Feeling uncomfortable or even a little anxious in a crowded elevator or a small windowless room is an experience that may occur to some people. But when this feeling turns into an intense, irrational, persistent and paralyzing fear that prevents a person from being in such spaces, we face a clinical condition called claustrophobia or phobia of tight spaces. This state is one of the most well-known types of specific phobia. The important thing about the phobia of tight spaces is that the main fear is not necessarily the smallness of the space itself, but is often related to the fear of possible negative consequences such as running out of air or being unable to move and escape. Accurate understanding of the fear of tight spaces is essential for its effective diagnosis and treatment. Phobia of confined spaces as a specific phobia (DSM-5 classification) In the psychiatric classification system, agoraphobia is specifically classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a specific phobia of the situational type. This means that a person's fear and anxiety arise specifically in response to being in closed or confined situations. To be diagnosed with a phobia of confined spaces, specific general phobia criteria must be present: the fear or anxiety must be pronounced and disproportionate to the actual danger, occur almost always in the face of the situation, result in active avoidance or tolerance of intense distress, persist for at least six months, and cause significant impairment in social, occupational, or other life domains. Distinguishing claustrophobia from agoraphobia and panic disorder Accurate differential diagnosis of angiophobia from other anxiety disorders that may have similar symptoms is very important. The two main disorders to consider are Agoraphobia and Panic Disorder. In agoraphobia, the person fears a wide range of situations (which can include enclosed spaces), but the main fear is the difficulty of escaping or the lack of access to help if anxiety or panic symptoms occur. In panic disorder, a person experiences unexpected panic attacks and is worried about the next attacks; These attacks are not necessarily triggered by closed spaces. In contrast, in phobia of confined spaces, fear and anxiety (and a possible panic attack) are caused directly by being in a closed or confined space. Common triggers and fundamental fears in phobia of tight spaces A wide range of situations can act as triggers for people with agoraphobia. The intensity of the reaction may vary depending on the size of the space, the duration of staying in it and the possibility of exit. Common triggers: - Elevators (especially small or crowded) - Small rooms, without windows, or with locked doors (such as dressing rooms, airplane toilets) - Tunnels, caves, basements, closets - Tunnel-like medical imaging devices (such as MRI) - Small or crowded cars, crowded public transportation - Being in a tight crowd - Even some tight or restrictive clothing (such as a turtleneck). Basic fears: Fear of suffocation - Fear of physical restriction and inability to move or escape (Fear of restriction) - Fear of losing control (physical or mental) - Fear of severe anxiety symptoms (such as fear of fainting). Signs of anxiety and panic in confined spaces The reaction of a person with a phobia of tight spaces when faced with a closed space can be very fast and intense. Anxiety can quickly turn into a full-blown panic attack. Common physical symptoms include: - Severe heart palpitations - Profuse sweating - Trembling - shortness of breath - Feeling of pressure on the chest (which may be associated with the fear of suffocation) - Feeling dizzy or weak - Nausea - Hot flashes In this situation, negative and catastrophic thoughts rush into the person's mind at the same time, such as "I'm stuck here", "There is no escape", "I'm running out of air", "Now I'm losing control or going crazy". The experience is so unpleasant that it leads to a strong desire to immediately flee the situation and strong avoidance of similar situations in the future. Effective treatment approaches for phobia of tight spaces Agoraphobia is one of the specific phobias that respond well to treatment. The main treatments include cognitive behavioral therapy and exposure therapy, each of which has its own conditions and of course can have positive effects as well. Cognitive Behavioral Therapy (CBT) - Psychological education about anxiety and the cycle of fear and avoidance. - Identifying and challenging negative and irrational thoughts related to closed spaces. - Teaching anxiety management techniques such as deep breathing and muscle relaxation. - Sometimes Interoceptive Exposure to reduce fear of physical symptoms of anxiety. Exposure Therapy: - Imaginal Exposure: Imagining yourself in closed spaces. - Exposure to virtual reality (Virtual Reality Exposure Therapy - VRET): very effective and safe simulation of spaces such as an elevator, subway or MRI machine. - Exposure in the real environment (In vivo exposure): starting with less scary spaces (such as sitting in a car with closed doors) and gradually progressing to more challenging spaces (such as using an elevator for a floor). The treatment of phobia of confined spaces usually does not require drug therapy, except in very severe cases or to facilitate the initial stages of exposure. Nurali; Specialist in the management and specialized treatment of claustrophobia Living with a phobia of confined spaces can be very limiting and exhausting. Avoiding elevators, tunnels, flying or even some necessary medical examinations can take away many opportunities. But it is important to know that claustrophobia is not a personality weakness, but a treatable clinical condition. Nourali Psychological Services and Counseling Center is ready to help you in the treatment of fear of closed spaces by providing specialized evidence-based diagnosis and treatment services, including virtual reality therapy (VRET). To get rid of this bottleneck and get more information, contact us.