Got Anxiety? The anatomy of a phobia (part 3)
Claustrophobia, the fear of enclosed spaces, is one of the most prevalent phobias, affecting more than 5 percent of the population.
However, as is the case with many phobias, most people rarely seek treatment for this condition, due to engaging in extensive avoidance behaviors related to enclosed spaces such as elevators, airplanes, small rooms, subway trains, crowded areas, etc.
For example, it is not uncommon for someone to walk up 12 or more flights of steps, rather than use an elevator. There are always “core fears” that are associated with a particular anxiety condition.
The question becomes, what precisely do those with claustrophobia fear the most. In order to answer this question, let’s focus on someone who has a phobia of elevators.
As is the case with any phobic object, the person is not afraid of the object itself; they are fearful of experiencing a terrible consequence while interacting with the object or situation.
Research indicates there are two primary core fears associated with claustrophobia: (1) fear of physical restriction/entrapment and (2) fear of suffocation.
FEAR OF PHYSICAL RESTRICTION
The concept of physical restriction involves three components: (a) the experience of feeling trapped, (b) feeling unable to escape becomes even more intense when one believes the threat of harm exists, and (c) the belief that there exists a threat to the supply of fresh air.
Evidence that the mere act of being physically restrained results in feelings of intense fear comes from research, which shows that people who were restrained in the absence of any type of real threat (e.g., having an adequate supply of air) showed immediate and significant increases in heart rate and blood pressure.
The subjective feeling of being trapped is also quite common among those who suffer from panic disorder and agoraphobia.
These individuals report excessive anxiety while waiting in long lines at a store, having their head placed under a hairdryer, or needing to undergo an MRI medical procedure.
Many young children also display fear when having their hair cut. Years ago, agoraphobia used to be termed “barber chair syndrome,” due to the process of being belted into a chair and having a strap tied around one’s throat.
FEAR OF SUFFOCATION
The core fear of suffocation is another prominent feature reported by those who are claustrophobic.
However, it is interesting to note this same fear is also reported by those who are not claustrophobic (e.g., those who have a fear of vomiting or chocking).
A fear of suffocation may arise from the belief that there is insuffient air available in a particular setting; adequate access to air is blocked by having one’s mouth covered; or due to a health issue such as an obstructed airway passage.
Thus, being in an enclosed space is often interpreted as a threat to one’s breathing, which is why the majority of claustrophobics report a fear of suffocating and dying, which then triggers sensations of shortness of breath.
Although this perceived threat of suffocation is exaggerated, it is understandable in the sense that many people, not just claustrophobics, overestimate how much oxygen is needed in order to survive.
There are also situations in which fears of enclosed spaces exist in which suffocation plays no role.
For example, there is no danger of suffocation while sitting in a barber’s chair or being in a crowded football stadium in the open air.
In working with claustrophobic patients within our private practice in Incline Village, when we ask the person what their primary fear is concerning enclosed spaces, he or she soon runs out of explanations regarding what they fear most.
He or she simply states, “I just feel trapped.” This response coincides with my previous article in this 4-part series on Phobias, which discussed the evolutionary model concerning the development of phobias.
Feeling “trapped” may trigger a genetic fear response designed to protect oneself for the sole purpose of survival.
TREATMENT FOR CLAUSTROPHOBIA
Claustrophobia comprises a number of strongly held beliefs concerning entrapment, suffocation, and loss of control.
Removal of any one of these beliefs can collapse the remaining beliefs, thus leading to the elimination of claustrophobia.
Research over the past several decades has consistently shown that Cognitive-Behavior Therapy (CBT) remains the most effective treatment for phobias.
In the final analysis, studies indicate that the fear of suffocation appears to be the dominant core fear for those who suffer from claustrophobia, followed by a fear of entrapment and physical restriction.
Claustrophobia is one of the most treatable phobias, typically involving no more than 6-8 sessions of gradual exposure to the feared object or situation, along with modifying one’s overestimation of threat associated with enclosed spaces.
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California and is co-executive director of the Center for Anxiety & Chronic Worry, with offices in Incline Village. He may be reached for comment at firstname.lastname@example.org; visit anxiety treatmentinclinevillage.com to learn more.