-face contact with a therapist whilst going through the programme.
Such an approach may be beneficial to highly motivated, organised and well-supported individuals, in that it relies on a high degree of personal determination. It may not be so effective for people who experience difficulties using positive self-talk or have a history of trauma or addiction or, naturally, those who have a dislike of computers.
This form of therapy values clients as expert, not the therapist, and supports your ability to sort out your issues with your own skills, resources and motivation. You are asked to describe the changes you are already making in the direction of solving the problem, and will be supported by the therapist to continue thinking up and trying out your own strategies. Creativity is encouraged. This highly targeted, short-term therapy could suit motivated people who might find more practitioner-led therapy intrusive, but is less likely to be effective where there has been significant trauma or addiction. Occasionally available through the NHS, and also through private practitioners and online services.
Other therapies which individuals have found helpful include creative arts therapies (art, drama, music): psychodynamic therapy: person-centred and humanistic counselling. Some of these therapies may be available within the NHS and all are available privately. It is unlikely that a practictioner from one of these disciplines would go with you to the confined spaces you wish to re-enter. However, they can help you develop an overall resilience, enabling you to make the journey yourself, or to find additional support elsewhere.
There are a huge range of self-help strategies which have proved effective, for example the use of relaxation techniques, visualisation, green exercise, resilience building, mindfulness, diaries of success, role and motivation planning, calm packs and more**. Family, friends, counsellors, therapists or primary health care practitioners from many different disciplines may be willing to support individuals who want to try them out.
The core element of any effective approach will be finding ways to build a feeling of internal safety and security, and from that base, taking tiny and persistent steps toward the desired goal with an attitude which prioritises self-respect and finding new learning in each experience.
*-**Drawn from ‘Claustrophobia – Finding Your Way Out: hope and help for people who fear and avoid confined spaces’. Perry, A. (2008) Worth Publishing, London.