Shorter communicationEvidence for fear of restriction and fear of suffocation as components of claustrophobia
Introduction
Recent approaches to understanding claustrophobia have proposed that the fear is comprised of two separable components, fear of suffocation and fear of confinement (Rachman, 1997). Support for this view derives largely from factor analytic investigations of questionnaire responses. For example, Rachman and Taylor (1993)identified two separable rationally derived subscales from their claustrophobia questionnaire. Responses from a sample of university students subjected to a principal components analysis supported the existence of the two scales of the claustrophobia questionnaire. In addition, responses to behavioral tests concerned with confinement and suffocation confirmed the two factor structure. Similarly, Valentiner et al., (1996)developed a questionnaire to measure suffocation concerns and entrapment concerns. These authors used exploratory and confirmatory factor analyses of student responses to demonstrate the existence of scales predominantly reflecting entrapment and suffocation concerns.
The most direct evidence bearing on the separate contribution of fear of confinement and of suffocation to claustrophobic fears comes from demonstrations that procedures impacting on fear of confinement or suffocation alone reduce fear of confinement or suffocation respectively, but do not impact on the concerns that were not targeted. Such a methodology is proposed by Rachman (1997)for demonstrating the importance of suffocation concerns to claustrophobic fear. Arguably, successful completion of a MRI scan provides a powerful exposure to the experience of confinement without the possibility of suffocation. In contrast, most chambers used in the investigation of claustrophobic fear in the past have incorporated both restriction, in terms of size, and the possibility of suffocation, in that they are enclosed (e.g. Rachman & Levitt, 1988). Patients undergoing MRI scans lie inside a narrow cylindrical chamber. While the chamber is restrictive, dark and noisy, it is not sealed and patients can literally see the light at the end of the tunnel. Kilborn and Labbe (1990)examined fear reactions associated with MRI scans in a sample of 108 patients, 62 of whom provided information immediately before the scan and one month after the scan. Kilborn and Labbe reported scores from the Speilberger state-trait anxiety inventory (STAI) and the fear survey schedule (FSS) prior to the scan and at one month follow-up for those who (a) did and (b) did not complete the scan. Importantly for the present discussion, an examination of Kilborn and Labbe's results suggests that scores for state anxiety, FSS total and FSS item `enclosed places' increased from prescan levels to follow-up among people who failed to complete the scan but decreased among those who did complete the scan. Successful completion of the scan may be regarded as providing an exposure trial leading to reduced fear at follow-up.
The present study examines the impact of successful completion of a magnetic resonance imaging (MRI) scan on fear scores derived from Rachman and Taylor (1993)suffocation and confinement subscales. If fear of confinement and fear of suffocation are separable fears, it would be predicted that patients successfully completing MRI scans would show a decrease in their confinement scores in the absence of any change in suffocation scores.
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Subjects
The data presented here were collected as part of a larger investigation of predictors of anxiety reactions following MRI scans. All out-patients scheduled for appointments across a three week period at two large teaching hospitals in Sydney (Royal Prince Alfred Hospital, Camperdown, and Westmead Hospital, Westmead) were invited to participate in the research. Data were collected on three occasions, one week prior to the scan, on the day of the scan and one month after the scan. The data
Results
Seventy-eight people participated in all three phases of the research. Table 2 presents the average scores from before and after the scan on the total FSS score derived by summing the first 73 items (Wolpe & Lang, 1977), anxiety and stress scales and on the confinement and suffocation subscales. The scores on the confinement subscale and the total FSS score declined from pre- to postmeasurement.
The patterns of performance presented in Table 2 were the same for those who reported fear of
Discussion
The most successful treatment for specific fear reactions, such as fear of enclosed places, involves in vivo exposure to the feared situation. In the present study, a reduction in both FSS total scores and confinement subscale scores occurred following successful completion of the MRI scan. That this decrease is specific to confinement is suggested by the finding that neither general state anxiety nor suffocation subscale scores change over time.
These findings are largely consistent with
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