Claustrophobia: features, causes and treatment

Just a couple of centuries ago, people were not aware of mental disorders, and those who behave differently from others were simply called "possessed" and implied that they were controlled by otherworldly forces with clearly ill intentions. But on the whole, the number of mentally ill people was less than now.

Unfortunately, the modern pace of life, the desire of people to create and preserve their space under the sun does not predispose to preserving mental health. Therefore, disorders such as claustrophobia are considered diseases of our advanced technological age, in which space for humans has become multidimensional in every sense.

The name of its disorder comes from two languages ​​- claustrum (lat.) - "closed room" and φ? Βος (other Greek) - "fear". Thus, Claustrophobia is an irrational fear of confined and cramped spaces. Phobia is considered psychopathology. Together with agoraphobia (fear of open spaces, squares, crowds), it represents the most common pathological obsessive fears in the modern world.

The claustrophobe is extremely anxious if he suddenly finds himself in a small room, especially if there are few or no windows in it. Such a person tries to keep the front door open, but he is afraid to go deep into the room, trying to stay as close to the exit as possible.

Everything becomes even worse if there is no opportunity to leave the small space at certain moments (the elevator is on the way, the railway carriage will also not be able to leave quickly, and there is nothing to say about the toilet on the plane). But claustrophobic patients are afraid not only of tight spaces, but also of being in a dense crowd.

According to the results of recent studies, today they suffer from such a pathological condition from 5 to 8% of the world's population, and women face this fear about twice as often as men. Such fear can develop in children.

But, despite its widespread distribution, only a tiny percentage of claustrophobes get real treatment for a psychopathological condition, since many of them have learned to live in such a way as not to create circumstances for themselves to panic (there is no closet in the house, instead of an elevator, there is a staircase, instead of a trip in a packed to overflowing bus - walk to the destination). These are the conclusions reached by experts at the University of Wisconsin-Madison, who devoted a whole scientific study to the spread of claustrophobia in the world.

Thus, it is foolish to deny the scope of the problem and the very fact of its existence. Claustrophobia is a disease that is not even called that because the fear is directly caused by the closed or narrow spaces themselves.... Animal horror and panic in a claustrophobe is caused by the prospect of being closed in them, to be deprived of the opportunity to exit.

Claustrophobia is often confused with cletrophobia (this is a specific fear of being trapped), although there really is quite a lot in common between them. But claustrophobia is a broader concept. It is an almost insurmountable fear, for which the patient himself usually does not find a rational explanation.

Famous actresses Michelle Pfeiffer and Naomi Watts live with this diagnosis. Uma Thurman, who has been suffering from claustrophobia since childhood, went for a real feat: during the filming of the sequel to "Bill" (its second part), she refused an understudy and herself played in a scene where she is buried alive in a coffin. Then the actress said more than once that she didn't have to play anything at that moment, all the emotions were real, the horror was genuine.

At the root of the fear of confined space lies a very ancient fear that once propelled civilization far forward, helping it to survive. This is the fear of death. And once it was he who helped save the lives of entire tribes in a world where a lot depended on a person's reaction to changes in the external environment. The world of the ancients was indeed much more dangerous, and as soon as you gape, you could get as the main dish for dinner with predators or representatives of a competing tribe.

Today we are not threatened by hungry tigers and aggressive neighbors with axes, no one is trying to eat, kill, destroy us in the physical sense, but everyone (yes, absolutely everyone!) Of the human race has the fear of not finding a way out in time. The human brain did not have time to get rid of the ancient strong instincts, because they were formed over millennia. But for some, such fears are dormant as unnecessary, while for others they are strong, as before, and even stronger, which is a manifestation of claustrophobia.

Many researchers consider claustrophobia to be a so-called “prepared” phobia, and it was human nature itself that prepared it. You just need a strong trigger for the fear that lives in each of us to awaken and show itself in all its "glory".

Modern psychology has several points of view on the causes of fear of closed and confined spaces. First of all, the version of the sense of personal space is considered.If a person has a wide personal space, then any penetration into it will be perceived as a threat, and the risks of claustrophobia increase. However, this "buffer" zone has never been seen, touched, and empirically discovered. Therefore, the most probable today is another version - a difficult experience from childhood.

Many people who have such a problem have no complaints about their own parents, but remember that in childhood they experienced a strong fear and fear for their lives when, out of hooligan motives or accidentally during the game, comrades or brothers-sisters were locked in a cramped room (in dresser, chest, closet, basement). The child could get lost in the crowd and adults could not find him for a long time. The fear that he experienced in all these situations is the main factor in the development of claustrophobia in the future.

The most severe forms of the disorder occur if, in childhood, a person is faced with aggression or violence that will occur to him in a confined space. Such fear is firmly fixed in memory and is immediately reproduced throughout life in all situations when a person is in the same or similar place.

The hereditary reason is also considered, in any case, medicine knows the facts when several generations of one family suffered from such a disorder. However, they did not find any special gene, the mutations of which could underlie the fear of small enclosed spaces. There is an assumption that the whole point is in the type of upbringing - the children of sick parents simply copied the behavior and reactions of their mothers and fathers.

Since children themselves cannot be critical of parental behavior, they simply accepted the model of perception of the adult world as the only correct one, and the same fear became a part of their own life.

If you look at this phobia from the point of view of medicine and science, then the mechanisms of claustrophobia should be sought in the work of the amygdala of the brain. It is there, in this small but extremely important part of our brain, that the reaction that psychiatrists call "run or defend" occurs. As soon as such a reaction is activated, the nuclei of the amygdala begin to transmit an impulse to each other along the chain, which affects breathing, and the release of stress hormones, and blood pressure, and heart rate.

An interesting explanation for claustrophobia was offered by John A. Spencer, who, in his writings, discovered the connection between mental pathology and birth trauma. He suggested that during pathological childbirth, when the child walks along the birth canal slowly, experiences hypoxia (especially its acute form), he develops true claustrophobia.

Researchers of our time drew attention to the fact that the use of MRI has significantly increased the number of people with a fear of confined spaces... The need to lie motionless in a confined space for a long time in itself can cause the first attack, which will then be repeated when a person finds himself in similar or similar circumstances.

Sometimes a phobia develops not on personal experience, but on the experience of others, which a person observes (most of all, the child's psyche is capable of empathy). In other words, a film or news report about people trapped somewhere underground in a mine, especially if there are already victims, can form a clear connection in a child between an enclosed space and danger and even death.

The disorder can manifest itself in different ways, but there are always two most important signs - a strong fear of restriction and a fear of suffocation. The classic course of claustrophobia implies that the following circumstances are terrible for a person (one, two or more at once):

• small room;
• a room closed from the outside, if a person is inside;
• CT and MRI diagnostic devices;
• interior of a car, bus, plane, train carriage, compartment;
• any tunnels, caves, basements, long narrow corridors;
• shower cabins;
• elevator.

It is noteworthy that fear of being in a hairdresser's chair and fear of a dental chair are not insignificant. At the same time, a person is not afraid of pain, dentists and dental treatment, he is afraid of the limitation that arises at the time of shrinkage in the dentist's chair.

Finding themselves in one of these situations, more than 90% of patients begin to feel fear of suffocation, they are afraid that in a small area they simply will not have enough air for breathing. Against the background of this double fear, signs of a loss of self-control appear, that is, a person cannot control himself. The claustrophobic brain sends him incorrect spatial signals and there is a feeling that the outlines of the environment are blurry, there is no clarity.

Instant disturbances in the functioning of the central nervous system under the influence of adrenaline lead to rapid breathing and increased heartbeat. The mouth dries up - the salivary glands reduce the volume of secretion, but the work of the sweat glands increases - the person begins to sweat a lot. There is a feeling of pressure in the chest, it becomes difficult to take a full breath, there is a strong tinnitus, ringing. The stomach contracts.

Everything that happens to the body, the brain perceives as "Sure sign of a deadly threat", and therefore a person immediately has a fear of death. In response to such a thought, the adrenal glands enter into action, which also contribute, activating the additional production of adrenaline. A panic attack begins.

After several such situations, the claustrophobe begins to avoid possible attacks by all means, simply avoiding situations in which this can happen again. Avoidance reinforces existing fear. Indeed, the number of attacks begins to decline, but not at all because the disease has receded. It's just that a person has learned to live so as not to get into difficult situations. If he does get into them, an attack is almost inevitable.

With a severe course of violation, a person deprives himself of the opportunity to live fully - he is forced to always keep the doors open, he can give up his dream job only because it is somehow connected with the need to go through a long corridor in the office or being in a closed room. A person stops traveling, being unable to overcome fear even at the mere prospect of entering a train compartment or sitting in a passenger car.

This type of phobia is quite easy to diagnose, therefore, difficulties do not arise not only for specialists, but also for the patients themselves. The details of what is happening helps to establish a special questionnaire of Rahman and Taylor, after answering the questions of which the doctor can not only accurately diagnose claustrophobia, but also determine its exact type and depth of the disorder.The anxiety scale, also used in diagnostics, contains 20 questions.

Getting rid of claustrophobia on your own is very difficult, almost impossible. Despite the fact that the claustrophobe is well aware that there are no real reasons to fear for his life in the elevator car or in the shower room, he cannot overcome himself, because fear has become a part of himself. That is why those who want to truly overcome their weakness (and fear makes a person weak and vulnerable), be sure to see a doctor.

Firstly, one may come across dubious recommendations in which a person may be advised to withdraw into himself and stop sharing fears with loved ones, to avoid elevators and corridors. All this will only aggravate the course of the disease. Secondly, while a person is trying to heal himself, the mental disorder becomes more persistent, profound, and it will take longer to heal it. In other words, time is precious.

Along with treatment, in order to achieve better and faster results, you should try to adhere to these recommendations of psychologists.

• Get a small stuffed toy, a talisman (any little thing you can put in your pocket). It is important that she reminds you of a pleasant event, immediately evokes clear pleasant associations. If you start to feel anxiety, immediately pick it up, touch, look, smell, do whatever you want, but try to reproduce in your memory exactly those pleasant memories that are associated with this thing.
• Do not limit yourself in communication. Try to communicate more often and meet with friends and colleagues. A “call to a friend” also helps - at the first signs of an increase in anxiety, you should dial the number of a close and dear person who can just chat with you about something.
• Master breathing techniques and gymnastics, this helps to better control yourself if severe anxiety appears.
• Do not avoid closed rooms and corridors, elevators and showers, gradually form in your mind that a closed one is not always dangerous, and even vice versa, because a dangerous enemy or evil spirits cannot get into a closed room.

Sometimes there is a vital need for MRI - this is a very informative diagnostic method. But how to force yourself to lie in the narrow capsule of the apparatus and stay there for quite a long time is a big question. The procedure lasts about an hour, and it is absolutely impossible for a claustrophobe to survive this time to do, for example, an MRI of the brain or other part of the body.

It is clear that no one is authorized to force anyone. Any patient has the right to refuse diagnostics for personal reasons, without even explaining them to doctors. But is this a way out? After all, dangerous pathologies may remain undiagnosed and the person will not receive the treatment he needs on time.

If the form of claustrophobia is not severe, then you can use the formation of a new mental attitude. The staff shows the claustrophobic that the capsule of the device is not completely sealed, the device can be left at any time, whenever you want, on your own without the help of specialists. If a person understands this, it may be easier for him to go through the necessary procedure.

If the capabilities of a medical institution allow offering an open tomograph to a patient with claustrophobia, then it should be used. If there is no other apparatus besides a closed one, then other options can be considered. In case of severe mental impairment, it is shown, with the patient's consent, the use of drugs that induce sound drug sleep (by the way, this is how MRI is done for young children, who simply cannot be forced to lie down quietly for an hour).

It is accepted to treat claustrophobia in a complex manner, and you should not think that there are pills that can quickly defeat the problem. An individual approach is required, high-quality psychotherapy, and medications just do not show a pronounced effect in the fight against the fear of confined spaces.

As with most other anxiety disorders, drug therapy is not very effective. Tranquilizers help only partially and temporarily eliminate some of the symptoms (reduce fear), but after the end of their intake, the development of drug addiction by construction is not excluded, and panic attacks come back again and again. The use of antidepressants is shown to be more effective but only in combination with psychotherapeutic techniques.

Cognitive therapy is the most effective treatment for claustrophobia. The doctor identifies not only situations in which a person is afraid, but also the reasons for these fears, and they usually lie in wrong beliefs and thoughts. A specialist in psychology or psychotherapy helps to create new beliefs, and the person's anxiety is noticeably reduced.

Psychology is aware of several studies of the effectiveness of cognitive therapy in the case of claustrophobia. A great specialist in this mental disorder S. J. Rahman (who is also a co-author of the diagnostic method) has proved empirically that the method helps about 30% of patients even without additional measures.

At the next stage, the patient can be offered in vivo immersion - this method allows a person to look their own fears in the face. First, the patient is placed in circumstances in which he experiences less fear, and gradually increase the level of fear to the maximum, moving on to the most terrible experiences for him. It has been proven that the effectiveness of this method is about 75%.

The method of interroceptive exposure is more gentle for the patient than in vivo, since all “dangerous” situations are created and controlled by specialists, and the immersion in them is very smooth and gradual. The effectiveness of the method is slightly lower than that of cognitive therapy and in vivo - only 25%.

Recently, more modern techniques and methods have appeared in the arsenal of psychiatrists, for example, the use of distraction by virtual reality. The experiment was carried out on patients with clinically diagnosed claustrophobia. They were offered to undergo an MRI scan. And only those who received augmented reality glasses with a special 3D SnowWorld program were able to complete the MRI procedure completely, without resorting to the use of medications.

There is no specific prophylaxis. Parents need to take care of her - punishment in a corner, closet or closet is not worth practicing, especially if the child is sensitive and very impressionable. In adulthood, it is recommended to learn how to relax - this is exactly what will help to avoid anxiety attacks.