Hypnosis for Claustrophobia (Fear of Enclosed Spaces)

What is Claustrophobia?

Claustrophobia is the fear of enclosed or confined places, or of places you cannot leave freely. It belongs to the specific phobias, that is, intense fears triggered by a particular situation and out of proportion to the actual danger of that situation.

We set aside the word "irrational", widely used on this subject. The fear is out of proportion, it is not absurd: a lift that breaks down, a scan where you must not move, a plane you cannot get off are objectively constraining situations.

Two components, often mixed together

This is not a turn of phrase: a questionnaire validated since 2001, the *Claustrophobia Questionnaire*, measures claustrophobia on two distinct scales, and that structure has been found again in English, French and Dutch.

• The fear of running out of air. Attention turns to breathing, the space seems confined, and the more you monitor your breath, the more laboured it becomes. This loop is the main driver for many people.
• The fear of being restricted, that is, of not being able to move or get out when you decide to. It explains why some people are perfectly fine in a cupboard whose door stays open and not at all in the same cupboard locked, at identical volume.

The two often go together, but not always, and it is measurable: a study of seventy-eight people undergoing an MRI showed that exposure to confinement lowered the restriction component without touching the air component.

The situations most often involved: lifts, imaging scans, flying, tunnels, the underground and crowded transport, small rooms without windows, tight clothing or equipment, sometimes the dentist's chair.

It is not the same as agoraphobia, and it is not the place that separates them. In claustrophobia, the fear is about the enclosed space itself: suffocating, being stuck. In agoraphobia, the place matters less than the idea of feeling unwell with no way out and no help, which is why the classifications also list enclosed places among agoraphobic situations, alongside transport, queues and open spaces. One situation feared for what it is, is a specific phobia; several situations feared for what might happen there, is something else. If you recognise yourself more in the second description, see Hypnosis for Agoraphobia and Panic Attacks. The general subject is covered on Hypnosis for Fears and Phobias.

Where does it come from? The reference framework describes three paths: a specific episode lived through, seeing the fear in someone else, or information received. In practice, many people find none of those three in their history, and that is normal: the absence of a triggering memory makes the fear neither less real nor harder to work with. Whatever the origin, it is avoidance that then settles it in for the long term.

Hypnosis for Claustrophobia: aims and benefits

Let us start with what hypnosis does not do.

It does not replace medical advice or medication prescribed for a scan. It does not spare you going, step by step, into the situations you avoid. It is not the reference approach for specific phobias, which remains graded exposure. And it does not guarantee that you will get through the scan without difficulty.

What an accompaniment aims at

• Undoing the breathing loop. Learning to stop monitoring your breath is often the quickest lever, because it is the monitoring that creates the sense of suffocating, not the volume of the room.
• Preparing a specific situation by going through it mentally, in detail and at your pace, from the lift door to the way out.
• Setting up a resource usable where you are, with your eyes closed, without anyone noticing.
• Working on duration. What frightens is not the space, it is the idea of staying in it. Part of the work bears on the relationship to time, and that is particularly useful for a scan whose length is known in advance.
• Revisiting an old memory of being shut in, where one exists and where it does not call for specialist support.

What we will not do: build a barrier

A word on a formulation that circulates widely, and that needs setting aside.

It is sometimes proposed to install a mental barrier in order to detach emotionally from difficult situations. It is appealing and counterproductive. A barrier works like a safety behaviour: it relieves in the moment, becomes necessary, then its absence becomes distressing in turn. It is the same mechanism as the door left ajar or the seat near the exit.

The work goes the other way: discovering, in steps you choose, that the situation can be gone through and that the sensations subside on their own.

A phrase from the previous version of this page says very well where this goes, and we are keeping it: you may never enjoy lifts, but you will be able to use them when you need to. The aim is not to enjoy, it is to be able.

What the research says

For specific phobias, it is graded exposure that has the best level of evidence, and this is not a generality borrowed from other fears: the trial was done on claustrophobia. In 2001, a Swedish team divided forty-six people meeting the diagnostic criteria between a single three-hour session of exposure, five sessions of exposure, five sessions of cognitive therapy, and a waiting list. The three treatments did as well as one another, with seventy-nine per cent showing clinically significant improvement against eighteen per cent on the waiting list. That belongs to a psychologist, and it is what should be considered first.

On hypnosis and claustrophobia as a phobia, there is no randomised controlled trial. Preparation for an imaging scan, on the other hand, has been studied, and that is where the data comes closest to what we do.

In Berlin, a radiology team had fifty-five at-risk people listen to a twenty-three-minute self-hypnosis recording while waiting for their MRI, and compared their results with those of eighty-nine people scanned on the same machine: sixteen per cent claustrophobic reactions against forty-three, and two per cent needing sedation against sixteen. The authors themselves point out that people were not randomly allocated and that the control group was historical: this is an observation, not a trial. A Swiss team separately reviewed forty people who had already had to interrupt an MRI; supported with medical hypnosis, all of them completed their scan, with image quality equivalent to that obtained under general anaesthesia. Again, a retrospective series. The first reports go back to 1990.

It is also worth saying what this work is not. The most cited trial on non-medicinal support in radiology, published in *The Lancet* in 2000, covered invasive procedures, percutaneous vascular and renal interventions under analgesia, and not a diagnostic imaging scan. The work closest to an MRI is the one cited at the top of this page: training teams to communicate better brought down the rate of incomplete scans across nearly a hundred thousand visits.

How a Hypnosis session on this subject unfolds

The conversation. Which situations are a problem, since when, what you avoid today, and whether there is a deadline. If there is a scan date, all the work is organised around it. We will also ask whether medical care is under way and whether anything has been prescribed.

The aim. Framed together and concrete. For example: taking the lift to the third floor this week, or getting through the scan on the 14th without interrupting it.

The induction. A natural state of focused attention you already know without naming it. You stay conscious, you hear everything, you can speak and you can stop whenever you wish. On this subject, the practitioner stays in spoken contact with you from beginning to end, which matters when the fear is about being shut in.

The work. It bears most often on breathing and on how to stop monitoring it, on the mental rehearsal of a specific situation, on the relationship to duration, and sometimes on an old memory of being shut in. An honest point about breathing: breathing exercises are debated, some authors objecting that they become a support you can no longer do without. A trial published in 2000 compared behavioural therapy with and without breathing work, and found no difference. So it is not the technique that does the work, it is ceasing to monitor.

The return and the exercise. A conversation about what you experienced, a self-hypnosis exercise to take away, designed to be usable lying down and still, and a step to take before the next session.

The number of sessions is settled at the first conversation. For preparing a scan, the calendar obviously follows the date. Sessions work in person as well as by video.