Claustrophobia - can you run out of oxygen in lifts?

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abc
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Claustrophobia - can you run out of oxygen in lifts?

Post by abc »

Hi All. I'm wondering if anyone know of evidence that shows its really unlikely to die of lack of oxygen if you every get stuck in a lift or enclosed space. I have a client who is struggling to overcome her fear of running out of air if she is in small spaces for too long. We've been doing exposure but she still isn't convinced. I've looked for something that says how unlikely it is, or how long air will last (or anything) but the NHS web stops me from going into anything that might be slightly useful (Arggghhh). Any help?
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escapee
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Post by escapee »

Not exactly what you're looking for but I read of some therapy where the client went into a very small room, and the therapist lit an incense stick outside the door. The client being able to smell it allowed them to understand the amount of airflow that there actually was. I wonder if you could do something similar?
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miriam
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Post by miriam »

Our fire safety lecture explained that a human can survive on less oxygen than a fire needs, so theoretically even if trapped in an entirely sealed room with a fire, the fire would burn out and we'd still be able to crawl away.

But people get trapped in lifts for hours and are fine, even if lots of people are sharing the air. There is footage online of one poor guy trapped for 41 hours, and barring some minor hallucinations (and presumably problems regarding how to go to the toilet) he was fine.

Never one to be defeated by a challenge, I have searched out trivia from the internet to enable me to calculate how long a person could last on the air in a space 2m cubed....

We breathe using half to one litre of air per breath unless exerting, but we only use up 1/4 of the oxygen in it. We breathe at 6-12 breaths per minute, using around 12 litres of air per minute, but we can use that air 3-4 times before it becomes problematic, so we "use up" 3-4 litres of air per minute. A litre is 10cm*10cm*10cm, so a lift 2m*2m*2m contains 8000 litres of air, enough to last 33.5 hours.

But lifts are of couse never airtight, as they have to comply with a strict code of safety that includes a clause on having "adequate ventilation, even in an emergency" which they are checked against annually! And that level of ventilation is determined by the maximum load capacity (which is many more people than are ever in the lift).

Hope that helps!
Miriam

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Post by Ruthie »

Nice evidencing there Miriam - and love the incense stick behavioural experiment escapee. Will be bearing both of those in mind if I am working with anyone with that sort of phobia in the future :).

I think when people aren't convinced, the next step needs to be really well designed behavioural experiments that directly test the thoughts that person is having. Escapee's incense one is a really nice gentle one.

Also maybe thinking about some ideas around physiological arousal and misinterpretation of symptoms and how you can test those out - e.g. racing heart, sweating, palpitations could be misinterpreted as running out of air.

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abc
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Post by abc »

Thanks for your help guys. I've been doing exposure with her, explaining things like - it gets hotter due to body heat (which is hotter when anxious), hyperventaltion isn't suffocating - you are actually over breathing, there tiny wee spaces there and air can get through. I've shown her evidence that lifts aren't air tight (from a lift manaufactuer). She is just so convinced she will run out of air. But i'm loving the incense idea - would that set off a fire alarm in a health centre? It shouldn't do should it?

And i'm so impressed by miriam's detective work and finding how long you can survive in an air tight container. Althoug I might not mention that to her as she still doesn't believe lifts are ventilated. I even thought of telling her if she ever was to be trapped somewhere small for days she wouldn't suffocate but rather starve / freeze to death but she would probably then carry around food and layers with her! How unprofessional is it to lock her in a small space for a day just to prove her thoughts wrong? ha ha!

Thanks again guys. and hopefully this is useful for others too!

xxx
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maven
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Post by maven »

I've just thought, you could also do probability calculations on the chances of getting trapped in a lift and work out that it is less than something like winning the lottery (which our clients never seem to get fixated on as the inevitable freak of chance that will come their way). Certainly there are 11 billion lift journeys per year in the USA and only 26 lift-related deaths per year, of which more than half are of people being paid to work on the lift...
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Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare
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Post by Ruthie »

abc wrote:But i'm loving the incense idea - would that set off a fire alarm in a health centre? It shouldn't do should it?
I doubt it, but worth finding out before you do the experiment! If it does, then you could try using aromatherapy oils or something really scenty to see if that smell will carry into the lift. You could have a lot of fun with smelly stuff at your work!

Be patient with your client and yourself - these fears can take a lot of time to work through and it's really tough for people to do something they're so genuinely terrified off - even when you (and probably they) know that the fear is very unrealistic.

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Post by Kentucky_Freud_Chicken »

The standard piece of advice I give is that the human body cannot suffocate itself through anxiety, you will pass out first to reduce breathing and the body will correct itself. I think it's quite a calming image.

Practically though, is there anyway you could actually sit them in a stationary lift for a while? Maybe she works in an office with an understanding manager or maybe there's a spare lift at your workplace or something. I'm a big beliver that talking about things like this can only do so much.

Just out of interest, why does she want to go into lifts? Taking the stairs is much healthier!
abc
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Post by abc »

its not just lifts - its any small space. even public toilet cubicals (and there is only so long she can hold it in for!). and cause she has a young child who needs a pram when out in public and has a lot of hospital apts, so lifts are her only option.

And I have located a lift that rarely gets used, so we will spend some time just going up and down in the lift. we may look weird to everyone else, but hey ho!
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Post by Ruthie »

There is a wonderful example in the Oxford Behavioural Experiment's book about a psychologist and client who rode up and down an escalator repeatedly in a shopping centre. They were taken in by security! :lol:

I always tell people this story when we're planning behavioural experiments in public places so we can work out a contingency plan and take precautions. E.g. telling the shopping centre security in advance what you're doing or knowing what to say if you bump into someone either of you know.

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katyboo
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Post by katyboo »

i would not go in the lift with her though! may be a bit of safety there that prevents disconfirming her beliefs.
You prob need her to be more specfic too- how long would she have to be in the lift before she suffocated, how woudlld she know she was suffocating- ie what would be the first sign of it? This will help design the behavioural experiments.
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Post by Bella »

Maybe behavioural experiments and exposure wont actually help? May be something else is going on and you need to think from a different perspective?

Running out of air, suffocating, dying...sounds psychodynamic to me :wink:
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Post by Ruthie »

Ignore Bella - she's just too chicken to challenge her therapist thoughts and emotions around increasing clients' anxiety through exposure work and her own lack of confidence in the CBT approach ;):lol:! That's what it means when someone goes all psychodynamic on you! :wink: . (Make what you like about the excessive use of smilies in this paragraph.)

Katyboo - I would go with the client in the lift at least initially, but withdraw later if I thought only going in a lift in my presence was becoming a safety behaviour - e.g. the clients' thoughts were, "If Ruthie is here, it will be alright but I could never do this on my own." If the clients' thoughts are more along the lines of, "If I go in this lift, I will run out of air and I will suffocate" then actually my presence might be even more distressing as I would be there using up the valuable air. Like you said, it's about being specific about the thoughts and making precise predictions so you can design a really good behavioural experiment.

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miriam
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Post by miriam »

Bella does have a point though. It would be helpful to know whether suffocating is symbolic of something for the client, or reminiscent of a frightening memory, or symbolises a loss of control or humiliation. It may not just be a fear of suffocating per se (though CBT would probably treat it the same regardless). I like the Personal Construct idea of 'drilling down' into the meaning of the thought for the client, by asking things like "and that would mean?" or "and the worst thing about that would be?" but with this client I'd most want to ask "have you ever felt like you'd run out of breath and suffocate (before the lift thing)?" in case there is a near-drowning, or a threat of smothering, or something lurking in the past.
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Post by Ruthie »

Just to clarify, I was being flippant with Bella! I do agree with you Miriam - although in CBT that style of questioning ("and that would mean?" or "and the worst thing about that would be?") would be called downward arrowing. Asking about what may be lurking in the past is identifying the key formative experiences that lie behind the current difficulties. Can you tell I'm getting very into my specialist CBT placement atm? ;)
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