Indian Journal of Health Social Work
A CASE REPORT ON CLAUSTROPHOBIA
Happy Saharan1, Annu2, Aadesh Sachdeva3
1 M.A Psychology, Kurukshetra University, Kurukshetra, Haryana, 2M.A Psychology, Post Graduate
Diploma in Guidance, Counselling and Psychotherapy, Kurukshetra University, Kurukshetra,
Haryana, 3 M.A Psychology Scholar, IGNOU
Correspondence : Happy Saharan, e-mail-happysaharan9@gmail.com
ABSTRACT
OBJECTIVES: The purpose of the study is to explore the course of Claustrophobia and to determine
the efficacy of psychotherapeutic management to mollify the symptoms associated with
Claustrophobia and to improve the client’s overall functioning. Research Design: Case study
Sample and method: The present study was carried out in Kalpana Chawla Govt. Medical College,
Karnal (Haryana) and 45-year-old married female was included. Treatment plan was formulated
according to psychotherapeutic management wherein different management techniques were
utilized to modify the client’s confusion and behaviour.
KEYWORDS: Claustrophobia,CBT
INTRODUCTION: A phobia is a fear that significantly impairs a person’s ability to go about their daily lives. A life-impairing action is avoiding the dreaded thing or situation (Schowalter, 1994). There are numerous types of anxiety disorders, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include selective mutism, particular phobias, generalized anxiety disorder, panic disorder, social anxiety disorder, and separation anxiety disorder. The specific phobias can be further divided into kinds related to animals, the natural world, situations, and blood injection injuries (Muris, et.al.).
Claustrophobia : – Claustrophobia is a specific phobia where one fears closed spaces (claustro means closed). One of the anxiety disorders, claustrophobia is defined by a fear of enclosed and cramped spaces. Claustrophobia is thought to be one of the most common pathological anxieties, along with agora phobia . Patients with claustrophobia experience discomfort and even anxiety in enclosed spaces, such as elevators, cramped rooms without windows, hallways, attics, basements, etc. The trait of claustrophobic persons is that they never shut the door to the room and always strive to stand close to the exit so that they can escape the room quickly. When a person is unable to leave the location whenever she wishes, such as in an elevator, airplane, or train carriage, the anxiety is considerably more severe. Most individuals make effort to avoid using elevators and prefer to take the stairs instead. Additionally, claustrophobia is defined by a person’s dislike of large crowds since their movements are restricted there and the throng creates the illusion of a tight space (Nerdy, 2022). People with claustrophobia are not afraid of enclosed spaces in and of themselves; rather, they are afraid of what might occur there. While agoraphobia is widely understood to be a dread of what might happen in public, such as having a panic attack, claustrophobia can also be viewed in this light—the majority of claustrophobic patients report feeling confined. Most enclosed spaces involve some degree of movement limitation and trapping . Animals are vulnerable “in situations of confined space” without a doubt, and people could also be. Experimental neuroses can be easily created in animals when they are kept in a small space (Wo lpe , 196 8). People who experience claustrophobia worry about suffocating. People who experience claustrophobia see this extremely acute and expected aspect as a serious threat. When in a small place, many claustrophobic people worry they will suffocate, which is frequently accompanied by a feeling of being out of breath.
Epidemiology : – The prevalence of claustrophobia ranges from 7.7% to 12.5% throughout the course of a year (Wardenaar, et.al., 2017). Women are more likely than men to experience particular phobias ( Burste in , et . al ., 2012 ) . According to research, among those under the age of 16 there is a 1 in 10 prevalence of anxiety disorders (Muris, et.al.). A 2007 European study examined numerous studies from various institutions and found that between 1% and 15% of patients receiving MRIs reported having claustrophobia; on average, 2.3% of patients required sedation or were unable to be imaged as a result (Dewey, et.al, 2007).
Prognosis : – Claustrophobia patients frequently experience a prolonged course of their anxiety illness, which raises the risk of developing other psychopathologies (Muris, et.al.). According to studies, phobias among teens were more prevalent and the disease started younger. Patients with situational and blood-injection-injury-specific phobias were shown to have the strongest correlations with measures of impairment and severity in the same investigations (Burstein, et.al., 2012). Animal phobias were less associated with heightened feelings of despair and anxiety than were phobias of the natural world.
A CASE REPORT
According to the patient: – Mrs. X, 45 yrs.
old female, Sikh, Married, belonging from
higher Middle – class family, A Resident
of Karnal (Haryana), Reported with the Chief
Compliant of fear while locked in a room or
in a lift or in a car/flight. Also, she mentioned
that they have their only son living in Germany
and they now have to shift in Germany with
their son. But due to this fear Mrs. X is not
able to sit in the flight. She has also tried to
travel in some domestic flights to come out
of this phobia, but all these things gone in
vain and have wasted a lot of money. She
informed that whenever she is in these phobic
situations she feels headache, anxiety, fear
of being dead, secretion of sweat, pain in legs
and arms, unconsciousness (sometimes). She
has been suffering from this problem since
her childhood.
According to Informant : – Rubbing hands due to anxiety and fear, shouting, crying, dizziness, spanking on the door, Patients husband described that during their marriage days, patient was quite afraid of being in to lifts only. But, along with the time this thing continue s to increa se an d now she has deve loped s evere fear from some more situations, like closing a room’s door, sitting in a car with its windows shut, switching off the lights, boarding in a flight. Husband also mentioned that they have to go to Germany to live with their son. But due to her wife’s fear they are not able to go. So, to get rid of this problem, once they tried to travel in a domestic flight from Amritsar to Delhi. But immediately after the take-off of the flight, Mrs . X started screaming and crying , scratching her hands and got unconscious. Due to this, the flight crew member considered seriously and they decided to do an emergency landing and later they didn’t allow the patient to board again. So, they had to return to A mritsar by bus .Patient lives in a small family with her husband , father – in law , and mother – in law. Her overall interpersonal relationship with family was uneasy on that ti m e .
ON MENTAL STATUS EXAMINATION(MSE): Her attitude toward sex amination was cooperative and communicable. General appearance of patient was normal. She wears clean clothes, hair was well, Eye to eye contact was maintained, voice was clear, audible , speech was soft . Subjectively patient reported ”I AM OK” objectively appeared sad and worried. She was oriented to time, place, and person. Attent ion an d con ce ntration we re g ood. Immediate, recent and remote memory was intact. Fund of knowledge was average level. Cognitive functions were intact. Personal and social judgement was impaired. Insight grade 1- awareness to illness but blaming to external factors.
Objectives to be focused: –
· Establishing a therapeutics alliance
with the patient
· To develop insight about the
nature, course and prognosis of
Claustrophobia
· To motivate patient to take
counselling sessions
· Clear the misconception about the
illness of Claustrophobia
· Continue to function normally.
· Managing your symptoms .
· Relapse management .
Psychotherapeutic Management (Types and techniques of intervention ) Psychoeducation: Psychoeducation was made available to the patient and his family in order to educate them on the illness’ nature, course, treatments, and prognosis as well as to dispel any preconceptions they may have about it. As the client had little chance of recovering, this was done to help the client deal with the disease better. There are also instructions on how to cut back on repetitive medical exams and investigations .
Family Therapy : Inform family about
patient’s condition, necessity of medication,
and value of counselling sessions. Regular
medication use will aid in improvement.
Involve the patient’s relatives in the activities.
Cognitive Behaviour therapy: Structured
therapy in which the patient learns about
phobias and anxiety and is urged to face and
alter the specific beliefs and behaviours that
trigger fear.
Relaxation and visualization exercises:
Deep breathing exercises, meditation, and
muscle-relaxing activities can all be used to
manage negative thoughts and anxiety.
Exposure therapy: To assist you overcome
your fear, it progressively introduces you to
the frightening scenarios. At initially, you
might only examine a picture of a confined
area. Then, with the aid of your therapist, you
gradually get closer to being in a small place.
Therapy process
Session 1: A clinical interview and the
collection of the patient’s case history took
place during the first session. Establishment
of a therapeutic relationship with the patient
to enable her to share his experiences,
feelings, and difficulties, and to learn about
her illnesses, anxiety and panic attack, as well
as her family and social interactions, before
learning how her illnesses began.
Session 2: Family members first participated
in a psychoeducational session about the
nature, origin, and prognosis of the patient’s
illness. This session’s primary goal is to
provide information about description of the
symptoms of claustrophobia. To relieve the
patient’s own anxiety and help her grow more
seriously and they decided to do an emergency
landing and later they didn’t allow the patient
to board again. So, they had to return to
A m r i t s a r b y b u s .
A CASE REPORT ON CLAUSTROPHOBIA
Indian Journal of Health Social Work. 5(1) January-June, 2023 5 5
self-assured.
Session 3: Making the patient capable of
releasing her emotional and psychological
feelings was the main goal of this session.
The patient was also informed that everyone
has their own solutions to problems and that
it is important to identify, mobilise, and
educate others about different perspectives
on how to define problems, define situations,
and solve problems. She was informed of the
problem-solving coping mechanisms.
Session 4: CBT use various techniques and
self-help strategies and self-help strategies to
help a person with claustrophobia reduce and
manage their anxiety and panic attacks
symptoms. It helps people examine
the thoughts, feelings and behaviours that relate to
symptom or situation.
She was encouraged to recognize and discuss
events that cause excessive anxiety and ranks
them from most to least stressful. This is
frequently described as a hierarchy of fears.
It has been told to her that she seeks to
replace unproductive mental patterns with
more const ruct ive, rea list ic methods of
approaching these circumstances. She moves
up the hierarchy from the least triggering
(such as using an elevator) to the most
triggering (such as setting in locked room),
she was encouraged and modelling was
provided to gain confidence and eventually
stop being afraid of enclosed spaces. You
have to learn to identify, reassess and modify
your thinking and learn to solve problems to
improve your coping abilities. Instead of
avoiding your phobia, confront it and also
learn to maintain mental and physical
calmness.
Session 5: Patient was given relaxation
techniques that helped her to relax at time
when she feels anxious and feel panic attacks
when. Yoga, morning and evening walk has
been suggested to the patient.
Relaxation exercise:
Patient was made to breathe deeply when she
feels panic and fear. She was asked to close
her eyes and take deep and slow breath. Air
fills your lungs when you inhale deeply, and
you feel your lower tummy lift. Deep breathing
helps the lungs receive a full supply of oxygen,
and as a result, the heart rate and blood
pressure decrease.
Mindfulness meditation:
She was made to sit quietly and focus on
her natura l breathing and visualizing a
soothing scene. Distraction is a good way to
block off fear. Keeping in mind that you are
secure and using meditation can help you
relax your body and mind
Positive affirmations:
When the panic starts to set in, find a mantra
for yourself, an affirmation, or anything else
you can repeat to yourself to calm yourself.
Try saying something like, “I’m not in danger,
I’m safe,” or “This feeling is fleeting and it’ll
pass.”
Session 6: Exposure Therapy: In this
session she was trained to use Deep breathing
and relaxation exercise when she was exposed
with elevator. Step by step her triggering
stimuli were presented as the user focuses
on achieving bodily and mental relaxation.
They eventually reach a point where she can
face her fear without being nervous.
DISCUSSION
The present study is to explore the course of
Claustrophobia and to determine the efficacy
of psychotherapeutic management to mollify
the symptoms associated with Claustrophobia
and to improve the client’s overall functioning.
With some modifications of standard behavior
therapy procedures, behavioral treatments
have been successfully utilized with a broad
range of clinical problems , including
depression, management of dementia and
problems of family caregivers, retraining of
self-care skills, and management of severe
behavioral problems (e.g., Carstensen &
A CASE REPORT ON CLAUSTROPHOBIA
Indian Journal of Health Social Work. 5(1) January-June, 2023 5 6
Edelstein, 1987; Hussian, 1981; Pinkston &
Linsk, 1984).
CONCLUSION
Six sessions were held with the patient. Later
the patient reported the therapist considerable
improvement in terms of symptoms. She
reported that her distress, health related
worries are now in control, and now she felt
confident and result revealed more
improvement in her problem (claustrophobia)
than individuals with simple medical service.
REFERENCES
Burstein, M., Georgiades, K., He, J.P.,
Schmitz, A., Feig, E., Khazanov, G.K.,
& Merikangas, K. (2012). Specific
phobia among U.S. adolescents:
phenomenology and
typology. Depress Anxiety.
Carstensen, L. L., Edelstein, B. A. (Eds.)
(1987). Handbook of
clinicalgeronrology. New York:
Pergamon Press.
Dewey, M., Schink, T., & Dewey, C.F. (2007).
Claustrophobia during magnetic
resonance imaging: cohort study in
over 55,000 patients. J Magn Reson
Imaging.
Hussian, R. A. (1981). Geriatric Psychology:
A behavioral perspective. New York:
Van Nostrand Reinhold. Conflict of interest: None
Role of funding source: None
Muris, P., Simon, E., Lijphart, H., Bos, A., Hale,
W., & Schmeitz, K. (2017).
International Child and Adolescent
Anxiety Assessment Expert Group
(ICAAAEG). The Youth Anxiety
Measure for DSM-5 (YAM-5):
Development and First Psychometric
Evidence of a New Scale for Assessing
Anxiety Disorders Symptoms of
Children and Adolescents. Child
Psychiatry Hum Dev. 48(1), 1-17.
Nerdy, S. (2022). ‘Case study
on claustrophobia’.
Pinkslon, E.M., Linsk, N.L. (1984). Care of the
elderly: A family approach. New York:
Pergamon Press.
Schowalter, J.E.(1994). Fears and
phobias. Pediatr Rev, 15(10), 384-8.
Wardenaar, K.J., Lim, C.C.W., Al-Hamzawi,
A.O., Alonso, J., Andrade, L.H., Benjet,
C., Bunting, B., de Girolamo, G.,
Demyttenaere, K., Florescu. S.E.,
Gureje, O., Hisateru, T., Hu, C., Huang,
Y., Karam, E., Kiejna, A., Lepine, J.P.,
Navarro, M.F., Oakley, B.M., Piazza, M.,
Posada, V.J., Ten, H.M.L., Torres, Y.,
Xavier, M., Zarkov, Z., Kessler, R.C.,
Scott, K.M., & de Jonge, P. (2017).
The cross-national epidemiology of specific
phobia in the World Mental Health.
