You're earning less than you should because the better paying job you've been offered requires using an elevator to get to your office. You're late for dinner at the in-laws again, because you avoided the tunnel shortcut. For years, you've been managing your claustrophobia by avoiding enclosed spaces that might stir up feelings of anxiety and suffocation. Now you're beginning to realize that your phobia has had the upper hand all along.

Defining Claustrophobia

Claustrophobia is known to the psychiatric community as a type of specific phobia, meaning that there is one specific aversion causing the anxiety, in this case fear of enclosed spaces or crowds. This is in contrast to generalized anxiety disorder in which a broad spectrum of situations produce anxiety reactions.

Claustrophobia causes anxiety, which in some, may lead to panic disorder. In others it leads to avoidance. This can create difficulties for the individual who structures their lives around avoiding their anxiety triggers.

Phobias may not make sense to someone who doesn't have them, but reactions to specific phobias are very real. At first, it may seem difficult to narrow down the cause of someone's phobia because of its interconnection with other disorders. Eventually, a pattern will emerge.

How do these fears start in some people and not others? There are many factors that come into play.

Origins of Claustrophobia

Unlike other specific phobias, which seem to present themselves during childhood or in a person's mid-20s, the onset of claustrophobia is more spread out, from as young as age 4 through adulthood. Its origins might be one traumatic experience, such as being stuck in an elevator, or from sympathizing with another person's experience, such as hearing about a man trapped in an elevator for the weekend.

As in any specific phobia, the claustrophobic's avoidance of what they fear most serves to reinforce the phobic pattern not allowing them a chance to see that what they fear is unlikely to happen.

For a person with claustrophobia, the ultimate fear may involve being caught in an elevator and running out of air. Although the person may understand that the fear is irrational, even imagining such an event is enough to cause an anxiety attack. That's because the mind doesn't always differentiate between reality and illusion.

Treatment

The following types of therapy have been helpful in some cases:

• Cognitive behavioral techniques
• Exposure therapy
• Relaxation exercises
• Eye movement desensitization and reprocessing

Multiple treatments have been tested for use in specific phobias, all with varying success. The therapy that has proven to have the most success for claustrophobia and other specific phobias is in vivo exposure. This involves exposing the person to real life encounters with the feared situation (virtual reality exposure).

A Closer Look at Cognitive Behavioral Therapy

Cognitive behavioral treatment is a type of cognitive therapy that helps clients to think and act differently. It has been quite successful in tackling phobias. Rather than talking through fears, the person is exposed to the feared object or situation in a gradual and controlled way known as systematic desensitization. Exposure to the feared situation replaces the reinforced fear with a sense of control.

In order to be effective, the therapy must be directed to the specific phobia that causes the anxiety. Cognitive behavioral therapy is generally 16 session and can be one-on-one or in a group.

Evaluating

Therapy begins with an evaluation to determine if the client is a good candidate for psychotherapy.

Identifying Irrational Thinking

Next, clients are taught to identify irrational thinking. The biggest problem plaguing people with a specific phobia is their tendency to see a remote possibility as a distinct probability. For example, despite rationally understanding that people safely take elevators every day, people with claustrophobia keep returning to stories they've heard about unsafe cables or about some unlucky person who got stuck in an elevator during a city-wide blackout.

Learning and Practicing New Thinking Patterns

Without destroying the therapist-patient rapport, the therapist works on helping to point out why the fear is irrational. Once the problematic thinking has been worked through, the next step is to practice the new thoughts by imagining themselves in their feared situation feeling calm. It helps also helps to have people keep a daily evidence log, in which they record, for instance, evidence of elevators that they witnessed not crashing or the number of airplanes taking off and landing safely at an airport.

Using Systematic Desensitization

In this next step, a person with claustrophobia will be brought to an elevator and encouraged to watch it go up and down, and watch people get on and off without a single lock-in or crash. The next step is actually going up 1 floor and then back down. The length of time is increased until the the person no longer needs to think calming thoughts to handle the situation.

If you are claustrophobic, talk to your doctor about getting help for this very treatable condition. By overcoming your fears, you will regain your independence and improve the quality of your life.