یک در مقابل پنج جلسه از مواجهه درمانی و پنج جلسه درمان شناختی- در درمان تنگناهراسی

Forty-six patients fulfilling the DSM-IV criteria for claustrophobia were assessed with behavioral, physiological, and self-report measures. They were randomly assigned to four conditions: (1) one-session (E1); or (2) five-sessions of exposure (E5); (3) five-sessions of cognitive therapy (C5); and (4) Wait-list for 5 weeks. The first condition consisted of a single 3 h session of massed exposure, and condition 2 and 3 of 5 h of gradual treatment, which was done individually by very experienced therapists. The results showed that treatment was significantly better than the wait-list condition, and the three treatments did equally well with no differences between them. At post-treatment 79% of treatment patients vs 18% of the wait-list controls had improved to a clinically significant extent. When the three treatments were compared 80% in the E1-group, 81% in the E5-group, and 79% in the C5-group were clinically improved. At the 1 year follow-up the corresponding figures were 100%, 81%, and 93%, respectively. The implications of these results are discussed.

Claustrophobia is one of the most prevalent specific phobias in the general population. Costello (1982) reported a prevalence study of 449 women in Calgary, Canada. Twelve percent reported having a fear of closed spaces, crowds or elevators, and 4% said that the fear was severe. Kirkpatrick (1984) investigated 342 women and 200 men in Indiana, USA. Of the women 22.5% said that they had a fear of enclosed spaces, and 13.4% reported the fear to be severe. Among the men 7.5% reported a fear, but only 3% said that it was severe. Chapman (1997) described the results of the large ECA-study in five US cities (N>18,000). The proportion of these fulfilling DSM-III phobia criteria was 2.4% for closed spaces, 2.1% for tunnels, bridges and 2.6% for crowds. There is no information as to the co-morbidity between these fears but the proportion having a phobia for any of these situations is probably 3–4%. Finally, in the National Co-morbidity Survey (N>8000; Curtis, Magee, Eaton, Wittchen & Kessler, 1998) the lifetime prevalence of phobia for closed spaces was 4.2%, which put it in third place after phobia for animals (5.7%) and heights (5.3%). In conclusion, except for the Kirkpatrick (1984) study there seems to be an agreement on the lifetime prevalence of claustrophobia at about 4%.