Need An MRI? Tips for Claustrophobics from Boston Univ. Expert

Ever wonder what makes you afraid? Dr. Todd Farchione of Boston University’s Center for Anxiety and Related Disorders says when it comes to claustrophobia fear can spring from several sources. You might have a frightening experience in a tight space, leading you to fear enclosed spaces. You might watch someone else have a frightening reaction to a small space, leading you to equate confinement with fear. But sometimes it’s much less personal. You can thank evolution, says Dr. Farchione. “Every emotion that we experience is tied to a reaction and that serves an evolutionary function. So when I feel fear, what do we want to do? Well, fight or flight.” Thousands of years ago fight or flight was a necessity. Today, when it comes to getting an MRI, that innate reaction is considerably less helpful if your doctor says you need a scan to guide your treatment.

The escape reaction leads some people to crawl right out the end of an MRI machine during the middle of an exam. Linda Raimondi knows firsthand. She can sense a panic attack coming. Linda says doing online research didn’t do her fear any favors. “With so many people having MRIs today and us having access to the Internet, we know too much. Going in, my fear is compounded and it made it even worse.”

Self Talk and Getting Real

For someone like Linda, it can be hard to rationalize the fear. She tries to tell herself the walls aren’t closing in on her, but her fear makes it hard to believe. “I can only take so much and I gotta get outta here.” That’s not uncommon, according to Dr. Farchione:

“The more that the person tries to stay calm, it can actually have a paradoxical effect, where they say, ‘Ok, I’m not staying calm, what does that mean?’ And then it can build on itself very quickly.”

Suddenly, anxiety has spiraled into a panic attack. Dr. Farchione’s best advice for you: Be ready to experience the fear. “It’s almost like being able to be ok with the fear that we’re experiencing in that situation and tolerate that,” he says. “Be present and tolerate that experience and stay put.” Sounds simple, but it can be tough to do when your brain is screaming, “GET OUT OF HERE!!!” That’s where “self talk” can help. The idea of talking yourself through a frightening situation begins with being clear about how dangerous the situation really is. That means asking lots of questions before your exam. Find out:

1. What is an MRI?
2. How long is it going to last?
3. What will it be like?

The answers to those questions can help you set your thinking straight and quell the anxiety. Dr. Farchione doesn’t just research and help others, he’s had an MRI and can relate. In this video he talks about how he used self talk when he felt the panic rising during his exam:

When Rosanna Chiodo’s doctor told her she needed an MRI, she did her homework. She knew her fear would likely prevent her from getting a scan in a traditional MRI because of her claustrophobia. She tracked down a High-field Open MRI at Center for Diagnostic Imaging in Chelmsford, MA. Then she started practicing her self talk. As Rosanna prepared for her exam, climbed onto the table and slid into the machine, she had a constant dialogue going in her head.

“I’m trying to talk myself through the moment, saying I’m not going to be here forever. I think it’s more of a trust issue. If you feel like you can’t get out, is somebody going to let you out?”

Rosanna repeated to herself that no one was going to leave her in the scanner. That she would be done in half an hour. That she would get to go home. That this is no big deal. And she made it all the way through, admitting after the exam that it wasn’t bad and she could do it again if needed. Dr. Farchione says if you can talk yourself through it, you can dial down the feeling of danger. “It’s being able to do self talk that’s going to help us diminish the danger associated with the situation, and very importantly be able to make us feel more comfortable in our ability to cope.”

Exposure-Based Treatment for Claustrophobia

Once you’ve set your thinking straight, Dr. Farchione recommends easing yourself into the situation. This is the part you can do before your appointment – either at home or with professional help. It’s called exposure-based therapy and means you expose yourself to the thing that frightens you. Working with a therapist, some exposure-based treatments for a specific phobia can be done in an afternoon. Dr. Farchione says at Boston University’s Center for Anxiety and Related Disorders (CARD) they’ll spend 3 to 4 hours helping people conquer claustrophobia. Part of the treatment involves using an enclosed closet-like space. As you work through exposing yourself to the situation that scares you – yes, actually getting into a closet – you develop basic skills to help you cope with your fear.

But you don’t always need a professional to do exposure-based treatment according to Dr. Farchione. He recommends getting your thinking straight and then easing yourself into the situation.

“Take this as an opportunity to say, you know, I don’t think I can do this MRI. I’m either going to get some help from somebody who knows how to do an exposure-based treatment. Or, you know what, I’ll start doing exposures on my own that are going to mimic that situation.”

You can try this by finding a confined space at home and simply practicing. Your best bet is a space that makes you feel uncomfortable and taps into your fear – perhaps it’s a closet or the space under your bed. Dr. Farchione even suggests crawling between your mattress and a fitted sheet to produce the claustrophobic reaction. But before you expose yourself to the situation, create a fear ladder.

Building a Claustrophobia Fear Ladder

A fear ladder (also called a fear hierarchy) is a list of steps that starts with a simple exposure that mimics an MRI and escalates to actually getting the scan. The steps might look something like this:

1. Start by looking at photos of an MRI machine
2. Sit in a closet with the door open
3. While you’re in the closet, try listening to MRI sounds
4. Next try closing the closet door

For more examples of steps to conquering phobias with fear ladders, click here. By simulating the experience and responding to the fear you experience, you will build up your confidence. With each success, plan to reward yourself. Positive reinforcement will keep you climbing the steps toward your goal. And if the step is too difficult, go back down the ladder. Dr. Farchione says the key to a fear ladder is easing into it and being kind to yourself:

“If a person does it every day for a week, I guarantee you that person is going to feel more confident in their ability to manage the situation and they’re going to have less of a physical response to the situation because of that process of habituation.”

It may seem easiest to just avoid what makes you afraid. But when it comes to your health, skipping an MRI is not usually the best option. And experts say avoiding your fear is actually what maintains it. Using exposures can prepare you to confront the scanner, teach you to manage your fear, help you finish your exam, and get you headed home with a sense of accomplishment.