Around 10% of the UK population is estimated to be affected by claustrophobia at some point during their lifetime, according to the NHS. Agoraphobia is a fear of being stuck in a situation or place where it is difficult to escape; some define agoraphobia as a fear of open spaces, but this is not always correct. Agoraphobia and claustrophobia have overlapping symptoms and triggers. The main difference is shown within the DSM-5 (The Diagnostic and Statistical Manual Of Mental Disorders, used by many mental health professionals), in which agoraphobia is listed as an independent psychiatric disorder and claustrophobia is a specific phobia.
Both agoraphobia and claustrophobia can cause a fear of situations such as being in an elevator, a crowded room, or on public transport such as buses, trains, and planes. Think of a crowded bus on the morning commute. You are not able to get off the bus until it is at the next stop, and you are tightly packed in with a hundred other commuters. If you have claustrophobia, you may find yourself panicking in this situation, or even avoiding it altogether. If your fear of enclosed spaces persists and you begin avoiding these situations to the point it impacts on your daily life and wellbeing, then you may be diagnosed with agoraphobia. A fear of enclosed spaces may be relatively common, but once it begins to impact on your day-to-day life, then you must begin to look for ways to cope so that it does not control you.
So, how do we manage a fear of enclosed spaces on public transport? There are a few tried and tested methods that are recommended by health professionals and people with lived experience.
Exposure therapy
If you are so fearful of public transport that you avoid it altogether, exposure therapy is a great way to ease back in and eventually overcome your fear without becoming too overwhelmed.
If you are scared of taking a train, try travelling for just a few stops at a quiet time of the day when it’s likely to be less crowded. Many people find it easier to travel in enclosed spaces when there are fewer passengers onboard, as it is less crowded, and they are less nervous about who is watching them.
As you continue to practice this journey, the anxiety will decrease as your brain learns that what you are scared of (panicking and needing to escape) doesn’t happen. Once you can do those few stops without anxiety, try travelling for longer, or at a busier time of day. Work your way up until you can travel on public transport at busy times without fear.
Exposure therapy is hard work and requires resilience, patience with yourself, and the ability to talk yourself down when you do start to feel panic. Many of these tools are taught in Cognitive Behavioural Therapy (CBT), and you can learn more about how exposure therapy is used in CBT on the NHS website. If you are struggling to complete exposure therapy by yourself, consider speaking to a CBT therapist. You can usually self-refer to your local Talking Therapies service or you can speak to your GP who can refer you.
Reduce anxiety in other areas of your life
If your anxiety is not limited to enclosed spaces but is exacerbated by them, try working on your anxiety outside of public transport first. Whether it’s getting enough sleep, exercising, or practising good self-care, a positive routine can help lower your anxiety and make it easier when you do try exposure therapy.
For some people, medication is a good way to reduce anxiety enough to begin exposure therapy, and once they become accustomed to the things that they fear, they can then reduce or stop taking medication. If you are unsure about this, speak to your doctor or another healthcare professional.
Remember that anxiety is common
According to the charity Anxiety UK, there were 8.2 million cases of anxiety disorders worldwide. When travelling by bus, train, plane, boat, or any other method of public transport that involves a confined space, statistically speaking, you are likely not the only person within that enclosed space who is frightened.
Many people living with anxiety are afraid that they will embarrass themselves if they panic in a space they cannot easily leave, but in reality, the stigma around mental health is going down, albeit slowly, and people are more understanding. Imagine if you saw somebody else panicking on public transport. Would you be embarrassed for them, or would you be sympathetic?
Envision the worst-case scenario
What are you most afraid of happening? Let’s say that your fear of enclosed spaces is particularly high on aeroplanes because they’re crowded and you can’t get off whenever you want to. Now, let’s say you board the plane, the door closes, the plane takes off, and you’re suddenly struck with panic. You start screaming, crying, and hyperventilating. Everyone stares at you.
That’s it. That is the worst-case scenario. No matter how terrible and endless it feels at the time, maybe you can take some comfort in knowing that the human body cannot sustain a panic attack forever, as it will run too low on adrenaline. The fight-or-flight response is designed to be a short-term reaction, which is why most panic attacks only last between 10 and 30 minutes. Aeroplane staff are well trained in handling nervous passengers and will be able to coach you through your panic attack. AnxietyUK estimates that one in ten of the population is affected by a fear of flying. On a passenger jet of 300 people, at least 30 are, statistically, likely to be nervous.
Now that you’ve envisioned the worst-case scenario, ask yourself: how likely it is to happen? How many times have you screamed, cried, and hyperventilated during a flight? How many times have you seen any of the other 30 anxious people doing that? Often, we spend too long focusing on the "what ifs" of a situation that is very, very unlikely to happen. And if it does happen, so what? The most likely outcome is that the air steward will calm you down, the other passengers will be sympathetic, and nobody will remember it a month from now.
To cope with a fear of enclosed spaces on public transport, remember that you are not the only one. Humans are in-built with a fight-or-flight survival response that tells us we are in danger, and sometimes that signal is misplaced. With exposure therapy, ongoing self-care and remembering that this is a common feeling among a significant percentage of the population, a fear of public transport can be managed, reduced and, with the right amount of work, eradicated.