Ask the Doctor: Claustrophobia Treatment; “Chemo Brain;” Benefits of Journaling

Q: I have always suffered from extreme claustrophobia. Is there a way to treat it, or will I always have anxiety in tight spaces?

A: Like many other phobias, claustrophobia can often be treated successfully with some form of psychotherapy. You would start any form of therapy by describing the situations that cause you to be anxious.

Exposure therapy is widely used and can be quite effective for some people with claustrophobia. During exposure therapy, an individual is gradually exposed to the subject of his or her fear while a therapist provides helpful guidance in managing anxious feelings. The idea is that while you’re in an anxiety-inducing situation, you are with someone helping you through it. Over time, you will be able to face these things on your own.

Another commonly used treatment is cognitive behaviorial therapy (CBT). With CBT, a therapist would help you think differently about enclosed spaces, with the goal of having those new thoughts lead to more confident feelings and behaviors.

Your first step, however, is to seek out treatment with a mental health professional, who can give you treatment options.

Q: I’ve gone through two chemotherapy treatments for cancer and have noticed a change in my thinking and my memory. I’ve heard the term “chemo brain.” What is it?

A: “Chemo brain” is a term that is used a great deal, but may not be entirely accurate. The idea is that the effects of powerful chemotherapy agents can cause difficulties with concentration, organization, short-term memory and other brain functions. But many researchers believe that changes in cognition and memory may have many causes, not just chemotherapy. The stress and anxiety of a cancer diagnosis and subsequent treatments (of any kind) may lead to fuzzy thinking and attention problems. Strong pain-relieving medications can have the same effects. Certain cancers themselves can cause the body to release chemicals that affect memory and other brain functions. And obviously, cancer that has spread to the brain can affect your thinking.

There are no specific tests to diagnose chemo brain or specific treatments for its symptoms. For some people, chemo brain symptoms are temporary and will start to fade once cancer treatment ends. If pain medications are the problem, you may want to talk to your doctor about alternative drugs or other therapies. If your memory and thinking changes persist, you may want to consult with a neuropsychologist, who may help you with those changes.

Q: I recently started seeing a therapist for anxiety and stress, and she suggested journaling my thoughts and feelings. Writing, however, makes me self-conscious. Is journaling really that helpful?

A: For many people, keeping a journal helps them clearly state their thoughts, feelings, ideas, reactions, fears, etc., which in turn helps them understand their condition more clearly. It’s a way of starting to gain control over emotions, thoughts, or memories that may be troubling you. Journaling can serve two purposes: It helps you focus your thoughts, and it gives you a record you can refer to later to examine how your condition has changed or what sorts of things have triggered anxiety in the past and how you coped.

But like any therapeutic strategy, journaling isn’t for everyone. Some people become more concerned about capturing their feelings with precise language or worry about grammar and other issues because a therapist may read or hear some of the passages.

If you can stop worrying about trying to write a perfect paper and instead focus on getting your thoughts and feelings down, you may get much more out of the experience.

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