Claustrophobia: Coping with the Fear of Enclosed Spaces

What is claustrophobia and why does it happen? Learn the causes of fear in lifts, MRI scanners and tunnels, plus practical ways of coping with it.

Your chest tightens when the lift doors close, your breathing narrows as you enter a tunnel, or a wave of panic washes over you when your doctor says you need an MRI scan. In a crowded metro carriage, a windowless meeting room or the cramped toilet of an aeroplane, the feeling of "I have to get out right now" may take over. Claustrophobia is an intense and disproportionate fear of being in enclosed, narrow or exit-restricted spaces. This fear is often dismissed as "a bit of discomfort"; yet it can affect many areas of life, from health screenings to public transport, from working life to holiday plans. In this article we explain the two basic components of the fear of enclosed spaces, why the brain sounds the alarm in these places, practical tips for unavoidable situations such as MRI scans, and ways of facing the fear step by step.

What Is Claustrophobia?

The word derives from the Latin "claustrum", meaning "closed place", and the Greek "phobos", meaning "fear". In psychology it is classed as a specific phobia of the situational type. Many people may feel a little uneasy in a tight space; this is entirely natural. A clinical assessment becomes meaningful, however, when the fear is intense, persistent and restricts the person's life.

The fear of enclosed spaces typically arises in situations such as these:

• Lifts, especially crowded or small ones
• Medical imaging machines such as MRI and CT scanners
• Tunnels and underground transport lines such as the metro and Marmaray
• Aeroplanes, especially the moment the doors close, and aircraft toilets
• Windowless rooms, basements, small bathrooms, changing cubicles
• Revolving doors, doors that can lock, car wash tunnels
• Crowded concert halls or cramped rows of seats

If you would like to know how phobias work in general, our article on what a phobia is offers a comprehensive framework.

The Two Faces of the Fear of Enclosed Spaces

Researchers think the fear of enclosed spaces is usually fed by two basic fears. Knowing which is more dominant in you helps guide the choice of coping strategies.

Fear of restriction

This is the fear of being unable to move, of being squeezed in, of being unable to get out and of losing control. The person fears the door locking, the lift stopping or being unable to move in a crowd. The question "What happens if I get trapped here?" is at the heart of this fear.

Fear of suffocation and stale air

This is the fear that the air will run out, the oxygen will be used up and breathing will become impossible. The person feels the air in an enclosed space becoming "heavy", focuses on their breathing, and the more breathless they feel, the more the fear grows. Yet the sense of breathlessness experienced during anxiety usually comes not from a shortage of air but from the anxiety itself and from faster breathing.

In many people these two fears are present together and feed each other.

What Are the Symptoms of Claustrophobia?

The following symptoms may appear in an enclosed space, or when thinking about one:

• Palpitations, sweating, trembling, hot flushes
• Shortness of breath, tightness in the chest, a lump in the throat
• Dizziness, light-headedness, feeling as if you might faint
• An urge to escape, constantly checking the door or exit
• Thoughts such as "I won't be able to get out", "I will suffocate", "I will lose control"
• Intense fear that can turn into a panic attack

Alongside these, changes appear in the person's daily behaviour too: always taking the stairs instead of the lift, sitting near the door in crowded places, leaving doors open, changing route to avoid long tunnels, or postponing necessary medical tests.

Why Does the Fear of Enclosed Spaces Develop?

Experience

The fear can begin with an experience such as being locked in a cupboard or room in childhood, being stuck in a lift, or being squeezed in a crowd. Sometimes, even if the event itself was very small, the intense fear of that moment is registered by the brain as a powerful warning.

Observation and information

Watching parents' tension in enclosed spaces, listening to stories of people trapped, or seeing such events in the news and on social media can also contribute to learning the fear.

The earthquake experience and fear of rubble

After the 6 February 2023 earthquakes, many people saw images of people trapped under rubble in the news and on social media. Some noticed that, since then, the thought "If something happens, I will be trapped here" has become stronger in enclosed spaces, basements or the inner rooms of tall buildings. After a major disaster, fears of this kind are understandable reactions. However, if the fear does not subside over time and increasingly narrows the person's life, an assessment with a specialist is helpful. If post-earthquake fears are directly linked to a traumatic experience, a trauma-focused approach may be needed.

Preparedness and temperament

From an evolutionary perspective, avoiding narrow spaces from which escape is impossible may have helped our ancestors survive. For this reason, people may learn such fears more easily than others. People who are prone to anxiety and sensitive to bodily sensations can also be affected more.

The mechanism that maintains the fear

Whatever the starting point, what keeps the fear of enclosed spaces alive for a long time is avoidance and safety behaviours. When the person does not take the lift, postpones the MRI appointment or leaves the door open, they feel instant relief. But from this relief the brain concludes, "If I hadn't escaped, something bad would have happened", and the fear grows stronger.

The fear of enclosed spaces does not grow because the door closes, but because of the belief that we cannot cope while the door is closed. This belief can only change through safe experiences.

Coping with the Fear of Enclosed Spaces: Practical Tips

Avoiding some enclosed spaces is not possible. Health tests in particular should not be postponed.

Before and during an MRI scan

• Tell them in advance: When booking the appointment and before the scan, tell the team that you have anxiety about enclosed spaces. The team can explain the process and talk with you during the scan.
• Find out about the process: Ask roughly how long the scan will last, what sounds the machine will make, and how the alarm bell placed in your hand for calling for help works. Reducing the unknown reduces anxiety.
• Ask about options: Some centres may have wider or open-design scanners; you can discuss this option with your doctor and the centre.
• Close your eyes or use a mask: Some people find that not seeing the inner surface of the machine makes it easier.
• Slow your breathing: Breathing in for a count of four and out for a count of six helps calm the body.
• Take a mental journey: Imagine a place you love in full detail, or set yourself a mental task such as counting throughout the scan.

Make the decision about whether a sedative is needed during the test together with your doctor.

In a lift

• When the door closes, notice and name the sensations in your body: "My heart is speeding up, this is anxiety."
• Plant your feet firmly on the floor and focus on a point on the lift wall or on the floor indicator.
• Remember that lifts have ventilation systems and emergency buttons, and that even if you were stuck, running out of air is not a likely scenario.

On a plane and on public transport

Choosing aisle seats, doing a breathing exercise before take-off and directing your attention to a book or film during the journey can help. However, use these strategies not as a substitute for escape but as tools that support you in staying in the situation.

Facing enclosed spaces step by step

The plan below is based on the principle of exposure. With intense fears, doing this work together with a specialist is safer and more effective.

1. Build a fear ladder: Rank situations involving enclosed spaces from easiest to hardest and give each an anxiety rating from 0 to 10. For example: closing the bathroom door and waiting for a minute (3), sitting in a small room with the door closed for five minutes (4), going up one floor in a lift alone (5), going up several floors in a crowded lift (7), passing through a long tunnel (8).
2. Write down your prediction: Before each step, answer the question "What am I afraid will happen, and how strongly do I believe it?"
3. Start with an easy step: Choose a situation with an anxiety rating of 3-4.
4. Stay: When anxiety rises, do not escape; observe how anxiety rises and falls like a wave.
5. Drop safety behaviours: Gradually reduce behaviours such as touching the door, constantly looking at the exit or holding your phone.
6. Note the outcome: Did the thing you feared happen? How high did your anxiety peak, and what was it at the end?
7. Repeat: Repeat the same step until your anxiety drops noticeably, then move to the next step up.

Let us think through how this plan might work with a fictional example. Suppose someone who has an MRI scan in three weeks is thinking of cancelling the appointment because of their fear of enclosed spaces. In the first week, every day they close the bathroom door, sit in the dark for a few minutes and slow their breathing. In the second week, lying under a blanket with their face partly covered, they imitate the feeling they will have during the MRI, and listen online to the sounds an MRI machine makes. In the third week, they get into a crowded lift several times and get used to the moment the door closes. Each time they write down the prediction "I will stop breathing", then note what actually happened. On the day of the scan the anxiety does not vanish completely; but the person now has concrete experiences that they can stay in the machine alongside this anxiety. Of course, everyone's process is different, and with intense fears, preparing with a specialist is more effective.

Making peace with the feeling of breathlessness

If the fear of stale air is dominant, getting used to this sensation with controlled exercises can be helpful. In therapy, sensations similar to breathlessness are sometimes created deliberately, for example by breathing through a straw or running on the spot for a short time. The aim is to experience that this sensation, although uncomfortable, is not dangerous. People with breathing or heart problems must consult a doctor before doing such exercises. For techniques for slowing the breath, you can read our article on breathing exercises for anxiety.

When Should You Seek Professional Support?

You might consider seeing a specialist in the following situations:

• You are postponing necessary health tests such as an MRI because of anxiety.
• Avoiding places such as lifts, the metro or tunnels noticeably restricts your work or daily life.
• You frequently have panic attacks in enclosed spaces.
• Your fear is spreading to crowded places, public transport and being away from home. This may be related to agoraphobia.
• A fear that developed after an earthquake or another traumatic event is not subsiding, and nightmares and sudden flashbacks accompany it.

Always have a doctor assess whether symptoms such as shortness of breath and chest pain have a medical cause.

How Is Claustrophobia Addressed in Therapy?

One of the most researched approaches to the fear of enclosed spaces is exposure, which is part of cognitive behavioural therapy. The therapy process usually includes these components:

• Assessment: Whether the fear is one of restriction, suffocation or panic, and in which situations it intensifies, is determined.
• Psychoeducation: The bodily symptoms of anxiety and the real causes of the sensation of breathlessness are explained clearly.
• Cognitive work: Thoughts such as "If the lift stops, I'll run out of air" or "I'll go mad in an enclosed space" are tested against evidence.
• Graded exposure: Imagery, work with videos and photographs, followed by planned and safe encounters with real enclosed spaces.
• Interoceptive exposure: Getting used to feared bodily sensations in a controlled way.
• Preparation for medical tests: If there is an upcoming test such as an MRI, a preparation plan specific to this process can be made in therapy.

You can find information about work on anxiety and fears on the anxiety and panic page. The therapy process varies from person to person; we would like you to know that support is possible whenever you feel ready.

Frequently Asked Questions

Can the fear of enclosed spaces be treated?

The fear of enclosed spaces is known as one of the difficulties that respond well to therapy. With graded exposure and cognitive work, many people experience a marked reduction in their fear. The process and outcome vary from person to person.

I have claustrophobia and need an MRI scan. What should I do?

First, tell your doctor and the centre where the scan will take place about your anxiety. Learning about the process in advance, practising breathing techniques and, if necessary, asking about different scanner options can make things easier. Your doctor can decide whether you need medication support.

If I get stuck in a lift, will I run out of air?

Lifts have ventilation systems and are not completely airtight cabins. Being trapped can be frightening, but the air running out is not an expected outcome. In such a moment, using the emergency button and slowing your breathing are the most useful steps.

Do children experience a fear of enclosed spaces?

Yes, fears of the dark and of enclosed spaces can occur in children, and some are developmentally normal. If the fear is excessive for the child's age or restricts their daily life, it can be helpful to seek support from a child and adolescent mental health specialist.

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• #exposure

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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