When you walk into your workplace and skip the elevators to take the stairs, you wonder how people can stand being shut into a tiny elevator. How can they even breathe in there?
Or maybe you walk by the steps to subway stops and hurry a little faster, because the thought of being down in that little tunnel gives you the shivers. And just thinking about that MRI you had to have a few years ago still makes you sick. If you hadn’t had your friend there, you don’t know how you would have made it through.
You’ve always found it embarrassing that you feel so much fear in these situations, and it’s annoying to have to plan your whole day around managing that fear, but that’s just how it is, right?
Not quite! Claustrophobia, or fear of enclosed spaces, is life-altering, holding you back and adding stress to your day-to-day life. It’s also something that you can overcome with the right mental health support. At Suffolk DBT, our ERP-trained therapists help people face their fears and reclaim their ability to live life on their own terms.
Let’s explore claustrophobia and how ERP can help:
Fear of enclosed spaces can severely limit your life
For some people, especially those who have had experiences being trapped in small spaces, being enclosed can feel like a disaster. The lack of control and the fear that something bad is about to happen again can lead people to go to great lengths to try to regain a sense of safety.
Avoidance shrinks your life without resolving your fears
One of the most common ways people try to manage fear of enclosed spaces is by staying away from them.
Avoiding enclosed spaces that trigger your claustrophobia can provide some temporary relief, but it doesn’t help you overcome the fear, and it can even reinforce it. When your brain thinks safety comes from avoidance, it seeks more safety and pursues more avoidance.
Claustrophobia can lead you to avoid:
- Elevators or revolving doors
- Tunnels, including along roads (like the Lincoln Tunnel or the subway)
- Medical equipment like MRIs and CT scanners
- Cars, planes, trains, buses, and subways
- Caves or cellars
- Windowless rooms
Your life becomes smaller and smaller as you avoid triggers, and that can slowly trap you in a life full of places you can’t go. This can be especially limiting in a city like NYC, where it becomes hard to go anywhere or do anything without using at least one enclosed space.
Safety behaviors can take over your attention, keeping you from enjoying life
For moments where you can’t avoid a claustrophobia trigger, you may resort to other safety behaviors like only traveling with a friend, scanning for exits, opening windows, staying near the door, repeatedly planning what you’re doing, always having a fan or water, or using music, scrolling on your phone, a book, or other distractions.
When you’re always looking for the door, it’s hard to enjoy a party. When you’re only able to think about having to use the elevator tomorrow, it’s tough to enjoy a nice dinner today. Safety behaviors can become so ingrained in your life that you don’t even notice how much time they take up, but they sap your energy, ruin the moment, and keep you feeling scared.
How does ERP work for claustrophobia?
Claustrophobia limits your life by pushing you to seek safety and control over uncertainty when you’re in enclosed spaces. Exposure and response prevention therapy, or ERP, helps you by reducing your fear through gradual exposures to triggers AND reduction or elimination of safety behaviors.
ERP at Suffolk DBT starts with understanding your fear and fear responses
Your therapist at Suffolk DBT will start by learning about what your specific enclosed-space-related fears are, and how you have learned to manage that fear. You’ll explore your claustrophobia triggers and determine which are the most distressing and which are the least distressing, to guide your treatment.
Before working with your Long Island therapist, you may not even fully realize how much avoidance and safety behavior you’ve built into your daily life.
“I just don’t like the hassle of an airport without my spouse with me,” “I like getting my steps in, I’ll take the stairs,” or “The subway takes forever, I’m taking a cab,” are all plausible reasons to do something, but they’re also effective ways to cover up avoidance of the enclosed space of an airplane, an elevator, or a subway tunnel.
Having clarity on how you cope can help you and your therapist plan how you’ll face your fear and manage your responses to the fear.
Gradual, structured exposures are explored during and between sessions
Once you understand the triggers you’d like to work on, you and your therapist can plan exposures. An exposure is a situation where you deliberately seek out a claustrophobia trigger and engage with it, without using safety behaviors.
You won’t be left with nothing to help you manage the stress and fear of your exposures! Your therapist will help you find ways to withstand your fear, like breathing exercises and visualizations, so you aren’t trying to avoid or control how you feel.
This might sound awful, and we understand! You will start with exposures that are least distressing, and gradually build up to exposures that are more upsetting with time. You’ll learn how to tolerate the discomfort of uncertainty in a slow and step-wise way, with support from your therapist throughout.
Response prevention helps break the fear cycle
Response prevention is the key to working through your fear of enclosed spaces. There’s claustrophobia-specific research that shows that using safety behaviors during an exposure causes you to anticipate more danger and slows down your progress in treatment. Skipping safety behaviors can actually make the situation feel less dangerous over time!
Response prevention can be straightforward, like not avoiding situations you previously avoided. It can also be more complex, like for safety behaviors that are entirely mental. You need to not participate in the behavior, but also need to make sure you aren’t creating another safety behavior. Your therapist can help you understand the difference and make constructive choices here.
This isn’t an all-or-nothing process; just like when you choose your exposures and start at the lowest distress level, you might start by setting a timer and delaying a safety behavior before you stop using it altogether. You could also start by envisioning a frightening scenario in a therapy session and practicing response prevention with therapist support, then trying it out in real life when you’re more confident you can skip safety behaviors.
Let’s consider a scenario where you’re actually entering that work elevator. Here’s how ERP for phobias could work:
You walk into work, and decide today is the day you’ll take the elevator.
Instead of trying to stick to the door of the elevator, rush out when the ride is over, and spend the whole time running an exit plan through your mind, your ERP plan may include having you move to the side of the elevator, or even the back corner, and redirect your thoughts toward something else, like your grocery list.
You don’t try to argue with the fear thoughts; you just let them come and go. You let one or two people exit the elevator before you, and you gently and firmly redirect your thoughts back to your work when your mind tries to wander back to how scary elevators are.
You will probably feel stress, especially at first, but with time and practice (and dedicated response prevention), you’ll find it’s easier to live with that stress! You’re stronger than you think, and ERP can prove it to you.
ERP for phobias at Suffolk DBT reduces the control fear has over your life
Can you envision yourself in a future where you are willing to step into an elevator, or take a train, without letting fear decide how you handle the situation?
When you’re working on ERP with your therapist at Suffolk DBT, you’ll have a better understanding of why you’re feeling so much fear, and you’ll also have a variety of distress tolerance skills that can support you through both planned and unplanned exposures to claustrophobia triggers.
You’ll see with time that you can use ERP whenever you want, not just when you plan to use it. ERP gives you the power to choose what you want to do, and proves you can handle the stress of fear without resorting to exhausting safety behaviors or being trapped by avoidance.
If you’re ready to face claustrophobia, with the support of a trained and compassionate therapist, connect with us today to get started!