Claustrophobia

There have been only a few studies, most by Rachman and his colleagues (Rachman, 1997) who found that the responses to the items in a claustrophobia questionnaire could be characterised by two factors describing fears of restriction or of suffocation. The former was most evident, for example, in response to the situation 'lying in a tight sleeping bag enclosing legs and arms, tied at the neck'. The latter was apparent in answers to 'swimming with a nose plug'. Rachman (1997) notes the resemblance to fears of suffocation in panic attacks. Claustrophobic patients, compared with others, anticipate more events that provoke such fears (Ost & Csatlos, 2000). If subjects acknowledge that they anticipate a catastrophe as the result of suffocation or restriction and this is a main influence on their claustrophobia, modification of these beliefs should occur with treatment. Furthermore, treatment that addressed those cognitions explicitly should be effective.

No study summarises the clinical significance of claustrophobia but instances of life-threatening incapacity are described: fear and intolerance of radiological examination in an MRI scanner (McIsaac et al., 1998), of an airway mask for sleep apnoea (Edinger & Rodney, 1993), of gas masks in military personnel (Ritchie, 2002) and hyperbaric delivery of oxygen (Hillard, 1990).

All but one of the studies in Table 20.2 (Botella et al., 2000) examined groups of subjects and all showed consistent improvement with exposure treatment on measures of fear. One study showed that, among subjects designated as physiological factors, those on a waiting list were as successful as the treatment groups on behavioural measures. (Ost, Johansson & Jerremalm, 1982). Only one study (Booth & Rachman, 1992) found no advantage over exposure of explicitly addressing the cognitions experienced in claustrophobia. However, no predictions were made about the power of the statistical design: perhaps too few subjects were selected to test the null hypothesis.

It is not possible to determine the effect of comorbid disorders because subjects with such disorders were excluded in all studies. Furthermore, the impact of, or on, impairment was also ignored in all studies.

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