Author
Monika Tempel, as appeared in Alpha1 Journal 2/2024.
Does constriction cause particular anxiety for respiratory patients?
Subway or elevator, cinema or department store, body plethysmograph or MRI tube: If the mere mention of these terms evokes feelings of unease in you, then this article may be of interest to you.
Claustrophobia: the trail of words
Claustrophobia (fear of enclosed spaces) refers to the fear of narrow or enclosed spaces, or the fear of being actually or perceived as being trapped.
The etymology of claustrophobia already leads to surprising insights. Claustrum (Latin) means bar, barrier, or closure. So, someone has deliberately blocked an entrance: a villain, perhaps?
This feeling of confinement can allow fear to creep in. The German word "Angst" (fear) derives from the Latin word "angustus," meaning narrow or constricted. The connection between confinement and fear is thus already evident in language. This suggests that a deep link between confinement and fear also exists in people's consciousness.
In fact, the fear of enclosed spaces is a widespread phenomenon: at least 7 percent of the population suffers from claustrophobic anxiety. Women are twice as likely to be affected as men.
The terminology can also be misleading. In German, claustrophobia is often translated as "Platzangst" (fear of open spaces). The technical term for fear of open spaces is agoraphobia (from the Latin "agora," meaning marketplace). People suffering from agoraphobia fear places without escape routes or help available should they experience a panic attack.
In technical terminology, agoraphobia refers more to the opposite of claustrophobia, although according to the scientific classification, claustrophobia falls under the clinical picture of agoraphobia.
German language, difficult language! And yet: The trail of words leads us, at least via the connection between narrowness and fear, to the possible causes of claustrophobia.
Investigating the causes of claustrophobia
Both psychological and physical causes are considered responsible for claustrophobia.
trauma
One does not necessarily have to follow an older psychoanalytic explanation that assumed experiences before or during birth (due to the narrowness of the uterine cavity and being squeezed into the even narrower birth canal) as the causes of claustrophobia.
A traumatic experience in one's life history is more likely to be the cause: for example, if someone has been stuck in an elevator for a long time, trapped in an accident, or buried in an earthquake.
Early childhood relationships
Overly safety-conscious, anxious parents sometimes try to protect their children from all potential dangers through overprotectiveness. This can exacerbate a predisposition to claustrophobic anxieties.
Stress levels
Claustrophobia is often associated with increased stress levels, which may be long-standing or acutely severe. These acute stressors often stem from experiences of loss (loss of health due to serious illness or accident, loss of a loved one through separation or death, job loss).
Genetic predisposition
Finally, one possible cause must be mentioned in this list: There is growing scientific evidence that a genetic predisposition plays a role in the development of anxiety disorders. The autonomic nervous system and the centers for emotion regulation in the brain (especially the limbic system) play a key role in this.
These brain centers for emotion regulation are also a focus of interest for researchers investigating shortness of breath, as they are thought to play a central role in the emotional processing of these experiences. Indeed, studies have demonstrated structural changes in emotion regulation areas associated with shortness of breath. This could provide an initial indication that people with lung diseases (due to their shortness of breath experiences) are actually more susceptible to claustrophobic anxiety. This assumption is further supported by the following examination of the triggers for a panic response in confined spaces.
For some of you, certain medical examinations (such as body plethysmography or magnetic resonance imaging) may be like a nightmare.
Triggers for claustrophobic fears
For some of you, dear readers, certain medical examinations (such as body plethysmography or magnetic resonance imaging) may be like a nightmare. The mere thought of having to go "into the tube" (i.e., into an MRI or CT scanner) again soon can trigger panic. And despite the completely transparent plastic walls, the mere thought of the lung function testing booth can trigger the familiar panic symptoms in some patients: chest tightness, shortness of breath, trembling, sweating, palpitations, dizziness, or a feeling of weakness.
This triggering of symptoms, even through anticipated situations imagined only in thought, is also described by "researchers of shortness of breath" in relation to anxieties associated with shortness of breath. The phenomenon is likely based on so-called priors: past experiences (priors) create expectations in the brain, which are updated by the respective information. In lung diseases, a connection can thus be learned between key stimuli that trigger shortness of breath (e.g., stairs, excitement) and subjective shortness of breath, as well as the associated anxiety.
Patients with lung diseases are usually familiar with both: experiences of shortness of breath in everyday life and experiences of shortness of breath during medical examinations or treatments. Furthermore, assuming that the brains of lung patients are particularly sensitive to fears of shortness of breath, this may explain their susceptibility to claustrophobic anxieties.
Speculation? Perhaps (still) – but presumably less and less unlikely with increasing research!
Treatment and prognosis for claustrophobia
Anxiety disorders (including claustrophobia) are generally considered highly treatable, with a high success rate (up to 80 percent). Treatment involves psychotherapy (primarily cognitive behavioral therapy) and medication (primarily antidepressants, antipsychotics, and, in emergencies, anxiolytics).
Does the prognosis look just as favorable for lung patients with claustrophobic anxieties?
Firstly, absolutely: because simply knowing that claustrophobia is a widespread phenomenon (even among people with healthy lungs) can contribute to normalization.
Secondly, the lives of patients with lung diseases do not always correspond to those of the general population. People with lung diseases typically experience shortness of breath more frequently than those with healthy lungs, and they are more likely to undergo examinations and treatments in cubicles and tubes.
Therefore, lung patients who aim for a proactive approach to claustrophobic anxieties usually face greater challenges.
It is therefore by no means dishonorable for patients to request a mild sedative before an MRI scan, for example. (They are in good company: According to one study, approximately 14 percent of patients require medication to calm their nerves before an MRI scan due to anxiety.) Alternatively, affected lung patients can try to schedule appointments at a center with "open" MRI systems, which are generally better tolerated.
Anyone who wants to confront their claustrophobic fears in everyday life (for example, before going to the cinema, using an elevator, or driving through a tunnel) should keep the basic principles for dealing with fears in mind:
- Those who flee from fear will be overtaken by it.
- The possibilities for Fear confrontation in a virtual reality This opens up new perspectives, especially for lung patients with claustrophobia.
- Less stress means less shortness of breath and therefore, generally, a lower susceptibility to claustrophobic anxieties. All opportunities for stress reduction and relaxation should therefore be utilized.
If you have any comments or questions about this article, please feel free to contact me.
