Not going to the dentist, not having medical check-ups that could save your life or prevent illness, being terrified of going to hospital – even to visit friends – all this can be a painful reality for someone with needle phobia (aichmophobia).

Negative reactions from others like laughing or mocking or being told to “get over it” add to the stress.

This phobia is very much a hidden problem, according to Gerard Butcher, a Dublin-based CBT therapist and chair of Cognitive Behavioural Psychotherapy Ireland (www.cbti.ie).

“That’s because many people feel ashamed that they have a problem like this,” he says.

“They may feel that they are not as good as other people but in reality they genuinely cannot help the experience they are having.”

Research studies suggest that 3-4% of the general population have a needle phobia, though the real figure is likely to be much higher due to its hidden nature. Most people with the phobia never seek help, however.

“One study found that 95% of those with needle/blood injury phobia never went for help at all,” he says.

“That’s a lot of people. It’s really important, then, that those who have the phobia accept that they have it and that they look for help as soon as they can. The treatment is not easy but it is better than the consequence.”

IMPACT ON LIFE TRIGGERS TREATMENT

Most people with needle phobia only seek help when it seriously impacts on their lives.

“If it is having a big effect – if they need essential treatment for a health condition, for example, and they just can’t face it – and if they are highly motivated to alter that, then they will look for treatment to help them overcome the phobia.”

In reality, most of us don’t particularly like the idea of getting injections, he points out.

“We see it, though, as something that we can temporarily put up with, but those with needle phobia will go to extreme lengths to avoid needles, even avoiding treatment for cancer.

“We’ve known of people who are pregnant not going for blood tests, so it can be very debilitating.”

He knows a significant number of people who don’t go for dental treatment because of needle phobia too.

DO ANYTHING TO AVOID

But what is a phobia?

“A phobic condition is considered to be a situation that will not cause the majority of people anxiety but those with the phobia will experience irrational fear.”

Needle phobia is what’s called a specific or simple phobia, he says.

“‘Simple’ is a misnomer as the phobia is far from simple. Many people with phobias have quite debilitating conditions and will do almost anything to avoid being in the presence of that stimulus in case it will provoke a very serious reaction.”

The reaction starts with a marked feeling of fear.

“The person’s heart rate will increase and they will experience a great deal of anxiety. They will often dream of or think about the situation time and time again in advance if they have to go to places where they might be exposed to their fear, eg needles/injections.

“Hospital smells can set it off and people with blood or needle phobia will even avoid visiting friends in hospital just in case they come across anything that will cause them distress.

“Most people with phobias spend a lot of time thinking and planning ahead. When they are asked to do something, they have to consider the impact doing that might have on them. In that way, it limits what they can do in life, to some degree.”

TWO DIFFERENT TYPES

There are two types of needle phobias, he points out, making needle phobia markedly different than other phobias.

“About 75% of people with this phobia will worry about fainting and most likely will do so if they are exposed to needles and blood or blood injury.

“The other 25% will have had bad experiences from a young age from going to a clinic for a jab, maybe, or having seen something that was very unpleasant for them. This group will not necessarily faint but will experience a great deal of anxiety.”

Very often needle phobia isn’t taken seriously enough by doctors, he says.

“It’s important to emphasise that when people with blood injury or needle phobia say they are going to faint, they are going to faint. We’ve got to be conscious of that. These people will experience an extreme reaction and they will have it very quickly, so what they say does need to be taken seriously.”

TREATMENT – WHAT DOES IT INVOLVE?

Treatment with a CBT therapist involves a full (verbal) assessment first.

“Very often the person may have other anxieties that go with the phobia. We know that there is a higher rate of anxiety disorder, depression and psychological conditions in people with this disorder,” he says, “so therefore full assessment needs to be done (a full case history taken) as you may not end up treating one specific issue but a range of issues, including the needle/blood phobia.”

GRADED EXPOSURE AND APPLIED TENSION

The main treatment approach is graded exposure in vivo (graded exposure in real life).

“This is where the person is exposed in a gradual way to situations that they avoid or are afraid of.

“With needle phobia, we might start off, depending on the level of fear and anxiety the person has, by introducing pictures of needles and gradually move up to the real thing – actual needles themselves.

“It may involve, in certain circumstances, going with clients to hospitals or clinics and ultimately dealing with the idea of them getting an injection themselves.”

LEARNING TO MANAGE ANXIETY

Being taught to manage their fainting response or anxiety in an appropriate way is part of the treatment as well.

“Those who may faint or have that response are taught a technique called applied tension. The idea here is that they actually learn how to raise their blood pressure rather than allowing it to be lowered (which causes fainting).”

This involves teaching very simple muscle tension techniques.

“We find that this helps people to stop fainting. Lying down may be a useful strategy, too. We teach them to do everything they can to avoid doing anything that will cause the condition to get worse.”

CAN BE GENETIC

It is also important to remember that this condition may be genetic.

“Many people have a first or second degree family member who have the condition as well, so it can be genetically inherited. Studies have shown that 50% of those with the phobia have a relative with it also.

“Also, if a parent is anxious in situations where a child is getting a vaccination, for instance, it doesn’t help. The child will be alert to this and it may increase their anxiety. Needle phobia can be a learned condition – if they see it, they may develop that response themselves – but for the most part parents or other family members will have had the phobia themselves so the child has a genetic predisposition to it.”

HOW LONG DOES TREATMENT TAKE?

The length of time it takes to satisfactorily treat the phobia depends on how bad it is. The thought processes that have developed over a long period of time have to be unravelled. Most people don’t seek help until they are adults, so you are unravelling the historical process of how they view their problem and how they view themselves as a consequence of that.

“You are also working on teaching them how to manage their own internal physiological response as well.”

Treatment begins slowly, with the patient or client always being in charge of how much is done at each session.

“The main thing is that during each session they experience a decrease in their anxiety.

“What people need to experience is to stay in the situation (seeing a needle/or a picture of one, for example) for long enough for the anxiety level to come down. This is a process we call habituation.”

Success varies a lot from person to person, he says.

“We would start off with a situation that is very safe for the individual, ensuring that they know they are not going to faint, if that is their experience. For some people, if they manage to hold themselves in the situation for five minutes then that might be enough. Others might need an hour before their anxiety would come down sufficiently for them to feel okay.

“All this can be very difficult for people to tolerate, but the therapist will be helping them to manage the anxiety appropriately while they are going through that.”

NEEDLE PHOBIA BEGINS IN CHILDHOOD

For the majority of people, the phobia seems to begin in childhood, usually around the ages of seven to nine.

“That’s what the research shows but it’s probably a time when children are exposed to vaccinations in schools and may have seen other children being afraid as well. That’s possibly why it’s seen then. Unfortunately, a child may avoid going to school if there is a jab planned.”

SUCCESS RATE OF TREATMENT

But what is the success rate for treatment?

“It can vary. Specific phobias are often treated relatively quickly if there is no co-morbid feature, in other words, if there isn’t another condition as well as it will be complicated by that. Most people will do well within a relatively short period of time but so much depends on their willingness to participate and stay with treatment but it is a successful treatment. The important thing to remember is that there is help out there and that learning how to challenge the experience they have will help them an awful lot.” CL

Who to call for help

To find a CBT therapist, see the Cognitive Behavioural Psychotherapy Ireland website www.cbti.ie.

Some people try hypnotherapy or psychotherapy for the treatment of phobias also. For a list of therapists, see www.chpa.ie| www.psychoterhapycouncil.ie|www.irish-

counselling.ie|www.icbt.ie.