A bit of claustrophobia is normal – stop treating it as a disease

Rush hour Hong Kong MTR.

“Claustrophobia” is generally described as an irrational fear of confined spaces, and it has been estimated to affect some 5-7% of the world population. Clearly, some people are more distressed than others when they are in confined spaces, but a fear of physical restraint is so normal that it seems illogical not to be somewhat claustrophobic.

There are all manner of circumstances in which people can become trapped – most distressingly in collapsed buildings or road traffic accidents. These are clearly life-threatening situations, and – as in many other so-called mental disorders – this illustrates how adaptive and understandable it is to dislike the sensation of being confined.

Firefighters conduct confined space training. Sarah Cherry/wikimedia

Those of us who dislike restraint tend to experience a sense of rising panic when trapped, and it seems this panic – a fear of the developing and building sensations of a rising heart rate, dizziness, shortness of breath, or feelings of unreality – frightens us as much as the objective reality of the situation.

However, anxieties like claustrophobia can build up to take over somebody’s whole life – making everyday tasks such as commuting or taking a lift impossible. For these people, it is a major problem, which is the reason the condition has been labelled as a “disorder” and the fears as “irrational”. Perhaps, however, it may be more appropriate, as well as more empathetic to the people who are experiencing these difficulties, to suggest that these are normal reactions that have grown to become a problem.

On the other hand, some people tolerate situations of restraint and confinement really well. Submariners, potholers and cosmonauts, for example, have to have a high tolerance of the reality of working in confined spaces, and a high tolerance of the sensations of anxiety these can trigger.

Rescue workers practicing to liberate the trapped miners at the San Jose mine near Copiapo, Chile, on October 11, 2010. Chilean Mine Rescue/wikimedia, CC BY-SA

It makes a lot of sense to recognise these differences, as they can help us understand how vulnerable we are to developing a real problem. People appear to differ in the degree to which they need personal space. They also differ in the extent to which they can tolerate their own distressing thoughts and sensations.

What’s more, there are many reasons why people could find confined spaces particularly distressing. Some people have had traumatic experiences. In one classic study, 21 miners who had been trapped underground for 14 days were found to have been very significantly affected (as you might expect) by the experience, which included developing claustrophobia.

Combating claustrophobia

But the good news is that there are actually ways to overcome claustrophobia. Cognitive behavioural therapy typically involves helping someone facing distressing situations and remaining calm until the sensation – the panic attack – goes away. It will eventually. As with many psychological issues, this is much more about learning to respond to ordinary and understandable reactions than it is “curing” some sort of disease. Just as with all kinds of psychological therapy, nobody can be guaranteed a positive outcome, but these kinds of therapies are generally regarded as moderately effective.

Stuck in a lift? Try to relax. Dieselducy, Andrew R/Wikimedia, CC BY-SA

So … if you’re stuck in a lift, and it breaks down, and you start to panic, what should you do? Although it’s obvious, but obviously very difficult, don’t panic. Most people will find that their feelings of anxiety will rapidly grow when they realise that they’re trapped; they’ll get all the sensations of fear (raised heart-rate, changes to breathing, weird sensations that result from the consequent changes in blood chemistry). These will be greater, and happen quicker, for some people rather than others. But even if you’ve never experienced them before, these sensations will reduce over time. Just wait it out.

Claustrophobia is very rational; in the sense that it’s rational to be anxious about the possibility of being trapped. But if you’re stuck in a lift, the most likely threat is really that you’ll be very, very, bored.