Claustrophobia is huge problem which affects a lot of people in their everyday life, not to mention the financial and scientific difficulties with prematurely terminated MRI-sessions, due to claustrophobia. In this essay there will be a further introduction of phobias in general and also a deeper presentation of claustrophobia in order to reach a better understanding of the nature of this disorder and how it affect people’s daily life compared to the effect of a single claustrophobic reaction, when it is caused by the experience of a confined space. The objective of this essay is to investigate several treatment options, to find the most effective way of treating the condition in an attempt to diminish the personal and societal issues.

The purpose of this study was to investigate the process of change during three interventions for claustrophobia, and to provide descriptive data about this fear. Forty-eight participants, recruited from the community through the local media, were randomly assigned to one of four groups: exposure to the locked test closet used for assessment, exposure to the sensations of anxiety (interoceptive exposure), modification of underlying 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, but not predictions of fear or heart rate, were lowered, an important finding since this group had no exposure to the closet during training. The interoceptive group made some modest gains, but these did not translate into reduction in fear scores. An analysis of the timing of fear reduction, and of treatment generalization, provided some clues as to the mechanism of change. Structured interviews provided data on aspects of the fear including its onset, patterns of current avoidance, and common salient cognitions. The results are discussed in the light of recent findings on panic disorder. / Arts, Faculty of / Psychology, Department of / Graduate

Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references.

Claustrophobia, a fear of enclosed spaces, is thought of as being a unitary phenomenon. However, different subtypes of claustrophobia may exist. Some claustrophobics may be more similar to individuals with Panic Disorder with Agoraphobia in terms of situations feared, cognitions and symptoms whereas others might be similar to simple phobics with a specific fear of enclosed spaces. The purpose of this study was to investigate whether such subtypes exist. The Claustrophobia Situations Questionnaire (CSQ) and the Claustrophobia General Cognitions Questionnaire (CGCQ) were developed and exploratory factor analyses were performed on these scales. Two-factor solutions for both the anxiety and avoidance ratings on the CSQ were obtained accounting for 40.8% and 33.8% of the variance, respectively. Two subscales were created from each two-factor solution. A three-factor solution was obtained for the CGCQ accounting for 53.6% of the variance from which three subscales were created. Differential validity of the scales and their utility in identifying claustrophobic subtypes was assessed. Self-report measures and physiological response to a hyperventilation challenge were used to validate claustrophobic subtypes. A significant main effect for "Avoidance of Crowds" was found when using heart rate change and post heart rate as dependent measures. Specifically, subjects high on the "Avoidance of Crowds" subscale demonstrated greater heart rate change and post heart rate than subjects low on the "Avoidance of Crowds" subscale. This suggests subjects avoidant of panic-like situations had a greater physiological reaction to the hyperventilation challenge, a task considered to be problematic for panic disordered individuals. Therefore, the results generally suggest the existence of claustrophobic subtypes. The present study was the first to compare subjects differentiated on the basis of claustrophobic subtypes in terms of their physiological response to a hyperventilation challenge. This study both supported and extended past research by developing questionnaires (the CSQ and CGCQ) capable of identifying different claustrophobic situational and cognitive factors. / Master of Science

Exposure therapy is the gold standard treatment for anxiety disorders, but reductions in fear following exposure often do not generalize well outside the context in which they took place. This study tested a strategy for increasing generalization that involved revisiting the memory of a prior exposure experience in order to enhance the retrieval of the learning that occurred. Forty-five participants (29 females, 16 males) with claustrophobia received exposure training consisting of repeated 5-minute trials lying inside a narrow cabinet laid on its back. One week later, they were randomly assigned to either enhanced mental reinstatement (EMR) or control procedures. Results of the exposure training showed significant decreases in subjective fear, heart rate and avoidance in the training context, as well as reduced claustrophobia symptoms. As expected, fear levels in the mock MRI scanner one week later increased relative to the exposure training context post-treatment. Compared to the control condition, the EMR intervention led to significantly reduced heart rate reactivity in the mock MRI scanner, but not to reduced self-reported fear or avoidance of the mock scanner, nor to differences in claustrophobia symptoms at one-month follow-up. Expectancy violations about coping self-efficacy, measured via participants’ surprise about their ability to effectively cope during exposure, predicted lower fear in the mock MRI regardless of condition. Fear-related expectancy violations, reflecting greater discrepancy in expected vs. actual fear levels during exposure, predicted greater fear in the mock MRI. Results highlight the potential for mental reinstatement of exposure to improve generalization of learning in claustrophobia, though effects may be limited. The impact of expectancy violations on exposure outcomes may depend on the type of expectancy that is violated.

This essay examines the themes of paranoia and claustrophobia as elements of horror in John Campbell’s novella “Who Goes There?” (1938) and John Carpenter’s film-adaptation of said novella, called The Thing (1982). The novella and the film utilize the lack of trust and reliability in between the characters as elements of fear as well as supernatural elements in the form of a monster. This essay focuses on the different parts of the story running through both versions, mainly the setting, the characters and the monster, to show how the themes of paranoia and claustrophobia are used throughout these as elements of fear and horror. With the help of Sigmund Freud’s concept of the uncanny, as well as other sources, this essay argues that while the monster plays an important role throughout the story, the threats created by the paranoia and claustrophobia are equal to the monster itself.

Bakgrund Klaustrofobi och ångest är vanliga orsaker till avbrutna eller inställda MR-undersökningar. Utöver problem för patienten kan det ha en negativ inverkan på ekonomin för aktuell vårdinrättning och följaktligen samhället i stort. Även patientflödet kan påverkas, där undersökningarna antingen tar längre tid än planerat eller inte kan genomföras alls, något som kan leda till en försenad diagnos om undersökningen inte genomförs. Syfte Syftet med studien var att undersöka vilka metoder som används för att underlätta för patienter med klaustrofobi och ångest i samband med MR-undersökningar och även att undersöka om det finns fler metoder som visat sig framgångsrika i forskning och som skulle kunna implementeras i det kliniska arbetet. Metod Studien är en systematisk litteraturstudie där vetenskapliga artiklar samlats in genom sökning i relevanta databaser enligt bestämda urvalskriterier och som sedan kvalitetsgranskats med hjälp av Willmans granskningsprotokoll, analyserats och sammanställts till ett resultat. Resultat Studiernas resultat visade att strategier som tillämpats både före och under undersökningen kan ha betydelse för patientens upplevda nivå av klaustrofobi och ångest och skulle därför kunna användas för att förbättra genomförandet och även kvalitén av MR-undersökningen. Slutsats Flertalet strategier såsom; patientinformation, lugnande läkemedel samt kommunikation används för att hantera patienters ångest och klaustrofobi i samband med MR-undersökningar. God kommunikation och information har visat sig viktig för patientens vårdupplevelse. Flera alternativ har studerats, som exempelvis; VR, hypnos, informationsfilmer samt flertalet studier på patienternas upplevelser av magnetkamerans utformning. Mer forskning är dock önskvärd inom området. / Background Claustrophobia and anxiety are common causes of MRI examinations being interrupted or cancelled. This is not only problematic for the individual patient but also causes a negative impact on the workflow, where the examinations may take up more time than allotted or even cancelled at the last minute. The latter causing a negative financial impact for the hospital and as for the patient it may result in a late diagnosis, or a lack thereof. Aim The purpose of this study was to investigate what methods are used to facilitate patients with claustrophobia or anxiety associated with MRI examinations and to explore related scientific developments. Method The study is a systematic literature study where relevant data was collected by searching relevant databases according to specific selection criteria which was then reviewed, analyzed and compiled into a result. Result The results of the studies showed that strategies applied both before and during the examination may be important for the patient's perceived level of anxiety and could therefore affect the implementation and the diagnostic quality of the MRI examination. Conclusion Various methods, like patient information, sedatives and communication are used to manage patients' anxiety and claustrophobia when undergoing MRI examinations. Good communication and information have proven to be important for the patient's experience. Several alternatives have been studied, such as VR, hypnosis, information films and studies on patients' experiences of the design of the magnetic camera. However, more research is needed.

Introduktion: Magnetisk resonastomografi (MR) är en teknik som blivit alltmer vanligt inom medicinsk diagnostik. Trots att MR-tekniken är icke-invasiv undersökningmetod kan MR-undersökningen orsaka rädsla, oro och klaustrofobi hos patienter. Detta kräver extra resurser som exempelvis sedering och i vissa fall anestesi, vilket kan leda till att patienten behöver längre vårdtid och därmed ökande kostnader. Röntgensjuksköterska behöver kunskap om andra åtgärder än sedering. Syfte: Att belysa alternativa åtgärder som kan minska den vuxna patientens behov av sedering i samband med magnetkameraundersökningar. Metod: Studien som genomförts är en allmän litteraturöversikt där artiklar har hämtats från databaser. I studien ingår både kvantitativa och kvalitativa artiklar som i sin tur har kvalitetsgranskats och analyserats utifrån syftet. Resultat: Resultatet som helhet visade att det finns olika åtgärder i samband med MR tillexempel tydlig kommunikation, bra bemötande, information i form av videolänk, telefonsamtal, Virtual Reality (VR), patientutbildning, självhypnos och Magnetkamerans utformning i form av MR kort-tunnel, tunnelhåldiametrar 70-centimeter, MR öppenskanner, MR skannermiljön. Slutsats: De metoder som framkom i resultaten kan vara till stor nytta för röntgensjuksköterskor att få en större förståelse för hur det hjälper patienten som är orolig och har klaustrofobi för att få en bättre upplevelse av MRundersökningen. Det är viktigt att röntgensjuksköterskan är kompetent, respektfull, lyhörd och empatisk som kan ge en god och säker vårdmiljö.

Panic disorder (PD) and claustrophobia are commonly co-occurring anxiety disorders associated with high distress and impairment. Interoceptive exposure (IE; exposure focused on anxiety about somatic sensations) is a well-established component of treatments for PD, but little is known about the specificity of its effects or individual response patterns resulting from this intervention. This study investigated the utility of IE in the treatment of PD with claustrophobia, examining its mechanisms in isolation and in combination with more traditional exposure to phobic situations (situational exposure). Ten adults with PD and claustrophobia (aged 23-74, 30% female) were treated with a flexible single-case experimental approach. Participants received up to 6 sessions of IE exercises (e.g., running in place to build tolerance to racing heart). Nonresponders received up to 6 additional sessions of IE combined with situational exposure entailing entering a closet to induce claustrophobia. Hypotheses included: 1) Reductions in somatic anxiety coinciding with the introduction of IE; 2) Reductions in agoraphobic symptoms coinciding with the introduction of situational exposure for initial nonresponders; 3) Habituation to both interventions whereby distress and participants’ expectancy of the most feared outcome (e.g., fainting) would decrease, and fear tolerance would increase, with improvements maintained at retest. Four participants experienced a clinically significant reduction in somatic anxiety coinciding with IE as predicted; three other participants improved following the addition of situational exposure. One aspect of agoraphobic anxiety – willingness to enter enclosed spaces – generally improved only after combined exposure, as predicted. Both IE and combined exposure elicited habituation whereby distress and expectancies of feared outcomes decreased and fear tolerance increased, supporting hypotheses. All improvements were maintained at retest. Ideographic analysis suggested that IE can rapidly change beliefs about somatic sensations and lead to distress habituation, but has variable immediate effects on overall somatic anxiety and does not reliably reduce related symptom sets (e.g., agoraphobia). IE appeared more helpful to participants who were fearful of the physical consequences of somatic sensations (e.g., heart attack) vs. other consequences (e.g., embarrassment). The observed variability in response to IE and combined exposure suggests a need for individualized implementation of treatments in PD with claustrophobia.

Bakgrund:Klaustrofobi är en form av ångest och rädsla som kännetecknas av kraftig rädsla för trånga eller instängda utrymmen. MR-maskinens trånga utrymme kan framkalla klaustrofobiska och ångestreaktioner. Effekterna av klaustrofobi och ångest vid MR-undersökningar kan resultera i tidigt avbrutna undersökningar och ha ekonomiska konsekvenser. Röntgensjuksköterskan möter dessa reaktioner och underlättar för patienten genom hela undersökningen. Syfte:Syftet med denna studie var att beskriva strategier som röntgensjuksköterskan använder för att hjälpa patienter att hantera ångest och klaustrofobiska reaktioner vid MR-undersökningar. Metod: En kvalitativ metod valdes och datainsamlingen utfördes genom semistrukturerade intervjuer, som sedan analyserades med manifest innehållsanalys. Resultat:Två identifierade kategorier är: att ge individuellt anpassad förberedelse med subkategorier undersöknings genomgång, avslappnande metoder, behov av lugnande läkemedel, bemötande, större tunnel och patientpositionering, samt att förmedla kunskap och öka patientens förståelse av proceduren med subkategorier informationsöverföring genom kommunikation och röntgensjuksköterskans erfarenheter. Slutsats: I studien presenterades olika metoder som röntgensjuksköterskan använder för att hjälpa patienter som upplever klaustrofobiska och ångestrelaterade reaktioner. Dessa metoder inkluderar bland annat kommunikation, sedering, användning av större tunnel samt andra lindrande metoder. / Baground: Claustrophobia is a form of anxiety and fear characterized by intense fear of confined or enclosed spaces. The narrow space of an MRI machine can trigger claustrophobic and anxiety reactions. The effects of claustrophobia and anxiety during MRI examinations can result in early termination of scans and have economic consequences. Radiographers face these reactions and facilitate patients throughout the examination. Aim: The purpose of this study was to describe strategies that radiographers use to help patients manage anxiety and claustrophobic reactions during MRI examinations. Method: A qualitative method was chosen, and data collection was conducted through semi-structured interviews, which were then analyzed using manifest content analysis. Result:Two identified categories are: providing individually tailored preparation with subcategories examination review, relaxation methods, need for sedative medication, approach, larger tunnel and patient positioning , and conveying knowledge and increasing the patients understanding of the procedure with subcategories for information dissemination through communication and radiographers experiences. Conclusion:The study presented various methods that radiographers use to assist patients experiencing claustrophobic and anxiety reactions. These methods include communication, sedation, use of larger tunnels, and other relieving methods.