Needle phobia - Anxiety UK

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Needle phobia - Anxiety UK

InjectionPhobiaand Needle PhobiaA brief guide


Injection Phobia andNeedle phobiaMany people fear injections to some extent, but once thatfear becomes persistent, excessive and unreasonable, thenthe fear becomes a phobia. Injection phobia is the fear andavoidance of receiving various types of injections, and/orof having a blood sample withdrawn through venipuncture.This is a specific phobia and is extremely common yetnot very well recognised, affecting 3.5 % to 10% of thepopulationHow do I know if I have an injection orneedle phobia?99If you have a marked, persistent, andexcessive fear of needles.99If exposure to needles almost invariably provokesin you an immediate anxiety response.99If you recognise this fear is excessive.99If needle-sticks are either avoided, orendured with intense anxiety or distress.99The avoidance, anxiety or distress significantlyinterferes with your normal routine,occupational or academic functioning,social activities or relationships, or there issevere distress about having the phobia.2


Remember: Fears of objects or situations are commonduring childhood, especially the preschool period, but theydon’t normally interfere with a child’s daily functioning.Common childhood fears need to be distinguished fromspecific phobias, as the latter are irrational, interfere withdaily routines, and lead to problematic behaviors. Childrenwith specific phobias may have symptoms similar to adults,or may present by displaying behaviours such as crying,tantrums, clinging or freezing.How will injection orneedle phobia affect me?Usually injection phobia will manifest itself in 3 differentways: physically (in that you will experience real physicalsymptoms), psychologically (in that you will experience achange in your thought patterns) and behaviorally (in thatyou will find yourself behaving differently). The table onthe next page explains just some of the ways that injectionphobia can impact on you:3


What will it affect?Impact on youBodySufferers of injection phobia typicallyexperience temporary palpitations andincreased heart rate/blood pressure. Also,fear may be expressed with increased bloodpressure, shortness of breath, dry mouth,nausea, tremor, feeling faint or actually fainting,and/or feelings of panic. A full-blown panicattack can occur if you believe that escapeis impossible.ActionsYou may find it hard to watch or look at yourblood or injury, and or to receive an injectionor other invasive medical procedure. You mayfeel the need to escape. You may avoid anymedical contact for fear of being confrontedby needles or injections. You might also avoidany places associated with needles/injectionssuch hospitals, doctors’ surgeries, bloodtransfusion units and dentists.ThoughtsIn experiencing a rush of fear you might findfrightening thoughts running through yourmind. These could be fears about losingcontrol and/or that you are going to faint.You may have the thought that somethingawful is going to happen, even if you don’tknow what that is.4


Laura’s* personal experience“I have had this phobia for as long as I can remember. Like manysufferers, it is also coupled with an intense dislike of anything involvingblood and gore. I don’t think I’ve had any particularly bad experiencesthat caused the phobia, although I know that my dad occasionally faintsat injections, and my mum would always dread blood tests.The funny thing is, I really know that the injection itself, or the bloodtest, or whatever, doesn’t really hurt, and I’m lucky that I don’t go faint.It’s just the thought of it that bothers me. In fact, I’ll often spend hoursworrying about something that lasts for about 3 seconds. Nuts! But Iknow I’m not on my own.I’ve definitely got better as I’ve got older. I remember dreadinginjections weeks in advance of the event- so much that when I was a kidthat I would almost be sick. I would try to get out of school if I knewwe were due to have an injection, and when it came time for Rubella, Imanaged to convince my mum that people had died after having theinjection, so that she wouldn’t make me have it!As an adult, I’ve taken risks by not taking injections that were advised.For instance I once worked in a job where I was advised to have acourse of three Hepatitis B injections. I had two, but then because I waspretty low risk for infection, I never quite got round to going back forthe third….However, there is good news – I’m actually now doing really well atgetting myself over this problem. I needed some blood tests doingrecently, and confessed my phobia to my really fabulous GP. She wasjust brilliant. I have now had a number of blood tests, and feel almostcompletely relaxed about them. Yes, really. I started by having the firsttest with my arm covered in copious quantities of this product. Thisis a local anaesthetic gel that you can get from the chemist, and it’s agodsend. The blood test was fine – did not feel a thing. Then, for thenext one, I used the gel, but left it on for less time than before, and itwas fine too. The next one I left it on for even less time, and it too wastotally fine. I’m down to the point where it’s hardly worth putting any ofthe gel on, so I think next time (or maybe the time after…) I’m going tobe brave and do it without the gel. I’m very confident that I’ll get there,and it feels great.Oh, and the other thing that helped was that my husband promised tobuy me a present every time I was ‘brave’! So far, I have one lovely redbelt, two pairs of ear-rings and a necklace!”5


What causes Injection orNeedle Phobia?There are several different theories about why somepeople are needle phobic. One theory suggests thatbecause our first injection hurt (having an injection is not apleasant experience for anyone) it is therefore quite naturalto experience a certain amount of fear with subsequentinjections. Most of us have our first injection as a childand for many this is a frightening experience because youare left with a doctor who you perceive as a stranger: youdon’t know why you are being hurt with a needle and youcannot understand why your parent/guardian would allowyou to be ‘hurt’ in this way.Another theory suggests that we learn to fear needles/injections from our parents or other significant adults.Many people with needle phobia recall parents tellingthem as children to “stay away from needles - you mightcatch something”, and many remember being told to “bebrave” whilst having an injection despite feeling terrified.Many also recall that a significant adult was needle phobictoo. As children we are led to believe that our guardiansknow best so if we see them behaving in a phobic mannerin response to needles/injections, we accept that there is agood reason for this behaviour.Phobias can also be associative, which means that theobject of our phobia can be associated with somethingnegative. For instance, a person may receive bad newsand notice a needle/syringe at the same time. Anotherexample of how this may occur is after having had a bloodtest, and later being told that you have a serious illness.6


Children can often remember seeing elderly relativeshaving injections, and then later dying, and so the childthus associates injections with death/ illness.Finally, needle phobia may occur as a result of traumaticexperience with needles/injections. For example, havingan injection prior to an operation, or enduring a particularlypainful injection as a child. Most children go through aphase of fearing needles/injections, but eventually growout of it. However, adults who develop needle phobiaoften trace back the source of their fear to an incident thatoccurred during childhood.7


Degrees of injection orneedle phobiaSome people with a phobia are able to live normally butthe severity of anxiety experienced varies from suffererto sufferer with some finding themselves unable to cope.Some people with needle phobia may find themselveshaving occasional nightmares about being forced to havean injection; others may not be able to leave their homein case they encounter a syringe. To this end, such peoplewith needle phobia are effectively agoraphobic albeitas a result of a different set of circumstances to thosetraditionally behind the onset of such a condition.Many people with needle phobia are so afraid of injectionsand needles that they are willing to endure any amount ofpain and discomfort in order to avoid having an injectionor feeling a needle. At the other end, those that domuster up the courage to have an injection, may faintduring the process and then become anxious aboutfainting. A fear of fainting and avoidance of fainting maysubsequently develop.Some people cannot even bear to say the word “needle/injection”, or look at pictures of needles/injections inmagazines. Also, some people with needle phobia mayfeel anxiety almost immediately upon confronting thephobic stimulus (injections, needles, blood, etc), but thelevel of anxiety experienced usually varies with both thedegree of proximity to the phobic stimulus and the degreeto which escape from the stimulus is limited.8


What treatmentsare available?Just as experience of needle phobia varies from sufferer tosufferer, ways of coping vary from person to person too.Systematic Desensitisation/Behavioural ExposureOne method that has been consistently proven tobe effective in the treatment of anxiety and phobiasis systematic desensitisation (sometimes known asbehavioural exposure). In this technique individualsgradually expose themselves to the situation theyare phobic about in a gradual manner. With sufficientrepetition through practice, the event loses its anxietyprovokingpower. At the end of training you will find thatthe event has lost its power to make you anxious.Systematic Desensitisation can either be done with atherapist or can be self-administered (the successfulness ofthe latter being defined by your willingness to encounteryour fear). You can find out more information about theself-administered systematic desensitisation procedure inthe next pages.Behavioural exposure is an essential component ofCognitive Behavioural Therapy (CBT), which is commonlyused for the treatment of injection phobia. CBT is anevidence based intervention that works with problemsin the present, and looks at strategies for managingnegative thoughts and behaviours that may feed into ananxiety problem.Clinical Hypnotherapy9


10Clinical hypnotherapy can also help those with aninjection/ needle phobia. Anxiety UK has a popular servicewhich has helped many sufferers of specific phobias.Hypnotherapy involves getting into a state of deeprelaxation, and using visualisation techniques to explorethe phobia further. This therapy takes place in a one-to-onesituation and can produce beneficial effects in a relativelyshort space of time.


How can I help myself?Self-administered behaviouralexposure programThere are three steps in the self-administered behaviouralexposure hierarchy:1. Relaxation2. Constructing an anxiety hierarchy3. Pairing relaxation with the situations detailed inyour hierarchy.Step One: RelaxationIt is useful that you know how to get into a relaxed stateof mind before going into your behavioural exposurehierarchy. Some people like to practice progressivemuscular relaxation, breathing exercises or meditationto allow them to induce a relaxed state of mind beforeencountering their phobic situation or object. Relaxationcan take some practice, so it may be useful to practice forsome time in advance before beginning your exposurework. All that matters is that you choose a method ofrelaxation that is most comfortable for you.Step Two: Constructing an anxiety hierarchyOverviewFor this example, the hierarchy that you construct willcontain situations or scenes involving some aspect ofhaving an injection. These situations will most likely besituations you have actually experienced (e.g. booking11


an appointment, waiting in the waiting room of your GPsurgery, going into the room where the injection will beadministered, seeing the needle, and then having theinjection). The important point is that items included in ananxiety hierarchy describe situations which produce varyinglevels of anxiety, some more worrisome than others; this iswhat hierarchy means, and the details of this are presentedlater in the booklet.You should describe the items in your anxiety hierarchy insufficient detail to enable you to vividly imagine each step.It might be sufficient to say “standing in line at the ticketcounter,” but saying “standing in a long line at the crowdedticket counter with nothing to do but wait to get myluggage checked” might be more graphic. Remember thatitems are most effective if they can help you experience theevent in your imagination, not just describe it.Creating an anxiety hierarchyYou should attempt to create about 16 or 17 situations atthe beginning. Most people tend to discard some itemsin the sorting process, so you can expect to end up withabout 10 to 15 items in your final hierarchy. To aid insorting the items, write each one on a separate index card.As was mentioned earlier, the situations or scenes in yourhierarchy should represent a fairly well-spaced progressionof anxiety. The best way to achieve this goal is to firstgrade the anxiety of each item by assigning it a numberon a scale from 0 to 100, where 100 is the highest levelof anxiety imaginable and 0 is no anxiety (completerelaxation). Write this number on the back of the indexcard for the item being graded. At this point, you need notworry about how well-spaced the items are; just give eachitem the first number grade that “pops into your head.”12


When each item has an anxiety grade, your next step willbe to sort the cards into 5 piles. Each pile will represent adifferent category of anxiety, as follows:PileAnxiety GradeLow AnxietyMedium Low AnxietyMedium AnxietyMedium High AnxietyHigh Anxiety1–1920–3940–5960–7980–100The goal here is to end up with at least two items ineach pile.If this happens, congratulations. If not, you will have togo back and re-evaluate some items or create some newitems. When you have finished, combine all the cards intoone pile that is ordered from lowest to highest anxiety. Thisis your personal anxiety hierarchy. Set the cards aside forone day.It helps to check the accuracy of your ordering by shufflingthe cards in the next day or so. Without looking at thegrades on the back of the cards, re-order them. Thencheck the grades to see if your second ordering is thesame as the first. If not, make some adjustments. Youdon’t have to waste a lot of time with this; just try to getan order that feels right and that represents a fairly smoothprogression from low to high anxiety.13


Sample fear of injections/ needles hierarchyThe following is a sample hierarchy to help you developyour own hierarchy. Your items should, of course, be fullydetailed.999999999999Looking at a picture of a cartoon needleTouching a picture of a needleHolding a real needleInjecting an orange with a real needleDriving past your surgeryGoing to your surgery to talkabout having an injection99Going to have an injection using a topicalanaesthetic to numb the injection site99Going to get an injection99Repeat as requiredThe self-administered behaviouralexposure procedureThe self-administered behavioural exposure procedureis presented below. It consists of seven steps that arerepeated for each item of your anxiety hierarchy. Your taskwill be to work through each item of your anxiety hierarchyfollowing these seven steps.Step 1. Induce relaxation using your preferred relaxationtechnique.14


Step 2. Read the appropriate item from your hierarchy. Inthe first session, this will be the first item in the hierarchy,while in the other sessions this will be the last item fromthe previous session.Step 3. Go into the situation for a tolerable time.Note. The length of “a tolerable time” will vary. Be carefulof overloading yourself on the first encounter with an item,especially with high anxiety items. Although it might seema short time, 10 seconds of exposure might be all you cantolerate. Slowly increase the amount of time you spend inthe situation on subsequent presentations until you cantolerate at least 30 minutes of exposure.Step 4. Remove yourself from the situation and determinethe level of anxiety that you are experiencing (on a 0 – 100scale). Re-establish your relaxation again and relax forabout 30 seconds.Step 5. Go back into the situation and stay there for atolerable time – the longer you stay the betterStep 6. Stop and again determine your level of anxiety. Ifyou are experiencing any anxiety, return to Step 2. If youfeel no anxiety, go on to Step 7.Step 7. Move on to the next item of your hierarchy. Repeatthe above procedure for this next item, beginning withStep 1.End each session with several minutes of relaxation.What potential problems might I encounter?You might encounter either of two major problems duringbehavioural exposure:15


1) You might experience no anxiety at the presentation ofan item.2) You might be unable to decrease a high level of anxietyeven after numerous cycles.Some causes and solutions of these problems arepresented below.Problem 1:Little or no anxiety is produced on the first or second cycleof an anxiety hierarchy item.CauseThe situation is notchallenging enoughThe situation inducesa lower level of anxietythan a previous itemSolutionTake a step up your ladder andsee if your anxiety increasesEliminate this itemProblem 2:A high level of anxiety persists after numerous cycles.CauseThe situation has notbeen placed in theappropriate order inyour hierarchySolutionDevelop a new item to beplaced before this itemorPlace this item later in yourhierarchy16


Finally: additional helpWhile some people may be able to work through abehavioural exposure program on their own, it may bethat you require additional support (particularly if youranxiety is very high). Anxiety UK recommends the use ofCognitive Behavioural Therapy (which will allow you towork through an exposure program with a therapist) orclinical hypnotherapy (which allows you to learn to relax,and go through an exposure program using visualisation).You can access both of these therapies through AnxietyUK at minimal cost and with no waiting time. For moreinformation call our helpline on 08444 775 774.17


Useful contacts:Anxiety UKZion Community Resource Centre339 Stretford RoadHulmeManchesterM15 4ZYwww.anxietyuk.org.uksupport@anxietyuk.org.uk08444 775 774Other sources of help and support:www.livinglifetothefull.com – a great resource forindividuals experiencing anxiety and depressionhttp://moodgym.anu.edu.au/welcome - an onlinecomputerised cognitive behavioural therapy resourcewww.nice.org.uk – for treatment guidance for anxietyhttp://www.cci.health.wa.gov.au – a free resource thatallows users to download cognitive behavioural therapycourseswww.glasgowsteps.com – an NHS website with lots ofinformation and case studieswww.needlephobia.co.uk - this website has beendeveloped by smith&nephew and contains a range ofresources relevant to needle phobia18


British Association for Behavioural and CognitivePsychotherapies (BABCP)Victoria Buildings9 - 13 Silver StreetBuryBL9 0EUTel: 0161 797 4484Fax: 0161 797 2670Email: babcp@babcp.comWebsite: www.babcp.comThe British Association for Counselling and Psychotherapy(BACP)BABCP House,15 St John’s Business Park,Lutterworth,LeicestershireLE17 4HBEmail: bacp@bacp.co.ukWebsite: www.bacp.co.ukGeneral enquiries: 0870 443 5252Fast Facts: Anxiety, Panic and Phobias by Malcolm H LaderISBN: 190373441XOvercoming Anxiety by H Kennerley ISBN: 1854874225Overcoming Anxiety: A Five Areas Approach by Dr ChrisWilliams ISBN: 034081005X*Names have been changed to protect anonymity© Anxiety UK 2010Design and produced by Flux Designwww.flux-design.co.uk19


Anxiety UKZion Community Resources Centre,339 Stretford Road, Hulme,Manchester M15 4ZYTel: 08444 775 774Website: www.anxietyuk.org.ukEmail: enquiries@anxietyuk.org.ukEstablished 1970Registered charity no: 1113403This booklet was sponsored by an educational grant provided bySmith and Nephew

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