Claustrophobia And Anxiety
Abstract
MRI machines can trigger claustrophobia and anxiety and the designers have known about this issue from the introduction of the first MRI machines. It is important to understand the specific qualities of MRI machines that trigger these reactions and it is also important to understand why the industry has not fully address this issue. The concept for this paper comes from the statistics of claustrophobia and anxiety incidents and from personal experience with claustrophobia during an MRI procedure.
The literature review demonstrated that between 5% and 10.6% of the people screened prior to an MRI scan are found to be claustrophobic, with another 7% discovering claustrophobic tendencies at the time of the procedure. Another 30% …show more content…
have anxiety brought on by the procedure as well.
The perspectives for this study include the perspective of the patient and the designers and engineers who design the MRI machines. The research approach is qualitative, which includes questionnaires and the personal experiences of those who have direct experience with the phenomenon as well as from the designers and engineers involved in the design of MRI machines.
The research questions are, “Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?” and “The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?”
The sampling from the patients will be a random sample of 100 patients who have had anxiety and claustrophobic reactions to MRI scans for the first question and a sample of 200 engineers and designers who have contributed to the design of MRI machines for the second question.
The concepts to be explored by this study are the specific qualities of MRI machines that trigger claustrophobia and anxiety for the first question and the opinions, engineering justifications and other reasons from the engineers and designers for the second question. The analysis type will be through grounded theory, where the data will be open-coded to form an index with the key aspects of the data which will be constant compared to sort and contrast the data.
Introduction
The purpose of this writing is to address the issue of claustrophobia and anxiety triggered by MRI machines. From the introduction of the MRI machine to perform better and more detailed scans of the body, the issue of claustrophobia and anxiety has existed, and yet the issue has never been fully addressed. The reasons behind why these machines cause so much stress and the reasons why the industry has chosen to make minimal changes to the machines to address this issue must be explored if this issue is to be fully addressed.
This issue will be explored by using a qualitative research approach and two specific elements of this issue will be examined by way of research questions. The first element to be examined is the particular qualities of MRI machines that trigger claustrophobia and anxiety. The second element of this issue to be examined concerns the possible reasons why MRI machines have not been redesigned to address these qualities.
Conceptualization
There many topics of interest to me that would make for a reasonable research project; however, based upon my recent experiences, I have chosen Claustrophobia as my focus.
Claustrophobia is a very broad subject indeed, but again, my experience, or rather, my ordeal, has dictated the tighter focus of Claustrophobia and MRI scans.
Upon a cursory search on the subject of claustrophobia and MRI scans, I have found that this is actually quite a large problem with a rich gold mine of information about this subject. For instance, about 5% of the population is claustrophobic, yet 10% of all MRI scans in the United States fail because of this issue. There are several questions that I want to ask about this subject, not the least of which is why? Why do MRI machines trigger claustrophobia? Why aren’t more MRI machines designed with this issue in mind? What can be done to reduce or alleviate the anxiety that claustrophobia produces, in order for a patient to have a successful scan?
Claustrophobia is a fear of enclosed spaces but how does one ever really know they are claustrophobic. For my own personal experience, I had absolutely no clue that I was until I was face to face with a big mean looking machine called an …show more content…
MRI.
My first attempt at a closed MRI personally even the concept makes me shudder. But still I had no real clue. I was brave I thought it’s just a machine what could go wrong. They had me all prepared and I lay on the table, they gave me headphones and my choice of music. I put the headphones on and they started moving the table into the evil cylinder. They got me to my shoulders and it was OVER. First of all, I felt like one shoulder would eventually touch the other (yes I was that squished). Second I had about 2 inches above my face that was ALL machine. This was not going to be a good test…..EPIC fail.
SO now I am aware of my claustrophobia…what would be the next step for this MRI scaredy-cat. Well doctor said we will do an open MRI. I said that sounds like a plan. Open to me well seems to mean OPEN. They lie.
While it was indeed more open than the closed MRI, the top of the machine is now oh about 4-6 inches above my face. I don’t know about anyone else but I knew that this TWO year old MRI machine would break and I would die inside. No matter what anyone said I could not calm my fears, my anxiety…again EPIC fail.
They say third times a charm right? Well in this case yes it was however it took a 2 mg Xanax to chill me out enough to get through the 25 minute scan of my back. Needless to say about a half hour after the test the real effects of my Xanax kicked in and I slept 8 hours.
My only consolation is that I am not alone in this fear. Research proves it.
Literature Review
The good folks at Proscan Imaging have a pamphlet that they have developed to help with the issue of claustrophobia and MRI scans. They address this issue with many useful suggestions, but more importantly, they have an interesting statistic. They indicate that between 5% and 10.6% of the people who have been screened before receiving an MRI scan are claustrophobic. About 7% of patients discover that they are claustrophobic at the time of the scan. Another 30% of patients have milder anxiety from having to lie still in a confined space for the duration of the procedure (Proscan Imaging, 2010).
McIsaac, Thordarson, Shafran, Rachman and Poole did a study published in 1998 about claustrophobia and the MRI procedure in order to investigate the nature of the anxiety experienced during MRI scans, to determine the predictors of anxiety during the procedure and to examine the secondary effects of anxiety from undergoing the procedure (McIssac, H. K, et. al. 1998).
MRIsafety.com presents an article with good information about the impact of emotional distress, the factors that contribute to distress and several stress minimizing techniquest that can be used by a technician to help claustrophobic patients (Shellock, 2012).
Perspective
There seems to be many ways to define, diagnose or theorize about claustrophobia as it pertains to the MRI procedure, however, I believe that more literature review and exposure to other studies about this phenomenon will yield a better understanding of the various perspectives available for this issue as this project progresses. It appears that the perspective of a researcher, MRI technician, perspective MRI patient and advising physician have been seen in the literature so far, however, I am searching for a more complete understanding of the nature of the issue at this point.
Research Approach
I believe that this particular subject would best be explored by using a qualitative research approach, due in part to my own experience of the phenomenon and also because of the subjective nature of the experience of claustrophobia as it pertains to MRI scans. It seems to me that this is a personal and embarassing experience, both for the patient and for the technician and a qualitative research approach will most likely yield the essense and substance of this
experience.
A questionnaire with a section for experience narrative to be given to a random sampling of 80 to 100 MRI patients from the local hospitals would be a very good beginning to gather the information for a qualitative research project. Direct observation of patients who have no issues with the procedure and those with varying levels of anxiety, including those who interrupt the procedure and those who are unable to go through with it would also be beneficial, in order to have comparisons. If the hospitals would be willing to release the information, it would also be beneficial to interview those who have failed to show up for their appointments due to claustrophobia issues.
Based upon these research methods, I believe that a qualitative, rather than a quantitative approach would be the most beneficial to research claustrophobia and MRI scans.
Forming Research Questions
Claustrophobia can be a debilitating experience for those who suffer from this condition. When a routine MRI procedure triggers a claustrophobic or anxiety reaction, the procedure will often fail. The patient who experiences claustrophobia brought on by the prospect of an MRI scan might stop the procedure prematurely, balk at entering the MRI machine or fail to show up for the appointment altogether. This costs time, money and, in the case of the patient, embarrassment and further anxiety or sense of failure. There are several questions that naturally arise when one considers this issue.
Qualitative Question 1
Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?
One of the reasons for using a qualitative measure for this question is to gain a deeper understanding of the phenomenon, which in this case is claustrophobia and how it is triggered by MRI machines (Trochim & Donnelly, 2008). The data to be gathered to answer this question includes subjective perceptions by patients who have experienced claustrophobia brought on by an MRI scan or the prospect of an MRI scan. Details include any physical characteristics that specifically triggered the anxiety effects, such as the size of the bore, whether the bore was lighted or dark, or any other characteristics that specifically brought about an anxiety reaction. Other details to be gathered are any psychological triggers, such as the fear of getting stuck in the bore with no fast way to get out, a fear that the machine will collapse on the patient, a fear that the technicians will forget that the patient is in the machine, and any other psychological beliefs that could trigger the anxiety reaction.
The expectation is that themes will emerge from the data that will shed light on the common experiences and triggering stimuli for this phenomenon. If such common themes emerge, it might be possible to isolate the physical characteristics of the MRI machine for possible re-engineering and also to isolate the psychological beliefs so they can be addressed by medical staff as well.
Qualitative Question 2
The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?
This qualitative question is more in line with a feasibility study, rather than a research study, however, it seems to be a worthy and useful question to develop an answer for. A literature review of other design and feasibility studies as well as explanations from engineers, medical technicians and radiologists might yield sufficient data to develop common themes to answer the question.
Based upon the findings in qualitative question 1, the answer to qualitative question 2 might also yield a better design that could possibly fully mitigate the anxiety that current MRI machines produce in those who experience claustrophobia when faced with the prospect of this routine scanning procedure. After all, isn’t the point to research to find solutions to problems or to find ways to overcome obstacles and to improve the quality of life? If such a significant number of people who suffer from claustrophobia from MRI scans were to have this issue completely resolved, wouldn’t life be easier? The cost in time, money and the psychological effects of embarrassment and a sense of failure would be eliminated, which would benefit the patient and the medical industry as a whole.
Sampling and Data Types
Qualitative Question 1
Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?
The specific phenomenon that will be studied by asking this question is the triggering factors about MRI machines that bring about a claustrophobic or anxiety reaction. It is to be hoped that the feelings of the participants will be captured by the questions, such as “a tomb-like tube”, or “a panicky, smothering feeling when going into the machine” as examples. In capturing these participant feelings, the expectation is that specific themes will begin to emerge that might provide a more complete understanding of the phenomenon of claustrophobia and anxiety as it relates to the MRI procedure.
The participant sample will need to be limited to those who experience claustrophobia and anxiety when exposed to an MRI procedure. I believe that a sample size of 100 participants with a random experience from mild anxiety to debilitating claustrophobia will be sufficient to gather both the feelings of the participants and the specific qualities about the MRI machine that induces the claustrophobic and anxiety reaction. It will not be necessary to expose the participants to the actual machine in order to avoid causing harm. Pictures of MRI machines coupled with their past experience should suffice to gather the data.
Qualitative Question 2
The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?
The specific phenomenon will be studied in this case is why the design of MRI machines has not changed since the first use and subsequent claustrophobic reaction to the design. Over the years while MRI machines have been in use, there have been significant claustrophobic and anxiety reactions to these machines. It is important to understand why the engineers who design these machines have not created machines designed to alleviate these reactions. It would seem to be a simple matter of a study where those who have such reactions could volunteer to test new designs until the reactions are negated. Why has this not been done?
The sample for this question would be the engineers who design MRI machines, both past and present. Due to the assumed number of these engineers, the sample might need to be the whole population, if there are, say, 200 engineers in the world that design MRI machines. If there are more than that number, then a representative sample should be selected from those engineers with the most knowledge, understanding and involvement in the design of MRI machines should be purposefully selected and interviewed.
In this particular case, based upon the first round of interviews and data gathering, it might be wise to use analysis driven purposeful sampling (Coyne, 1997) to further reduce the sample and define the thematic issues that might be involved from the engineering standpoint as to why these machines have yet to be fully claustrophobia and anxiety proof.
Concepts
Qualitative Question 1
Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?
The concept that will be studied from this question consists of the actual triggering qualities of MRI machines. These qualities include the parts of the MRI machine that inspire anxiety and claustrophobia, and is not limited to the bore. It is also important to gather personal experience narratives and observations of patient reactions in order to add richness to the data for the purpose of possibly describing the experience of claustrophobia categorized by which parts of an MRI machine or what qualities an MRI machine possesses that cause the claustrophobia or anxiety reaction. If the various elements of MRI machines that trigger claustrophobia and anxiety can be identified, then it might be possible to construct a viable engineering plan to address these issues for future patients. Currently, the only options available to patients that suffer from claustrophobia and anxiety during MRI procedures are to be medicated or to abandon the procedure altogether. Even the so-called “open” MRI machines have qualities that trigger claustrophobia and anxiety, which must also be identified.
Qualitative Question 2
The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?
The concept that will be studied from this question consists of the opinions, engineering justifications and other reasons gathered from professionals involved in the design of MRI machines. This is the concept of why the engineers chose to build machines in the way that they did and why they did not take into account claustrophobia and anxiety. Another bit of data that would be useful would be why studies on what particular qualities about the MRI machine specifically trigger claustrophobia and anxiety. The analysis of this data can be valuable in that it might give direction for further study on the part of the engineers that design MRI machines. The analysis of this information is as important as the information gathered for the first question, in that by finding these reasons, they might be addressed both from a psychological and engineering point of view.
Analysis Types
There are a couple of methods of analysis available that would be appropriate for the qualitative data gathered for these questions. Data reduction is a method designed to reduce the data throughout the study and, by applying coding and constant comparison, patterns, relationships, links and themes begin to emerge. Analytic induction involves reviewing all of the data that has been gathered for categories of phenomena, defining sets of relationships, further development of hypotheses, the gathering of more data if needed and refining the hypotheses until meaning has been derived (The Association for Educational Communications and Technology, 2001).
The most appropriate method of analysis for this type of data seems to be through the use of a grounded theory perspective. Through grounded theory method, the data is open-coded, where the key aspects of the data are used to create an index, followed by constant comparison, which is where the elements of the data are continuously sorted and contrasted. At this point, a decision is made whether to perform theoretical resampling, where more data is gathered to add more meaning to the existing data. This process continues until redundancy begins to happen in the constant comparison phase, at which point the data is at theoretical saturation (Trochim & Donnelly, 2008).
Conclusion
The issue of claustrophobia and anxiety brought about by MRI scans has existed from the introduction of the MRI machine; however, the issue has never been fully explored and addressed. It is important to understand the specific qualities about MRI machines from the patient’s point of view that trigger the claustrophobia and anxiety reaction and it is also important to understand why the designers and engineers have chosen to only minimally address these issues, if there is to be real change in the way that future MRI machines are designed.
Self-Reflection
This topic has been of specific interest to me due to my own personal issues and experiences with claustrophobia and MRI scans. While I have been able to have the procedure, thanks to medication, the issue continues to persist. It is not enough to provide patients with medications and coping techniques to overcome the issue of claustrophobia and anxiety when faced with MRI scans. The industry and medical community must approach this issue with intelligence and care to understand the real triggering factors and they must respond by requiring design changes that address this issue.
The process of designing this study has helped me to understand some of the processes by which a real solution to this issue might be achieved. There is much work that needs to be done on the part of researchers if this issue is to be resolved in a satisfactory way. By performing this research, it can be hoped that one day MRI machines might be friendly enough for anyone without the use of medication or coping techniques.
References
Coyne, I. T. (1997). Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? Journal of Advanced Nursing, 623-630.
Disher, B., Lenarduzzi, L., Lewis, B., & Teeuwen, J. (2006, March 21). The History of MRI. Retrieved April 10, 2012, from University of Windsor: http://web2.uwindsor.ca/courses/physics/high_schools/2006/Medical_Imaging/mrihistory.html
Frank G. Shellock, P. (2012). Claustrophobia, Anxiety, and Emotional Distress. Retrieved April 3, 2012, from MRIsafety.com: http://www.mrisafety.com/safety_article.asp?subject=181
McIssac, H. K., Thordarson, D. S., Shafran, R., Rachman, S., & Poole, G. (1998). Claustrophobia and the Magnetic Resonance Imaging Procedure. Journal of Behavioral Medicine, 21(3), 255 - 268.
Proscan Imaging. (2010). Claustrophobia and mri: Reducing anxiety during your examination. Retrieved April 3, 2012, from Proscan Imaging: http://www.proscan.com/_filelib/FileCabinet/Medical_Pieces/claustro_web.pdf?FileName=claustro_web.pdf
Trochim, W. M., & Donnelly, J. P. (2008). The Research Methods Knowledge Base. Mason: Atomic Dog.
The Association for Educational Communications and Technology. (2001). The Handbook of Research for Educational Communications and Technology. Bloomington: The Association for Educational Communications and Technology.
MRI machines can trigger claustrophobia and anxiety and the designers have known about this issue from the introduction of the first MRI machines. It is important to understand the specific qualities of MRI machines that trigger these reactions and it is also important to understand why the industry has not fully address this issue. The concept for this paper comes from the statistics of claustrophobia and anxiety incidents and from personal experience with claustrophobia during an MRI procedure.
The literature review demonstrated that between 5% and 10.6% of the people screened prior to an MRI scan are found to be claustrophobic, with another 7% discovering claustrophobic tendencies at the time of the procedure. Another 30% …show more content…
have anxiety brought on by the procedure as well.
The perspectives for this study include the perspective of the patient and the designers and engineers who design the MRI machines. The research approach is qualitative, which includes questionnaires and the personal experiences of those who have direct experience with the phenomenon as well as from the designers and engineers involved in the design of MRI machines.
The research questions are, “Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?” and “The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?”
The sampling from the patients will be a random sample of 100 patients who have had anxiety and claustrophobic reactions to MRI scans for the first question and a sample of 200 engineers and designers who have contributed to the design of MRI machines for the second question.
The concepts to be explored by this study are the specific qualities of MRI machines that trigger claustrophobia and anxiety for the first question and the opinions, engineering justifications and other reasons from the engineers and designers for the second question. The analysis type will be through grounded theory, where the data will be open-coded to form an index with the key aspects of the data which will be constant compared to sort and contrast the data.
Introduction
The purpose of this writing is to address the issue of claustrophobia and anxiety triggered by MRI machines. From the introduction of the MRI machine to perform better and more detailed scans of the body, the issue of claustrophobia and anxiety has existed, and yet the issue has never been fully addressed. The reasons behind why these machines cause so much stress and the reasons why the industry has chosen to make minimal changes to the machines to address this issue must be explored if this issue is to be fully addressed.
This issue will be explored by using a qualitative research approach and two specific elements of this issue will be examined by way of research questions. The first element to be examined is the particular qualities of MRI machines that trigger claustrophobia and anxiety. The second element of this issue to be examined concerns the possible reasons why MRI machines have not been redesigned to address these qualities.
Conceptualization
There many topics of interest to me that would make for a reasonable research project; however, based upon my recent experiences, I have chosen Claustrophobia as my focus.
Claustrophobia is a very broad subject indeed, but again, my experience, or rather, my ordeal, has dictated the tighter focus of Claustrophobia and MRI scans.
Upon a cursory search on the subject of claustrophobia and MRI scans, I have found that this is actually quite a large problem with a rich gold mine of information about this subject. For instance, about 5% of the population is claustrophobic, yet 10% of all MRI scans in the United States fail because of this issue. There are several questions that I want to ask about this subject, not the least of which is why? Why do MRI machines trigger claustrophobia? Why aren’t more MRI machines designed with this issue in mind? What can be done to reduce or alleviate the anxiety that claustrophobia produces, in order for a patient to have a successful scan?
Claustrophobia is a fear of enclosed spaces but how does one ever really know they are claustrophobic. For my own personal experience, I had absolutely no clue that I was until I was face to face with a big mean looking machine called an …show more content…
MRI.
My first attempt at a closed MRI personally even the concept makes me shudder. But still I had no real clue. I was brave I thought it’s just a machine what could go wrong. They had me all prepared and I lay on the table, they gave me headphones and my choice of music. I put the headphones on and they started moving the table into the evil cylinder. They got me to my shoulders and it was OVER. First of all, I felt like one shoulder would eventually touch the other (yes I was that squished). Second I had about 2 inches above my face that was ALL machine. This was not going to be a good test…..EPIC fail.
SO now I am aware of my claustrophobia…what would be the next step for this MRI scaredy-cat. Well doctor said we will do an open MRI. I said that sounds like a plan. Open to me well seems to mean OPEN. They lie.
While it was indeed more open than the closed MRI, the top of the machine is now oh about 4-6 inches above my face. I don’t know about anyone else but I knew that this TWO year old MRI machine would break and I would die inside. No matter what anyone said I could not calm my fears, my anxiety…again EPIC fail.
They say third times a charm right? Well in this case yes it was however it took a 2 mg Xanax to chill me out enough to get through the 25 minute scan of my back. Needless to say about a half hour after the test the real effects of my Xanax kicked in and I slept 8 hours.
My only consolation is that I am not alone in this fear. Research proves it.
Literature Review
The good folks at Proscan Imaging have a pamphlet that they have developed to help with the issue of claustrophobia and MRI scans. They address this issue with many useful suggestions, but more importantly, they have an interesting statistic. They indicate that between 5% and 10.6% of the people who have been screened before receiving an MRI scan are claustrophobic. About 7% of patients discover that they are claustrophobic at the time of the scan. Another 30% of patients have milder anxiety from having to lie still in a confined space for the duration of the procedure (Proscan Imaging, 2010).
McIsaac, Thordarson, Shafran, Rachman and Poole did a study published in 1998 about claustrophobia and the MRI procedure in order to investigate the nature of the anxiety experienced during MRI scans, to determine the predictors of anxiety during the procedure and to examine the secondary effects of anxiety from undergoing the procedure (McIssac, H. K, et. al. 1998).
MRIsafety.com presents an article with good information about the impact of emotional distress, the factors that contribute to distress and several stress minimizing techniquest that can be used by a technician to help claustrophobic patients (Shellock, 2012).
Perspective
There seems to be many ways to define, diagnose or theorize about claustrophobia as it pertains to the MRI procedure, however, I believe that more literature review and exposure to other studies about this phenomenon will yield a better understanding of the various perspectives available for this issue as this project progresses. It appears that the perspective of a researcher, MRI technician, perspective MRI patient and advising physician have been seen in the literature so far, however, I am searching for a more complete understanding of the nature of the issue at this point.
Research Approach
I believe that this particular subject would best be explored by using a qualitative research approach, due in part to my own experience of the phenomenon and also because of the subjective nature of the experience of claustrophobia as it pertains to MRI scans. It seems to me that this is a personal and embarassing experience, both for the patient and for the technician and a qualitative research approach will most likely yield the essense and substance of this
experience.
A questionnaire with a section for experience narrative to be given to a random sampling of 80 to 100 MRI patients from the local hospitals would be a very good beginning to gather the information for a qualitative research project. Direct observation of patients who have no issues with the procedure and those with varying levels of anxiety, including those who interrupt the procedure and those who are unable to go through with it would also be beneficial, in order to have comparisons. If the hospitals would be willing to release the information, it would also be beneficial to interview those who have failed to show up for their appointments due to claustrophobia issues.
Based upon these research methods, I believe that a qualitative, rather than a quantitative approach would be the most beneficial to research claustrophobia and MRI scans.
Forming Research Questions
Claustrophobia can be a debilitating experience for those who suffer from this condition. When a routine MRI procedure triggers a claustrophobic or anxiety reaction, the procedure will often fail. The patient who experiences claustrophobia brought on by the prospect of an MRI scan might stop the procedure prematurely, balk at entering the MRI machine or fail to show up for the appointment altogether. This costs time, money and, in the case of the patient, embarrassment and further anxiety or sense of failure. There are several questions that naturally arise when one considers this issue.
Qualitative Question 1
Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?
One of the reasons for using a qualitative measure for this question is to gain a deeper understanding of the phenomenon, which in this case is claustrophobia and how it is triggered by MRI machines (Trochim & Donnelly, 2008). The data to be gathered to answer this question includes subjective perceptions by patients who have experienced claustrophobia brought on by an MRI scan or the prospect of an MRI scan. Details include any physical characteristics that specifically triggered the anxiety effects, such as the size of the bore, whether the bore was lighted or dark, or any other characteristics that specifically brought about an anxiety reaction. Other details to be gathered are any psychological triggers, such as the fear of getting stuck in the bore with no fast way to get out, a fear that the machine will collapse on the patient, a fear that the technicians will forget that the patient is in the machine, and any other psychological beliefs that could trigger the anxiety reaction.
The expectation is that themes will emerge from the data that will shed light on the common experiences and triggering stimuli for this phenomenon. If such common themes emerge, it might be possible to isolate the physical characteristics of the MRI machine for possible re-engineering and also to isolate the psychological beliefs so they can be addressed by medical staff as well.
Qualitative Question 2
The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?
This qualitative question is more in line with a feasibility study, rather than a research study, however, it seems to be a worthy and useful question to develop an answer for. A literature review of other design and feasibility studies as well as explanations from engineers, medical technicians and radiologists might yield sufficient data to develop common themes to answer the question.
Based upon the findings in qualitative question 1, the answer to qualitative question 2 might also yield a better design that could possibly fully mitigate the anxiety that current MRI machines produce in those who experience claustrophobia when faced with the prospect of this routine scanning procedure. After all, isn’t the point to research to find solutions to problems or to find ways to overcome obstacles and to improve the quality of life? If such a significant number of people who suffer from claustrophobia from MRI scans were to have this issue completely resolved, wouldn’t life be easier? The cost in time, money and the psychological effects of embarrassment and a sense of failure would be eliminated, which would benefit the patient and the medical industry as a whole.
Sampling and Data Types
Qualitative Question 1
Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?
The specific phenomenon that will be studied by asking this question is the triggering factors about MRI machines that bring about a claustrophobic or anxiety reaction. It is to be hoped that the feelings of the participants will be captured by the questions, such as “a tomb-like tube”, or “a panicky, smothering feeling when going into the machine” as examples. In capturing these participant feelings, the expectation is that specific themes will begin to emerge that might provide a more complete understanding of the phenomenon of claustrophobia and anxiety as it relates to the MRI procedure.
The participant sample will need to be limited to those who experience claustrophobia and anxiety when exposed to an MRI procedure. I believe that a sample size of 100 participants with a random experience from mild anxiety to debilitating claustrophobia will be sufficient to gather both the feelings of the participants and the specific qualities about the MRI machine that induces the claustrophobic and anxiety reaction. It will not be necessary to expose the participants to the actual machine in order to avoid causing harm. Pictures of MRI machines coupled with their past experience should suffice to gather the data.
Qualitative Question 2
The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?
The specific phenomenon will be studied in this case is why the design of MRI machines has not changed since the first use and subsequent claustrophobic reaction to the design. Over the years while MRI machines have been in use, there have been significant claustrophobic and anxiety reactions to these machines. It is important to understand why the engineers who design these machines have not created machines designed to alleviate these reactions. It would seem to be a simple matter of a study where those who have such reactions could volunteer to test new designs until the reactions are negated. Why has this not been done?
The sample for this question would be the engineers who design MRI machines, both past and present. Due to the assumed number of these engineers, the sample might need to be the whole population, if there are, say, 200 engineers in the world that design MRI machines. If there are more than that number, then a representative sample should be selected from those engineers with the most knowledge, understanding and involvement in the design of MRI machines should be purposefully selected and interviewed.
In this particular case, based upon the first round of interviews and data gathering, it might be wise to use analysis driven purposeful sampling (Coyne, 1997) to further reduce the sample and define the thematic issues that might be involved from the engineering standpoint as to why these machines have yet to be fully claustrophobia and anxiety proof.
Concepts
Qualitative Question 1
Based upon the information available, what specific quality or qualities about MRI machines triggers claustrophobia and anxiety?
The concept that will be studied from this question consists of the actual triggering qualities of MRI machines. These qualities include the parts of the MRI machine that inspire anxiety and claustrophobia, and is not limited to the bore. It is also important to gather personal experience narratives and observations of patient reactions in order to add richness to the data for the purpose of possibly describing the experience of claustrophobia categorized by which parts of an MRI machine or what qualities an MRI machine possesses that cause the claustrophobia or anxiety reaction. If the various elements of MRI machines that trigger claustrophobia and anxiety can be identified, then it might be possible to construct a viable engineering plan to address these issues for future patients. Currently, the only options available to patients that suffer from claustrophobia and anxiety during MRI procedures are to be medicated or to abandon the procedure altogether. Even the so-called “open” MRI machines have qualities that trigger claustrophobia and anxiety, which must also be identified.
Qualitative Question 2
The medical industry has known about MRI machines triggering claustrophobia and anxiety since the first MRI machine was used in 1977 (Disher, Lenarduzzi, Lewis, & Teeuwen, 2006). Why has a fully claustrophobia friendly design not been introduced to replace existing machines?
The concept that will be studied from this question consists of the opinions, engineering justifications and other reasons gathered from professionals involved in the design of MRI machines. This is the concept of why the engineers chose to build machines in the way that they did and why they did not take into account claustrophobia and anxiety. Another bit of data that would be useful would be why studies on what particular qualities about the MRI machine specifically trigger claustrophobia and anxiety. The analysis of this data can be valuable in that it might give direction for further study on the part of the engineers that design MRI machines. The analysis of this information is as important as the information gathered for the first question, in that by finding these reasons, they might be addressed both from a psychological and engineering point of view.
Analysis Types
There are a couple of methods of analysis available that would be appropriate for the qualitative data gathered for these questions. Data reduction is a method designed to reduce the data throughout the study and, by applying coding and constant comparison, patterns, relationships, links and themes begin to emerge. Analytic induction involves reviewing all of the data that has been gathered for categories of phenomena, defining sets of relationships, further development of hypotheses, the gathering of more data if needed and refining the hypotheses until meaning has been derived (The Association for Educational Communications and Technology, 2001).
The most appropriate method of analysis for this type of data seems to be through the use of a grounded theory perspective. Through grounded theory method, the data is open-coded, where the key aspects of the data are used to create an index, followed by constant comparison, which is where the elements of the data are continuously sorted and contrasted. At this point, a decision is made whether to perform theoretical resampling, where more data is gathered to add more meaning to the existing data. This process continues until redundancy begins to happen in the constant comparison phase, at which point the data is at theoretical saturation (Trochim & Donnelly, 2008).
Conclusion
The issue of claustrophobia and anxiety brought about by MRI scans has existed from the introduction of the MRI machine; however, the issue has never been fully explored and addressed. It is important to understand the specific qualities about MRI machines from the patient’s point of view that trigger the claustrophobia and anxiety reaction and it is also important to understand why the designers and engineers have chosen to only minimally address these issues, if there is to be real change in the way that future MRI machines are designed.
Self-Reflection
This topic has been of specific interest to me due to my own personal issues and experiences with claustrophobia and MRI scans. While I have been able to have the procedure, thanks to medication, the issue continues to persist. It is not enough to provide patients with medications and coping techniques to overcome the issue of claustrophobia and anxiety when faced with MRI scans. The industry and medical community must approach this issue with intelligence and care to understand the real triggering factors and they must respond by requiring design changes that address this issue.
The process of designing this study has helped me to understand some of the processes by which a real solution to this issue might be achieved. There is much work that needs to be done on the part of researchers if this issue is to be resolved in a satisfactory way. By performing this research, it can be hoped that one day MRI machines might be friendly enough for anyone without the use of medication or coping techniques.
References
Coyne, I. T. (1997). Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? Journal of Advanced Nursing, 623-630.
Disher, B., Lenarduzzi, L., Lewis, B., & Teeuwen, J. (2006, March 21). The History of MRI. Retrieved April 10, 2012, from University of Windsor: http://web2.uwindsor.ca/courses/physics/high_schools/2006/Medical_Imaging/mrihistory.html
Frank G. Shellock, P. (2012). Claustrophobia, Anxiety, and Emotional Distress. Retrieved April 3, 2012, from MRIsafety.com: http://www.mrisafety.com/safety_article.asp?subject=181
McIssac, H. K., Thordarson, D. S., Shafran, R., Rachman, S., & Poole, G. (1998). Claustrophobia and the Magnetic Resonance Imaging Procedure. Journal of Behavioral Medicine, 21(3), 255 - 268.
Proscan Imaging. (2010). Claustrophobia and mri: Reducing anxiety during your examination. Retrieved April 3, 2012, from Proscan Imaging: http://www.proscan.com/_filelib/FileCabinet/Medical_Pieces/claustro_web.pdf?FileName=claustro_web.pdf
Trochim, W. M., & Donnelly, J. P. (2008). The Research Methods Knowledge Base. Mason: Atomic Dog.
The Association for Educational Communications and Technology. (2001). The Handbook of Research for Educational Communications and Technology. Bloomington: The Association for Educational Communications and Technology.