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Claustrophobic fear and the magnetic resonance imaging procedure McIsaac, Heather K.


The study was designed to assess the characteristics of fear induced by the Magnetic Resonance Imaging Procedure (MRI). The responses of two groups are compared: 1) patients who are completely encapsulated within the MRI machine, and 2) patients who are scanned only below the hip and are therefore not enclosed within the MRI machine. Fear is a multifaceted phenomenon composed of three components: 1) cognitive, 2) behavioral, and 3) physiological. Within this study three the components were assessed to provide a more detailed description of MRI-related claustrophobic fear. Knowing the specific factors which influence patient anxiety will help determine future treatment of MRI-related distress. Since many patients endure the scan while experiencing moderate to severe anxiety the extent to which anxiety influences the diagnostic value of the examination (i.e. clarity of scan image) was evaluated. There was a significant correlation between Beck Anxiety Inventory scores, a measure of subjective distress and physiological symptoms accompanying stress, and the level of motion artifact in the scan picture. Thus, anxiety contributes to motion artifact which degrades the MRI scan image. The poorer quality scan may reduce the diagnostic value of the scan making it necessary for several repetitions which increase hospital time, expense, and patient discomfort. Regression analyses were used to assess the contribution of several variables (e.g. anxiety sensitivity, fears of suffocation and restriction, fearful thoughts about the experience) to provide a predictive profile of those patients who may experience the most distress undergoing the procedure. Two variables were predictive of anxiety during the MRI scan - scores on the Claustrophobia Questionnaire and endorsement of fearful thoughts about the procedure. Patients who were more likely to experience distress in the scan scored higher on these measures indicating their primary concerns were about the claustrophobic aspects of MRI situation and the thoughts they have about undergoing the experience. The thoughts most highly correlated were those related to suffocation and restriction. Eleven out of eighty eighty patients experienced a panic attack during the scan, of which three resulted in scan termination. The patients who experienced panic attacks scored on average 30 points higher on the Claustrophobia Questionnaire at pre-scan, thus, this measure has predictive validity as to which patients may experience the most amount of MRI-related fear. There was no difference between the two groups on position of entry into the MRI machine.

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