Going shopping, dining out or running errands downtown used to take Mary — whose last name is concealed to protect her privacy — longer than most. It was worth the sacrifice to wait for street parking, rather than to settle for a spot in a parking garage with low ceilings, she explained. “I feel like I’m going to be crushed in there,” she told her therapist, Reid Wilson, a clinical psychologist in Chapel Hill, North Carolina, in a 2012 session that was recorded for an educational DVD, “especially if they’re big and they’re a labyrinth or if the ramps get crowded and if traffic’s not moving.”
Air travel was also exhausting for Mary, a middle-aged teacher who agreed to have her therapy sessions taped and published in order to help clinicians learn to treat patients like her. “When I get on an airplane and the hatch door closes, I suddenly realize that there’s no outdoor air source and there’s no way for me to leave,” she told Wilson. “My heart starts racing and sometimes it’s been so bad I felt like I was going to have a heart attack.”
[See: 17 Ways Heart Health Varies in Men and Women.]
Though Mary didn’t use the term “claustrophobia” to describe herself to Wilson, that’s precisely what she was experiencing, Wilson told U.S. News in an interview. The condition, considered a specific phobia in the American Psychiatric Association’s Diagnostic and Statistical Manual, is an anxiety disorder marked mainly by fear — fear of suffocation and immobilization, says Wilson, an adjunct associate professor of psychiatry at the University of North Carolina School of Medicine who specializes in treating anxiety disorders.
For some, claustrophobia manifests in elevators or subways; for others, it arises during MRIs; for many, it happens in more situations than one. “They’ll be standing in a room, and it’s starting to feel stuffy, and there’s that closed-in feeling and they just need to get outside,” says Wilson, author of “Stopping the Noise in Your Head: The New Way to Overcome Anxiety and Worry,” who notes that the condition is often confused with panic disorder.
Up to 9 percent of the U.S. population has a specific phobia, according to the APA, including claustrophobia. Few seek help. “The phobias are the most predominant anxiety disorders that there are, but most [people with] them never get any treatment,” Wilson says. Instead, they do their best to avoid the situations that scare them.
But people who seek help can overcome their fears. “This isn’t like Type 1 diabetes,” which has to be managed through life, Wilson says. Nor is it something that people can usually “just get over,” adds Brenda Wiederhold, a clinical psychologist who treats anxiety disorders at the Virtual Reality Medical Center in San Diego and Brussels. She says fear that’s unrelenting, excessive and irrational should drive patients to see a professional who treats anxiety. “If you’re starting to avoid things; if you know you need a medical test and you put off the MRI for a year — that’s when it’s gone from a fear to a phobia,” she says, noting that the condition typically manifests when people with a genetic predisposition for an anxiety disorder face a life stressor.
Even people whose claustrophobia-related anxiety isn’t debilitating or constant can improve with treatment. “Whether you have the disorder or you don’t have the disorder, if you have something that’s unpleasant to you, and you want to get rid of it — that’s the sign to get help,” Wilson says.
[See: How to Find the Best Mental Health Professional for You.]
Meantime, try these expert-endorsed strategies to keep the panic at bay:
1. Embrace logic.
A key feature of claustrophobia — or any phobia, for that matter — is a fear that exceeds the actual threat. Mary, for instance, worried that her plane would run out of oxygen. “Yeah,” Wilson jokes with her in the video, “I’ve read all those stories of planes running out of oxygen — it’s awful.” She also worried that parking garage ceilings would collapse and that too many cars on the ramps would deplete the parking structure’s air supply.
But once Mary trained her logical voice to speak louder than her fearful one, she was able to sit in her car in a parking garage — with her windows up. “It’s not going to collapse, there’s plenty of air and, yes, the ceiling’s low and you’re not going to like it, but it’s going to be fine,” she recited to herself in a clip of her therapy session. “There is enough air and I’m not going to suffocate.”
Clearing up misconceptions in order to change anxiety-provoking thought patterns is more powerful than, say, deep breathing in an effort to calm a racing heart, Wilson says. “We’re not working on your symptoms, we’re working on your response to your symptoms,” he says. “Your symptoms will go away when you get out of the way.”
2. Face your fears.
Wilson admits his work is a bit sadistic. After all, he encourages people to do the very thing that upsets them most. He coached Mary, for instance, to breathe for 30 seconds through a cocktail straw with her nose plugged and, later, to sit with two pillowcases taped over her head. “It’s got to be difficult,” he says, but it works. Mary, for one, has since been able to navigate parking garages, tunnels and plane trips with less anxiety — and in the case of air travel, less medication — than before, she told Wilson in follow-up correspondence. “You get to work on the physical sensations separate from their context,” Wilson says. That way, he adds, “when you get on the elevator and start to have those feelings, you’re able to say, ‘Been here, done that.'”
In Wiederhold’s virtual reality center, which she directs, people are able to transition to facing their fears by first imagining the situation that scares them, then undergoing a virtual reality simulation of that situation and finally experiencing it in real life. “Some people can’t make that leap between sitting and imagining and going into the real world, which is where the virtual reality works,” she says.
One 83-year-old woman, for instance, came to Wiederhold after her doctor ordered an MRI sans sedation. Not only did she fear the MRI, but Wiederhold learned she also refused to take the elevator — despite her age and two knee replacements. But after two more traditional sessions rooted in cognitive behavioral therapy and six virtual reality sessions that simulated riding in an elevator, the woman was able to take the elevator for the first time in 40 years. She also got her MRI, which came up clear. “It was really a life-changing event,” Wiederhold recalls. “She said, ‘I can’t believe I waited until 83 to do this.'”
3. Connect, relax and distract.
At the Augusta University Health Radiology Department in Augusta, Georgia, clinicians and technologists often see patients who anticipate feeling claustrophobic before undergoing an MRI. “There’s a wide degree of claustrophobia, and that means that a wide array of solutions can be offered to the patients,” says Dr. James Rawson, who heads up the Medical College of Georgia’s radiology department and also chairs the American College of Radiology Commission on Patient- and Family-Centered Care.
On the extreme end, patients are sedated, although that’s rare, Rawson says. Some take an anti-anxiety medication like Valium. But most patients can get by with simple, non-pharmaceutical options like asking a friend or family member to hold their foot, which can remind them they’re not alone, Rawson says. Some research even suggests that spending time pre-MRI with a therapy dog can help reduce the need for anti-anxiety medications, which, Rawson points out, require the patient to arrange a ride home. Other patients appreciate the comfort of a warm blanket. “Of all the technology we work with in radiology, I’ve been amazed at the impact of the blanket warmer,” he says.
[See: 8 Ways to Relax Now.]
The unit also has walls painted with beachy scenes and MRI machines with skylights that reveal Georgia palm trees and sunshine, thanks to patients who were invited to sit alongside the architects and engineers who designed them. “A lot of what we’ve been able to accomplish has been because we’ve embraced patients as our partners,” Rawson says. “That’s a mindset that’s very helpful both for the patients and the physicians.”
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How to Cope With Claustrophobia originally appeared on usnews.com
