Kevin suffers from claustrophobia. This is the characterized as fear of enclosed spaces or fear that you cannot escape (Nevid, Rathus, & Greene 2018), for Kevin the enclosed space he fears is specific to the elevator. This is quite debilitating for Kevin’s lifestyle because he happens to be an elevator mechanic and it is part of his job to ride the elevator after he has fixed it to make sure his fix was a success. His chronic fear arose three years prior when he was pinned in an overturned elevator car for almost an hour. He now avoids riding the elevator at all costs and is thinking of finding a different occupation even if it means more trouble for him. When he is working, if he has no choice but to ride the elevator it results in overwhelming panic and he fears he will fall unconscious before he gets to the floor stop. He worries each night if he will make it through the next day. (Story retrieved from Nevid, Rathus, & Greene 2018).
Claustrophobia is a specific category of phobias, which are fears “of an object or situation that is disproportional to the threat it poses” (Nevid et al., 2018). When a person comes in contact with the trigger of their phobia they experience high levels of mental stimulation which creates a strong urge to avoid the situation or the trigger itself. Because of the constant nature of the anxiety when he faces the confinement of the elevator, and the avoidance behavior exhibited in Kevin daily life, it is likely claustrophobia is a sound diagnosis. Although Kevin’s age is not given in the text “the mean age of onset for claustrophobia 20 years old” (Nevid et al., 2018) Since it is clear Kevin is an adult, his adult onset or development is common for this phobia. Because of the nature of the incident that caused Kevin’s panic, there is indication that classical conditioning is at the root his fear response.
Before he was trapped three years ago the previously neutral stimulus of riding the elevator promoted no response in Kevin. However, the thought of riding the elevator, is now associated to being stuck making riding a conditioned stimulus for fear. The anxiety that results from thinking about or standing in an elevator creates a negative reinforcement that contributes to Kevin’s avoidance of elevators. Kevin does not wish to feel the anxiety associated with riding, so he doesn’t. He avoids the elevator to relieve his anxiety.
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It is also likely that there is a cognitive and biological basis for Kevin’s fear that increased his risk for developing the phobia. Cognitively, Kevin may have an oversensitivity to threatening cues (Nevid et al., 2018). Emotions rule the fear response which is coined as “fight or flight”. This describes our primal function of survival. It is called primal because it is the part of the brain that has survived years millions of years of evolution. Humans were made to respond to dangers in order to live another day. Now the dangers we face are no longer the life or death situations of our ancestors but there is no way to tell the brain that. Kevin may be overly sensitive the threat of the elevator because the “primal” centers of the brain have overacted to the threat. His logic and reasoning have been overpowered by the internal alarm system of his limbic system (2018).
Biologically, Kevin may be predisposed for developing a phobia due to his genetics. He may have genes that cause greater activation of the amygdala when he is scared. This limbic structure controls the emotional regulation of a person and with the greater activation predisposition it may be prone to be easily excitable. And make a person prone to phobic responses when they are alarmed (Nevid et al., 2018). Because there is not much to be done in the way of changing a person’s genetics there are various treatments available to try and combat Kevin’s claustrophobia.
Kevin may be best suited for gradual exposure in terms of approaching his treatment. This is “a stepwise approach in which phobic individuals gradually confront the objects or situations that they fear” (Nevid et al., 2018). In order to get rid of the anxiety this procedure effectively undoes the classical conditioning. If Kevin can ride the elevator repeatedly without anything adverse occurring, then he will no longer associate the elevator with the feeling of being trapped. I would choose this treatment rather than flooding which would be effectively forcing Kevin onto the elevator and making him stay there until the feeling subsides. I feel that this may scare Kevin more and if he should pass out it would result in another bad thing happening on an elevator.
The gradual approach allows Kevin to be exposed slowly. To take it one floor at a time, literally. He may wish to be surrounded by people he trusts while he tries each step as it comes along. He may first try just standing in the elevator with the doors open and then standing in an unmoving elevator until his panic subsides (Nevid et al., 2018). Kevin must not be anxious or panicky throughout the time before they try going further or adding on. This progression would continue until he could ride the elevator from the basement to the top floor without being afraid.
If starting out is challenging for Kevin and he doesn’t wish to try standing in an elevator, he could try virtual reality. This would enable him to see what he would see on an elevator all around him without actually having to set foot on one. Still if these approaches did not work he would try going to cognitive behavioral therapy which seeks to “identify and correct dysfunctional and distorted beliefs” (Nevid et al., 2018). One way to do this is to identify flaws in Kevin’s logic and show him that fearing the elevator is not logical. Maybe using discussion to get Kevin to come to the conclusion that elevators are not unsafe would help reduce his fear. Lastly, if neither gradual exposure nor cognitive therapy work he may want to seek anti-anxiety medication to treat the anxiety.
Reference
- Nevid, J. S., Rathus, S. A., & Greene, B. (2018). Abnormal psychology in a changing world (10th ed.). p. 176-190 Hoboken, NJ: Pearson Higher Education.
