Claustrophobia in an MRI scanner or hyperbaric chamber: what helps

Claustrophobia is a fear of confined spaces, and an MRI scanner or a hyperbaric chamber can set it off even in people who manage lifts and trains without much thought. Here is what claustrophobia is, how the NHS treats it, practical ways to get through a scan, and what enclosed-space anxiety means if you are considering hyperbaric oxygen therapy.

What is claustrophobia?

The NHS describes claustrophobia as an irrational fear of confined spaces. Some people feel mild anxiety in a small space, while others have severe anxiety or a panic attack. The NHS estimates that around 10 percent of the UK population is affected at some point in their lives.

Physical symptoms can include sweating, trembling, hot flushes or chills, shortness of breath, a choking sensation and a rapid heartbeat. People also describe a fear of losing control, of fainting, or of dying. Even thinking about a situation, without being in it, can be enough to trigger it. The NHS says claustrophobia is often caused by a traumatic event in early childhood, such as being trapped in a confined space.

None of that is a personal failing. It is a recognised anxiety problem, and there are practical steps and NHS talking treatments for it.

Why can an MRI scan trigger claustrophobia?

An MRI scan combines several triggers at once. You need to lie still inside the scanner so it can take clear images, and the NHS guide to MRI scans says a scan usually takes between 15 minutes and 1 hour, sometimes longer. The machine makes loud bangs and clicks, so you are given ear plugs or headphones. The radiographer controls the scanner from another room.

Newer scanner designs help less than you might hope. A randomised trial published in PLoS One assigned 174 people with raised claustrophobia scores to either an open scanner or a modern short-bore scanner. Claustrophobic events that left the scan incomplete happened in 39 percent of the short-bore group and 26 percent of the open group, a difference that was not statistically significant. The authors concluded that even recent scanners cannot prevent claustrophobia.

The same trial found that 7 months later, perceived claustrophobia had increased in 32 percent of people who had an event during their scan, against 11 percent of those who did not. A difficult scan can make the next one harder, which is a good reason to plan ahead rather than hope for the best.

How can you cope with claustrophobia in an MRI?

The most useful step is also the simplest. The NHS advises letting the hospital know before the day of your appointment if you have claustrophobia, which gives the team time to plan with you.

Things to ask about:

• A medicine to help you relax. The NHS says you can talk to your consultant about a sedative. If you have one, someone will need to collect you and take you home, and you should not drive for 24 hours.
• Bringing someone with you. The NHS MRI guide says you can ask whether someone can support you during the scan.
• An open or upright scanner. The NHS notes that some centres are designed for people with severe MRI anxiety, but they are often only available privately.
• How you will communicate. The radiographer can hear and speak to you during the scan. Tell them if you start to feel unwell.

Other approaches have some evidence behind them, though it is uneven. A systematic review of 38 studies found that measures including information combined with psychological support, mock MRI practice, audiovisual systems, guided imagery and cognitive behavioural approaches each had some positive effect on at least one outcome, such as anxiety, sedation or completing the scan. The quality of the studies varied.

On the day, a slow breathing exercise gives your attention somewhere to go. The NHS breathing exercise for stress suggests breathing in through your nose and out through your mouth, gently and regularly, counting from 1 to 5 on each breath if that helps, and repeating for at least 5 minutes. Practise it at home first so it feels familiar. If panic builds, the NHS advice is to stay where you are if possible and focus on something non-threatening.

What is the treatment for claustrophobia?

A scan is usually a one-off. If claustrophobia shapes your life more widely, it is worth treating the fear itself. The NHS lists these options:

• Cognitive behavioural therapy (CBT). A talking therapy that explores your thoughts, feelings and behaviour, and develops practical ways of dealing with your phobia.
• Exposure therapy. A type of CBT that gradually exposes you to the situation that causes your fear. It is sometimes called desensitisation therapy.
• Self-help. The NHS guide to treating phobias suggests breathing exercises, talking to someone you trust about your phobia, and joining a self-help group online or in person.
• Medicines. Antidepressants or tranquilisers are sometimes used.

You can get free talking therapies, including CBT, on the NHS. You do not need a referral from your GP: you can refer yourself directly to an NHS talking therapies service, or ask a GP to refer you if you prefer.

Can you have hyperbaric oxygen therapy if you are claustrophobic?

Some people with claustrophobia manage sessions comfortably, and some find them impractical. A hyperbaric chamber is an enclosed space, and ours is a single-person soft-shell chamber. A 2017 review of HBOT side effects reported confinement anxiety in single-person chambers at 8 events per 10,000 treatments. That figure is low, but it cannot tell you how you personally will feel.

A session at HBOT Medics differs from a scan in a few ways that matter for anxiety:

• You are briefed first. Before every session the operator explains how to clear your ears, how to communicate and how the session is stopped.
• The pressure change is gradual. The chamber pressurises slowly to 1.5 ATA, and most of what you notice is in your ears.
• You can communicate throughout. You stay in contact with the operator for the whole session, and it is fine to say you feel warm, restless or uneasy.
• You can ask to stop. A session can be stopped at any point. Pressure is still released gradually, so leaving the chamber is controlled rather than instant. Knowing that before you start helps you make an informed choice.

Our page on what happens during treatment sets out each step, and what happens in an HBOT session covers the hour in more detail. The chamber page describes the equipment itself.

Be honest with yourself about how severe your fear is. Severe claustrophobia can make sessions impractical, and nobody should feel pressured to continue through significant distress. Claustrophobia is one of the answers covered on our page about who HBOT is not suitable for. If enclosed spaces worry you, tell reception in advance so the process can be explained before you commit, and consider starting with a single session rather than a course.

The short version

For a scan, tell the hospital early, ask about a relaxing medicine or bringing someone, and practise slow breathing. For the fear itself, CBT and exposure therapy are available on the NHS, and you can refer yourself. For a hyperbaric chamber, talk to us first, and know that you stay in contact with the operator and can ask to stop. No referral needed. Medical consultation included. You can see available times whenever you are ready.