Claustrophobia - PowerPoint Presentation

Slide1
Slide2

Claustrophobia

[

Fear of a small / enclosed

spaces]

Prof Craig A. Jackson

Acting Head of School of Social SciencesSlide3

A leading question…

What’s the difference between dogs and horses?Slide4

Aetiology of Claustrophobia

Classed as Anxiety Disorder

Results in:

Panic attacks

Behavioural

changes [short-term and longer term]

Onset common in

late adolescence / early adulthood

Often faulty

(

mis

)attribution of

causes

of panic attacksSlide5

Phobia Types

Simple / Specific Phobias

animal phobias

 – such as dogs, spiders, snakes or rodents

environmental phobias

 – such as heights, deep water and germs

situational phobias

 – such as visiting the dentist or flying

bodily phobias

 – such as blood, vomit or having injections

sexual phobias 

– such as performance anxiety or the fear of getting

an STD

Complex phobias

agoraphobia

social phobiaSlide6

Prevalence

Severe Claustrophobia:5%– 7% global population

1% - 5% in USA

Median 3.2 million adults

Less than 1%

receive

treatment

One year prevalence: 9% 22% severe 30% moderate 48% mild(Kessler etal 2005)Slide7

Diagnosis DSM V

Classed as Anxiety Disorder

not a true “phobia”

Recurrent unexpected attacks

Attacks occurring within 1 month of the other

Concern about additional attacks

Concern about consequences of attacks

Significant / marked change in behaviour due to attacksSlide8

Trigger Points

Elevators

Crowds

Windowless rooms

Tight-necked clothing

Any social situation has triggering-potentialSlide9

Biological

Causes?

Amygdala reduction & processing

(

Hayan

etal

2009)Pre-disposition to avoid small spaces: horses’ evolutionary mechanismcave-dweller / fighter theory disputes this

Genetic defect / prepared phobia

(El-

Kordi

etal

2013)Perceptual augmentationSlide10

Social / Environmental

Causes?

Conditioning / Learned behaviours

Childhood experiences

Adult experiences

Chronic stress

Substance misuse

Disordered Personality / overly cautious styleSlide11

Childhood

causes?

Stuck in dark room

Shut in a box

Deep pool

Separated from parents / gets lost

Head stuck in railingsStuck in a hole / enclosed space / cardboard boxSlide12

Misattribution Theory

Panic attack

Reinforced

by

repeated reactions to panic attacks

Subsequent anxiety (about panic attacks)Preoccupation with panic attacks / hypervigilanceResulting in avoidance of “trigger” situationsSelf-diagnosis

Self help groups Slide13

Misattribution Theory

Slide14

Cognitive Perceptual Processes

faulty perception of environment

Fear disrupts

accurate perception

environment

perceived

incorrectlyAnxiety disrupts perception furtherSlide15

Personal

Space and

Claustrophobia

“near

space”

“far

space”

“Find the mid-point on the line

”

People

with larger near spaces reported higher rates of claustrophobic fear than people with smaller near

spaces.

Results

are consistent with a defensive function of near space representation.Suggests that an over-projection of near space may play an important role in the etiology of claustrophobia.

Lourenco 2011

v

vSlide16

Behavioural Effects

Fearful conduct

Clothing removal

Avoidant behaviours

Need to be near fresh air sources

Need to avoid closed environments Negative attributionsConfirmation biasSlide17

Immediate Symptoms

Panic attacks

Sweating

Nausea

Increased BPM

Fainting

Hyperventilation

ShakingEmbarrassment Out of body experiences / dissociation Slide18

Secondary Symptoms

Reduced Quality of Life

Reduced social contact

Occupational deficits

“Home-Invasion” syndrome

Increased medication use decreased treatment options

Increased medical consultations

Greater substance use / misuseIatrogenic HarmSlide19

Psychological Fears

Fear of Restriction

&

Fear of Suffocation

Rachman

& Taylor (1993)Slide20

Fear of Restriction

Small rooms

Locked rooms

Cars

Tunnels

Cellars

Elevators

Trains Subways Caves Aeroplanes CrowdsSlide21

Fear of Suffocation

Not

necessarily fearful of the area

per se

,

Fearful of possible

consequences of unavoidable

confinementBarber’s chairs QueuingSeatbelts / restraints MRI chambersMedical testing Multi-storey carparksElevators TrainsTunnels Catastrophizing

-

“What if”

syndromeSlide22

Claustrophobia Questionnaire (CLQ)

Rachman

& Taylor (1993

)

Rachman

, Taylor,

Radomsky (1999)Radomsky etal 2001The CLQ has already been used as a screening measure for anxiety and panic while undergoing the MRI procedure McIsaac et al.,

(1998)Slide23

Claustrophobia Questionnaire (CLQ)Slide24

Claustrophobia Questionnaire (CLQ)Slide25

Claustrophobia & Cognitions in MRI

N=130

Outpatients

MRI Anxiety during scan correlated to perceived amount

of:

pain

suffocation harm caused by machine lack of controlPrevious MRI experience not correlated to anxiety levels Allows development of a MRI intolerant personality / patient

Thorpe et al (2008)Slide26

Interventions for Claustrophobia

Medication

Hypnotherapy

+

ve

In vivo / Graded Exposure

Cognitive Behavioural Therapy +ve -ve Herbal remedies

Solution Focused

Therapy

Behavioural Therapy Mindfulness

-

ve

Interoceptive Exposure FloodingSlide27

Cognitive Techniques for MRIs Slide28

References

Hayano, Nakamura, Asami

, Uehara, Yoshida,

Roppongi, Otsuka, Inoue, Hirayasu. Smaller amygdala is associated with anxiety in patients

with panic disorder

. Psychiatry

and Clinical Neurosciences 2009; 63:

266–276.El-Kordi, Kästner, Grube, Klugmann, Begemann, Sperling, Hammerschmidt, Hammer, Stepniak, Patzig, de Monasterio-Schrader, Strenzke, Flügge, Werner, Pawlak, Nave, Ehrenreich. A single gene defect causing claustrophobia. Transl Psychiatry 2013; 3.Miller RM,

Behavior

of the Horse: claustrophobia. Journal of Equine Veterinary Science 1997; 17(1): 10-11

Thorpe S,

Salkovskis

PM,

Dittner A. Claustrophobia in MRI: the role of cognitions. Magnetic Resonance Imaging 2008; 26: 1081-1088