John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Treatment of Claustrophobia

RRP Claustrophobia Trial by Dr. Tkach

What are Phobias?

Let's look at the big picture first. The term phobia refers to a fear of a particular thing or type of event or activity. We all have things we fear. Such fears become phobias when the fear becomes so severe that it is irrational and disabling. The person suffering from the fear recognizes this aspect of his/her fear. But, the fear itself is very real.


Claustrophobia is one of the most prevalent phobias. 12% of people have some claustrophobic symptoms and 4% have it severely. Claustrophobia is the fear of being trapped in an enclosed place such as small rooms, locked rooms, cars, airplanes, tunnels, cellars, elevators, subway trains, caves, areas crowded with people, magnetic resonance imaging machines, CPAP machines for sleep apnea, and hyperbaric oxygen chambers.

However, the two main features of claustrophobia are the fears of being in a restricted space and suffocation. The fear is severe and can reach panic proportions. Panic is anxiety or fear at a level that makes you feel you are going to die.

MRI based claustrophobia is especially important because when you are having an MRI done, it is because your doctor seriously needs the result of the MRI exam. 37-40% of people having an MRI done experience moderate to severe claustrophobic anxiety. About 2% of people just cannot go through it. 30% of people with MRI claustrophobia find that after 1 month, their symptoms are worse. Time does not heal their wound.

The average age of onset of claustrophobia is 20.

Anxiety Disorders

Technically, phobias are part of a bigger picture called anxiety disorders. This is a common problem that affects about 18% of Americans. Phobias are more common at times of high stress. The experience of a phobia may include headache, sweating, muscle spasms, heart palpitations, sexual dysfunction, and increased blood pressure. Depression accompanies anxiety in 60% of people.

The Purpose of Phobias

The purpose of fear is to protect. Fear alerts us to a danger that we need to protect ourselves against. Fear is a survival emotion or feeling. According to Dr. Barnett's RRP theory, the number one urge a person has is to survive. Once frightened, a person is alerted to guard against that danger in the future. Even when sleeping or doing other things, there is a part of the mind awake and watching out for danger.

Causes of Phobias

  1. Neuromuscular- low levels of GABA, a neurotransmitter.
  2. Amygdala dysfunction- these are two paired areas in the brain stem that connect fear responses to the hypothalamus and cerebellum.
  3. Stress
  4. Previous emotional trauma (RRP theory)

Treatment of Phobias

  1. Cognitive/Behavioral therapy (CBT) is a form of talk therapy and is 30% effective for claustrophobia. A variant of CBT is counseling to accept the symptoms, but not to let the fear reach 100%. Research in behavioral therapy of claustrophobia found that patients did about a well as they were going to after one session as after 5 sessions.
  2. Desensitization- graduated in vivo exposure. The patient is exposed to graduated increasingly severe exposure to the object of one's fear such as airplane flights, spiders, snakes, etc. I want to say here that this method seems to me to be potentially cruel. I do not support it. A new computer based variation on this theme is Virtual Reality exposure.
  3. Relaxation
  4. Drugs including
    Prozac Effexor Neurontin Remeron
    Zoloft Xanax Lyrica Quetiapine
    Paxil Klonopin Nardil Piperazine
    Lexapro Valium Parnate Hydroxyzine

Natural Treatments

  1. Regular aerobic exercise
  2. Improving sleep
  3. Reducing caffeine

How Claustrophobia (or any Phobia) Develops

According to Dr. Barnett's RRP Theory, emotional traumas lead to symptoms like claustrophobia. If a Child is hurt over and over by the Parent, he/she begins to develop a fear of the hurtful experience occurring again. Eventually, there comes a time when the Child realizes this repeated hurt is not fair. His friends are not being treated that way by their parents. At this point, the Child gets angry. However, it is dangerous to express this anger at the Parent. The Child needs the Parents' support to survive. This leads to guilt.

Guilt is the most powerful of the emotions. It locks the Child in a prison of the mind.

The sequence is:

Pain -> Fear -> Anger -> Guilt

Let's see some examples.

The Case of T.

This successful RRP treatment occurred as a single visit lasting 1 hour and 31 minutes. T. is an anxious 70 years old married lady in good health. The day before our session she had been riding in the car with her husband. They traveled through a dense Montana forest on a dirt road to visit friends.

As they traveled deeper into the darkening mountain forest, she became anxious. She felt the trees were closing in on her. Even though the sky above was clearly visible, she had an irrational perception that the road and trees were becoming a tunnel and closing in on her. She felt, "I'm not going to be able to get out." She feared a forest fire.

By the time she got to the house, 2 miles, she was in a state of panic. Everyone at the house tried frantically to talk her down from her panic.

T. had had similar experiences in other settings such as:

  1. 12 minutes into a cavern guided tour with her children 40 years ago.
  2. Driving in the Chesapeake Bay tunnel and Boston tunnel, she said, "The fear that takes over is ridiculous."
  3. Hiking in a wide canyon in Arizona.
  4. In doctors' offices and hallways.
  5. When she could not find her way out of an underground parking lot.

I asked T. to close her eyes and go back to a claustrophobic episode. I asked her to feel the fear and panic without reliving the experience. I guided her to let the uncomfortable feelings take her back to the first time she experienced it (Affect Bridge). This uncovered an event at age 20. She was able to resolve that traumatic event without telling me what happened. She got her smile back and reintegrated the personality.

A feature of RRP that sets it apart from other forms of psychotherapy is that the patient is not required to tell the RRP therapist anything private, secret, personal, or embarrassing.

A month after her RRP session T. told me by phone that she had not had anymore claustrophobic events. She successfully traveled back into the forest that evening. She was able to travel tunnels, fly in airplanes, and travel in a subway train.

The Case of H.

63-year-old H. tried to use a CPAP machine for sleep apnea. He put the mask on his nose. Within 2 minutes, he was in a state of panic. He felt like he was going to die. He could not get out of the panic. His wife brought him to see me immediately. In a 2 hour session, using RRP, he uncovered a traumatized Child ego state at age 4. He described it. His two older brothers had rolled him up in a blanket in such a way that he could not breathe or escape. Mother found him after a few minutes and freed him.

H. was able to resolve this traumatic event and followed the standard RRP steps with my guidance. He tried using the CPAP mask and machine several times over the next week. He was able to use it a few hours without panic or fear. Ultimately, he could not adapt to CPAP. He returned the CPAP machine.

This case illustrates the two major components of claustrophobia: 1. He was confined against his will in a restricted space and 2. He feared suffocation.

More About RRP

RRP is a profound new form of psychotherapy that is gentle, non-threatening, and effective. RRP offers you great hope for relief from symptoms (symptom list).

RRP is symptom oriented. It runs on feelings. Buried within the symptom is the path to cure of that symptom. What I do is to guide you gently to uncover and resolve troublesome conflicts that arose at those past critical events. It was at that point that a part of you lost your smile. You will know RRP worked when you get your smile back.

Your experience with RRP is likely to be wonderful, profound and very beneficial.

  1. History of RRP

    Canadian medical doctor Edgar Barnett invented RRP in 2003. Dr. Barnett was born and raised in England. He went to Medical School in England. Initially a family doctor, he observed that many problems were not helped by medicines alone because they were also psychological. He has been doing psychotherapy for over 40 years. He has written two books on psychotherapy: 1. ANALYTICAL HYPNOTHERAPY 2. UNLOCK YOUR MIND. His RRP evolved after 40 years of his experiences treating patients with psychological problems. Dr. Barnett started training me in RRP in April 2004. We have written a book about RRP.

  2. What is RRP?

    At first we thought it was a type of hypnosis or "waking hypnosis," and it may very well be. Dr. Barnett thinks it is a special form of hypnosis. For me, the problem with that is that hypnosis traditionally requires a procedure called induction, induction of a hypnotic trance. To you, it will seem like daydreaming.

    The reason traditional psychotherapies sometimes fail is that they require people to reveal their innermost, private, personal, embarrassing, threatening, or frightening secrets and the details of those secrets. There is none of that with RRP. It is okay to tell me personal things, but I won't require it of you.

    The procedure is between you and yourself. I, as therapist, guide you, and I am there with you so you do not need to go through it alone. Where you are about to go in the RRP state, I have been many times. I know the way in. I know the way out. I will be there with you every step of the way.

  3. The Goal of the RRP Therapy Session

    The goal of your Rapid Reintegration Procedure (RRP) session with me is to free you up from some sort of unwanted symptom that pesters you. A symptom can be any one of a large number of problems such as overeating, phobias (fears of specific things), smoking, anxiety, stage fright, test anxiety, nightmares, panic, anorexia, and so on. (See the symptom list)

    The first step is for you to decide what symptom you want help with. What unwanted behavior or problem do you want to get rid of or get help for? There is a feeling that goes with that symptom. Try to identify what the feeling is that you experience when you have the urge to do the unwanted behavior or experience the symptom.

  4. What Will You Experience In RRP?

    You sit in a chair with your eyes close, and I guide you through recalling feelings and finding old memories. It is very simple, it occurs very easily. It is like daydreaming. If you can daydream, you can do RRP.

    You do not need to suffer in RRP. You do not need to relive traumatic events. You can recall them without reliving them. During RRP you will still be in control at all times. If something about RRP puzzles you, just ask me. If you want to stop, you will be able to do so easily. Your being in control makes RRP easy and non-threatening.

  5. Getting Results

    RRP is results oriented. You and I want to get results for you. We want to free you up from uncomfortable symptoms and feeling. When you have gotten results from RRP it will be obvious to you. There will be immediate relief.

    We will just keep working until you get results. That may take 26 minutes or it may take four sessions of two hours each. But it does not go for years.

    If RRP does not get results for you within 4-6 sessions, then you need a different form of treatment. In that case, you should work with a psychiatrist, clinical psychologist, or counselor.

    Your RRP work with me complements your work with your primary doctor or therapist. I am not taking over your case from your doctor. I am helping out. With your permission, I shall send a report to your doctor.

    For example, if you come to me for overeating, I can help you profoundly with RRP. But I am not going to tell you what to eat or how much. That's for you and your dietician to work on.

  6. After Your RRP Session
    1. Memories will come back to you, perhaps of things you have not thought about for a long time. This will go on for months and even years.
    2. Once you have experienced RRP, you can do a lot of this RRP work yourself. When you experience the symptom, instead of bemoaning it, say to yourself, "Hot dog. This is the symptom I want to get rid of. Here's my chance, and I know how to do it now."

    It used to be that you were imprisoned by your symptom. Now, RRP can set you free.

  7. Other Things to Consider about RRP

    What will your life be like once you have achieved freedom from your symptoms? If you have been suffering from your symptoms for years, you have built up a life style, and those around you have adjusted to it.

    Ideally, RRP results are immediate and dramatic. When you have achieved results in RRP therapy, there will be no question in your mind about it. Your whole attitude about your symptoms will change and surprise you and others. You will be delighted. As I have said before, it is like being released from jail and given all the respect, rights, and privileges of a normal citizen, a first class citizen.

    If your symptoms have made you shy about going out of the house and being around other people due to the stress, that will change. You will find yourself more outgoing. You will likely create new friendships. How will that affect your current friends? How will that affect your spouse? The two of you should talk about it before you start RRP.

    I am not saying these things to discourage you from RRP. I just want you to let those close to you know that you are working on a way to free yourself from your symptoms to protect your health. And they should know that when RRP does work for you, they might notice some nice changes in you.

    I videotape the sessions for Dr. Barnett to give me supervision. These videotapes are confidential.

  8. How To Get Started With RRP

    Dr. Barnett and I are doing clinical trials of RRP in the treatment of a wide variety of symptoms, especially when standard treatments have failed. We want to take it out for a spin and see what it can do.

    Because these are trial studies, there will be no fee. If RRP sounds interesting to you do this:

    1. Determine if you want me to help you. Make a commitment to work with me. That will be very easy. I won't ask you to do anything difficult. You will find it easy to work with me.
    2. Let's work in cooperation with your doctor or therapist. Obtain a letter of referral from him or her at your expense. The letter should state clearly that the doctor is referring you to me for RRP therapy as an adjunct to the other treatments, briefly state what the symptoms are, present medicines and what drugs and treatments have been tried. Your doctor must understand I am not an internist and I am NOT trying to take over your care or your medications management. Those things are up to you and your personal doctor. c. Understand that I videotape the sessions for Dr. Barnett to review, and I shall review them.
    3. Discuss with your family and friends how your life is about to change. Ask them to support you in this effort. Think it over for about a week before you go on to the next step.
    4. Call my secretary to schedule yourself for RRP. (406) 587-5442.
    5. Come to my home on a Saturday morning or several Saturdays. If you are not going to come, you must call my office two days in advance and cancel. I am doing this in my spare time, and I don't have much spare time. If you fail to show up for your session, you will be dropped from the study. I'd like you to bring a spouse, relative, or friend as a chaperone.
    6. Send me a letter at 6 months, one year, two years, and three years letting me know how you are doing.
    7. Sign the attached release of liability.
    8. To prepare for RRP, do this homework assignment. Every time you experience your symptoms, instead of bemoaning it, identify the feelings associated the symptoms.

Potential Risks of RRP

Dr. Barnett has treated over a thousand patients with RRP and has found no negative consequences. RRP is new, and there is no history of adverse outcomes. The main risk of RRP is failure to get results. But, Dr. Tkach and Dr. Barnett feel that RRP is highly likely to get results. When results are slow to achieve, it may require several sessions.

Uncovering forgotten old traumas can be distressing, but finding and working through such critical events is the whole point of therapy. You will not go through it alone. Dr. Tkach will be with you every step of the way. If you become too uncomfortable, just open your eyes and stop the session. Then talk about it with Dr. Tkach before resuming RRP. You will not be required to do anything you do not want to do.

If you are feeling suicidal, tell me, and your primary doctor or therapist and get help with that.

See the separate information sheet on the recovery of false memories.

You will have to read and sign a copy of this with the release form before being seen by Dr. Tkach for RRP.

Learn more about the Rapid Reintegration Procedure or buy a copy of Dr. Barnett and Dr Tkach's book.