Article
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

In this study we tested the hypothesis that claustrophobia is composed of two elements: fear of suffocation and fear of restriction. A self-report claustrophobia questionnaire, interview questions, and behavioural exposure tests were administered to an unselected sample of 179 university students. Results from each method of assessment supported the hypothesis, and suffocation and restriction fears were found to be moderately correlated. The basis of the correlation is considered and a number of explanations are set out. It is also suggested that these fears may be necessary but probably not sufficient for claustrophobia to occur, and that other factors, such as anxiety sensitivity, may play an important role.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Taylor and Cox have proposed a four-factor model of AS consisting of "fear of respiratory symptoms," "fear of publicly observable anxiety reactions," "fear of cardiovascular symptoms," and "fear of cognitive dyscontrol." Within this context, there is emerging evidence that the greater the degree of specificity between preexisting fear about bodily 3 sensations and symptoms induced during challenge, the better anxiety-related responding can be predicted (Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999;Rachman & Taylor, 1993). For instance, Schmidt (1999) recently found that cardiopulmonary fears were the only dimension that predicted anxiety and bodily sensations produced by 35% CO 2 inhalation (see also Aikens, Zvolensky, & Eifert, 2000;McNally & Eke, 1996;Zvolensky, Goodie, McNeil, Sperry, & Sorrell, in press). ...
... Our first goal was to further evaluate whether multiple AS dimensions (i.e., fears of respiratory symptoms, publicly observable anxiety reactions, cardiovascular symptoms, and cognitive dyscontrol) predicted anxiety and fear in response to CO 2 challenge, relative to other theoretically relevant variables (e.g., trait anxiety). Consistent with existing research Rachman & Taylor, 1993;Schmidt, 1999), we expected that concerns about the negative consequences of respiratory symptoms, cardiac symptoms, and cognitive dyscontrol, all of which can be produced by CO 2 inhalation, would be more predictive of provocation-induced anxiety than other concerns not related to those 8 symptoms (i.e., fear of publicly observable symptoms of anxiety) and trait anxiety. The second aim of this study was to provide an initial test as to whether the use of avoidant coping strategies, as measured by the COPE Inventory (Carver, Scheier, & Weintraub, 1989) independently predicted particular aspects of anxious and fearful responding to interoceptive provocation. ...
... ASI-R. Based on previous research (e.g., Eifert et al., 1999;Rachman & Taylor, 1993;Schmidt, 1999), we expected that challenge-relevant concerns about the negative consequences of respiratory symptoms, cardiac symptoms, and cognitive dyscontrol, would be more predictive of provocation-induced anxiety than other concerns less related to challenge-induced sensations (i.e., fear of publicly observable symptoms of anxiety) and trait anxiety. Consistent with this hypothesis, the Fear of Cardiac Symptoms subscale uniquely predicted an increased number and intensity of challenge-induced cognitive symptoms of panic, including catastrophic cognitions. ...
... Generalmente, la claustrofobia está asociada con aquellas fobias nombradas como situacionales o ambientales (por ejemplo, oscuridad, altura, volar en avión), formando un conjunto o factor legítimo de fobia, es decir, las personas que presentan miedo a un estímulo tenden a hacer lo mismo con respecto a los demás del mismo grupo (Muris, Schmidt, & Merckelbach, 1999;Öst & Csatlos, 2000;Stravynski, Basoglu, Marks, Sengun, & Marks, 1995). Es común afirmar que las personas que sufren de esta fobia temen situaciones que implican restricción y/o confinamiento (Febbraro & Clum, 1995;Rachman & Taylor, 1993). No obstante, Martínez, García y Botella (2003) afirman que ésta concepción está cambiando, admitiéndose que no necesariamente las personas que padecen de claustrofobia temen a espacios cerrados, sino lo que puede ocurrir en situaciones en las que tengan que permanecer en esos locales es que perciban como amenazadoras las posibilidades de restricción y asfixia. ...
... Los objetivos de este estudio han sido reunir evidencias de validez factorial, validez convergente y fiabilidad del Cuestionario de Claustrofobia -CC (Rachman & Taylor, 1993;Radomsky et al., 2001) en Brasil, evaluando la diferencia de género frente a esta fobia. Confiamos haberlos logrado. ...
Article
Full-text available
This study aimed at adapting the Claustrophobia Questionnaire to the Brazilian context. Specifically, it intended to know its factor structure and reliability, to test different theoretical models (i.e., uni-factor and bi-factor), to joint evidences of its convergent validity, and to know if its scores vary according to the gender of the subjects. Participated 224 undergraduate students, mostly of them female (75.3%) and single (78.5%), with a mean age of 24.2 years. They answered the Claustrophobia Questionnaire and the General Health Questionnaire, as well as five demographic questions. As it was theoretically expected, the bi-factor model was more adequate than the uni-factor ones, and the psychological distress positively correlated itself with the general and the specific factors of claustrophobia. It was observed that women scored higher in claustrophobia than men, independent of the considered factor (suffocation or restriction). It was concluded that the Claustrophobia Questionnaire presents acceptable psychometric parameters, coherent with those previously observed.
... 14 Anxiety disorders among adults with OSA are common 15,16 and evidence suggests that anxiety disorders and the fear of choking may be more prevalent in severe OSA 17 and in those OSA adults with higher body mass index (BMI). 18 As claustrophobia is an anxiety disorder that is associated with elevated anxiety sensitivity 14 and anxiety disorders are prevalent among adults with OSA, it stands to reason that the prevalence of claustrophobia may be higher in adults with OSA than the general population. ...
... Other claustrophobia intervention strategies have yet to be developed or tested in CPAPtreated OSA. As claustrophobia is hypothesized to include two components, fear of suffocation and fear of restriction, 14 and patient-reported barriers to CPAP are often anecdotally described very similarly, future claustrophobia intervention research in the CPAP-treated OSA population may necessarily address both these components. If these components of claustrophobia are individually and/or collectively contributory to this phobic anxiety disorder in adults with OSA, then it is possible that both claustrophobia components are important intervention targets to reduce or attenuate claustrophobia with CPAP treatment and potentially improve CPAP adherence. ...
Article
(1) Determine claustrophobia frequency in adults with obstructive sleep apnea (OSA) after first CPAP night; (2) determine if claustrophobia influences CPAP non-adherence. Claustrophobia is common among CPAP-treated OSA adults yet few studies have examined the problem. Secondary analysis of prospective, longitudinal study of OSA adults (n = 97). CPAP-Adapted Fear and Avoidance Scale (CPAP-FAAS) collected immediately after CPAP titration polysomnogram. objective CPAP use at 1week and 1month. Sixty-three percent had claustrophobic tendencies. Females had higher CPAP-FAAS scores than males. FAAS ≥25, positive score for claustrophobic tendencies, was influential on CPAP non-adherence at 1week (aOR = 5.53, 95% CI 1.04, 29.24, p = 0.04) and less CPAP use at 1month (aOR = 5.06, 95% CI 1.48, 17.37, p = 0.01) when adjusted for body mass index and CPAP mask style. Claustrophobia is prevalent among CPAP-treated OSA adults and influences short-term and longer-term CPAP non-adherence. Interventions are needed to address this treatment-related barrier. Copyright © 2015 Elsevier Inc. All rights reserved.
... This anxiety tends to come from feelings of isolation (Wada and Sakugawa, 1990) or of being trapped (Carmody and Sterling, 1993). Up to 7% of the world's population suffer from severe claustrophobia, involving feelings of being trapped or being unable to breathe (Rachman and Taylor, 1993). Specific phobias and anxiety disorders in general can impact work performance in several ways, including reducing productivity, irregular work attendance, poor concentration and increased mistakes and errors (Wald, 2011). ...
... Attempts to mitigate allostatic load focus on social and cognitive therapies (see Section 8), but also investigate those individuals who have natural resilience to stress (''achieving a positive outcome in the face of adversity"; McEwen et al., 2015), and it may be that certain individuals are more suited for work in stressful environments than others. Underground workplaces are not necessarily threatening, but workers with claustrophobia or other specific anxiety disorders should be considered carefully and underground environments should be designed to reduce feelings of restriction or threat to air supply (Rachman and Taylor, 1993). ...
Article
Working in underground spaces appears to be a possible solution for urban areas with lack of space or areas characterised by extremes of temperature. Besides pure engineering questions, it is also critical to understand the relationship between the architectural specificities of underground spaces and human behaviour and performance. Research to date has provided preliminary evidence on this question. Yet, during the last decade, contemporary cognitive neuroscience, experimental psychology and behavioural science have made impressive progress in the measurement, monitoring and understanding of human cognition and behaviour. These novel approaches offer advanced tools to study the human brain, body and mind; other disciplines (economics, political science, ergonomics and, recently, architecture) have successfully adopted these methods. The aim of the present paper is to introduce these concepts to the research community who studies the effects of underground work and offer practical examples of how these methods can be employed to understand crucial problems related to “underground psychology”. These new conceptual tools enable reliable isolation of various cognitive functions in a quantifiable way; identification of individual differences in responses to the environment; uncovering of underlying motivational factors; and establishment of a more mechanistic explanation of human behaviour. Cognitive neuroscience inspired methods offer a new exciting, comprehensive, more objective, and systematic examination of human behaviour in underground spaces and open new possibilities for identification of effective interventional strategies to improve the design of modern underground environments.
... The participants also completed the Claustrophobia Questionnaire (CLQ; Rachman and Taylor 1993;Radomsky et al. 2001), a 26-item self-report questionnaire assessing trait claustrophobic fear. They had to indicate for each item how anxious they would feel in the described situations from 1 (not at all anxious) to 5 (extremely anxious). ...
... This provides a check on our manipulation of how threatening the different types of stimuli were. Table 2 shows the ratings for the Claustrophobia Questionnaire (CLQ; Rachman and Taylor 1993;Radomsky et al. 2001). Figure 1 shows the results. ...
Article
Full-text available
Time-to-collision (TTC) underestimation has been interpreted as an adaptive response that allows observers to have more time to engage in a defensive behaviour. This bias seems, therefore, strongly linked to action preparation. There is evidence that the observer’s physical fitness modulates the underestimation effect so that people who need more time to react (i.e., those with less physical fitness) show a stronger underestimation effect. Here we investigated whether this bias is influenced by the momentary action capability of the observers. In the first experiment, participants estimated the time-to-collision of threatening or non-threatening stimuli while being mildly immobilized (with a chin-rest) or while standing freely. Having reduced the possibility of movement led participants to show more underestimation of the approaching stimuli. However, this effect was not stronger for threatening relative to non-threatening stimuli. The effect of the action capability found in the first experiment could be interpreted as an expansion of peripersonal space (PPS). In the second experiment, we thus investigated the generality of this effect using an established paradigm to measure the size of peripersonal space. Participants bisected lines from different distances while in the chin-rest or standing freely. The results replicated the classic left-to-right gradient in lateral spatial attention with increasing viewing distance, but no effect of immobilization was found. The manipulation of the momentary action capability of the observers influenced the participants’ performance in the TTC task but not in the line bisection task. These results are discussed in relation to the different functions of PPS.
... The darkness of UG could invoke fear and a sense of entrapment [15]. For those who suffer from claustrophobia and anxiety disorders, being UG could cause them to feel that they are unable to breathe as they could regard UG as an area with limited oxygen supply [16]. However, repeat exposure to this perceived threat to their wellbeing could cause some individuals to adapt their fear response e.g., from initial heart rate increases to gradual reduction [17]. ...
... This could be acute in small workspaces where movement is restricted [32]. Windowless environments could also affect wayfinding since external landmarks are absent and cannot be used as reference points [16]. This could induce stress and frustration amongst UG workers [33]. ...
Chapter
Full-text available
With increasing population density in urban areas, underground space use in these urban centres is also on the rise. This can be in the form of more traditional underground (UG) facilities, such as water treatment plants and subway stations, but also more diversified uses such as underground offices and data centres. As these relatively novel underground workspaces are constructed, we need to take a human centric approach to ensure that the workers are happy and healthy. When designing any space, it is important to consider the relationships between the environmental, architectural characteristics and behavior and wellbeing. This is crucial in underground developments, as the initial cost of developing an underground space is significantly higher (at least in the short term) than aboveground and would have to be offset by a longer building life. Previous studies show negative attitudes towards working underground and hint at possible psychological and health complaints. Major themes include lighting and circadian rhythms, metabolic changes and claustrophobia. However, these studies are over thirty years old and mainly concentrate on self-report measures. To respond to this challenge, we have systematically examined the relationship between underground spaces and human performance in a 4 year research program. Using mixed methods such as psychophysiological measurements, cognitive tests and interviews, we examine the architectural and engineering choices that could impact or mitigate specific issues related to underground work environment.
... Causes of claustrophobia are likely to be extremely small tonsils, genetic predisposition, or emotional responses induced by the classical condition. e two main symptoms are the fear of enclosed spaces and the fear of constriction [3][4][5]. Psychological literature suggests that people with claustrophobia do not necessarily fear the enclosed spaces themselves; instead, they fear that some dangerous event will occur in this type of environment, leading to insufficient air within the space and causing suffocation. ...
... e goal is to correct the person's misunderstanding toward the objects of their fear. A study by Rachman and Taylor [4] showed that cognitive therapy is effective in nearly 30% of individuals with claustrophobia, effectively reducing their fear and negative thoughts regarding specific environments [7,8]. In vivo exposure therapy, which forces patients into the environments they fear, allows individuals to experience their fear. ...
Article
Full-text available
Claustrophobia is an anxiety disorder characterized by the fear of enclosed spaces. Although medication treatment can effectively control symptoms, the effects quickly disappear once medication is discontinued. Many studies have shown that combining psychotherapy and medication is more efficacious than solely using medication. However, the weaknesses of the traditional psychotherapy are that it is time-consuming and expensive. Alternatively, vivo exposure therapy is proposed in which anxiety is gradually triggered with stimuli. Targeting claustrophobia is diagnosed using the traditional method, and this study established virtual reality (VR) and augmented reality (AR) environments consistent with claustrophobic characteristics, comparing the two using an experimental process to examine whether VR and AR environments are equally capable of triggering anxiety in participants. This study further analysed the efficacies of VR and AR by measuring changes in participant’s heart rates variability (HRV) and examining data from survey questionnaires. HRV results indicated that the proposed VR system and AR system were both able to trigger anxiety. Furthermore, the AR environment produced a stronger experience for the participants and caused physiological reactions more evident than those caused by the VR environment. Regarding the anxiety questionnaire, the participants suggested that their anxiety was significantly higher in the VR environment than in the AR environment.
... n The overall claustrophobic event rate of 9.8% (640 of 6520) in patients who were referred for MR imaging of any part of the body in the routine clinical environment was much higher than expected. C laustrophobia, the fear of an enclosed space, is defined in the Diagnostic and Statistical Manual of Mental Disorders as a situational anxiety disorder (1), and it has two moderately related components-fear of restriction and fear of suffocation (2). Although an estimated 3% of the general population experiences claustrophobia (3), its incidence may range from 0.7% to 14.0% in patients scheduled for magnetic resonance (MR) imaging (4). ...
... The first 18-month cohort was exposed to psychometric testing with the German version of the validated English claustrophobia questionnaire (CLQ) ( Table E1 [online]) before MR imaging (CLQ cohort). The CLQ was developed in 1993 to explore claustrophobia (2) and was used during MR imaging at a later time to test its reliability (12). It was revised by Radomsky et al in 2001 (6) and was used in this study. ...
Article
Full-text available
Purpose To analyze claustrophobia during magnetic resonance (MR) imaging and to explore the potential of the 26-item claustrophobia questionnaire (CLQ) (range, 0-4) as a screening tool in patients scheduled for MR imaging. Materials and Methods The study received institutional review board approval, and patients in the CLQ cohort provided informed consent. A total of 6520 consecutive patients were included. Overall, 4288 patients completed the CLQ before MR imaging (CLQ cohort), and 2232 patients underwent MR imaging without having completed the CLQ (non-CLQ cohort). Claustrophobic events were recorded by the staff. Results The CLQ mean score in patients with claustrophobic events (1.48 ± 0.93) was significantly higher (P < .01) than in the group without claustrophobic events (0.60 ± 0.5). The CLQ cutoff value was 0.16 for men and 0.56 for women. Because of the low prevalence, negative predictive values of CLQ cutoff values (men, 0.99 [573 of 582]; women, 0.97 [745 of 766]) were higher than positive predictive values (men, 0.01 [88 of 582]; women, 0.16 [192 of 1186]). The overall claustrophobic event rate was 9.8% (640 of 6520; 95% confidence interval [CI]: 9.1, 10.6). The CLQ did not induce claustrophobic events because the event rate in the CLQ cohort was significantly lower than that in the non-CLQ cohort, as shown by the adjusted odds ratio of 0.81 (95% CI: 0.68, 0.96). Conclusion The CLQ is a suitable screening tool for the absence of a subsequent claustrophobic event. Furthermore, while it is possible to identify patients with a considerable risk of claustrophobia, prediction in individual patients is not possible. (©) RSNA, 2016 Online supplemental material is available for this article.
... Similar to both agoraphobia and acrophobia (i.e., fear of heights), claustrophobia is described as a distortion in the relationship between the body and surrounding environment (i.e., spatial orientation) [14,20]. Two major components of claustrophobia have been suggested that include the fear of suffocating and fear of restriction or confinement [21]. Symptoms include a subjective feeling of being trapped, being suffocated, and fear of encountering such confinement and suffocation among individuals with claustrophobia [22]. ...
Article
Full-text available
Background: Changes in the visual environment and thereby, the spatial orientation, can induce postural instability leading to falls. Virtual reality (VR) has been used to expose individuals to virtual environments (VE) that increase postural threats. Claustrophobia is an anxiety disorder categorized under situational phobias and can induce such postural threats in a VE. Purpose: The purpose of the study was to investigate if VR-generated claustrophobic simulation has any impact on postural threats that might lead to postural instability. Methods: Thirty healthy men and women (age: 20.7 ± 1.2 years; height: 166.5 ± 7.3 cm; mass: 71.7 ± 16.2 kg) were tested for postural stability while standing on a force platform, upon exposure to five different testing trials, including a normal stance (NoVR), in stationary VE (VR), and three consecutive, randomly initiated, unexpected claustrophobia trials (VR CP1, VR CP2, VR CP3). The claustrophobia trials involved all four walls closing in towards the center of the room. Center of pressure (COP)-derived postural sway variables were analyzed with a one-way repeated measures analysis of variance at an alpha level of 0.05. Results: Significant main effect differences existed in all but one dependent COP-derived postural sway variables, at p < 0.05. Post-hoc pairwise comparisons with a Bonferroni correction revealed that, predominantly, postural sway excursions were significantly lower in claustrophobia trials compared to NoVR and VR, but only accomplished with significantly increased sway velocity. Conclusion: The VR CP trials induced lower postural sway magnitude, but with increased velocity, suggesting a bracing and co-contraction strategy when exposed to virtual claustrophobic postural threats. Additionally, postural sway decreased with subsequent claustrophobia trials, suggesting potential motor learning effects. Findings from the study offer insights to postural control behavior under virtual claustrophobic simulations and can aid in VR exposure therapy for claustrophobia.
... I soggetti sono preoccupati di quello che può capitare loro in spazi ristretti, dal momento che percepiscono maggiormente il pericolo quando sono impossibilitati a muoversi. Caleidoscopio Uno studio fattoriale di Rachman & Taylor (1993) ha evidenziato la presenza, in soggetti claustrofobici, di due fattori moderatamente correlati, il senso di soffocamento e la sensazione di essere in trappola. ...
... Prior to the conditioning procedure, participants completed the Dutch version of the Claustrophobia Scale (Rachman and Taylor, 1993;Van Diest et al., 2010) to measure fear of suffocation. This was done because previous work has suggested that interindividual differences in Fear of Suffocation modulate the respiratory response to resistive loads (Pappens et al., 2012b;Alius et al., 2013). ...
... and were predominantly female (82%), white (76.19%), and non-Hispanic (71.43%). A detailed description of the sample characteristics is presented in Table 1 (35,36). ...
... The 26-item CLQ (Radomsky et al. 2001) is a revised and shortened version of the original CLQ (Rachman & Taylor, 1993) comprising 36 items. The CLQ rates the degree of anxiety aroused by different potentially claustrophobic situations (5-point answer scales: 0, not at all to 4, extremely). ...
Article
Previous studies of the dimensional structure of panic attack symptoms have mostly identified a respiratory and a vestibular/mixed somatic dimension. Evidence for additional dimensions such as a cardiac dimension and the allocation of several of the panic attack symptom criteria is less consistent. Clarifying the dimensional structure of the panic attack symptoms should help to specify the relationship of potential risk factors like anxiety sensitivity and fear of suffocation to the experience of panic attacks and the development of panic disorder. Method. In an outpatient multicentre study 350 panic patients with agoraphobia rated the intensity of each of the ten DSM-IV bodily symptoms during a typical panic attack. The factor structure of these data was investigated with nonlinear confirmatory factor analysis (CFA). The identified bodily symptom dimensions were related to panic cognitions, anxiety sensitivity and fear of suffocation by means of nonlinear structural equation modelling (SEM). Results. CFA indicated a respiratory, a vestibular/mixed somatic and a cardiac dimension of the bodily symptom criteria. These three factors were differentially associated with specific panic cognitions, different anxiety sensitivity facets and suffocation fear. Conclusions. Taking into account the dimensional structure of panic attack symptoms may help to increase the specificity of the associations between the experience of panic attack symptoms and various panic related constructs.
... and were predominantly female (82%), white (76.19%), and non-Hispanic (71.43%). A detailed description of the sample characteristics is presented in Table 1 (35,36). ...
Article
Full-text available
Objective: Preclinical studies have shown that low-dose methylene blue increases mitochondrial cytochrome oxidase activity in the brain and improves memory retention after learning tasks, including fear extinction. The authors report on the first controlled experiment to examine the memory-enhancing effects of posttraining methylene blue administration on retention of fear extinction and contextual memory following fear extinction training. Method: Adult participants displaying marked claustrophobic fear were randomly assigned to double-blind administration of 260 mg of methylene blue (N=23) or administration of placebo (N=19) immediately following six 5-minute extinction trials in an enclosed chamber. Retesting occurred 1 month later to assess fear renewal as indexed by peak fear during exposure to a nontraining chamber, with the prediction that the effects of methylene blue would vary as a function of fear reduction achieved during extinction training. Incidental contextual memory was assessed 1 and 30 days after training to assess the cognitive-enhancing effects of methylene blue independent of its effects on fear attenuation. Results: Consistent with predictions, participants displaying low end fear posttraining showed significantly less fear at the 1-month follow-up if they received methylene blue posttraining compared with placebo. In contrast, participants displaying moderate to high levels of posttraining fear tended to fare worse at the follow-up if they received methylene blue posttraining. Methylene blue's enhancement of contextual memory was unrelated to initial or posttraining claustrophobic fear. Conclusions: Methylene blue enhances memory and the retention of fear extinction when administered after a successful exposure session but may have a deleterious effect on extinction when administered after an unsuccessful exposure session.
... Prior to the conditioning procedure, participants completed the Dutch version of the Claustrophobia Scale (Rachman and Taylor, 1993;Van Diest et al., 2010) to measure fear of suffocation. This was done because previous work has suggested that interindividual M a n u s c r i p t 9 differences in Fear of Suffocation modulate the respiratory response to resistive loads (Pappens et al., 2012b;Alius et al., 2013). ...
Article
Claims have been made that breathing is in part controlled by feedforward regulation. In a classical conditioning paradigm, we investigated anticipatory increases in the inspiratory motor drive as measured by inspiratory occlusion pressure (P100). In an acquisition phase, an experimental group (N=13) received a low-intensity resistive load (5cmH2O/l/s) for three consecutive inspirations as Conditioned Stimulus (CS), preceding a load of a stronger intensity (20cmH2O/l/s) for three subsequent inspirations as Unconditioned Stimulus (US). The control group (N=11) received the low-intensity load for 6 consecutive inspirations. In a post-acquisition phase both groups received the low-intensity load for 6 consecutive inspirations. Responses to the CS-load only differed between groups during the first acquisition trials and a strong increase in P100 during the US-loads was observed, which habituated across the experiment. Our results suggest that the disruption caused by adding low to moderate resistive loads to three consecutive inspirations results in a short-lasting anticipatory increase in inspiratory motor drive.
... The problem with this suggestion is that many specific phobias are characterized by fears of experiencing Depression and Anxiety panic-like symptoms. Claustrophobia is characterized by fear of suffocation, [11] acrophobia is associated with fear of dizziness, [12] and blood-injection-injury phobia is characterized by fear of fainting. [13] Thus, in terms of feared consequences (cognitive ideation), the distinction between specific phobia and agoraphobia is blurred. ...
Article
The recently published DSM-5 contains a number of changes pertinent to panic disorder and agoraphobia. These changes include separation of panic disorder and agoraphobia into separate diagnoses, the addition of criteria and guidelines for distinguishing agoraphobia from specific phobia, the addition of a 6-month duration requirement for agoraphobia, the addition of panic attacks as a specifier to any DSM-5 diagnosis, changes to descriptors of panic attack types, as well as various changes to the descriptive text. It is crucial that clinicians and researchers working with individuals presenting with panic attacks and panic-like symptoms understand these changes. The purpose of the current paper is to provide a summary of the main changes, to critique the changes in the context of available empirical evidence, and to highlight clinical implications and potential impact on mental health service utilization. Several of the changes have the potential to improve access to evidence-based treatment; yet, although certain changes appear justified in that they were based on converging evidence from different empirical sources, other changes appear questionable, at least based on the information presented in the DSM-5 text and related publications. Ongoing research of DSM-5 panic disorder and agoraphobia as well as application of the new diagnostic criteria in clinical contexts is needed to further inform the strengths and limitations of DSM-5 conceptualizations of panic disorder and agoraphobia.
... All participants assessed their levels of fear and avoidance in the feared situations related to their problem (0 = "No fear at all/I never avoid" to 10 = "Severe fear/I always avoid"). Claustrophobia Questionnaire [20]. Acrophobia Questionnaire [21]. ...
Article
Full-text available
This paper presents innovative data on the role of presence as a predictor of treatment efficacy using Virtual Reality (VR) exposure therapy. One hundred and seven people suffering mental disorders participated in this study. We analyzed the predicting role of various components of presence by means of the Presence and Reality Judgment Questionnaire. Our results indicated that "emotional involvement" and "influence of the quality of software in presence and reality judgment" were strong predictors of treatment efficacy. These results are relevant for the design of virtual environments in the field of VR therapy.
... SFS (Rachman & Taylor, 1993) is a 16-item questionnaire that lists claustrophobia-related situations to measure aspects of suffocation fear that have been hypothesized to relate to PD. Respondents are asked to indicate on a 5-point Likert scale (0 5 not at all anxious to 4 5 extremely anxious) how they would feel while working under a sink during vigorous exercise and while using an oxygen mask, among other situations. The SFS has a high level of internal consistency and adequate convergent validity with interoceptive distress (Zvolensky, Lejuez, & Eifert, 1998 ). ...
Article
Full-text available
To further understand the frequent co-occurrence of smoking and panic disorder (PD), we examined panic-relevant cognitive processes among heavy smokers, half of whom were in 12-hour withdrawal, and nonsmokers. All participants (N = 85) underwent a 5-minute carbon dioxide rebreathing challenge. Prior to the challenge, participants completed questionnaires on reasons for smoking, anxiety sensitivity, and suffocation fear. Results are consistent with a model in which smokers with predisposing risk factors (high anxiety sensitivity and high suffocation fear) misappraise bodily sensations and experience panicky symptoms. No evidence was found that being in acute withdrawal heightened this risk. Overall, findings highlight (a) cognitive vulnerabilities that may place smokers at elevated risk for developing PD and hence (b) potential targets for intervention.
... The lower order factors represent physical, psychological, and social concerns, and the higher order factor represents the global anxiety sensitivity construct (Stewart, Taylor, & Baker, 1997; Zinbarg, Mohlman, & Hong, 1999). There is emerging evidence that the greater the degree of specificity between pre-existing fear about bodily sensations and symptoms experienced, the better self-reported anxiety-related responding can be predicted (Eifert, Zvolensky, Sorrell, Hopko, & Lejuez, 1999; Rachman & Taylor, 1993). For instance, Schmidt (1999) recently found that cardiopulmonary fears, a subcomponent of anxiety sensitivity physical concerns, was the only dimension that predicted reported anxiety and bodily sensations during 35% CO 2 inhalation in panic disorder patients. ...
Article
Full-text available
The present study explored psychological predictors of response to a series of three 25 second inhalations of 20% carbon dioxide-enriched air in 60 nonclinical participants. Multiple regression analyses indicated that only anxiety sensitivity physical concerns predicted self-reported fear, whereas both physical anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted affective ratings of emotional arousal. In contrast, the psychological concerns anxiety sensitivity dimension predicted ratings of emotional displeasure (valence), and both psychological anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted emotional dyscontrol. No variables significantly predicted heart rate. These data are in accord with current models of emotional reactivity that highlight the role of cognitive variables in the production of anxious and fearful responding to somatic perturbation, and help further clarify the particular predictors of anxiety-related responding to biological challenge.
... The Kaiser rule suggested that three factors should be retained, whereas the scree method yielded four factors, thus three factors were initially retained. As Taylor et al. [1991Taylor et al. [ , 1992 and Rachman and Taylor [1993] have noted, the scree and Kaiser methods may yield an excessive number of factors when items are being factored. Thus a two factor solution was examined as well. ...
Article
Full-text available
The current study describes the validation of a new cognitive assessment measure for social phobia, entitled the Appraisal of Social Concerns (ASC). Item content is relevant to a range of social situations. The ASC can be used to tailor interventions to patients' idiosyncratic concerns. Data are presented from both clinical (n=71) and non-clinical (n=550) samples. Preliminary data indicate that the ASC has good internal consistency and test–retest reliability. The construct validity of the ASC is comparable to that of well-established measures in use with social phobics. A strength of the ASC is its sensitivity to the effect of treatment. An exploratory factor analysis yielded three factors tapping concerns about negative evaluation, observable symptoms, and social helplessness. Subscale scores were strongly correlated. Preliminary findings suggest that the ASC is a psychometrically sound, time efficient instrument that can be used for both clinical and research purposes. Depression and Anxiety 19:217–224, 2004. © 2004 Wiley-Liss, Inc.
... We measured self-reported anxiety, defensive behavior, protective reflex modulation, and autonomic responses during anticipation of (patients were sitting in front of the test chamber with its door open for 10 minutes) and exposure to a small (75 cm wide, 120 cm long, and 190 cm high) dark and closed test chamber (for a maximum of 10 minutes), constructed according to descriptions by € Ost, Johansson, and Jerremalm (1982). Rachman and colleagues (Rachman, Levitt, & Lopatka, 1988;Rachman & Taylor, 1993) have successfully used this test as an experimental model to investigate physiological and cognitive symptoms of panic attacks in patients with claustrophobia. Because marked fear of entrapment and avoidance of being in enclosed places is also a prominent symptom in patients with panic disorder and agoraphobia (Arrindell, Cox, Van der Ende, & Kwee, 1995;Cox, Swinson, Kuch, & Reichman, 1993;Kwon, Evans, & Oei, 1990;Rodriguez, Pagano, & Keller, 2007), we expected to evoke defensive responses during this test in a large proportion of the PD/AG patient group. ...
Article
Full-text available
In the current review, we reconceptualize a categorical diagnosis—panic disorder and agoraphobia—in terms of two constructs within the domain “negative valence systems” suggested by the Research Domain Criteria initiative. Panic attacks are considered as abrupt and intense fear responses to acute threat arising from inside the body, while anxious apprehension refers to anxiety responses to potential harm and more distant or uncertain threat. Taking a dimensional view, panic disorder with agoraphobia is defined with the threat-imminence model stating that defensive responses are dynamically organized along the dimension of the proximity of the threat. We tested this model within a large group of patients with panic disorder and agoraphobia (N5369 and N5124 in a replication sample) and found evidence that panic attacks are indeed instances of circa strike defense. This component of the defensive reactivity was related to genetic modulators within the serotonergic system. In contrast, anxious apprehension—characterized by attentive freezing during postencounter defense—was related to general distress and depressive mood, as well as to genetic modulations within the hypothalamic-pituitary-adrenal (HPA) axis. Patients with a strong behavioral tendency for active and passive avoidance responded better to exposure treatment if the therapist guides the patient through the exposure exercises.
... The CLQ (Radomsky et al., 2001) is a 26item assessment of claustrophobia symptoms. Participants are asked to rate how anxious they would feel on a 5-point Likert scale (0 = not at all anxious, 4 = extremely anxious) in situations eliciting concerns about suffocation and physical restriction, the two components of fear thought to underlie claustrophobia (Rachman & Taylor, 1993). For the purposes of this study, MENTAL REINSTATEMENT OF EXPOSURE 13 participants also indicated the strength of their desire to avoid the rated situations from 0 (no desire to avoid) to 4 (avoid at all costs). ...
Article
Fear of enclosed spaces prevents many people from receiving magnetic resonance imaging (MRI) scans. Although exposure therapy can effectively treat such fears, reductions in fear during exposure often do not generalize beyond the context in which they took place. This study tested a strategy designed to increase generalization, which involved revisiting the memory of a prior exposure to enhance retrieval of extinction learning. Forty-five participants with claustrophobia that included fear of MRI scans underwent a series of exposures lying inside a narrow cabinet. One week later, participants were randomly assigned to enhanced mental reinstatement (EMR) or control procedures. Prior to entering a mock MRI scanner, EMR participants recalled the memory of exposure training and listened to an audio recording of themselves describing what they learned, whereas control participants recalled a neutral memory. Compared to the control condition, EMR led to significantly reduced heart rate reactivity in the mock MRI scanner, but not self-reported fear or avoidance. There were no differences between conditions in claustrophobia symptoms or MRI fear at one-month follow-up. Results suggest some benefits of mental reinstatement for improving generalization of gains following exposure training for claustrophobia, with measures of subjective fear and physiological arousal showing discordant outcomes.
... Anxiety relating to underground spaces can come from worry about being isolated or trapped (Carmody and Sterling, 1993;Wada and Sakugawa, 1990). Up to seven per cent of the world suffer from claustrophobia (Rachman and Taylor, 1993). Claustrophobia and other anxiety disorders have been shown to affect work performance, reducing productivity and concentration, and increasing mistakes (Wald, 2011). ...
Conference Paper
Full-text available
Underground space is being diversified for more and more functions, including industrial, commercial, transport, educational, and recreational uses. Mixed-use complexes and multi-functional hubs are also being developed underground. As more uses are found for underground space, we should ensure that underground working does not affect human psychology and health. Previous research has examined psychological, health and social aspects associated with underground spaces but mainly employing relatively mono-disciplinary approaches and methodologies, many times in a non-systematic way. Additionally, research up to now has not employed the modern research tools that cognitive neuroscience, experimental social psychology and epidemiology offer. Our research project examines human health, behavior and attitude aspects related to the underground working environment in a multi-disciplinary and holistic way. The overall aim is to examine and address possible psychological and health-related impacts and to enhance social acceptance of underground workspaces. This project begins a unified, systematic and holistic examination of the interaction of human psychology and health with underground spaces to improve public acceptance of underground work. In this study, we present the key elements of a systematic research program examining the relationship between environmental and architectural characteristics of underground spaces with human behavior, cognition and well-being. Initial findings of the research plan show a multi-faceted set of aspects that can affect underground work, from psychological effects on work performance and creativity, social effects on cooperative and risk taking behaviors, health effects, and engineering parameters such as the aesthetic appearance of the space. Problems can arise from the design of underground workspaces, such as disruption from regular exposure to the outdoor environment. Social beliefs, attitudes and cultural meanings can affect the willingness to work underground. The confined environment that is created can amplify issues that are common to all workplaces, including environmental, emotional and motivational factors.
... Specific patient-rating scales useful in the initial detection and ongoing assessment of respiratory sensitivity include: (a) Claustrophobia Questionnaire (Rachman & Taylor, 1993); (b) Claustrophobia Concerns Questionnaire (Valentiner, Telch, Petruzzi, & Bolte, 1996); and (c) respiratory sensitivity subscale of the Texas Multifactor Anxiety Sensitivity Scale (see Appendix). ...
... There are a few studies about clinical analysis of claustrophobia [15] and about this anxiety in MRI procedures. [6] EEG mapping is a common tool in examining different phobias. ...
Article
Background: Exposure to small confined spaces evokes physiological responses such as increased heart rate in claustrophobic patients. However, little is known about electrocortical activity while these people are functionally exposed to such phobic situations. The aim of this study was to examine possible changes in electrocortical activity in this population. Method: Two highly affected patients with claustrophobia and two healthy controls participated in this in vivo study during which electroencephalographic (EEG) activity was continuously recorded. Relative power spectral density (rPSD) was compared between two situations of being relaxed in a well‑lit open area, and sitting in a relaxed chair in a small (90 cm × 180 cm × 155 cm) chamber with a dim light. This comparison of rPSDs in five frequency bands of EEG was intended to investigate possible patterns of change in electrical activity during fear‑related situation. This possible change was also compared between claustrophobic patients and healthy controls in all cortical areas. Results: Statistical models showed that there is a significant interaction between groups of participants and experimental situations in all frequency bands (P < 0.01). In other words, claustrophobic patients showed significantly different changes in electrical activity while going from rest to the test situation. Clear differences were observed in alpha and theta bands. In the theta band, while healthy controls showed an increase in rPSD, claustrophobic patients showed an opposite decrease in the power of electrical activity when entering the confined chamber. In alpha band, both groups showed an increase in rPSD, though this increase was significantly higher for claustrophobic patients. Conclusion: The effect of in vivo exposure to confined environments on EEG activity is different in claustrophobic patients than in healthy controls. Most of this contrast is observed in central and parietal areas of the cortex, and in the alpha and theta bands.
... As previous work introduced, social anxiety is thought to be more cognitive in nature [70,130,131,145] compared to other specific anxiety disorders, which are based in the interaction with either certain animals [24,149] or physical aspects of the world, such as height or space [47,126,128]: Cognitive models of social anxiety [37,70,71,145] depict this anxiety as a reaction to a mismatch between the individual's cognitive self-image, and the perceived expectations of the surrounding social context [70]. Socially-anxious individuals tend to overestimate the expectations of social observers and fear that they will not satisfy these high standards [72,73]; biased by previous 'failures', they are quick to judge that a social interaction or performance in front of others will go poorly [29]. ...
Article
The treatment of social anxiety through digital exposure therapy is challenging due to the cognitive properties of social anxiety-individuals need to be fully engaged in the task and feel themselves represented in the social situation; however, avatar customization has been shown to increase both engagement and social presence. In this paper, we harness techniques used in commercial games, and investigate how customizing self-representation in a novel digital exposure task for social anxiety influences the experience of social threat. In an online experiment with 200 participants, participants either customized their avatar or were assigned a predefined avatar. Participants then controlled the avatar through a virtual shop, where they had to solve a math problem, while a simulated audience within the virtual world observed them and negatively judged their performance. Our findings show that we can stimulate the fear of evaluation by others in our task, that fear is driven primarily by trait social anxiety, and that this relationship is strengthened for people higher in trait social anxiety. We provide new insights into the effects of customization in a novel therapeutic context, and embed the discussion of avatar customization into related work in social anxiety and human-computer interaction. ?
... [12][13] Although large treatment outcome studies have not been conducted on CPAP desensitization specifically, exposure therapy and desensitization are exceedingly well researched behavioral therapies with a large literature base supporting their use in a variety of phobic conditions, including claustrophobia, as well as anxiety disorders. [14][15][16] Moreover, given the lack of other efficacious strategies for improving CPAP adherence, the benefit to patients of improved adherence, and the minimal costs and risks of implementing a behavioral intervention such as CPAP desensitization, there is little reason not to offer this treatment to patients more widely. ...
Article
Full-text available
Introduction: Obstructive sleep apnea (OSA) is a common medical condition with well-established morbidity and mortality. Continuous positive airway pressure (CPAP) is a highly effective treatment prescribed to most individuals with OSA that has documented poor adherence rate for a variety of reasons including claustrophobia and discomfort. CPAP desensitization is an effective, simple, and brief treatment shown to improve adherence rates to CPAP. Methods: A psychologist specializing in behavioral sleep medicine developed this module focused on teaching medical residents the techniques of CPAP desensitization. The educational activity was an interactive 45-minute seminar which included a didactic component followed by a case presentation and interactive role-play. A postseminar survey was used to evaluate the content of the workshop, as well as growth in awareness and perception of knowledge and skills with a pre- to postworkshop evaluation. Results: In a survey of 25 primary care and psychiatry residents and sleep medicine fellows, 92% of respondents indicated that the topic of CPAP barriers and CPAP desensitization was important. Ratings of self-reported knowledge and skills improved nearly one-third following the workshop. Qualitative feedback indicated the utility and enthusiasm learners had for this topic. Discussion: The workshop on CPAP desensitization was a valuable tool that should be disseminated more widely to improve treatment adherence in the significant portion of the population that suffers from OSA which does not use adherence to positive airway pressure therapy. The workshop is applicable to other health professionals including medical students and nursing, social work, or psychology trainees.
... Claustrophobia is a common problem in magnetic resonance imaging (MRI) and has been defined as the combined fear of suffocation and restriction [2]. It is estimated to occur in 2.1 to 14.3% of all MRI examinations [3][4][5][6]. ...
Article
Full-text available
Objective: To investigate which magnetic resonance imaging (MRI) scanner designs claustrophobic patients prefer. Material/methods: We analyzed questionnaires completed by 160 patients at high risk for claustrophobia directly after a scan in either a short-bore or open panoramic scanner as part of a prospective randomized trial Enders et al (BMC Med Imaging 11:4, 2011). Scanner preferences were judged based on schematic drawings of four scanners. Information on the diagnostic performance of the depicted scanners was provided, too. Results: A majority of patients suggested upright open (59/160, 36.9%) and open panoramic (53/160, 33.1%) before short-bore designs (26/160, 16.3%, for all p < 0.001) for future development. When asked about patients' preferred scanner choice for an upcoming examination, information about a better diagnostic performance of a short-bore scanner significantly improved its preference rates (from 6/160 to 49/160 or 3.8 to 30.5%, p < 0.001). Patients with a claustrophobic event preferred open designs significantly more often than patients without a claustrophobic event (p = 0.047). Patients scanned in a short-bore scanner in our trial preferred this design significantly more often (p = 0.003). Noise reduction (51/160, 31.9%), more space over the head (44/160, 27.5%), and overall more space (33/160, 20.6%) were the commonest suggested areas of improvement. Conclusion: Patients at high risk for claustrophobia visually prefer open- over short-bore MRI designs for further development. Education about a better diagnostic performance of a visually less-attractive scanner can increase its acceptance. Noise and space were of most concern for claustrophobic patients. This information can guide individual referral of claustrophobic patients to scanners and future scanner development. Key points: • Patients at high risk for claustrophobia visually favor the further development of open scanners as opposed to short- and closed-bore scanner designs. • Educating claustrophobic patients about a higher diagnostic performance of a short-bore scanner can significantly increase their acceptance of this otherwise visually less-attractive design. • A medical history of earlier claustrophobic events in a given MRI scanner type and focusing on the features "more space" and "noise reduction" can help to guide referral of patients who are at high risk for claustrophobia.
... Per tale motivo Rachman e coll. (6,7) hanno proposto una struttura bifattoriale del costrutto della claustrofobia; essa, perciò, consisterebbe di due differenti, ma correlate, tipologie di paura, quella della restrizione fisica e quella di soffocare; entrambe in combinazione determinerebbero, quindi, la comparsa dei sintomi claustrofobici. Pertanto, basandosi su tale costrutto bifattoriale, Rachman e Taylor misero a punto un questionario denominato "The Claustrophobia Questionnaire" (CLQ) (6) che, ad oggi rappresenta l'unico questionario validato di tipo selfreport capace di misurare in modo specifico questi due fattori della claustrofobia. ...
Article
Objectives: Aim of our study was to adapt the Claustrophobia Questionnaire (CLQ) to the Italian context. Methods: In our study, a sample of 50 claustrophobic patients was compared to 50 healthy people (control group). All of them answered the Claustrophobia Questionnaire and the Stait-Trait Anxiety Inventory Form Y1 and Y2, as well as demographic questions. Results: As it was theoretically expected, our results confirmed the two-factor structure and showed that the Italian version of the CLQ has good psychometric properties. Indeed, it was observed that claustrophobic patients scored higher in claustrophobia than those from the control group. Conclusions: In conclusion, the Italian version of the CLQ is a reliable and valid instrument to assess claustrophobic fear.
Article
Alcohol, administered acutely, is known to cause CO2 hyposensitivity. CO2 hypersensitivity associated with anxiogenic hyperventilation (HV) could reasonably be expected to emerge as an opponent process upon withdrawal from chronic alcohol use. To test this hypothesis, we applied two well-known methods to quantify CO2 sensitivity in recently detoxified alcohol-dependent individuals and never alcohol-disordered individuals who are social drinkers. We found that the alcoholic group exhibited significantly greater CO2 sensitivity than did controls in response to both challenges. Indirect evidence of chronic HV was also obtained. These findings implicate the effect of chronic alcohol use on CNS-based CO2 sensitivity in heightening the vulnerability to disturbing anxiety symptoms and syndromes exhibited by alcoholic individuals. Future work must verify that pathological drinking actually causes the dysregulated respiratory responding observed in this study as is inferred in our conclusions.
Article
Full-text available
This paper reports on two studies that examined predictions derived from Reiss and McNally's (1985) expectancy model of fear behavior and Bandura's (1988) self-efficacy theory. In Study 1 of 138 participants displaying marked claustrophobic fears, scales were developed to measure Suffocation Concerns, Entrapment Concerns, and Coping Self-Efficacy. In Study 2 of 202 participants displaying marked claustrophobic fears, confirmatory factor and reliability analyses showed that these scales reliably tapped relatively discrete constructs. Predictions derived from the Reiss and McNally expectancy model and Bandura's self-efficacy theory were examined using behavioral, subjective, and physiological measures taken during a claustrophobic Behavioral Approach Test (BAT). Coping Self-Efficacy accounted for unique variance in subjective fear and heart-rate reactivity, but did not produce significantly better classification of participants' behavior beyond the expectancy model variable set. The expectancy model variable set meaningfully predicted behavioral approach, with the interaction between Expected Anxiety and Anxiety Sensitivity adding significantly to the classification beyond all other variables. These findings suggest that the expectancy model and self-efficacy theory provide meaningful and nonredundant accounts of phobic reactions.
Article
Full-text available
This paper addresses the argument that metafiction and reality are fundamentally identical in that they are both linguistic constructs within which humans experience claustrophobia. Metafiction exemplifies how the postmodern subject strives to escape all closed boundaries that limit their existential, cultural, or personal freedom. In this context, this article analytically examines the relationship between metafiction and claustrophobia in Paul Auster's novel City of Glass. It highlights how language plays a major role in restricting people to linguistic realities that have no connection with other realms outside language. The intended purpose is to illustrate how humans have become claustrophobic in a postmodern culture that delegitimises all major grand narratives or stories that once gave spiritual meaning to their lives.
Chapter
Systematic desensitization is a behavior therapy developed by Joseph Wolpe (1915–1997) for fear and anxiety. Treatment begins with an assessment that describes the objects and/or events that elicit fearfulness. It continues with three basic procedures: The therapist teaches the patient to relax the voluntary muscles. At the same time, the therapist and patient develop detailed descriptions of personal encounters with the objects and/or events that provoke fear and arrange them in order of increasing fearsomeness. Then the therapist instructs the patient to visualize the encounters in increasingly fearsome order while relaxed. The therapist also encourages the patient to confront the fearsome objects and/or events sometime after relaxed visualization of them.
Article
In this paper, panic disorder is described and the possible causes are reviewed. A hierarchical organization is presented in which causes extend from general causes of neurotic disorders to specific causes of particular symptoms. One particular cause of relevance to panic disorder is anxiety sensitivity. The pharmacological and psychological treatments for panic disorder are then reviewed and discussed in the context of anxiety sensitivity.
Chapter
Complaints of insomnia in adults with obstructive sleep apnea (OSA) are prevalent. Patients with comorbid insomnia and obstructive sleep apnea (COMISA) may experience the symptom burden of each disorder cumulatively, with more significant nocturnal sleep disruption and impairments in daytime functioning. Insomnia comorbid with OSA has been attributed to nonadherence with positive airway pressure (PAP) therapy, while excessive daytime sleepiness in untreated OSA has commonly been identified as a contraindication for the core components of CBT-I such as sleep restriction therapy. These findings pose challenges for treatment planning, sequencing, and implementation. Recent evidence suggests that CBT-I can be effective and well-tolerated to manage insomnia whether OSA is treated or untreated. Additional modifications to core components of CBT-I may be considered to best suit the clinical characteristics of patients with COMISA. Strategies such as motivational enhancement or systematic desensitization can also be integrated with CBT-I to target barriers to PAP adherence.
Article
Exposure therapy is indicated for individuals with sleep apnea who are unable to tolerate continuous positive airway pressure (CPAP) devices due to anxiety reactions. Some patients prescribed CPAP therapy for sleep-related breathing disorders experience claustrophobia, anxiety, or panic symptoms related to wearing the mask (feeling restricted) and/or tolerating the air pressure (feeling suffocated). Exposure therapy is indicated for such individuals. To understand the treatment needs of patients who present with claustrophobic reactions to CPAP, it seems useful to consider first the etiology and mechanisms that perpetuate such reactions. Claustrophobia is a form of specific phobia that entails extreme anxiety and panic elicited by situations such as tunnels, elevators, or other settings in which the individual experiences a sense of being closed in or entrapped.
Article
Full-text available
Claustrophobia, the well-known fear of being trapped in narrow/closed spaces, is often considered a conditioned response to traumatic experience. Surprisingly, we found that mutations affecting a single gene, encoding a stress-regulated neuronal protein, can cause claustrophobia. Gpm6a-deficient mice develop normally and lack obvious behavioral abnormalities. However, when mildly stressed by single-housing, these mice develop a striking claustrophobia-like phenotype, which is not inducible in wild-type controls, even by severe stress. The human GPM6A gene is located on chromosome 4q32-q34, a region linked to panic disorder. Sequence analysis of 115 claustrophobic and non-claustrophobic subjects identified nine variants in the noncoding region of the gene that are more frequent in affected individuals (P=0.028). One variant in the 3'untranslated region was linked to claustrophobia in two small pedigrees. This mutant mRNA is functional but cannot be silenced by neuronal miR124 derived itself from a stress-regulated transcript. We suggest that loosing dynamic regulation of neuronal GPM6A expression poses a genetic risk for claustrophobia.
Article
Continuous positive airway pressure (CPAP) is the preferred treatment for obstructive sleep apnea syndrome because it safely and effectively reduces or eliminates nighttime upper airway obstruction. Unfortunately, CPAP adherence rates are low(30% to 40%). For some patients, a history of trauma contributes to nonadherence by triggering a claustrophobic response to CPAP. Exposure is the treatment of choice for anxiety-based responses, such as claustrophobia. Here, we provide the first demonstration of the successful use of graduated in vivo exposure to treat an individual experiencing a trauma-related claustrophobic response to CPAP.
Article
Objectives—(1) Determine frequency of claustrophobia in adults with obstructive sleep apnea (OSA) after first CPAP night; and (2) determine if claustrophobia influences CPAP adherence. Background—Claustrophobia is a common clinical problem among CPAP-treated OSA adults yet few studies have examined the problem.
Article
Claims have been made that breathing is in part controlled by feedforward regulation. In a classical conditioning paradigm, we investigated anticipatory increases in the inspiratory motor drive as measured by inspiratory occlusion pressure (P100). In an acquisition phase, an experimental group (N = 13) received a low-intensity resistive load (5 cmH2O/l/s) for three consecutive inspirations as Conditioned Stimulus (CS), preceding a load of a stronger intensity (20 cmH2O/l/s) for three subsequent inspirations as Unconditioned Stimulus (US). The control group (N = 11) received the low-intensity load for 6 consecutive inspirations. In a post-acquisition phase both groups received the low-intensity load for 6 consecutive inspirations. Responses to the CS-load only differed between groups during the first acquisition trials and a strong increase in P100 during the US-loads was observed, which habituated across the experiment. Our results suggest that the disruption caused by adding low to moderate resistive loads to three consecutive inspirations results in a short-lasting anticipatory increase in inspiratory motor drive.
Chapter
Full-text available
Claustrophobia is the fear and avoidance of enclosed spaces. It is described as a specific phobia and falls under the general “situational subtype” in the DSM-IV and corresponds to the “enclosed spaces” subtype of specific (isolated) phobia in International Classification of Diseases. It is defined as a marked, persistent, excessive, or unreasonable fear that is cued by being, or anticipation of being, in an enclosed space. For the claustrophobic person, feeling trapped or being in a confined space should almost invariably provoke fear and discomfort if the phobia is mild or anxiety and panic attack if the phobia is more severe. The patient usually avoids the feared claustrophobic situations or else endures them with intense anxiety, discomfort, and a desire to escape. To qualify as a phobia, the severity of the avoidance, anxiety, or anticipation must interfere significantly with the person’s life and the symptoms must have been present for at least 6 consecutive months. The anxiety, panic attacks, or avoidance must not be better accounted for by another mental disorder such as, for example, agoraphobia or posttraumatic stress disorder. Typical situations that trigger claustrophobic fears are small rooms, locked rooms, closets, tunnels, elevators, subway trains, airplanes, functional magnetic resonance imaging (fMRI) or computerized tomography (CT) scans, etc. Feared situations can also involve the mere subjective impression of being trapped, as in situations of physical restraint or in a crowded place. A potentially difficult case of differential diagnosis is between panic disorder with agoraphobia and claustrophobia.
Article
The purpose of this study was to examine the extent to which anxiety-related individual difference variables predict anxious responding when individuals experience aversive bodily sensations. Thus, we explore several psychological and behavioral predictors of response to a single 25-sec inhalation of 20% carbon dioxide-enriched air in 70 nonclinical participants. Predictor variables included anxiety sensitivity, suffocation fear, heart-focused anxiety, and breath-holding duration. Multiple regression analyses indicated that only anxiety sensitivity significantly predicted postchallenge panic symptoms, whereas both anxiety sensitivity and suffocation fear predicted postchallenge anxiety. These data are in accord with current models of panic disorder that emphasize the role of “fear of fear” in producing heightened anxiety and panic symptoms and help clarify specific predictors of anxiety-related responding to biological challenge.
Article
Purpose: The present study was conducted in order to examine claustrophobia, noise sensitivity and vital signs according to anxiety sensitivity level in patients who have Magnet Resonance Imaging(MRI). Methods: With 100 outpatients, we measured anxiety sensitivity, claustrophobia, noise sensitivity and vital sign before and after MRI. Measuring tools were ASI, CLQ-M, and NSI. Data were collected from February to March, 2008. Results: The ASI score was higher in women than in men(p < .05), and no statistically significant difference was observed according to age, region of scanning, experience in MRI, and the use of contrast agent. Both men and women patients showed the same ASI score and decrease in CLQ M and NSI between before and after MRI. In women, ASI, CLQ M and NSI were in positive correlation with one another(p < .001), and in men, there was no correlation between ASI and CLQ M, and positive correlation was observed with NSI(p < .05). In comparison according to ASI level, blood pressure and pulse rate were not different in men and women. CLQ M was not different in men, but was different in women(p < .001). NSI was different in both men and women(men p < .05; women p < .001). Conclusion: MRI may cause claustrophobia in patients with high anxiety sensitivity, and noise appears to aggravate anxiety. In particular, claustrophobia was more serious in women than in men. Therefore, it is necessary to develop nursing interventions to reduce anxiety sensitivity particularly for female patients, and to make plans to educate and lower noise before MRI in order to reduce claustrophobia.
Article
Hoarding disorder is characterized by difficulty discarding objects and excessive clutter. The relationship between hoarding and claustrophobia, reactions to severely cluttered spaces, and clutter preferences are all areas that are yet to be investigated. The present study used a novel virtual reality (VR) platform to examine these domains. Two groups (i.e., with hoarding disorder, n = 36; without hoarding disorder, n = 40) similar in age and gender were recruited from the community. There were no differences in subjective or physiological reactivity to increasing VR clutter levels. The hoarding group reported a preference for slightly more cluttered VR rooms; however, they also reported higher claustrophobic fear. Results from this research advance our understanding of the relationship between hoarding symptoms and subjective experiences of clutter and offer implications for future VR research and treatment initiatives.
Chapter
Under the partial influences of paradigm shift form category to dimension, the Diagnostic and Statistical Manual of Mental Disorder (DSM) was revised to the fifth edition (DSM-5); however, due to the lack of consistent biological makers and processes and the restricted availability of dimensional meta-structure, the revisions for the DSM-5 were based on a combination of categorical and dimensional approaches. Anxiety disorders were more clearly and consistently defined in the DSM-5 with the removal of obsessive compulsive, acute stress, and post-traumatic stress disorders. Differences between the childhood and adulthood categories of anxiety disorders were decreased, and overall, the symmetrical classification of anxiety subtypes was increased, since separation anxiety disorder and selective mutism were considered anxiety disorders, not neurodevelopmental disorders. Additionally, based on growing evidence, agoraphobia is distinct from panic disorder. Next, considering cultural syndromes including taijin kyofusho, khyal cap, trung gio attacks, and ataque de nervios, cultural influences are considered a significant factor for definitions and presentations of anxiety disorders. Controversies in the DSM-5 criteria for anxiety disorders are lowering the diagnostic thresholds of anxiety disorders and limiting the dichotomous view of anxiety and depression when defining generalized anxiety disorder. Further studies of alternative approaches to the restrictions of the DSM-5 criteria of anxiety disorders, including transdiagnostic specifiers and dimensional assessment tools, may be required.
Chapter
This chapter explores how the immediacy and feeling of past times and places, and how they are important to health and wellbeing, might be conveyed through the humanities tradition of oral history. It reports on 17 oral history interviews conducted between 2005 and 2012 with senior residents of the town of Teignmouth, Devon, UK, who experienced the World War II coastal homefront first-hand, and in particular the numerous ‘tip and run’ air attacks that took place. The chapter focuses on how respondents recollect events as sensory encounters. It argues that these encounters are important experiences on their own right, involving their own level and form of knowing time and place, but also in terms of how they interplay with meanings consciously attributed to them. Whilst encounters can re-emerge like ‘hauntings’ from the past in the process of respondents recalling and conveying, they might equally act like pre-emptive affective facts, helping researchers feel, empathise with and ultimately reanimate what it felt like to be there.
Article
Questionnaires with ratings of 133 fear items were returned by 345 women and 200 men in northwestern Indiana. Respondents ranged in age from 15 to 89 yrs. Items having at least 10% of the responses rated as terror in one of the age groups were analyzed across age. Females showed five patterns as age increased: stability of fear; increasing fear; decreasing fear; increasing fear followed by a decrease in the older groups; and decreasing fear followed by an increase in the older groups. The predominant pattern among males was a sharp decrease after the younger age groups to very low levels in the older groups. Two common intense fears—those of harmless spiders and harmless snakes—seem to meet the theoretical criteria for biological preparedness. It is concluded that the preponderance of common intense fears of adults are the result of cultural and experiential influences.
Article
According to Reiss and McNally's expectancy theory, a high level of anxiety sensitivity (“fear of anxiety”) increases the risk for anxiety disorders, and plays a particularly important role in panic disorder (PD). There has yet to be a comprehensive comparison of anxiety sensitivity across the anxiety disorders. Using a measure of anxiety sensitivity known as the Anxiety Sensitivity Index (ASI), we assessed 313 patients, representing each of the six DSM-III-R anxiety disorders. ASI scores associated with each anxiety disorder were greater than those of normal controls, with the exception of simple phobia. The latter was in the normal range. The ASI scores associated with PD were significantly higher than those of the other anxiety disorders, with the exception of posttraumatic stress disorder (PTSD). There was a trend for the ASI scores associated with PD to be greater than those associated with PTSD. Analysis of the ASI item responses revealed that PD patients scored significantly higher than PTSD patients on items more central to the concept of anxiety sensitivity, as determined by principal components analysis. The pattern of results did not change when trait anxiety was used as a covariate. The implications for the expectancy theory are considered, and directions for further investigation are outlined.
Article
The purposes of this article are to summarize the author's expectancy model of fear, review the recent studies evaluating this model, and suggest directions for future research. Reiss' expectancy model holds that there are three fundamental fears (called sensitivities): the fear of injury, the fear of anxiety, and the fear of negative evaluation. Thus far, research on this model has focused on the fear of anxiety (anxiety sensitivity). The major research findings are as follows: simple phobias sometimes are motivated by expectations of panic attacks; the Anxiety Sensitivity Index (ASI) is a valid and unique measure of individual differences in the fear of anxiety sensations; the ASI is superior to measures of trait anxiety in the assessment of panic disorder; anxiety sensitivity is associated with agoraphobia, simple phobia, panic disorder, and substance abuse; and anxiety sensitivity is strongly associated with fearfulness. There is some preliminary support for the hypothesis that anxiety sensitivity is a risk factor for panic disorder. It is suggested that future researchers evaluate the hypotheses that anxiety and fear are distinct phenomena; that panic attacks are intense states of fear (not intense states of anxiety); and that anxiety sensitivity is a risk factor for both fearfulness and panic disorder.
Article
The overprediction of fear is common, and fearful people are particularly prone to overestimate how much fear they will experience. Predictions of fear tend to increase after underpredictions, to decrease after over predictions, and to remain constant after a correct match. Predictions of fear tend to become more accurate with practice.These features of predictions and their consequences have also been reported in studies of panic. Some features of the overprediction of pain resemble the findings on fear, and it is possible that the main properties of overprediction patterns are common to all aversive events/experiences. The functional value of the overprediction of fear is discussed, and clinical implications are considered.
Article
The purpose of this study was to investigate the process of change during three interventions for claustrophobia, with particular reference to cognitive changes. Forty-eight participants, recruited from the community through the local media, were randomly assigned to one of four groups: pure exposure, exposure to the sensations of anxiety (interoceptive exposure), modification of negative cognitions, or a control group. All interventions were given over three sessions. The exposure group proved superior to the control on a wide range of measures. In the cognitive group, scores of reported fear and panic, declined significantly. The interoceptive group made some modest gains. An analysis of the timing of fear reduction and of treatment generalization, provides some indications of the mechanism of change.
Article
The appropriate data from four recent experiments on claustrophobic panic were re-analyzed in order to address several questions about the relation of fear reduction to habituation. Significant differences were found between the fearful cognitions of those Ss who did and those Ss who did not show habituation of fear—86% of the non-habituators initially endorsed the cognitive items ‘I am going to pass out’ and ‘I am going to suffocate’. The comparable figures for the habituators were 23 and 31%. The non-habituators also endorsed certain bodily symptoms (e.g. shortness of breath) far more frequently than did the habituators. There was no relation between initial levels of fear and patterns of habituation. The return of fear was positively correlated with habituation. The results suggest that certain cognitions impeded the habituation of fear in a claustrophobic situation. Generally, the findings encourage the idea that fear reduction and habituation are related.
Article
Cognitive theories of panic entail a causal link between bodily sensations and fearful cognitions. In this light, the data collected from two experimental analyses of panic were re-examined in a search for meaningful links between the fearful cognitions and the bodily sensations reported during episodes of panic.Panic episodes were accompanied by many more fearful cognitions and bodily symptoms than no-panic episodes, and several understandable links between the bodily symptoms and cognitions emerged. The links between combinations of bodily symptoms and cognitions were even clearer than the links between single symptoms and cognitions. For example, when claustrophobic Ss reported bodily symptoms of dizziness, choking and shortness of breath in association with the cognition of suffocation, a panic was usually recorded. Among panic-disorder patients, the combination of palpitations, dizziness and shortness of breath accompanied by the cognition of passing out, was usually associated with a panic. The links observed in a group of panic-disorder patients were different to those observed in a group of claustrophobic Ss. Among the panic-disorder patients, the great majority of no-panic episodes were marked by an absence of fearful cognitions; in contrast, two-thirds of the no-panic episodes reported by the claustrophobic Ss were accompanied by at least one cognition.Although the observed links were meaningful, there were fewer than might have been expected. The overall number of links fell below expectation. Among the panic-disorder patents, only eight episodes of ‘non-cognitive panics’ were recorded.
Article
A clinical experiment comparing methods of fear reduction in claustrophobia was used as the basis for analysing the relationships between a number of cognitive variables and the reduction of claustrophobia. Both the number and believability of negative cognitions present were associated with fear reduction and return of fear; this was also found when considering the number of body sensations experienced. High fear and panic were always accompanied by these phenomena whilst zero fear was never reported in the presence of believable cognitions and body sensations. An absence of believable cognitions post-test was accompanied by an absence of claustrophobia in 10/13 subjects. Specifically, removal of belief in any of the cognitions "I will be trapped", "I will suffocate" and/or "I will lose control" was associated with removal of belief in all the other cognitions and a dramatic reduction in claustrophobia. Belief in one of these central cognitions was associated with the maintenance of fear. We conclude that it is possible to conceptualize claustrophobia as comprising a number of cognitions centred on key thoughts of trappedness, suffocation and loss of control.
Factor analysis: Hillsdale, NJ: Erlbaum
  • R L Gorsuch
Gorsuch, R. L. (1983). Factor analysis: Hillsdale, NJ: Erlbaum.
Modem fuclor unulysis Age, gender and patterns of common intense fears among adults
  • H H Harman
Harman, H. H. (1976). Modem fuclor unulysis (3rd edition, rev.). Chicago: University of Chicago Press. Kirkpatrick, D. R. (1984). Age, gender and patterns of common intense fears among adults. Behuviour Research and Therapy, 22, 141-150.
Anxiety reconceptualized Anxiety: New research and changing concepts
  • D F Klein
Klein, D. F. (1981). Anxiety reconceptualized. In D. F. Klein & J. Rabkin @Is.), Anxiety: New research and changing concepts (pp. 235-264). New York: Raven Press.
Mulfiplefucror analysis
  • L L Thurstone
Thurstone, L. L. (1947). Mulfiplefucror analysis. Chicago: University of Chicago Press,