Claustrophobia

What Causes Claustrophobia?

Scientists don’t yet fully understand what causes claustrophobia and other anxiety disorders. However, an individual’s risk for developing claustrophobia is probably due to a complex interaction of genetic and environmental factors.

Risk factors for claustrophobia include:

• History of panic disorder or other phobias
• Exposure to traumatic experiences such as abuse, violent crime, or loss of a loved one
• Certain personality traits, such as anxiety or general fearfulness
• Family history of claustrophobia or other phobias

Is Claustrophobia Hereditary?

People with a family history of claustrophobia, panic disorder, or other phobias have a higher risk of developing phobias, suggesting an inherited component to the disorders. However, scientists have not identified a single gene or a group of genes definitively associated with claustrophobia. Instead, claustrophobia is likely the result of a coincidence of multiple genetic and environmental factors.

In 2013, a study identified a single gene that seemed to be responsible for claustrophobic behaviors in mice. However, the study did not conclusively find a similar connection between the gene and claustrophobia in humans. Still, more research could help narrow the search for the genetic link to the disorder.

How Is Claustrophobia Detected?

Claustrophobia most often begins in childhood or adolescence. Signs that situational anxiety might rise to the level of diagnosable claustrophobia include:

• Being in small or enclosed spaces causes you significant distress.
• You’re always looking for a way to escape from anxiety-causing places.
• You take steps to avoid being in stressful places.
• You have a history of panic attacks.
• Your anxiety lasts for six months or more.

How Is Claustrophobia Diagnosed?

Diagnosis of claustrophobia begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that claustrophobia or panic disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for claustrophobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for claustrophobia include:

• Anxiety or fear is associated with small or enclosed spaces.
• Being in these spaces or thinking about them almost always causes anxiety.
• The anxiety is out of proportion to the danger posed by the situation.
• Anxiety-inducing situations are avoided or endured under intense distress.
• The anxiety lasts for six months or more.
• The anxiety causes significant distress or impairment.
• Another mental illness does not explain the symptoms.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Claustrophobia Treated?

A combination of medications and psychotherapy is often used to treat the symptoms of claustrophobia.

Medication

Different medications may be used to treat and manage claustrophobia. Individual medication plans depend on the patient’s age, responsiveness to treatments, and the severity of their symptoms.

• Selective serotonin reuptake inhibitors (SSRIs). These antidepressant drugs work by increasing the levels of serotonin, a neurotransmitter chemical in the brain. Common SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.
• Benzodiazepines. These anti-anxiety medications work relatively quickly to control symptoms. However, they may lose their effectiveness over time.

Psychotherapy

The most common therapeutic approaches used to treat claustrophobia include:

• Exposure therapy. This therapy involves gradual, controlled exposure to the situations that trigger symptoms. The goal is to help the patient understand and change their fear response to the situation. Exposure therapy is successful in the majority of cases when it is practiced correctly.
• Cognitive behavioral therapy (CBT). This process focuses on helping the patient identify a pattern of harmful thoughts and construct strategies and solutions for dealing with them.

How Does Claustrophobia Progress?

Most people who follow a treatment plan for claustrophobia see an improvement in their symptoms over time. However, an untreated phobia and long-term avoidance of fear-inducing situations can lead to complications, including:

• Depression
• Anxiety
• Relationship problems
• Problems at school or work
• Isolation
• Substance abuse

How Is Claustrophobia Prevented?

There is no known way to prevent claustrophobia. However, the disorder’s progression may be slowed or stopped if you address symptoms when they first appear. Steps you can take to keep your anxiety from getting worse include:

• When you feel anxiety-specific situations, practice putting yourself in those situations while the fear is still mild.
• Ask your friends and family to help you.
• Seek help from a mental health professional, especially if you experience panic attacks.

Claustrophobia Caregiver Tips

Claustrophobia often exists alongside other mental health conditions, a situation called co-morbidity. Here are a few of the disorders commonly associated with claustrophobia:

• Panic disorder and claustrophobia are very often co-morbid.
• People with claustrophobia often suffer from depression or other mood disorders.

Claustrophobia Brain Science

Scientists believe that symptoms of claustrophobia and phobias come from activity in the parts of the brain that control emotions and our reactions to them. These parts of the brain are collectively called the limbic system. The limbic system is associated with anxiety in several ways:

• The amygdala, the part of the brain responsible for detecting threats, may be hyperactive and may misidentify causes for fear or worry when none exist.
• An overactive amygdala may persistently cause the hypothalamus to trigger the hormonal response that produces the physical symptoms of phobias.
• Communication between the amygdala and the prefrontal cortex (PFC) may be impaired. The PFC is responsible for triggering a rational response to threats, and it may not be able to do so when it cannot effectively communicate with the amygdala.

Claustrophobia Research

Title: Use of CBD Oil in the Treatment of Panic Attack-Related Fear

Stage: Recruiting

Principal investigator: Michael J. Telch, PhD

University of Texas

Austin, TX 

This study aims to test whether cannabidiol (CBD) can interfere with the reconsolidation (storage) of pathological fear memory in humans.

The overarching goal of the proposed research project is to contribute to the development of a novel ultra-brief intervention for anxiety-related psychiatric disorders such as panic disorder and post-traumatic stress disorder (PTSD). Building off innovative work in the basic neuroscience of fear memory interference (see Stern et al., 2018 for a review), this experiment will be the first to evaluate whether cannabidiol (CBD) can interfere with the reconsolidation of naturally acquired pathological interoceptive fear memory in humans.

Participants who meet DSM-5 criteria for panic disorder or elevated subthreshold concerns about having additional panic attacks will be randomly assigned to one of three conditions: (1) Memory reactivation + CBD, (2) Memory reactivation+ Placebo, or (3) CBD alone.

NOTE: Due to the COVID-19 Pandemic, all study procedures will occur online and over videoconference with study staff. Additionally, CBD or placebo oil will be mailed to the participant’s location.

Title: Comparing Individual Therapies for Veterans With Depression, PTSD, and Panic Disorder

Stage: Recruiting

Principal investigator: Daniel F. Gros, PhD, MA, BS

Ralph H. Johnson VA Medical Center

Charleston, SC 

Cognitive behavioral therapy (CBT) is a brief, efficient, and effective treatment for depressive/anxiety disorders. However, CBT is largely underutilized within the Department of Veterans Affairs due to the cost and burden of training necessary to deliver all related disorder-specific treatments (DSTs). In contrast, transdiagnostic Behavior Therapy (TBT) is specifically designed to address numerous distinct disorders within a single protocol in Veterans with depressive/anxiety disorders, including post-traumatic stress disorder. The proposed research seeks to evaluate the efficacy of TBT by assessing psychiatric symptomatology and related impairment outcomes in Veterans with depressive/anxiety disorders via a randomized controlled trial of TBT and existing DSTs in Veterans with major depressive disorder, post-traumatic stress disorder, and panic disorder. Assessments will be completed at pre-, mid-, and post-treatment and 6-month follow-up. Process variables also will be investigated.

Title: Building an Outcomes Assessment Infrastructure to Assess Anxiety Treatment

Stage: Recruiting

Principal investigator: Jacqueline Sperling, PhD

McLean Hospital

Cambridge, MA

The collection of patient self-reports and diagnostic data will allow us to examine the efficacy of the treatment delivered in the McLean Anxiety Mastery Program. Using data gathered through routine clinical care, the investigators seek to explore whether patients in treatment show improvements from admission to discharge compared to patients on the waitlist and whether these gains are maintained three months post-discharge. The following are included as examples of some of the study’s hypotheses.

The study population will involve all assenting/consenting patients, both male and female, admitted to the McLean Anxiety Mastery Program at McLean Hospital. This program provides intensive group-based treatment for anxious youth (aged 6-19). Patients in the McLean Anxiety Mastery Program participate in a minimum of four weeks of treatment and attend the program for four days per week. Three days per week, patients attend group-based treatment for two-and-a-half hours per day. The fourth day of each week consists of a one-hour group-based treatment, a one-hour family meeting, and a one-hour exposure session that includes children and their caregivers. One day per week, parents also attend a one-hour parent guidance group as part of the overall treatment package. Patients also have psychopharmacology consultations with the program psychiatrist on a case-by-case basis. On their first birthday falling after the discharge date, patients are sent a birthday card that includes a greeting and reminders about coping skills that they learned in the program.

The investigators expect to recruit at least 45 assenting/consenting patients in the first year of the study. The plan is to treat six to eight patients during each one-month module and to have a waitlist if interest in the program exceeds the program’s capacity. If a waitlist exists, patients on this waitlist will be evaluated as the study’s control group once they are four weeks away from their target admission date.

Before the patient’s first assessment through the program, a clinician will inform the patient and caregivers about the opportunity to participate in a voluntary research study at the McLean Anxiety Mastery Program. Assent/consent will be requested to utilize these data for research purposes. The patient and caregivers will be told that all of the information gathered from the child- and caregiver-report measures are part of routine clinical practice, and permission is being sought to use this de-identified data for research purposes. The patient and caregivers will be reminded that their decision to, or not to, participate in the research study will not affect the treatment they receive.

The assessments are conducted at the following time points: 1) upon admission, 2) weekly while the patients are participating in treatment, 3) upon discharge, and 4) at a three-month follow-up visit.

The child- and parent-reported questionnaires are administered through REDCap Survey, a secure, HIPAA-compliant program for building and managing online surveys. The measures are completed on families’ devices at home. If a patient or family member does not complete the online survey within 48 hours, a clinician will contact them with a reminder one time via phone or e-mail. The survey does not include questions assessing risk (e.g., for suicidal ideation, self-harm, substance use).