Claustrophobia Treatment CardiffClaustrophobia is known as the fear of confined spaces. It is categorised as a type of anxiety disorder and as a specific (rather than a complex) phobia. The term is derived from the Latin word claustrum which translates as a “closed space" and from the Greek word phobos meaning "fear". Sufferers of claustrophobia have an illogical fear of being trapped in a confined space. Once trapped, you are convinced that you will have no means of escape. Natural to the development of claustrophobic traumas is the anticipation that the catastrophic outcome is certain. The mere thought of entering this confinement is enough to cause strained breathing as if your chest walls are threatening to close in on your lungs until complete suffocation. Breathlessness is a common feature of high anxiety or a panic attack. A panic attack is typical symptom of all phobias. With claustrophobia, breathlessness is one of the most prominent features of the panic attack. Where possible, avoidance is commonly sought to alleviate your anxiety symptoms. But as most claustrophobic sufferers are aware however, avoidance of these confined situations just intensifies your sensitivity to the relative confinement. It also increases your desperation to evacuate when you perceive that you are trapped or about to be confined in a situation.
Claustrophobia StatisticsClaustrophobia is an extremely common phobia. It is estimated that around 10% of the population in UK are affected by the condition in their lifetime.
Types of claustrophobiaClaustrophobic sufferers fear being trapped, fear being restricted and/or fear being breathless. The history of your personal traumas will influence your perception and ability to cope with either of these situations listed below.
Fear of confined spacesYou fear the relative closeness of the walls/objects that constrain you and/or obscure your view. Without seeing “space” immediately around you, you fear entrapment. You struggle to place trust in what operates (controls) the constraint e.g. an electronic door. The sound or visible operation of the exit is a strong trigger for your panic reaction. Your fear of these situations can be generalised or specific to one situation. They can include:
- Mechanical situations – lifts (elevators); public transport including airplanes, trains, coaches, ships; yachts and submarines; the underground and subway trains, particularly those that enter extended tunnels; carwashes; MRI or CT scans; fairground rides with limited visibility; small cars or taxis that are centrally locked.
- Structural situations – Toilet cubicles; wardrobes and closets; cellars and basements; store dressing rooms with lockable doors; any confined spaces or rooms that are dark; tight stairwells; mazes or labyrinths; mines or underground sites; tombs and coffins; shower cubicles; trailers.
- Natural situations – tunnels; caves or caverns.
Fear of being immobileClaustrophobic sufferers also trigger anxiety when you perceive that your movement is restricted. In these scenarios, you can appreciate that there is there is significant space in the distance, but you, the situation or other people inhibit or control your movement, or demand that you “stay put”. Feeling obstructed (as you would in a physically confined space), your panic prepares your limbs for “flight” mode, in readiness to run away to safety. Without actually using up this anxious energy, this can be felt as muscular tremors in your legs (feeling “jelly-like”). Being around people and displaying your panic symptoms (tremors or desperation to leave) can then cause you to feel embarrassed, further adding to your fear cycle. The fear of mobility situations can include those listed above (in fear of confined spaces) and the following:
- Mechanical situations – traffic jams, driving on motorways or roads with high surrounds e.g. high bushes or trees; sitting in the back seat of a two door car or taxi; using an escalator; a ride at the fairground/amusement park; revolving doors.
- Structural situations - hotels with sealed windows; being in the higher levels of a high rise building.
- Treatment situations – having a injection; needing a hospital medical procedure; being treated at the dentist/optician, or hairdresser/barber/beautician.
- Social situations – as a young child, losing sight of your family particularly amongst crowds; being in the middle of large crowds; bars and nightclubs; public speaking situations; work meetings; interviews; some social situations, some performance anxiety situations e.g. driving test; supermarket queue/line; other situations where you need to line up.
- Venue situations – inner/centre seating position (not close to aisles or windows) or crowd potential at cinemas, theatres, concert and sports venues; prisons.
- Natural situations – forests.
Fear of suffocationThe panic response which triggers breathlessness influences the claustrophobe to fear suffocation. You become hypersensitive to anything constrictive or partially constrictive touching your body, particularly over your head and respiratory organs. Environmental conditions where breathing is strained (because of heat or humidity) can also trigger anxiety with the urgent need to remove clothing to cool down and catch your breath. Since feeling hot, sweaty and itchy are common anxiety symptoms, this fear of constriction can extend to other parts of the body when they are also constricted in some way e.g. a cast around a limb. It’s as if the immobilised limb is being “choked” of air when it senses increased temperature changes and cannot move. The reflexive need to “evacuate” your whole body from the situation causes general anxiety which can only be eased when you have “ripped off” the constriction at the source. Fear of suffocation situations can include any of those listed above in close proximity to your body and the following:
- Clothing situations - Wearing tight-necked or tight fitting clothing over your body e.g. ties, polo neck sweaters, girdles etc.; fancy dress suits and masks.
- Apparatus/equipment situations – wearing apparatus over your face or head e.g. crash helmets, masks, breathing apparatus, medical apparatus; immobilising casts over your body; sleeping with your head under the bed clothing.
- Environmental situations – swimming under water with or without breathing equipment; hot and humid climates, being at high altitude.
What causes claustrophobia?A combination of childhood direct traumas and indirect traumas from your authority figures (usually your parents) will have the most impact on the development your claustrophobia. Some of the most traumatising childhood experiences include being accidentally (or purposefully as a game or as a punishment) locked in a box, cupboard or small room; being trapped in darkness; getting lost in a relatively confined space e.g. a series of tunnels; being separated and losing your parents in a crowd of people; being left for a period of time or abandoned in a confined space (e.g. the car) by your parents; near drowning in deep water; getting your body, particularly your head stuck or trapped somewhere. Your biology can also be connected to your claustrophobic fears. Previous childhood bullying involving near-suffocation (being strangled) can also contribute to adult claustrophobia. Spatial distortion is often identified as a cause of claustrophobia where you underestimate the horizontal distances of objects. However, it is unknown whether this distorted spatial perception is biologically linked at birth or is over-developed through trauma. Someone with a spider phobia is similarly likely to give an exaggerated account of their last spider trauma and the apparent size of the arachnid. Has this size distortion come from birth or learned from traumatic experiences? Most people can recall where they were and give precise details of their location at the time of an emotional experience. These experiences can be good or bad. Some people are extremely location-sensitive; usually those who are visually or spatially-oriented learners. With this learning style you can prioritise making an intense association with the physical features of your location (e.g. the size of the room) and your emotional experience, over what you were doing in the situation. With a visual learning style you may be more vulnerable to developing spatially-oriented fear, typical of the beliefs held with claustrophobia. Click this link for detailed information on the general causes of a phobia.
Major Common SymptomsThere are numerous claustrophobic symptoms that vary in severity including:
- Breathlessness, strained & rapid breathing (hyperventilation). A history of asthma attacks may complicate this symptom.
- Choking sensations.
- Body tremors, particularly in the legs. The legs feeling “restless”.
- Increased heart rate.
- Changes in temperature in the form of sweating, hot flashes or chills.
- “Butterflies” in the abdomen.
- Feeling light-headed or faint.
- Nausea or vomiting.
- Nervous diarrhoea.
- Numbness and tingling.
Living with claustrophobiaAs a child, regardless of how you have acquired your claustrophobia, you will continue to avoid these confined spaces to alleviate your anxiety. If your family understand your condition and treat it sensitively, it will limit the frequency of your panic attacks. Most situations have alternatives. Lifts can be avoided where stairs are available. The learning value of a school trip and the trauma of using a school bus/coach for transport can be assessed by all parties involved. If the family situation allows, the parents may provide their own transport. With family holidays, where there is a fear of flying, the family can agree to stay in UK or use an acceptable alternative method of travelling. As a growing child, you begin to understand the physiology of your condition. This helps you to anticipate and avoid many confined situations. But the need to confront them becomes a more of a challenge during teenage years, when there is growing pressure of social conformity. Fear of embarrassment (katagelophobia) connected to a social display of your panic attack adds another layer of anxiety to the fear of confined spaces. Teenagers with social anxiety want to avoid any behaviour that draws attention and is likely to cause humiliation in front of your peers. Amusement parks, large crowds in bars and nightclubs, and centre seating arrangements in concert or cinema venues are just some of the popular youth culture situations that could trigger panic attacks. Having the confidence to admit the condition can be a dilemma because it could be a source of ridicule by less sensitive members of the peer group. Some of these confined situations can affect the teenage pupil on a daily basis during school, affecting formal and informal public speaking situations. They can disrupt academic performance with the added stress during tests and exams. Excessive anticipatory anxiety may be detrimental to school attendance levels causing the teenager to suffer panic attacks each morning. If the claustrophobia and social phobia is mismanaged, the teenager or young adult will continually associate feeling safer when you are outside of the confined social situation. With each hurried evacuation, the urge to suddenly dash out of the situation becomes more impulsive. This can impact on infrequent but necessary situations like being stuck in traffic, having injections, medical procedures, MRI and CT scans, dental visits and other treatment situations like the barbers/hairdressers. The need to avoid the embarrassment of this panic response can even affect the development of relationships causing the abandoning of first dates, only to regret the cancellation after. If you have overcome this initial hurdle and the relationship flourishes, meeting the partner’s best friends and family can be traumatising. Work life can have its claustrophobic moments too, affecting participation in meetings and when speaking in public. Inevitably career progression can be hindered, avoiding interview situations and assessed presentations that are necessary for promotion. As more situations are avoided and opportunities are lost, the young adult may then be ready to assess the need to seek help. The subconscious layers of fear are well-formed at this stage however. To overcome it will demand a strong, determined desire and a reasonable period of behavioural adjustment. Professional help is still beneficial at this stage. The therapist will objectively evaluate the significance of the background traumas and identify the specific treatment criteria that will progressively alleviate your claustrophobia.
TreatmentPhobias are not usually formally diagnosed by your doctor. Observations by close family and friends may be met with a period of denial before fully accepting the condition and how it continues to affect you. Self-help – Where possible, constructive avoidance is the most common self help treatment method. But avoidance is usually a short-term fix without developing any skills and techniques to overcome the phobia. When you are ready to confront it, effective self-help methods however can include the use of breathing techniques to manage the general anxiety symptoms, particularly the fear of suffocation. Progressive self-help methods will consider your subjective criteria that exacerbate the fear, combined with repetitive, graduated exposure to those confined situations. Using this method, breathing techniques are used to keep the anxiety at moderate levels before gradually increasing the confinement of the physical environment. This will prevent high levels of anxiety or “flooding” which can have an adverse effect on overcoming the phobia. Choose criteria in which you feel comfortable first, and then add to the intensity in gradual stages. The criteria can include:
- Defining each situation as one where you can choose to calmly vacate (where possible).
- Assessing the relative physical confinement of the room or situation. Evaluating the notable design features and their position e.g. opening windows to “give air” and to permit a view, and sitting towards the aisle etc. (For many claustrophobic sufferers, how far you can see out into the distance is a significant feature of your anxiety management. You may be physically confined in the similar dimensions of a situation e.g. in an airplane or glass lift, but just because you can see out of a window, it will make a huge difference to your anxiety and drastically reduce your fear.)
- Establishing the number and proximity of the exits.
- Gradually extending the duration of the confinement. Aim for the anxiety to subside before changing the confinement of the situation or leaving the situation if possible.
- Aiming to access personal control of the exits if possible, rather than mechanical control or indirect control by another person.
- Establishing how many people are present in the situation and your relationship with them. Are they sensitive to your anxiety?
- If you are having a professional treatment, learning more about the treatment process and what you are likely to experience.
- Assessing how much you trust the professional directing the situation. Is there any benefit by admitting your fear to them? Can this trust be developed before the treatment situation?
- Identifying a helpful purpose for yourself in the confined situation e.g. practising breathing techniques, meditation, or mindfulness, cooperating with the treatment process, managing your time with activities if there is extended periods of boredom, learning presentation skills if giving a presentation etc.
- Practising using any “suffocating” or confining apparatus/equipment outside of “real” situation e.g. learning to spend time with a face mask on, relaxing in your own company or with someone you trust who can give you assistance if your anxiety is excessive.