Claustrophobia: features, causes and treatment

Just a couple of centuries ago, people did not know about mental disorders, and those who behave differently from the others were simply called "obsessed" and meant that they were controlled by otherworldly forces with clearly unkind intentions. But in general, the number of mentally ill was less than now.

Unfortunately, the modern pace of life, the desire of people to create and maintain their space under the sun do not predispose to the preservation of mental health. Therefore, disorders such as claustrophobia are considered diseases of our advanced technological age, in which the space for man in all senses has become multidimensional.

The name of its disorder leads from two languages ​​- claustrum (lat.) - “enclosed space” and φ? Βος (other Greek) - “fear”. In this way, 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.

Claustrophobe is very anxious if he suddenly finds himself in a small room, especially if there are no windows or there are few of them. Such a person tries to keep the front door open, and he himself is afraid to go deep into the room, trying to stay as close to the exit as possible.

Things get even worse if you can’t get out of the small space at certain times (the elevator goes, the railway carriage also doesn’t work out quickly, but there’s nothing to say about the toilet on the plane). But patients with claustrophobia are afraid not only of cramped spaces, but also of being in a dense crowd.

According to recent research, today people suffer from this 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 widespread use, only a tiny percentage of claustrophobes receive real treatment for their psychopathological state, since many of them have learned to live in such a way as not to create circumstances for panic (there is no closet in the house, instead of an elevator - a ladder, instead of a trip full bus - walking to the destination). It is precisely these conclusions that the University of Wisconsin-Madison experts came to, who devoted a whole scientific study to the spread of claustrophobia in the world.

Thus, it is foolish to deny the magnitude of the problem and the fact of its existence. Claustrophobia is a disease that is not even called so because the closed or narrow spaces themselves cause fear. The animal horror and panic of claustrophobic is caused by the prospect of being closed in them, losing the opportunity to exit.

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

Famous actresses Michelle Pfeiffer and Naomi Watts live with this diagnosis. Uma Thurman, who has been tormented by claustrophobia since her childhood, went on a real feat: during the filming of the sequel to Bill (the second part), she refused an understudy and herself played in a scene where she is buried alive in a coffin. Then the actress repeatedly said that she had nothing to play at this moment, all emotions were real, the horror was genuine.

At the root of the fear of confined space lies a very ancient fear that once advanced civilization far ahead, helping it survive. This is the fear of death. And once it was he who helped save the lives of entire tribes in a world where much depended on a person’s reaction to changes in the environment. The world of the ancients was indeed far more dangerous, and it was worth gawking how you could get to the predators or representatives of a competing tribe as a main dish for lunch.

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

Many researchers consider claustrophobia as the so-called “prepared” phobia, and human nature itself prepared it. All that is needed is a strong trigger so that the fear that lives in each of us wakes up and shows itself in all its "beauty."

Modern psychology has several points of view on the causes of the fear of closed and enclosed spaces. First of all, the version of sensation of personal space is considered.If a person has a wide personal space, then any penetration into him will be perceived as a threat, and the risks of claustrophobia increase. However, no one has ever seen this “buffer” zone, not perceived, and discovered it experimentally. And therefore, the most likely today is another version - hard experience from childhood.

Many people who have such a problem have no complaints against their own parents, but recall that in childhood they experienced strong fright and fear for their lives, when they were locked out of their comrades or by chance during the game, comrades or siblings (in chest of drawers, chest, closet, basement). The child could get lost in the crowd and adults could not find it 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 happen 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 finds himself in the same or similar place.

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

Since the children themselves cannot be critical of parental behavior, they simply accepted the model of perceiving the adult world as the only correct one, and the same fear became 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” arises. As soon as such a reaction is activated, the amygdala nuclei begin to transmit to each other a chain of impulses that affect respiration, the release of stress hormones, blood pressure, and the heart rate.

An interesting explanation of claustrophobia was suggested by John A. Spencer, who in his writings discovered a connection between mental pathology and birth injuries. He suggested that in pathological births, when a child walks along the birth canal slowly, experiences hypoxia (especially its acute form), he has true claustrophobia.

Researchers of the present paid attention to the fact that the use of MRI at times increased the number of people with fear of confined spaces. The need to lie still in a confined space for quite a long time by 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 that a person observes (the child’s psyche is most capable of empathy). In other words, a film or a news story about people stuck somewhere underground in a mine, especially if there are already victims, can form a clear connection between the closed space and danger and even death in a child.

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 several at once):

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

It is noteworthy that the fear of being in the hairdresser's chair and the horror of the dental chair are not uncommon. At the same time, a person is not afraid of pain, dentists and dental treatment, he is afraid of the restriction that occurs 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 they simply do not have enough air for breathing in a small area. Against the background of this double fear, signs of loss of self-control appear, that is, a person can not control himself. The claustrophobic brain sends him incorrect spatial signals and there is a feeling that the outlines of the surrounding are vague, there is no clarity.

Instant disruption of the central nervous system under the action of adrenaline leads to rapid breathing, to an increased heart rate. In the mouth it dries up - the salivary glands reduce the amount of secretion, but the work of sweat glands increases - a person begins to sweat a lot. There is a feeling of pressure in the chest, making a full breath becomes difficult, there is a strong tinnitus, ringing. The stomach contracts.

Everything that happens to the body, the brain perceives as “A 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 come into play, which also contribute, activating the additional production of adrenaline. A panic attack begins.

After several such situations, claustrophobic begins to avoid possible attacks by all means, simply moving away from situations in which such a thing could happen again. Avoidance perpetuates existing fear. Indeed, the number of seizures begins to decline, but not because the disease has receded. It’s just that a person learned to live in such a way so as not to fall 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 a full life - he is forced to always keep the doors open, can refuse to work his dream only because it is somehow connected with the need to go through a long corridor in the office or with being indoors. A person stops traveling, being unable to overcome the fear of even the prospect of entering a train compartment or getting into a passenger compartment of a car.

This type of phobia is quite easy to diagnose, so there are no difficulties not only among specialists, but also in the patients themselves. The details of what is happening helps to establish a special questionnaire by 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.

It is very difficult, almost impossible to get rid of claustrophobia on your own. Despite the fact that claustrophobic is well aware that there is no real reason to fear for his life in the elevator car or in the shower room, he cannot overcome himself, because fear has become 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 consult 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, avoid elevators and corridors. All this will only aggravate the course of the disease. Secondly, while a person is trying to heal himself, a mental disorder becomes more persistent, deeper, and then it will take longer to treat it. In other words, time is expensive.

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

• Get a small soft toy, a talisman (any trifle that can be placed in your pocket). It is important that she reminds you of a pleasant event, immediately caused clear pleasant associations. If you begin to feel anxiety, immediately pick it up, touch, look, smell, do what you want, but try to reproduce in your memory exactly those pleasant memories that are associated with this thing.
• Do not limit yourself to communication. Try to communicate more often and meet friends, colleagues. A “call to a friend” also helps - at the first signs of an increase in anxiety, it’s worth dialing 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 there is a strong anxiety.
• Do not avoid closed rooms and corridors, elevators and showers, gradually form an installation in yourself 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 a narrow capsule of the device and stay there for quite some time is a big question. The procedure lasts about an hour, and to survive this time to do, for example, an MRI of the brain or another part of the body, claustrophobia is completely impossible.

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 it a way out? Indeed, dangerous pathologies may remain undiagnosed and a person will not receive the treatment he needs on time.

If the form of claustrophobia is not severe, then you can take advantage of the formation of a new psychological setting. The staff shows to claustrophobia that the capsule of the device is not completely sealed, the device can be left at any time 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 make it possible to offer an open tomograph to a patient with claustrophobia, then it is worth using it. If there is no other device besides a closed one, then other options can be considered. In cases of severe mental impairment, it is indicated, with the consent of the patient, the use of drugs that cause a good medical sleep (by the way, this is done by MRI for young children, who simply cannot be forced to lie still for an hour).

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

As in most cases with other anxiety disorders, drug therapy does not show high efficiency. Tranquilizers help only partially and temporarily eliminate some of the symptoms (reduce fear), but after the end of their intake, the development of drug dependence is not ruled out, and panic attacks come back again and again. The use of antidepressants shows a higher effectiveness, but only in combination with psychotherapeutic techniques.

In most cases, claustrophobia helps to cure a method such as cognitive therapy. The doctor reveals not only situations in which a person is scared, but also the causes of these fears, and they usually lie in wrong beliefs and thoughts. A specialist in psychology or psychotherapy helps to create new beliefs, and a person’s anxiety is markedly reduced.

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

In the next stage, the patient may be offered in vivo immersion - this method allows a person to look into their own fears. First, the patient is placed in circumstances in which he experiences less fear, and gradually increase the level of fear to the maximum, passing to the most terrible experiences for him. It is proved 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 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 performed on patients with clinically diagnosed claustrophobia. They were asked to undergo an MRI. And only those who received augmented reality glasses with a special 3D SnowWorld program were able to undergo an MRI procedure completely, without resorting to the use of medications.

There is no specific prophylaxis. Parents need to take care of it - punishment in a corner, closet or closet should not be practiced, 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 panic attacks.