How to treat claustrophobia?

Exposure therapy. It gradually puts you into the situations that frighten you to help you get over your fear. At first, you might just look at a photo of a tight space. Then, with your therapist’s help, you work up to being inside a tight space.

Cognitive behavioral therapy (CBT). This is a type of talk therapy where you meet one-on-one with a trained therapist. You talk about the negative thoughts that drive your fear and learn ways to overcome them. You may get CBT alone or combined with exposure therapy.

Virtual reality (VR). It’s a treatment that uses computer simulations of tight spaces like elevators or MRI machines. Getting the experience of a tight space in the virtual world can help you get over your fear in a setting that feels safe.

If therapy isn’t enough, your doctor can prescribe anxiety drugs or antidepressants to help you deal with the situations that cause your fear.

Support is key when you’re trying to overcome a phobia. Talk to your partner, other family members, and friends. You can even ask them to come with you to therapy sessions.

By The Recovery Village Editor Jennifer Kopf Reviewer Tracy Smith Updated on12/26/19

Many people with claustrophobia go their entire lives without formal diagnosis or treatment. These individuals may try to manage their phobia by avoiding triggers and situations that prompt anxiety and panic, but it also causes them to miss out on important moments. Seeking help from a professional counselor, general practitioner or psychiatrist can help someone who has claustrophobia.

The treatment of phobias is dependent on psychological methods aiming to alter cognition and behavior. The most common treatment for claustrophobia is psychotherapy. Psychotherapy is used to assist individuals in defeating and coping with triggers and fears. An individual with claustrophobia is generally treated on an outpatient basis but can be treated inpatient if the phobia is especially severe.

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Medications Used for Treating Claustrophobia

Psychotropic medications are often used in conjunction with psychotherapy to treat claustrophobia but are not representative of a cure themselves. Medication can offer short-term relief but does not treat the underlying origin of the disorder. If utilized alone, when someone stops using the medication, claustrophobia symptoms may return.

A psychiatrist or physician may temporarily prescribe antidepressants or anti-anxiolytic medications to help alleviate the physical symptoms of panic. Medication can assist individuals in managing compulsive, physiological symptoms while seeking treatment simultaneously.

  • Antidepressants: Antidepressants can be beneficial when panic is relentless and unbearable. Antidepressants are regularly used to treat anxiety and phobia, selective serotonin reuptake inhibitors (SSRIs) are used most frequently. Serotonin is a neurotransmitter in the brain that manages mood. The purpose of SSRIs is to work to make serotonin more readily available to the brain, which can work to reduce anxiety. Medications like Zoloft, Paxil and Lexapro are commonly used SSRIs and effective for treating symptoms of claustrophobia.
  • Anti-anxiety medications: Anti-anxiety medications reduce the physiological symptoms that come with anxiety. Benzodiazepine medications treat less severe episodes of anxiety and can give relief quickly. However, benzodiazepine medications have an addictive quality and need monitoring. Buspirone is another anti-anxiolytic medication that is not fast-acting but has less potential for dependence.

Therapy Options for Claustrophobia

Psychotherapy is the most common treatment type for claustrophobia. Cognitive Behavioral Therapy(CBT) is an effective form of treatment that seeks to isolate thoughts that come with the fear response. In turn, therapy helps individuals replace these thoughts with healthier, practical thoughts. Enforcing new behaviors with healthy thought patterns seek to reaffirm this new way of thinking.

  • Eye Movement Desensitization and Reprocessing (EMDR): Eye movement desensitization and reprocessing (EMDR) is a treatment modality that has been somewhat effective for treating phobias associated with past trauma. This therapeutic intervention assists people in sorting out negative thoughts and emotions that may come with past trauma. A practitioner will assist an individual to focus on their inner experience of the trauma while visually following an outer stimulus.
  • Cognitive Behavioral Therapy: The theory behind cognitive behavioral therapy (CBT) involves changing damaging and irrational thought patterns to modify emotions and behaviors. Interventions aim to re-train the brain so that individuals can behave differently in places that they were originally fearful of. Clinicians help people to challenge, alter and confront attitudes and thought processes so they can change how they respond to stressful situations.
  • Relaxation and Visualization Exercises: Another treatment option for claustrophobia involves calming the mind and easing panic through relaxation and visualization activities. Deep breathing, progressive muscle relaxation, mindfulness and visualization are all techniques used to treat claustrophobia. In these interventions, individuals are instructed to count while breathing slowly and deeply, while visualizing a safe, calming place. Through mindfulness techniques, people are encouraged to focus on something tangible and non-threatening in the here and now.
  • Systematic desensitization: Systematic desensitization is another technique involving relaxation and visualization to decrease anxiety. In this technique, individuals are instructed to use relaxation and visualization techniques while experiencing anxiety related to the phobia. An individual is encouraged to focus on methods of physical and mental relaxation while being exposed to a trigger, with the idea that individuals can overcome their fear in successive steps.

Treating Claustrophobia with Co-Occurring Substance Abuse

Managing claustrophobia without professional help can be highly intense and distressing and could potentially lead to co-occurring substance abuse. Individuals may attempt to self-medicate with drugs and alcohol in attempts to alleviate physiological and emotional distress. It is very common for substance use disorders and phobias to coincide with each other.

Co-occurring substance use only serves to exacerbate the symptoms of claustrophobia. There are various side effects associated with drinking or drug abuse that could amplify physiological symptoms. Alcohol and drug abuse alter brain chemistry by reducing the levels of neurotransmitters that manage moods. This alteration can make a person more vulnerable to anxiety or mood disorders. Drugs and alcohol can also negatively impact physical health and cause isolation, making it harder to cope and obtain help.

A clinician needs to treat anxiety disorder and substance use disorder at the same time to achieve the best results. It is necessary for a treatment plan to cover both issues, because treating one and not the other may not help them recover from both. Dual diagnosis treatment is the most effective course of action for co-occurring substance use disorders and claustrophobia.

The fear of being constricted can be incapacitating and interfere with everyday functioning and overall happiness. Fortunately, claustrophobia is a treatable condition with a high recovery rate. Some individuals have the potential to outgrow claustrophobic thoughts and behaviors as they mature, while symptoms tend to linger longer for other people. There are several methods of treatment for anxiety including cognitive behavior therapy, visualization and relaxation and psychotropic medication interventions.

If you have anxiety and panic related to claustrophobia, you are not alone. There are many professionally trained therapists specializing in the treatment of claustrophobia who can assist you in implementing various treatment options.

If you or a loved one are simultaneously experiencing claustrophobia and a co-occurring substance use disorder, help is available. At The Recovery Village, a team of professionals offers a number of treatment programs for substance use and co-occurring disorder like claustrophobia. Call and speak with a representative to learn more about which treatment program could work for you.

Claustrophobia

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  • Claustrophobia fact sheet

    Claustrophobia Fact Sheet

    This fact sheet gives a detailed overview, as well as a look at some of the evidence based approaches to treating claustrophobia.

    Buy now

    Recommended resources

    Claustrophobia: Finding your way out is a book designed to provide hope and help for people who fear and avoid confined spaces. You can purchase this book from the Anxiety UK online shop here.

    Controlling Anxiety is a CD designed to help those who experience a phobia or anxiety. You can purchase yours from the Anxiety UK online shop here.

    10 Tips and Tricks for Reducing MRI Claustrophobia

    Infographic Text: Tips and Tricks for Reducing MRI Claustrophobia During Your Exam
    • Learn: Be aware of what will happen during the exam. Familiarize yourself with the machine, its noises, and exam procedures. Ask your scheduler, doctor, and technologist any questions you have as they arise. Knowledge can be empowering.
    • Focus on breathing: As simple as it is, focused breathing and other meditation techniques have a calming effect for most people.
    • Cover your face: Covering your face with a towel or washcloth or simply keeping your eyes close can help you feel as if you are at home or in a different space. You can’t see where you are so you are less likely to feel trapped.
    • Listen to music: In some cases, you are able to listen to music through headphones during your exam. This can help distract and calm you.
    • Try your own technique: If you already know something works for you, such as aromatherapy or a certain sound or image, ask if you would be able to use your own technique during the exam.
    • Talk to your tech: You are never alone! Your tech can talk to you and you can talk to your tech throughout the exam. You’ll even have a call button that will signal your tech in case of emergency or discomfort. They will also give you updates as to where you are in the exam process!
    • Count: Another simple techniques is counting. The monotony can be soothing, and if you count slowly, it can pass the time quicker than you might think!
    • Go to your “happy place”: This may sound silly, but if you think through the details of your “happy place” or the details of a good memory or a complex process, it can effectively distract you.
    • Bring Support: You can bring a friend or a family member to be with you during your exam. Sometimes they can even be in the room with you. Be sure it’s someone who understands you and calms you.
    • Remind yourself who’s in control: You are always in control of your exam. You will not have to do anything you are not comfortable with and our technologists will help you with any calming technique you choose. Be sure to also look into the open MRI and sedation options UVA offers.

    Why Am I Claustrophobic? What Can I Do About It?

    Does claustrophobia come from having been trapped? It may seem so. But, in my view, claustrophobia results from by Mobilization System dependency. Consider this post (condensed) from on the SOAR Fear of Flying Message Board

    Is anyone here claustrophobic? I can get in elevators, but I hate it and if it’s over 10 floors. I can’t do trains or any mode of transportation where I cannot exit when I need to. It’s really a bummer. I’ve been to therapy a few times for this and every time I am told I just have to walk through it – there is no cure.

    There is a cure. To understand it, let’s consider the levels at which response to threat can take place.

    Level One. The Immobilization System: freeze when touched. This is a primitive defense system. For example, some beetles roll over on their backs, and stick their legs up to feign death. This works if the attacker loses interest.

    Level Two. The Mobilization System: when the amygdala senses change, it releases stress hormones, causing an urge to run. This works if able to outrun an attacker. Drawback: false alarms; running away unnecessarily.

    Level Three: Executive Function (EF). Larger brains add a capacity for thought while retaining the amygdala. When stress hormones cause an urge to run, EF pushes back against the urge and assesses the situation and to determine if running is necessary.
    The problem at Level Three: the thinking brain produces an internal representation of the environment based on components of perception, memory, and imagination. The amygdala may react to what is presented in the internal representation.
    EF has a sub-function, Reflective Function (RF), that looks inward. Well-developed RF determines to what degree the internal representation is based on perception, reference to memory, of creative imagination. Well-developed RF separates imagined threats from real threats. How well RF develops depends on childhood relationships with caregivers. Some caregivers do not foster RF development. Also, when a child’s early life is problematic, the child may escape into imagination. If the imaginary world is preferred over the real world, the ability to separate imagination from perception may disappear with only a slight increase in stress hormones.

    Level Four: Social Engagement System (see: www.stephenporges.com). Operation of RF is protected by a person whose presence activates the calming parasympathetic nervous system which overrides the effects of stress hormones .
    Level Five; Internal Replica System. In place of a physically present calming person, internal replicas of a calming person activate the parasympathetic nervous system.
    If a person has not been fortunate enough to build in calming replicas, Level Five doesn’t hold. Regulation slides to Level Four where a physically present – rather than a psychologically present – person is needed.

    If no calming person is available, regulation slides to Level Three. EF cannot supply airtight answers to every imaginable threat. EF needs RF to identify and disqualify imagination-based threats. If RF is inadequate, imagination masquerades as real and EF cannot produce a sense of safety. The person slides down into Level Two, and the Mobilization System.

    In other words, Mobilization System dependency develops if the more advanced systems at levels three, four, and five are insufficient. It also means if Mobilization is blocked, the person has no way to control anxiety. And thus claustrophobia.

    Fortunately, the higher levels can be developed well enough to do the job and not leave a person dependent upon escape. This is done by deliberately providing the Level Five missing links, links between feelings of arousal and the present of a person who is both physically and emotionally safe to be with.

    Claustrophobia Techniques

    Tools for Claustrophobia

    First of all, forget about trying to analyse the cause – it is not particularly relevant to getting rid of the condition. Then approach the issue systematically.

    You need to believe in yourself and in your ability to free yourself from the claustrophobia response. Remind yourself frequently that it is a learned response – a response which you accidentally ‘picked up’ – and that what has been learned can be un-learned.

    (1) Tools to use when not in claustrophobic situations

    Examine how you usually ‘do’ the claustrophobia behaviour. Yes, I know you don’t do it deliberately but you do do it – even though the process occurs automatically. It is your brain, your body, and your emotions that are involved in this.

    A typical fear-cycle

    Once the trigger is encountered you rapidly go through a series of steps. These vary from person to person but will typically involve an escalating cycle such as:

    • you think of, or see, the the trigger
    • remember past moments of being uncomfortable in similar situations
    • begin awfulising self-talk
    • imagine a disaster movie of what is likely to happen
    • feel awful
    • wonder if people are noticing your distress
    • imagine what they might think and do if you lost control
    • imagine what it would be like to lose control.

    Many people will probably then re-run this sequence a number of times faster and faster – and feel terrible. And yet all of this all happens automatically!

    The mechanics of your fear-cycle

    Remember you are studying the ‘mechanics’ of your fear. You are examining how and not why you do it.

    It usually involves lots of fearful anticipating – thinking ahead about all the awful things that could or might occur! What if I got a panic attack and couldn’t get out of this room quickly – I might lose control completely etc. So you talk to yourself about what might happen and/or mentally visualise such events.

    This self talk and imaging then activates the body’s fear-handling process – the ‘fight or flight response’ – and you’re on your way to feeling really uncomfortable.

    Have you noticed how you do it? Great! You are on your way to eradicating the response. (Keep reminding yourself that it is just a learned response and not an illness.)

    Pin-point the trigger(s)

    The next step is easy because you’re probably an expert in this area: how do you know when to begin the claustrophobic mechanism?

    To be claustrophobic you have to ‘know’ when to have the fear. There has to be a trigger that alerts your mind-body that it is time to start the feelings and thoughts. The trigger can be approaching a threatening situation or can even be thinking about a past or forthcoming situation involving a lack of escape route.

    So, for you, what is the first thing you see or hear before the whole series of unpleasant physical and mental mechanisms kick in? (Do remember, it is not what do you first feel – the feeling is just the result of the rapid self-talk and visualising activity.)

    The question is what you see or hear that results in the fearful feeling!

    Is it the sight of the crowded lift? Or the moment when the cabin staff start pushing the door of the plane closed? Or when the meeting room goes silent just before the speaker begins?

    Most people will have more than one trigger. One person I worked had a whole list – dozens of them. If you do have quite a few simply pick the trigger you most commonly encounter.

    Arrange the triggers in a sequence

    You have now established the manner in which your fear cycle starts and then spirals upwards into a panic.

    Next you need to identify a whol;e serie4s of increasingly uncomfortable situations, culminating in the full blown claustrophobic reaction. Take, for example, a fear of being in a crowded lift (‘elevator’ in US English). Let’s say these are the stages in your increasing fear.

    1. Approaching the lift
    2. Watching the numbers change as it approaches your floor
    3. Imagining it being crowded
    4. The doors opening and people waiting inside
    5. Entering the lift
    6. The life stopping at another floor and more people getting on board
    7. Panicking about needing to get off
    8. Fleeing from the lift before it reaches your floor.

    You have also established your current (8) triggers and arranged these in order of increasing intensity.

    Desensitise yourself

    Next begin using this ‘hierarchy’ of triggers to desensitise yourself to these situations. This means using a method called Systematic Desensitisation to eradicate your fearful response to the situations that cause you fear.

    It is called ‘systematic’ because you do it in a very methodical manner. You first work on the least threatening situation. In this case it is approaching the lift.

    This is your first challenge. And you can do the following in imagination or in real life – or both. Let’s do it in imagination:

    1. Relax fully – sitting or lying
    2. Imagine approaching the life
    3. As soon as you begin to feel edgy or nervous open your eyes and sit or stand up.

    Repeat steps 1-3 a few times until you can imagine approaching the lift and still feel at ease. This may take one session or you may need to do it over a few sessions.

    Only when you are completely comfortable imagining approaching the lift do you then do it in real life – in vivo. Pick a quiet time of day and in a quiet building with few people around. It may help to have a friend standing a short distance away. Begin approaching the lift and as soon as you feel uncomfortable stop and withdraw to the starting point. Again, this may take a few attempts before you are comfortable approaching the life in real life.

    When you can comfortably reach the door a few times you’re ready for the next step – calling the lift and watching the numbers as it approaches. But, once again, do this in imagination first. Then in real life.

    Systematic Desensitisation is s-l-o-w

    Yes, it is very slow. But it is thorough and it does work.

    Yet, when you think how long you have had the phobia and how much difficulty it has caused you, well, what’s the hurry if you can get rid of it ‘systematically’?

    Patiently un-learn your way to freedom

    Once they start to master the first few steps in their hierarchy many people spoil their chances of success through impatience. They want to get rid of all of their fears NOW!

    Even with the assistance of a skilled professional it is likely to take a number of sessions to eradicate the claustrophobic response if you have had it for some time. After all, you’ve been ‘practising’ for months or years.

    So allow a realistic amount of time – a few hours with the assistance of a professional and up to a couple of months if you are doing it yourself and doing a little practise every day.

    And, once again, what’s your hurry? Either way you’re just a short few steps away from freedom!

    Believe in yourself!

    Finally it is critically important that you do believe you can overcome this. There really is no point in trying things! You must decide that you can and you will eradicate this fear from your life and begin living a normal life again. Just trying techniques or doing the rounds of therapists is wasting your time and possibly your money. This requires full commitment – full dedication.

    ‘Believing it’ means you can literally visualise a realistic end-result – of you living normally and feeling quite at ease in the situations that currently cause you anxiety. Begin creating this image today – and use it as a beacon to draw you forward through the normal ups and the downs of releasing yourself from a phobic habit.

    (Incidentally, because it is so slow, Systematic Desensitisation is not the method I would use when working with someone. But it is ideal if you are working on your own without professional assistance. If you are looking for professional assistance there are many types of therapy for claustrophobia. And I would suggest that you begin by seeking a therapist who, in addition to her or his professional qualifications, has at least Master Practitioner Certification in NLP. The NLP + therapy method can be quick.)

    (2) Tools and tips for emergencies

    These are some ways of managing the symptoms of claustrophobia if you find yourself in an uncomfortable situation. Although they are not really ‘fixes’ they can be very useful in managing your thoughts and feelings so that the situation doesn’t become over-whelming.

    These techniques will work better if you practise them while you’re feeling fine. That way you’re prepared and can simply switch them on when needed.

    Breathing techniques

    1. Avoid deep breathing – that just makes things worse.
    2. Avoid breath-holding – while not as bad as deep breathing it will cause you to become more tense.
    3. (Read our breathing section Breathing Methods web pages right now – so that you have the information available for emergency situations.)
    4. Progressively slow your breath and make it more shallow – to conserve carbon dioxide, our natural tranquilliser).

    Physical relaxing techniques

    1. Relax your shoulders. Let your arms hang and imagine they are heavy wet raincoats hangins from pegs (your shoulders).
    2. Relax your face – jaw, forehead.
    3. Relax your eyes. Blink more to moisten them. Let your eyelids droop very slightly – just a millimetre or so.

    Thinking techniques

    1. Use slow and calming self-talk to reassure yourself: it’s fine, I’m relaxing and letting go, these feelings will pass shortly, I’m just going to focus on relaxing while the situation is resolved, etc.
    2. Pay attention to things ‘outside’ you – your surroundings, other people, the décor, etc.
    3. If you are alone (or very brave) hum or sing.
    4. If possible chat with other people e.g. if you’re stuck in a life (elevator)

    Remember: each time you manage your thoughts and feelings when in a claustrophobic situation you weaken the claustrophobia habit.

    In this photo taken Thursday, June 3, 2010, Dr. Steven Birnbaum works a CT scanner with a patient at Southern New Hampshire Medical Center in Nashua, N.H. (AP Photo/Jim Cole) (AP)

    For many people, the thought alone of an MRI is enough to cause a full-blown panic attack.

    Approximately 9 percent of people have a clinical diagnosis of claustrophobia or a fear of enclosed places, according to a study in the journal Psychological Medicine. Yet experts agree that simply feeling claustrophobic during an MRI is common for most people, even those without a phobia.

    If you need to have an MRI, take heed. Experts agree with the right tools, most people will get through it without any problem.

    1. Ask about an open MRI.

    Although you still have to lie on a table with the machine overhead, an open MRI has more space, a shorter tube and all four sides are open. Likewise, an open upright MRI is completely open so you can see out while you’re seated.

    Since the type of MRI depends on what your doctor needs to see, you may not always have an option. “Although it’s an OK second choice, the image quality is not the same, ” Dr. Linda R. Aboody, director of radiology at Memorial Sloan-Kettering Cancer Center in Basking Ridge, N.J., said.

    2. Ask questions.

    You may already be worried about what the results will be so it’s a good idea to learn about the test beforehand to prevent any more anxiety. What’s more you may not even realize you’ll feel claustrophobic until you’re there.

    Ask the technician to explain how the exam will work and show you how to use the squeeze ball or intercom if you need to communicate with him. If you need contrast material through an IV and stop the test midway, you’ll have to wait for the solution to clear your system until you can repeat it. So if you still have questions, speak up.

    3. Get your own images.

    Although CAT scans are much wider than MRI’s people usually have a fear of it simply because they don’t know what it looks like, Aboody said.

    Regardless of the test, you might feel more comfortable if you can see the machine right before your scan. The imaging center may even allow you to make a separate appointment to take a tour.

    4. Listen to music.

    Music not only masks the loud sounds of an MRI, but it can also help you relax. Yet only if it’s the right genre. When the technician demanded Julie Lovan, of Charlotte, N.C. listen to music and suggested Christmas carols, she agreed. Yet when Mannheim Steamroller’s Carol of the Bells came on, Lovan wanted out. “I thought I was going to go crazy. I could feel my blood pressure getting higher so I just crawled right out,” Lovan, Founder of The Effortless Girl blog, said.

    So although you can’t bring in your smartphone, you can listen to your own CD or select a radio station using special headphones the center provides.

    5. Breathe, meditate, or pray.

    Deep breathing, visualization, meditation and prayer can all help you relax. Lovan, who has had more than 40 MRI’s in her lifetime, will pray and thank God for her blessings and for living in a time when MRI technology is available instead of thinking about what the results will show.

    6. Consider medication.

    Your doctor may prescribe Xanax or Valium for you to take 30 to 40 minutes before your MRI to calm your nerves.

    7. Try aromatherapy.

    “If we infuse vanilla or lavender on the pillow, we find that patients tolerate the exam much better,” Aboody said. You can also ask for a different scent or your favorite perfume.

    8. Ask for special treatment.

    Instead of staring at the tube or shutting your eyes, a plastic cage with a small mirror that fits over your head will allow you to see what is directly in front of you. “You don’t feel claustrophobic if you can see,” Lovan said.

    Some facilities also have video glasses which let you watch your favorite movie, TV or comedy show. Plus, ask for a blindfold or if you can turn your head to the side, lie on your stomach, or go in feet first, said Dr. Richard Wasley, medical director for MemorialCare Imaging Center at Orange Coast Memorial Medical Center in Fountain Valley, Calif.

    In fact a study in the Journal of Magnetic Resonance Imaging found that when people who were claustrophobic lied on their stomachs, they were much less likely to ask to stop the test.

    9. Get support.

    As long as a consent form is signed, a family member can be in the room with you as a source of comfort and to take your mind off the test.

    10. Seek out a therapist.

    Although it requires time, cognitive behavioral therapy (CBT) and biofeedback are two types of treatment that you can work on with a mental health professional to reduce your fear.

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