Ian Lockwood for Project UROK - Claustrophobia

Ian Lockwood for Project UROK




My full name is Ian Michael Lawrence Lockwood,
which is a lot of fun, and I’m an actor
and freelance artist in NYC. I started having
panic attacks when I was 15 years old. I was
also a huge hypochondriac at the time so my
parents didn’t really make much of it. And,
I just tried my best to deal with it, bottle
it up. Fast forward to in college a few years
later, I come out of the closet which is great,
I’ve never been happier. But it opens up
the bottle of things that I’ve bottled up,
my panic attacks return worse than ever. I’m
always shaking, always freaking out. I develop
a horrible obsessive love for my best friend
and everything comes crashing down. There
was a time that I couldn’t go to sleep without
being drunk or high or on a lot of sleeping
pills or Nyquil. So I finally saw help and
I got help and they put me in therapy they
gave me some low dose medication that really
helped me. And I’ve been so much happier
ever since. I was afraid to be alone with
my own thoughts, that’s why I couldn’t
go to sleep without help. If I stopped moving
my thoughts would scare me I’d start hyperventilating,
I’d have a complete panic attack over nothing.
That friend of mine, who I definitely developed
an unhealthy interest in, was actually a saint
for me at that time, he was so understanding.
It would have been so easy for him to be freaked
out by the whole thing and step back, but
he had dealt with a lot of anxiety issues
in his life, he actually had to leave school
for a while because of them. So he recommended
that I get help, and I was pretty ready to
do anything he would say, and it turned out
to be a great suggestion. I would say definitely
don’t be afraid to seek help, I don’t
know who you may be closest with, your
friends or your family. But, people do care
about you and it’s easy to shut yourself
off and try to bottle it up but people want
to help you. The difference in how I used
to feel and how I feel now is so great, but
I wouldn’t be where I am now if I didn’t
have that really tough period. And, I know so many
people are going through it right now and
there is another side to it. And I didn’t
think I would ever really be happy with who
I was. And I think I am happy with who I am
now, which is an awesome feeling. You are
okay.

https://www.youtube.com/watch?v=r7y2ufadp0I


Claustrophobia




Claustrophobia is the fear of having no escape
and being in closed or small spaces or rooms.
It is typically classified as an anxiety disorder
and often results in panic attack, and can
be the result of many situations or stimuli,
including elevators crowded to capacity, windowless
rooms, and even tight-necked clothing. The
onset of claustrophobia has been attributed
to many factors, including a reduction in
the size of the amygdala, classical conditioning,
or a genetic predisposition to fear small
spaces.
One study indicates that anywhere from 5â€"7%
of the world population is affected by severe
claustrophobia, but only a small percentage
of these people receive some kind of treatment
for the disorder.
Symptoms
Claustrophobia is typically thought to have
two key symptoms: fear of restriction and
fear of suffocation. A typical claustrophobic
will fear restriction in at least one, if
not several, of the following areas: small
rooms, locked rooms, cars, aeroplanes, trains,
tunnels, cellars, elevators, caves. Additionally,
the fear of restriction can cause some claustrophobics
to fear trivial matters such as sitting in
a haircutter’s chair or waiting in line
at a grocery store simply out of a fear of
confinement to a single space. Another possible
site for claustrophobic attacks is a dentist's
chair, particularly during dental surgery;
in that scenario, the fear is not of pain,
but of being confined. Some dentists offer
patients medication to ward off such attacks.
Often, when confined to an area, claustrophobics
begin to fear suffocation, believing that
there may be a lack of air in the area to
which they are confined.
Many claustrophobics remove clothing during
attacks, believing it will relieve the symptoms.
Any combination of the above symptoms can
lead to severe panic attacks. However, most
claustrophobics do everything in their power
to avoid these situations.
Diagnosis
Claustrophobia is the fear of having no escape,
and being closed in to a small space. It is
typically classified as an anxiety disorder
and often results in a rather severe panic
attack. It is also confused sometimes with
Cleithrophobia.
Scale
This method was developed in 1979 by interpreting
the files of patients diagnosed with claustrophobia
and by reading various scientific articles
about the diagnosis of the disorder. Once
an initial scale was developed, it was tested
and sharpened by several experts in the field.
Today, it consists of 20 questions that determine
anxiety levels and desire to avoid certain
situations. Several studies have proved this
scale to be effective in claustrophobia diagnosis.
Questionnaire
This method was developed by Rachman and Taylor,
two experts in the field, in 1993. This method
is effective in distinguishing symptoms stemming
from fear of suffocation and fear of restriction.
In 2001, it was modified from 36 to 24 items
by another group of field experts. This study
has also been proven very effective by various
studies.
Prevalence
One study conducted by University of Wisconsin-Madison’s
neurology department revealed that anywhere
from 2-5% of the world population is affected
by severe claustrophobia, but only a small
percentage of these people receive some kind
of treatment for the disorder.
Causes
The fears of enclosed spaces is an irrational
fear. Most claustrophobic people who find
themselves in a room without windows consciously
know that they aren’t in danger, yet these
same people will be afraid, possibly terrified
to the point of incapacitation, and many do
not know why. The exact cause of claustrophobia
is unknown, but there are many theories.
Amygdala
The amygdala is one of the smallest structures
in the brain, but also one of the most powerful.
The amygdala is needed for the conditioning
of fear, or the creation of a fight-or-flight
response. A fight-or-flight response is created,
when a stimulus is associated with a grievous
situation. Cheng believes that a phobia’s
roots are in this fight-or-flight response.
In generating a fight-or-flight response,
the amygdala acts in the following way: The
amygdala’s anterior nuclei associated with
fear communicate with each other. Nuclei send
out impulses to other nuclei, which influence
respiratory rate, physical arousal, the release
of adrenaline, blood pressure, heart rate,
behavioral fear response, and defensive responses,
which may include freezing up. These reactions
constitute an ‘autonomic failure’ in a
panic attack.
A study done by Fumi Hayano found that the
right amygdala was smaller in patients who
suffered from panic disorders. The reduction
of size occurred in a structure known as the
corticomedial nuclear group which the CE nucleus
belongs to. This causes interference, which
in turn causes abnormal reactions to aversive
stimuli in those with panic disorders. In
claustrophobic people, this translates as
panicking or overreacting to a situation in
which the person finds themselves physically
confined.
Classical conditioning
Claustrophobia results as the mind comes to
connect confinement with danger. It often
comes as a consequence of a traumatic childhood
experience, although the onset can come at
any point in an individual’s life. Such
an experience can occur multiple times, or
only once, to make a permanent impression
on the mind. The majority of claustrophobic
participants in an experiment done by Lars-Göran
Öst reported that their phobia had been andquot;acquired
as a result of a conditioning experience.andquot;
In most cases, claustrophobia seems to be
the result of past experiences.
Conditioning experiences
A few examples of common experiences that
could result in the onset of claustrophobia
in children are as follows:
A child is shut into a pitch-black room and
cannot find the door or the light-switch.
A child gets shut into a box.
A child is locked in a closet.
A child falls into a deep pool and cannot
swim.
A child gets separated from their parents
in a large crowd and gets lost.
A child sticks their head between the bars
of a fence and then cannot get back out.
A child crawls into a hole and gets stuck,
or cannot find their way back.
A child is left in their parent's car, truck,
or van.
The term ‘past experiences,’ according
to one author, can extend to the moment of
birth. In John A. Speyrer’s ‘’Claustrophobia
and the Fear of Death and Dying,’’ the
reader is brought to the conclusion that claustrophobia’s
high frequency is due to birth trauma, about
which he says is andquot;one of the most horrendous
experiences we can have during our lifetime,andquot;
and it is in this helpless moment that the
infant develops claustrophobia.
Magnetic resonance imaging, or the MRI, has
been attributed to the onset of claustrophobia.
Since a patient has to be put into the center
of a magnet to optimize imaging, the patient
finds themselves in a narrow tube for an extended
period of time. In a study involving claustrophobia
and the MRI, it was reported that 13% of patients
experienced a panic attack during the procedure.
The procedure has been linked not only to
the triggering of ‘preexisting’ claustrophobia,
but also to the onset in some people. These
panic attacks during the procedure make it
so the patient is unable to adjust to the
situation, and therefore the fear remains.
S.J. Rachman tells of an extreme example citing
the experience of 21 miners in the Claustrophobia
section of ‘’Phobias: A Handbook of Theory,
Research, and Treatment.’’ These miners
were trapped underground for 14 days, during
which six of the miners died of suffocation.
After their rescue, ten of the miners were
studied for ten years. All but one were greatly
changed by the experience, and six of those
developed phobias, phobias that involved andquot;confining
or limiting situations.andquot; The only miner who
did not develop any noticeable symptoms was
the one who acted as leader.
Another factor that could cause the onset
of claustrophobia is andquot;information received.andquot;
As Aureau Walding states in ‘’Causes of
Claustrophobia,’’ many people, especially
children, learn who and what to fear by watching
parents or peers. This method does not only
apply to observing a teacher, but also observing
victims. Vicarious classical conditioning
also includes when a person sees another person
exposed directly to an especially unpleasant
situation. This would be analogous to observing
someone getting stuck in a tight space, suffocated,
or any of the other examples that were listed
above.
Prepared phobia
There is research that suggests that claustrophobia
isn’t entirely a classically conditioned
or learned phobia. It is not necessarily an
inborn fear, but it is very likely what is
called a prepared phobia. As Erin Gersley
says in ‘’Phobias: Causes and Treatments,’’
humans are genetically predisposed to become
afraid of things that are dangerous to them.
Claustrophobia may fall under this category
because of its andquot;wide distribution… early
onset and seeming easy acquisition, and its
non-cognitive features.andquot; The acquisition of
claustrophobia may be part of a vestigial
evolutionary survival mechanism, a dormant
fear of entrapment and/or suffocation that
was once important for the survival of humanity
and could be easily awakened at any time.
Hostile environments in the past would have
made this kind of pre-programmed fear necessary,
and so the human mind developed the capacity
for andquot;efficient fear conditioning to certain
classes of dangerous stimuli.andquot;
Rachman provides an argument for this theory
in his article: ‘’Phobias.’’ He agrees
with the statement that phobias generally
concern objects that constitute a direct threat
to human survival, and that many of these
phobias are quickly acquired because of an
andquot;inherited biological preparedness.andquot; This
brings about a prepared phobia, which is not
quite innate, but is widely and easily learned.
As Rachman explains in the article: andquot;The main
features of prepared phobias are that they
are very easily acquired, selective, stable,
biologically significant, and probably [non-cognitive].andquot;
‘Selective’ and ‘biologically significant’
mean that they only relate to things that
directly threaten the health, safety, or survival
of an individual. ‘Non-cognitive’ suggests
that these fears are acquired unconsciously.
Both factors point to the theory that claustrophobia
is a prepared phobia that is already pre-programmed
into the mind of a human being.
Treatment
Cognitive therapy
Cognitive therapy is a widely accepted form
of treatment for most anxiety disorders. It
is also thought to be particularly effective
in combating disorders where the patient doesn’t
actually fear a situation but, rather, fears
what could result from being in such a situation.
The ultimate goal of cognitive therapy is
to modify distorted thoughts or misconceptions
associated with whatever is being feared;
the theory is that modifying these thoughts
will decrease anxiety and avoidance of certain
situations. For example, cognitive therapy
would attempt to convince a claustrophobic
patient that elevators are not dangerous but
are, in fact, very useful in getting you where
you would like to go faster. A study conducted
by S.J. Rachman shows that cognitive therapy
decreased fear and negative thoughts/connotations
by an average of around 30% in claustrophobic
patients tested, proving it to be a reasonably
effective method.
In vivo exposure
This method forces patients to face their
fears by complete exposure to whatever fear
they are experiencing. This is usually done
in a progressive manner starting with lesser
exposures and moving upward towards severe
exposures. For example, a claustrophobic patient
would start by going into an elevator and
work up to an MRI. Several studies have proven
this to be an effective method in combating
various phobias, claustrophobia included.
S.J. Rachman has also tested the effectiveness
of this method in treating claustrophobia
and found it to decrease fear and negative
thoughts/connotations by an average of nearly
75% in his patients. Of the methods he tested
in this particular study, this was by far
the most significant reduction.
Interoceptive exposure
This method attempts to recreate internal
physical sensations within a patient in a
controlled environment and is a less intense
version of in vivo exposure. This was the
final method of treatment tested by S.J. Rachman
in his 1992 study. It lowered fear and negative
thoughts/connotations by about 25%. These
numbers did not quite match those of in vivo
exposure or cognitive therapy, but still resulted
in significant reductions.
Other forms of treatment that have also been
shown to be reasonably effective are psychoeducation,
counter-conditioning, regressive hypnotherapy
and breathing re-training. Medications often
prescribed to help treat claustrophobia include
anti-depressants and beta-blockers, which
help to relieve the heart-pounding symptoms
often associated with anxiety attacks.
Studies
MRI procedure
Because they can produce a fear of both suffocation
and restriction, MRI scans often prove difficult
for claustrophobic patients. In fact, estimates
say that anywhere from 4â€"20% of patients
refuse to go through with the scan for precisely
this reason. One study estimates that this
percentage could be as high as 37% of all
MRI recipients. The average MRI takes around
50 minutes; this is more than enough time
to evoke extreme fear and anxiety in a severely
claustrophobic patient.
This study was conducted with three goals:
1. To discover the extent of anxiety during
an MRI. 2. To find predictors for anxiety
during an MRI. 3. To observe psychological
factors of undergoing an MRI. Eighty patients
were randomly chosen for this study and subjected
to several diagnostic tests to rate their
level of claustrophobic fear; none of these
patients had previously been diagnosed with
claustrophobia. They were also subjected to
several of the same tests after their MRI
to see if their anxiety levels had elevated.
This experiment concludes that the primary
component of anxiety experienced by patients
was most closely connected to claustrophobia.
This assertion stems from the high Claustrophobic
Questionnaire results of those who reported
anxiety during the scan. Almost 25% of the
patients reported at least moderate feelings
of anxiety during the scan and 3 were unable
to complete the scan at all. When asked a
month after their scan, 30% of patients reported
that their claustrophobic feelings had elevated
since the scan. The majority of these patients
claimed to have never had claustrophobic sensations
up to that point. This study concludes that
the Claustrophobic Questionnaire should be
used before allowing someone to have an MRI.
Use of virtual reality distraction to reduce
claustrophobia
The present case series with two patients
explored whether virtual reality distraction
could reduce claustrophobia symptoms during
a mock magnetic resonance imaging brain scan.
Two patients who met DSM-IV criteria for specific
phobia, situational type reported high levels
of anxiety during a mock 10-min MRI procedure
with no VR, and asked to terminate the scan
early. The patients were randomly assigned
to receive either VR or music distraction
for their second scan attempt. When immersed
in an illusory three-dimensional virtual world
named SnowWorld, patient 1 was able to complete
a 10-min mock scan with low anxiety and reported
an increase in self-efficacy afterwards. Patient
2 received andquot;music onlyandquot; distraction during
her second scan but was still not able to
complete a 10-min scan and asked to terminate
her second scan early. These results suggest
that immersive VR may prove effective at temporarily
reducing claustrophobia symptoms during MRI
scans and music may prove less effective.
Separating the fear of restriction and fear
of suffocation
Many experts who have studied claustrophobia
claim that it consists of two separable components:
fear of suffocation and fear of restriction.
In an effort to fully prove this assertion,
a study was conducted by three experts in
order to clearly prove a difference. The study
was conducted by issuing a questionnaire to
78 patients who received MRIs.
The data was compiled into a andquot;fear scaleandquot;
of sorts with separate subscales for suffocation
and confinement. Theoretically, these subscales
would be different if the contributing factors
are indeed separate. The study was successful
in proving that the symptoms are separate.
Therefore, according to this study, in order
to effectively combat claustrophobia, it is
necessary to attack both of these underlying
causes.
However, because this study only applied to
people who were able to finish their MRI,
those who were unable to complete the MRI
were not included in the study. It is likely
that many of these people dropped out because
of a severe case of claustrophobia. Therefore,
the absence of those who suffer the most from
claustrophobia could have skewed these statistics.
A group of students attending the University
of Texas at Austin were first given an initial
diagnostic and then given a score between
1 and 5 based on their potential to have claustrophobia.
Those who scored a 3 or higher were used in
the study. The students were then asked how
well they felt they could cope if forced to
stay in a small chamber for an extended period
of time. Concerns expressed in the questions
asked were separated into suffocation concerns
and entrapment concerns in order to distinguish
between the two perceived causes of claustrophobia.
The results of this study showed that the
majority of students feared entrapment far
more than suffocation. Because of this difference
in type of fear, it can yet again be asserted
that there is a clear difference in these
two symptoms.
Probability ratings in claustrophobic patients
and non-claustrophobics
This study was conducted on 98 people, 49
diagnosed claustrophobics and 49 andquot;community
controlsandquot; to find out if claustrophobics'
minds are distorted by andquot;anxiety-arousingandquot;
events to the point that they believe those
events are more likely to happen. Each person
was given three eventsâ€"a claustrophobic
event, a generally negative event, and a generally
positive eventâ€"and asked to rate how likely
it was that this event would happen to them.
As expected, the diagnosed claustrophobics
gave the claustrophobic events a significantly
higher likelihood of occurring than did the
control group. There was no noticeable difference
in either the positive or negative events.
However, this study is also potentially flawed
because the claustrophobic people had already
been diagnosed. Diagnosis of the disorder
could likely bias one’s belief that claustrophobic
events are more likely to occur to them.
See also
Agoraphobia
Anxiety disorder
List of phobias
Panic attack
Premature burial
References
Bibliography
Carlson, Neil R., et al. Psychology: the Science
of Behavior, 7th ed. Allyn andamp; Bacon, Pearson.
2010.
Cheng, Dominic T., et al. Human Amygdala Activity
During the Expression of Fear Responses. Behavioral
Neuroscience. Vol. 120. Harold B. Lee Library.
American Psychological Association. University
of Wisconsin. 14 Sept. 2006. Web. 18 Sept.
2010. [1]
Fritscher, Lisa. Claustrophobia: Fear of Enclosed
Spaces. About.com. New York Times Company.
21 Sept. 2009. Web. 9 Sept. 2010. [2]
Gersley, Erin. Phobias: Causes and Treatments.
AllPsych Journal. AllPsych Online. 17 Nov.
2001. Web. 18 Sept. 2010. [3]
Hayano, Fumi PhD., et al. Smaller Amygdala
Is Associated With Anxiety in Patients With
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Society of Psychiatry and Neurology 14 May
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Öst, Lars-Göran. The Claustrophobia Scale:
A Psychometric Evaluation. Harold B. Lee Library.
Stockholm University. 15 Feb. 2007. Web. 9
Sept. 2010. [5]
Rachman, S.J. Claustrophobia. Phobias: A
Handbook of Theory, Research, and Treatment.
John Wiley and Sons, Ltd. Baffins Lane, Chichester,
West Sussex, England. 1997.
Rachman, S.J. Phobias. Education.com. The
Gale Group. 2009. Web. 19 Sept. 2010. [6]
Speyrer, John A. Claustrophobia and the Fear
of Death and Dying. The Primal Psychotherapy
Page. N.p. 3 Oct. 1995. Web. 9 Sept. 2010.
[7]
Thorpe, Susan, Salkovis, Paul M., andamp; Dittner,
Antonia. Claustrophobia in MRI: the Role of
Cognitions. Magnetic Resonance Imaging. Vol.
26, Issue 8. Harold B. Lee Library. 3 June
2008. Web. 18 Sept. 2010. [8]
Walding, Aureau. Causes of Claustrophobia.
Livestrong.com. Livestrong Foundation. 11
June 2010. Web. 18 Sept. 2010. [9]
What Causes Claustrophobia? Neuroscience Blog.
NorthShore University HealthSystem. 11 June
2009. Web. 9 Sept. 2010. [10]

https://www.youtube.com/watch?v=V86-QsHlPqk