Materiały źródłowe

• #1 Claustrophobia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/35883

  Claustrophobia has a lifetime and 12-month prevalence of 7.7% to 12.5%. […] There is a higher prevalence of specific phobias in women. […] A 2007 European study reviewed various studies from different institutions and observed reported rates of claustrophobia among people undergoing magnetic resonance image ranging between 1% and 15%, with an average of 2.3% of patients needing sedation or being unable to be imaged because of claustrophobia.

• #2 Statistics & Facts On Claustrophobia | Risk Factors, Impact, Prevalence

  https://www.therecoveryvillage.com/mental-health/claustrophobia/claustrophobia-statistics/

  While claustrophobia can be difficult to live with, many people with the condition do not seek treatment. Statistics reveal the prevalence of claustrophobia, along with effective treatment options. […] Claustrophobia is relatively common, with a review of specific phobia research estimating that approximately 2.2% of the population experience a fear of enclosed spaces. Claustrophobia prevalence is higher among women and tends to emerge for the first time in adolescence or early adulthood. […] Despite the disruption caused by claustrophobia, reports show that a low percentage of those affected by it seek help just 7.8%. Many may avoid seeking treatment for fear of being exposed to an enclosed space. However, seeking help can result in a better quality of life.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Claustrophobia-Research.aspx

  Claustrophobia is a psychological disorder in which the person fears enclosed spaces or physical restriction. Severe claustrophobia has a high prevalence of around 4 percent in the population, and many more people have a milder version of the disorder. […] Although claustrophobia is fairly common and well known, there is much that is not yet understood about its origins and potential avenues of treatment. […] Claustrophobia can run in families. A single gene encoding a stress-regulated neuronal protein, GPm6a, can cause claustrophobia. In humans, mutations of the Gpm6a gene were more common in claustrophobic individuals than those without claustrophobia. […] Cognitive behavioral therapy and exposure therapy are the standard treatments for claustrophobia.

• #4 Claustrophobia – Wikipedia

  https://en.wikipedia.org/wiki/Claustrophobia

  One study indicates that anywhere from five to ten percent of the world population is affected by severe claustrophobia, but only a small percentage of these people receive some kind of treatment for the disorder. […] Claustrophobia is typically classified as an anxiety disorder and often results in a rather severe panic attack. […] Diagnosis of claustrophobia usually transpires from a consultation about other anxiety-related conditions. […] Several studies have proved this scale to be effective in claustrophobia diagnosis. […] In fact, estimates say that anywhere from 4 to 20% of patients refuse to go through with the scan for precisely this reason. […] This study concludes that the Claustrophobic Questionnaire (or an equivalent method of diagnosis) should be used before allowing someone to have an MRI.

• #5 Claustrophobia: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/37062

  Claustrophobia is a form of anxiety disorder, in which an irrational fear of having no escape or being closed-in can lead to a panic attack. […] It is considered a specific phobia according to the Diagnostic and Statistical Manual 5 (DSM-5). […] Up to 5 percent of Americans may experience claustrophobia. […] A diagnosis of claustrophobia may emerge during a consultation about another anxiety-related issue. […] For a specific phobia to be diagnosed, certain criteria need to be met. […] Symptoms usually appear during childhood or adolescence. […] Claustrophobia involves a fear of being restricted or confined to one area, so, having to wait in line at a checkout may also cause it in some people. […] Treatment often lasts around 10 weeks, with sessions twice a week. With appropriate treatment, it is possible to overcome claustrophobia.

• #6 Over 10 % of World’s Population Suffering from Claustrophobia,

  https://pharmanewsonline.com/over-10-of-worlds-population-suffering-from-claustrophobia-study-find/

  A recent study conducted by scientists at the University of Texas, Department of Philosophy and Psychiatry, affirms that over 10% of the worlds population is affected by claustrophobia, but only a little percentage of the population is aware of the condition and receives some kind of treatment for the disorder. […] Psychologists usually describe claustrophobia as a specific phobia and are typically classified as an anxiety disorder that often results in severe or mild panic attacks. […] The anxiety rate in everyone ranges from mild nervousness to a full-blown panic attack, the study finds. […] Another factor that predisposes someone to the condition is genes as the researchers detected a gene called GPM6A that they suspect may be a cause of claustrophobia. […] For doctors to diagnose anxiety as a phobia, it has to be serious enough to affect your ability to live a normal life.

• #7 Phobic Disorders: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/288016-overview

  Females are more frequently affected by specific phobia than males, at a rate of approximately 2:1, though rates vary across different phobic stimuli. Animal, natural environment, and situational specific phobias are predominately experienced by females, whereas blood-injection-injury phobia is experienced equally by the 2 sexes. […] Agoraphobia has a female-to-male ratio of 2-3:1. […] The prevalence of social anxiety disorder in the United States is higher in American Indians and lower in persons of Asian, Latino, African American, and Afro-Caribbean descent as compared with non-Hispanic white individuals. Prevalence figures for specific phobia and agoraphobia appear not to vary substantially across cultural or racial groups.

• #8 Reduction of Claustrophobia with Short-Bore versus Open Magnetic Resonance Imaging: A Randomized Controlled Trial | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0023494

  In this first randomized controlled trial on claustrophobia in MRI both, short-bore and open, scanners showed disappointing event rates of more than 25%, irrespective of patient characteristics and the anatomical region being examined. […] The CLQ may be a useful tool to detect patients at risk before claustrophobia occurs. The majority of patients who are affected are women (80% of our study population). Further developments towards a more patient-centered MR scanner environment are clearly needed to make this important diagnostic test available to all patients.

• #9 Phobic Disorders: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/288016-overview

  In general, specific phobia appears earlier than either social anxiety disorder or agoraphobia does. Most such phobias develop during childhood and eventually disappear. The estimated prevalence of specific phobia is approximately 5% in younger children and 16% in children aged 13-17 years. The prevalence is lower (3-5%) in older individuals, possibly reflecting a decrease in severity to subclinical levels. […] The 12-month prevalence of agoraphobia in adolescents and adults is approximately 1.7%. Agoraphobia may occur in childhood, but the incidence peaks in late adolescence and early adulthood. The 12-month prevalence in individuals older than 65 years is 0.4%. […] The phobic disorders appear to have a higher incidence among women. Higher rates of social anxiety disorder are found in females in the general population (with female-to-male ratios ranging from 1.5:1 to 2.2:1), and the sex difference in prevalence is more pronounced in adolescents and young adults.

• #10 Claustrophobia: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/37062

  Past or childhood experience is often the trigger that causes a person to associate small spaces with a sense of panic or imminent danger. […] Classic conditioning can also be inherited from parents or peers. […] Other theories that may explain claustrophobia include: […] Genetic factors: A dormant evolutionary survival mechanism causes reactions that are no longer needed in today’s world.

• #11 Does everyone have claustrophobia? | HowStuffWorks

  https://health.howstuffworks.com/mental-health/mental-disorders/claustrophobia.htm

  As many as 65 percent of patients who undergo an MRI scan suffer „dysphoric psychological reactions,” or in layman’s terms, sudden anxiety. […] While some believe the condition is passed down genetically, others say it’s transferred through conditioning. A child with a claustrophobe parent may learn to fear confined spaces after witnessing the parent suffer an anxious episode in a certain place. […] The concept of birth trauma certainly increases the estimated number of claustrophobes. Of course, there’s a significant difference between suffering an anxiety attack when trapped in a well and not being able to ride in an elevator, a common problem that clinically diagnosed claustrophobes face. But if Freud and his early followers are correct, there’s a little bit of a claustrophobe in all of us.

• #12 Reduction of claustrophobia during magnetic resonance imaging: methods and design of the

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/1471-2342-11-4

  Magnetic resonance (MR) imaging has been described as the most important medical innovation in the last 25 years. Over 80 million MR procedures are now performed each year and on average 2.3% (95% confidence interval: 2.0 to 2.5%) of all patients scheduled for MR imaging suffer from claustrophobia. Thus, prevention of MR imaging by claustrophobia is a common problem and approximately 2,000,000 MR procedures worldwide cannot be completed due to this situation. […] Between 1% and 15% of all patients scheduled for MR imaging suffer from claustrophobia and cannot be imaged, or they require sedation to complete the scan (mean: 2.3%; 95% confidence interval: 2.0% to 2.5%). Thus it can be estimated that worldwide approximately 2,000,000 MR procedures cannot be performed or are prematurely terminated due to claustrophobia.

• #13 Reduction of claustrophobia during magnetic resonance imaging: methods and design of the 'CLAUSTRO’ randomized controlled trial

  https://inis.iaea.org/search/search.aspx?orig_q=RN:46092447

  Magnetic resonance (MR) imaging has been described as the most important medical innovation in the last 25 years. Over 80 million MR procedures are now performed each year and on average 2.3% (95% confidence interval: 2.0 to 2.5%) of all patients scheduled for MR imaging suffer from claustrophobia. Thus, prevention of MR imaging by claustrophobia is a common problem and approximately 2,000,000 MR procedures worldwide cannot be completed due to this situation. […] The primary aim of this study is thus to determine whether an open MR scanner can reduce claustrophobic reactions, thereby enabling more examinations of claustrophobic patients without incurring the safety issues associated with conscious sedation. […] This randomized controlled trial will be the first direct comparison of open vertical and closed short-bore MR systems in regards to claustrophobia and image quality as well as diagnostic utility.

• #14

  https://link.springer.com/article/10.1007/s00330-021-07889-8

  Claustrophobia, a phobic anxiety disorder, is a well-known relative contraindication for MR, and anxiety or fear is triggered by confinement or the prospect of confinement in the MR environment. […] Claustrophobia affects 3 to 5% of the general population and is a relative contraindication to MR. In patients scheduled for MR, its reported incidence ranges between 1 and 37%, and the incidence of claustrophobic events varies, too, much depending on study population and type of MR scanner used. […] The MR community has made many advances to help patients with claustrophobia to cope with the triggered anxiety and to avoid claustrophobic events.

• #15 Claustrophobia in Magnetic Resonance Imaging: An Analysis of Causes, Impacts and Solutions

  https://www.diagnosticimaging.com/view/claustrophobia-in-mri-causes-impacts-solutions

  Given the frequent challenges in magnetic resonance imaging that are associated with claustrophobia, this author discusses innovations in noise reduction, radiofrequency coils and wide bore scanners, and emphasizes keys to relieving patient anxiety. […] Statistically, between 4 and 37 percent of patients experience anxiety during the examination with 1 to 15 percent exhibiting severe forms of anxiety, claustrophobia, or panic attacks. Moreover, 10 to 14.5 percent of MRI exams are prematurely terminated due to these symptoms. […] Claustrophobia, a term derived from the Latin „claustrum” (closed space) and the Greek „phobos” (fear), is defined as an intense and irrational fear of enclosed and confined spaces. […] The first visual impression of an MRI scanner is a relevant variable associated with the occurrence of claustrophobia. Claustrophobic reactions are related to cognitions such as harm caused by the machine.

• #16 Keys to helping patients handle MRI claustrophobia – By Unilabs

  https://staging.unilabs.com/byunilabs/our-health-solutions/keys-to-helping-patients-handle-mri-claustrophobia/

  MRI claustrophobia is not rare. It has been estimated that 2 million MRI scans worldwide cannot be performed every year, corresponding to premature termination or refusal due to claustrophobia. Approximately 1-2 out of 100 people who undergo MRI experience a claustrophobic reaction. […] Fear of confined spaces resulting in an emotional response may lead to physical symptoms, such as shortness of breath, trembling, sweating, dry mouth, tachycardia and chest pain. […] The unpleasant features related to MRI, such as spatial confinement, scan duration, noise and motion restriction, can potentially cause premature ending or low quality of the results, in addition to the negative effect on patient experience.

• #17 Claustrophobia in Magnetic Resonance Imaging: An Analysis of Causes, Impacts and Solutions

  https://www.diagnosticimaging.com/view/claustrophobia-in-mri-causes-impacts-solutions

  Therefore, it has been suggested that patient comfort should drive the development of new scanners. […] The use of such scanners in clinical routine contributed to the reduction of claustrophobic events and increased patient comfort in past studies. […] In recent decades, the field of MRI has witnessed significant technological innovations aimed at improving the patient experience, especially in managing claustrophobia. […] Reducing noise can help decrease exam-related anxiety and make the procedure more tolerable for patients. […] Another solution to mitigate claustrophobia is the introduction of wider-bore MRI scanners, known as „wide-bore magnets,” which have significantly reduced patient claustrophobic discomfort by providing a less restrictive environment. […] Despite technical challenges, such as the need for high-performance gradients, these scanners have positively impacted patient comfort and reduced interruptions due to claustrophobia. […] Overall, reducing noise in MRI scans is an important step toward improving patient experience, reducing anxiety, and enhancing cooperation during the examination.

• #18 Claustrophobia in MRI: Open Scanner v. Wide-Bore

  https://www.diagnosticimaging.com/view/claustrophobia-mri-open-scanner-v-wide-bore

  Claustrophobia affects up to 15 percent of all people, which can be a major problem for those needing an MRI study. […] Fear of suffocation and restriction prohibits about two million people with claustrophobia from undergoing MR imaging each year. […] According to the authors, more than 80 million MRI procedures are performed annually, but 1-15 percent of all patients (mean 2.3 percent) scheduled for the imaging procedure, suffer from claustrophobia, making the procedure impossible or requiring the use of conscious sedation. […] They estimate that about 2 million patients don’t get the procedure or terminate it early because of this fear of closed spaces. […] Newer, closed MRI scanners which are short and wide bore with noise reduction, have been shown to minimize claustrophobic reactions by a factor of up to three.

• #19 Reduction of claustrophobia during magnetic resonance imaging: methods and design of the

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/1471-2342-11-4

  However, even on such recent scanners, claustrophobic patients cannot undergo MR imaging without potentially life-threatening sedation. […] A more open vertical scanner configuration might be an alternative, but until recently such systems operated at rather low field strengths (0.2 T), resulting in poor image quality especially in imaging of the brain. […] Thus, recently introduced open MR scanners with an all-around view and both high field (1.0 T) and high gradient strength (up to 26 mT/m) might be a valuable clinical alternative to further reduce claustrophobia while maintaining diagnostic image quality and diagnostic accuracy. […] Therefore, it is unclear whether an open vertical or a closed short-bore MR design is more effective in reducing claustrophobia that prevents MR imaging.

• #20

  https://www.pagepress.org/medicine/gimle/article/view/536?articlesBySameAuthorPage=3

  Aim of our study was to adapt the Claustrophobia Questionnaire (CLQ) to the Italian context. […] In conclusion, the Italian version of the CLQ is a reliable and valid instrument to assess claustrophobic fear.

• #21

  https://link.springer.com/article/10.1007/s00330-021-07887-w

  To evaluate the influence of audio-guided self-hypnosis on claustrophobia in a high-risk cohort undergoing magnetic resonance (MR) imaging. […] There was significantly fewer claustrophobia in the self-hypnosis group (16%; 9/55), compared with the control group (43%; 38/89; odds ratio .14; p= .001). […] Self-hypnosis reduced the frequency of claustrophobia in the subgroup of patients above an established CLQ cut-off of .33 from 47% (37/78) to 18% (9/49; p= .002). […] Self-hypnosis reduced claustrophobia in high-risk patients undergoing imaging in an open MR scanner and might reduce the need for sedation and non-sedation coping actions. […] Forty percent of the patients at high risk for claustrophobia may also experience a claustrophobic event in an open MR scanner. […] Self-hypnosis while listening to an audio in the waiting room before the examination may reduce claustrophobic events in over 50% of patients with high risk for claustrophobia.

• #22 Acute procedural anxiety in adults: Epidemiology, clinical features, assessment, and diagnosis – UpToDate

  https://www.uptodate.com/contents/acute-procedural-anxiety-in-adults-epidemiology-clinical-features-assessment-and-diagnosis

  Claustrophobia miniscreen […] MRI claustrophobia […] Claustrophobia miniscreen.

• #23 Reduction of claustrophobia during magnetic resonance imaging: methods and design of the

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/1471-2342-11-4

  Therefore, claustrophobia is not only a common problem that prevents many patients from benefiting from the findings obtained with MR imaging but also represents an important socioeconomic issue for the health care system. […] Patients with claustrophobic anxiety are more likely to be frightened and experience a feeling of confinement or being closed in during MR imaging. […] Improving comfort during MR imaging (mainly reduction of noise and sensations of confinement by a fairly panoramic view) appears to be essential to avoid claustrophobic reactions. […] The positive effect of noise reduction and improved patient-centered design (short and wide bore) has recently been shown in a large cohort study in over 55,000 patients using a newly designed closed MR unit (with 97% noise reduction and cylindrical CT-like appearance) with 1.5-T field and up to 45 mT/m gradient strength.

• #24

  https://link.springer.com/article/10.1007/s00330-021-07887-w

  Self-hypnosis may also reduce the need for sedation and other time-consuming non-sedation coping actions and is preferred by high-risk patients for future examinations. […] Up to 10% of patients cannot undergo magnetic resonance (MR) imaging due to severe claustrophobia triggered by the small diameter of the MR tube or loud noises. […] Claustrophobic events are common but their prevalence varies with patients socioeconomic background and medical history. […] Distress during acquisition may lead to premature termination of the scan or reduce image quality due to motion artifacts, impeding proper interpretation of images. […] Hypnosis and relaxation techniques have been found to reduce patients anxiety and the need for medication during medical procedures. […] We hypothesize that audio-guided self-hypnosis before MR imaging can reduce claustrophobic events in patients at an increased risk of claustrophobia during MR imaging in an open scanner.

• #25 JMIR Mental Health – Experiences of Patients and Therapists Testing a Virtual Reality Exposure App for Symptoms of Claustrophobia: Mixed Methods Study

  https://mental.jmir.org/2022/12/e40056

  Epidemiological studies estimate a lifetime prevalence of 2.2%, with a treatment rate of 27.5%. […] However, subclinical symptoms in daily life that are reported by the general population have been observed in 12.5%. […] Specific phobias are associated with impairment and show high comorbidity with other mental health disorders. […] Moreover, a recent population-based survey in 24 countries showed that patients suffering from specific phobias who were seeking professional help received helpful treatment only in 23% of cases from their first professional contact. […] In the case of claustrophobia, the limitations due to this phobia become highly relevant for patients preparing for an MRI scan. […] Many radiographers report being confronted daily with claustrophobic patients. […] Only few studies describe VRE specifically aiming at the treatment of claustrophobia, although the first studies were conducted based on a case study as early as 1998.

• #26 Anesthesia management of a patient with claustrophobia undergoing surgery for rhegmatogenous retinal detachment: A case…

  https://ouci.dntb.gov.ua/en/works/9JwV6Gm7/

  Claustrophobia is a form of phobic anxiety disorder characterized by panic attacks. […] Anesthesia in patients with claustrophobia poses a challenge because these patients reject all treatments in an enclosed space. […] This case report shows that patients with claustrophobia need to be provided a comfortable environment for induction and awakening from anesthesia.

• #27

  https://journals.lww.com/md-journal/fulltext/2023/10200/anesthesia_management_of_a_patient_with.49.aspx

  Claustrophobia is a form of phobic anxiety disorder characterized by panic attacks. Anesthesia in patients with claustrophobia poses a challenge because these patients reject all treatments in an enclosed space. […] This case report shows that patients with claustrophobia need to be provided a comfortable environment for induction and awakening from anesthesia. […] Claustrophobia is an uncommon phobic anxiety disorder, and its prevalence varies from 7.7% to 12.5% in various populations. […] Anxiety on the day of the surgery is common; however, patients with extreme anxiety need to be taken seriously, and a psychiatrist should be consulted if possible. […] Therefore, psychotherapy combined with drug sedation is often used for clinical diagnosis, treatment, or elective surgery. […] Based on the severity of the anxiety disorder, patients may experience different types of claustrophobic events.

• #28 Breaking story: Fewer men with Grade Group 1 cancer are opting for surgery

  https://substack.com/home/post/p-162404143?utm_campaign=post&utm_medium=web

  A new generation of urologists is revolutionizing prostate cancer care, bringing innovative approaches to improve the experience of Active Surveillance (AS) patients with low-risk prostate cancer. […] How about eliminating gadolinium contrast and its risks for crossing the blood-brain barrier? Or reducing time in the MRI scanner to alleviate panic attacks, anxiety, and claustrophobia in prostate MRI procedures? […] Claustrophobia, needle phobia, and fear of contrast agents can deter men from pursuing AS for prostate cancer. […] The University of Michigan has started to explore offering prostate MRI without contrast for men on Active Surveillance, a significant step in non-invasive prostate cancer monitoring. […] Reduced MRI scan time can lower anxiety and claustrophobia in prostate imaging.

• #29

  https://link.springer.com/article/10.1007/s00330-021-07887-w

  The occurrence of a claustrophobic event was assumed if the scan terminated prematurely or if claustrophobia required intravenous or oral sedation or a non-sedation coping action at any time before or during the examination to complete the scan. […] Use of audio-guided self-hypnosis reduced claustrophobic events from 43% (38/89) to 16% (9/55), the need for sedation from 16 to 2% (14/89 vs 1/55), and non-sedation coping actions from 28 to 13% (25/89 vs 7/55). […] The main findings of our study are (a) audio-guided self-hypnosis significantly reduced claustrophobic events from 43 to 16% in high-risk patients; (b) the need for conscious sedation decreased from 16 to 2%; and (c) the need for time-consuming coping actions was reduced from 28 to 13% by audio-guided self-hypnosis. […] Self-hypnosis and the experience with MR imaging did not result in higher CLQ scores directly after imaging, and most patients (67%; 35/52) stated that they would prefer future MR imaging with support of self-hypnosis. […] Audio-guided self-hypnosis reduced claustrophobia in patients undergoing imaging in an open MR scanner with a high risk based on the claustrophobia questionnaire.

• #30 Claustrophobia – Wikipedia

  https://en.wikipedia.org/wiki/Claustrophobia

  The present case series with two patients explored whether virtual reality (VR) distraction could reduce claustrophobia symptoms during a mock magnetic resonance imaging (MRI) brain scan. […] Many experts who have studied claustrophobia claim that it consists of two separable components: fear of suffocation and fear of restriction. […] The study was successful in proving that the symptoms are separate. […] This study was conducted on 98 people, 49 diagnosed claustrophobics and 49 „community controls” to find out if claustrophobics’ minds are distorted by „anxiety-arousing” events (i.e. claustrophobic events) to the point that they believe those events are more likely to happen.

• #31 Phobic Disorders: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/288016-overview

  The 12-month prevalence rates for the United States are estimated as follows: Social anxiety disorder (social phobia) – 7%; Specific phobia – 7-9%; Agoraphobia – 1.7%. […] Social anxiety disorder appears to be less common in much of the world than it is in the United States, with 12-month prevalence estimates clustering in the range of 0.5-2.0%; median prevalence in Europe is 2.3%. Prevalence estimates for specific phobia in European countries are close to those in the United States (~6%) but are generally lower in Asian, African, and Latin American countries (2-4%). […] In the United States, social anxiety disorder tends to start early in life, with 75% of the patients experiencing its onset between ages 8 and 15 years and a median age at onset of 13 years. The 12-month prevalence estimates for social anxiety disorder in children and adolescents are comparable to those in adults. Prevalence decreases with advancing age; the 12-month prevalence for older adults is in approximately 7%.

• #32 SHOTSMAG CONFIDENTIAL: Tom Baragwanath on small-town claustrophobia

  http://wwwshotsmagcouk.blogspot.com/2024/02/tom-baragwanath-on-small-town.html

  In a town of thousands, hundreds, or even dozens, one feels constantly exposed, and constantly judged. […] And while its true that small communities can pull together in miraculous ways to face external threats, its just as common for these threats to pit neighbour against neighbour. […] And yet, theres something about small-town claustrophobia that keeps drawing me back to Masterton, and back into Lorraines story.

• #33 SHOTSMAG CONFIDENTIAL: Tom Baragwanath on small-town claustrophobia

  http://wwwshotsmagcouk.blogspot.com/2024/02/tom-baragwanath-on-small-town.html

  Some years ago, I moved from a place where it felt like everyone knew me and I, in turn, felt I knew everyone to a place where nobody knows me. […] This sudden anonymity was bracing, and a little thrilling. But soon, I found myself craving a little small-town claustrophobia. […] As far as its possible to know a person, Lorraine would know them or she would think she did. […] Lorraine would have an unerring compass when it came to navigating threats both within the community and outside of it. […] Because shed been watching; because shed been listening. […] It would mean navigating the invisible web of judgement and suspicion, and pulling apart some of the secrets binding people so tight they can barely breathe. […] It was a chance to explore small-town claustrophobia from all sides, and to understand what it is about marginal or forgotten places that writers especially writers of crime or thriller stories just cant seem to escape.

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