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Shi H, Li X, Huang X, Yang H, Li J, Yang X. Efficacy and safety of the Valsalva maneuver in relieving venipuncture pain in children and adults: A systematic review and meta-analysis. J Vasc Access 2024:11297298241231903. [PMID: 38390709 DOI: 10.1177/11297298241231903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Venipuncture is a common invasive clinical procedure, and pain management during puncture has been of interest to healthcare professionals. The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of the Valsalva maneuver (VM) for the relief of venipuncture pain in children and adults. PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP database, and CBM were searched from inception to December 2023 for all available randomized controlled trials (RCTs) that evaluated the impact of VM on venipuncture. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Continuous variables were analyzed by mean differences (MD) or standardized mean differences (SMD), whereas dichotomous variables were analyzed by risk ratios (RR). A total of 22 studies involving 1740 participants were included. The pooled results showed that VM relieved pain intensity during venipuncture in children (SMD = -0.89, 95% CI = -1.47 to -0.30, p = 0.003) and adults (SMD = -1.11, 95% CI = -1.46 to -0.77, p < 0.00001), reduced anxiety intensity (SMD = -1.07, 95% CI = -1.68 to -0.47, p = 0.0005), and shortened puncture time (MD = -13.52, 95% CI = -21.14 to -5.90, p = 0.0005). There was no significant difference in the success rate of venous cannulation, MAP, HR, or incidence of adverse events in subjects who performed VM compared to controls. VM was an effective and safe method of pain management that reduced pain intensity during venipuncture in children and adults without significant adverse effects. The results of this meta-analysis need to be further validated by more rigorous and larger RCTs.
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Affiliation(s)
- Haoning Shi
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Xia Li
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Xiaotong Huang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Haoran Yang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Jing Li
- School of Public Health, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Xiao Yang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
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2
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Sugai K, Shikuma J, Hiroike S, Abe H, Suzuki R. Successful introduction of sensor-augmented pump therapy in a patient with diabetes and needle phobia: A case report. J Diabetes Investig 2023; 14:1318-1320. [PMID: 37494142 PMCID: PMC10583640 DOI: 10.1111/jdi.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
Needle phobia is a specific phobia classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders-5, and can be a serious problem for patients requiring insulin injections. However, there have been few reports to date on the management of adults with diabetes and needle phobia. We here report a case of a woman with pancreatic diabetes who developed needle phobia and could no longer perform self-injections. She started to use a sensor-augmented pump (SAP), and was able to perform a puncture for the insulin pump and the continuous glucose monitoring sensor by herself. The SAP treatment achieved self-management, better glycemic control, and high treatment satisfaction quantified using the Diabetes Treatment Satisfaction Questionnaire in this patient. Our case suggests the therapeutic potential of SAP in adults with needle phobia and diabetes requiring insulin therapy.
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Affiliation(s)
- Keiji Sugai
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Junpei Shikuma
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Satoshi Hiroike
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Hironori Abe
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Ryo Suzuki
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
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3
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Wang L, Fang L, Zhou Y, Fang X, Liu J, Qu G. Efficacy and safety of vapocoolant spray for vascular puncture in children and adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0279463. [PMID: 36780438 PMCID: PMC9925002 DOI: 10.1371/journal.pone.0279463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/07/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE The aim was to evaluate the effectiveness and safety of the vapocoolants for vascular puncture in children and adults. METHOD The search was carried out in PubMed, Web of Science, Embase and The Cochrane Library, from inception to March 2022. Randomized controlled trials comparing vapocoolants to control conditions for participants received intravenous cannulation or arterial puncture were included. Two reviewers independently performed selection of studies, data extraction, and assessment of risk of bias. The analysis was performed using fixed or random-effects model with mean differences or standardized mean difference and risk ratios. RESULTS A total of 25 studies involving 3143 participants were included. Compared with control conditions, vapocoolants may not decrease the pain of patients with arterial puncture (SMD = -0.36, 95% CI = -0.92 to -0.19, P = 0.20), but may more effectively relieve pain for adults received vein puncture (SMD = -0.65, 95% CI = -0.85 to -0.45, P < 0.00001). The application of vapocoolant increased the procedural difficulty of medical personnel (RR = 2.49, 95% CI = 1.62 to 3.84, P<0.000 1) and participants were more willing to use the spray in the future (RR = 1.88, 95% CI = 1.34 to 2.64, P = 0.0002). There was no significant difference for the first attempt success rate of the procedure and the occurrence of adverse events. CONCLUSIONS Vapocoolant spray may relieve pain in adults received vein puncture and cannot cause severe side effects, but is ineffective in children. It also had no effect on patients with arterial puncture. In addition, the application of spray increases procedural difficulties for medical professionals, but does not decrease first attempt success rate, and many patients would like to use the spray again for pain relief in the future. Thus, more rigorous and large-scale studies are needed to determine its effectiveness in vascular access.
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Affiliation(s)
- Lan Wang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Liu Fang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yang Zhou
- School of Nursing, Weifang Medical University, Weifang, China
| | | | - Jiang Liu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Guiyu Qu
- School of Nursing, Weifang Medical University, Weifang, China
- * E-mail:
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4
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Phobia Exposure Therapy Using Virtual and Augmented Reality: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A specific phobia is a common anxiety-related disorder that can be treated efficiently using different therapies including exposure therapy or cognitive therapy. One of the most famous methods to treat a specific phobia is exposure therapy. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. One promising track of research lies in VR exposure therapy (VRET) and/or AR exposure therapy (ARET), where gradual exposure to a negative stimulus is used to reduce anxiety. In order to review existing works in this field, a systematic search was completed using the following databases: PubMed, ProQuest, Scopus, Web of Science, and Google Scholar. All studies that present VRET and/or ARET solutions were selected. By reviewing the article, each author then applied the inclusion and exclusion criteria, and 18 articles were selected. This systematic review aims to investigate the previous studies that used either VR and/or AR to treat any type of specific phobia in the last five years. The results demonstrated a positive outcome of virtual reality exposure treatment in the treatment of most phobias. In contrast, some of these treatments did not work for a few specific phobias in which the standard procedures were more effective. Besides, the study will also discuss the best of both technologies to treat a specific phobia. Furthermore, this review will present the limitations and future enhancements in this field.
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5
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von Mücke-Heim IA, Walter I, Nischwitz S, Erhardt A. Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report. Front Psychiatry 2022; 13:915058. [PMID: 35903630 PMCID: PMC9314666 DOI: 10.3389/fpsyt.2022.915058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most frequent mental disorders. Among the different subtypes, specific phobias are the commonest. Due to the ongoing SARS-CoV-19 pandemic, blood-injury-injection phobia (BII) has gained wider attention in the context of large-scale vaccination campaigns and public health. In this BII phobia mini-review and case report, we describe the successful treatment of a severe BII phobia case with combined fainting and psychogenic non-epileptic seizures (PNES) and demonstrate the role of specialized outpatient care. CASE REPORT The patient was a 28-year-old woman. She suffered from intense fear and recurrent fainting with regard to needles, injections, injuries, and at the sight of blood since early childhood. Medical history revealed infrequent events suggestive of PNES following panic attacks after sustained exposure to phobic stimuli. Family history was positive for circulation problems and BII fears. Psychopathological evaluation confirmed BII phobia symptoms and diagnosis was made according to the DSM-5. The Multidimensional Blood/Injury Phobia Inventory short version (MBPI-K) revealed severe manifestation of the disease. Neurological examination was ordinary. Repeated electroencephalography detected no epileptic pattern. Cranial magnetic resonance imaging showed normal morphology. Treatment was carried out by a seasoned, multidisciplinary team. Cognitive behavior therapy and exposure were performed. Modification of standard treatment protocol was necessary due to hurdles posed by recurrent fainting and a severe panic-triggered dissociative PNES during in vivo exposure. Modification was implemented by limiting in vivo exposure intensity to moderate anxiety levels. In addition to applied muscle tension and ventilation techniques, increased psychoeducation, cognitive restructuring, and distress tolerance skills (e.g., ice pack, verbal self-instructions) were used to strengthen the patient's situational control during in vivo exposure. A total of 15 sessions were performed. Therapy success was proven by 83% reduction in MBPI-K rating, SARS-CoV-19 vaccination, and a blood draw without psychological assistance, fainting, or seizure. CONCLUSION Taken together, this case demonstrates the potential of and need for specialized outpatient care and individualized treatment for severe BII phobia patients in order to provide them the perspective to have necessary medical procedures done and get vaccinated.
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Affiliation(s)
- Iven-Alex von Mücke-Heim
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Isabelle Walter
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany
| | - Sandra Nischwitz
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany
| | - Angelika Erhardt
- Max Planck Institute of Psychiatry, Outpatient Clinic, Munich, Germany.,Department of Psychiatry, Clinical Anxiety Research, University of Würzburg, Würzburg, Germany
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6
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Mason EC, Gaston JE, Pestell CF, Page AC. A comprehensive group-based cognitive behavioural treatment for blood-injection-injury phobia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:494-509. [PMID: 34750831 DOI: 10.1111/bjc.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A key feature of blood-injection-injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group-based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention. METHODS Participants took part in an 8-session, group-based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting). RESULTS There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre-treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre-treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others. CONCLUSION Despite the heterogeneous nature of BII phobia, this group-based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting. PRACTITIONER POINTS Disgust is a key maintaining factor in blood-injection-injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard. This study examined a novel group treatment for blood-injection-injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting. The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment. Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach.
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Affiliation(s)
- Elizabeth C Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Jonathan E Gaston
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew C Page
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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7
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Bertuzzi V, Fratini G, Tarquinio C, Cannistrà F, Granese V, Giusti EM, Castelnuovo G, Pietrabissa G. Single-Session Therapy by Appointment for the Treatment of Anxiety Disorders in Youth and Adults: A Systematic Review of the Literature. Front Psychol 2021; 12:721382. [PMID: 34539523 PMCID: PMC8440994 DOI: 10.3389/fpsyg.2021.721382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose: This systematic review provides a summary of the available evidence of the efficacy of single-session therapy (SST) on anxiety disorders in both youth and adults. Methods: PubMed, Scopus, Medline, and Google Scholar databases were search for relevant articles, and the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used for transparent reporting of the methodological quality of each selected study. Results: The search of electronic databases identified 18 reports based on rigorous inclusion criteria. Single-session therapy was found superior to no treatment in reducing anxiety symptoms, and similar results were observed while comparing SST to multi-treatment sessions. Discussion: The findings support the benefits of SST in enhancing cognitive, behavioral, and psychological outcomes in both youth and adults suffering from anxiety disorders across treatment conditions and approaches, SST thus appears to be a promising way of providing access to both private and public therapeutic services efficiently and cost-effectively. Conclusions: Single-session therapy is effective in treating anxiety disorders. Further research is required to quantify its cost-effectiveness and deepen the knowledge of effective treatment ingredients for both young people and the adult population suffering from diverse anxiety disorders. Systematic Review Registration: PROSPERO, identifier [CRD42021232024].
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Affiliation(s)
- Vanessa Bertuzzi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Giulia Fratini
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Claudia Tarquinio
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Valentina Granese
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Emanuele Maria Giusti
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
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8
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Abado E, Aue T, Okon-Singer H. Cognitive Biases in Blood-Injection-Injury Phobia: A Review. Front Psychiatry 2021; 12:678891. [PMID: 34326784 PMCID: PMC8313757 DOI: 10.3389/fpsyt.2021.678891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Blood-injection-injury (BII) phobia can lead to avoidance of crucial medical procedures and to detrimental health consequences, even among health workers. Yet unlike other specific phobias, BII phobia has been understudied. Specifically, while cognitive biases have been extensively investigated in other anxiety disorders, little is known about the same biases in BII phobia. The current article reviews cognitive biases in BII phobia and suggest future directions for further study and treatment. The reviewed biases include attention, expectancy, memory, perception, and interpretation biases. The investigation of these biases is highly relevant, as cognitive biases have been found to interact with anxiety symptoms. Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor perception biases. Mixed results were found for attention bias, as different studies found different components of attention bias, while others found no attention bias at all. Similarly, some studies found a-priori/a-posteriori expectancy biases, while other studies found only one type of bias. A better understanding of the cognitive particularities of BII phobia may lead to better treatments and ultimately reduce avoidance of needles and blood-related situations, thereby enabling individuals with BII phobia to undergo potentially life-saving medical procedures.
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Affiliation(s)
- Elinor Abado
- School of Psychological Sciences, University of Haifa, Haifa, Israel.,The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Tatjana Aue
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Hadas Okon-Singer
- School of Psychological Sciences, University of Haifa, Haifa, Israel.,The Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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Feasibility of one-session treatment for specific needle phobia in an adult IAPT service – a case series. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x2000046x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
One-session treatment for specific phobias (OST; Öst, 2012) has been found to be efficient and effective in reducing the severity of phobia in an adult population. This study aimed to investigate the feasibility of OST in an Improving Access to Psychological Therapy (IAPT) primary care service in the North East of England. Participants were four women and one man between the ages of 21 and 46 years; all presented with needle phobia. Treatment consisted of three clinical contacts: a 1-hour pre-treatment interview to identify the catastrophic belief centred on the phobic situation; a 2.5–3-hour treatment session using exposure in vivo (i.e. images, videos and handling of a syringe – no actual injections) and participant modelling in accordance with OST protocol; and a 30-minute follow-up telephone appointment. Outcome was measured with standard IAPT and additional psychometrics, as well as qualitative client feedback. The outcome suggests the application of OST to be effective for needle phobia, as well as feasible and cost- and resource-efficient in its application to an IAPT primary care service. Further research needs to investigate its effects in comparison with multiple single sessions of cognitive behavioural therapy in an adult population, as well as appropriate outcome measures to suit an IAPT application.
Key learning aims
(1)
To gain a basic understanding of one-session treatment for specific phobias (OST).
(2)
To enhance understanding of the implications of OST in an IAPT primary care service.
(3)
To acquire useful information about practicalities and challenges of OST in an IAPT primary care setting.
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10
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Davis TE, Ollendick TH, Öst LG. One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review. Annu Rev Clin Psychol 2019; 15:233-256. [PMID: 30550722 DOI: 10.1146/annurev-clinpsy-050718-095608] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.
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Affiliation(s)
- Thompson E Davis
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803, USA;
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24060, USA;
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden;
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11
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Berge KG, Agdal ML, Vika M, Skeie MS. Treatment of intra-oral injection phobia: a randomized delayed intervention controlled trial among Norwegian 10- to 16-year-olds. Acta Odontol Scand 2017; 75:294-301. [PMID: 28270029 DOI: 10.1080/00016357.2017.1297849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effect of five sessions of cognitive behavioural therapy (CBT) for 10- to 16-year-olds with intra-oral injection phobia. MATERIAL AND METHODS This was a randomized delayed intervention controlled trial in 67 patients, fulfilling the DSM-5 criteria for specific phobia. All patients received the same CBT performed by dentists specially trained in CBT. The patients were randomly assigned to either an immediate treatment group (ITG) (34 patients) or a waitlist-control group (WCG) (33 patients). The WCG was put on a waitlist for 5 weeks. After treatment, all patients were combined for post-treatment analyses. Assessments including the psychometric self-report scales Intra-oral injection fear scale (IOIF-s), Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Injection Phobia Scale for children (IS-c) and Mutilation Questionnaire for children (MQ-c) and a behavioural avoidance test (BAT) followed by a questionnaire on cognitions during the BAT, occurred pre-, post-treatment/waitlist and at a 1-year follow-up. RESULTS CBT had a significant effect compared to no treatment (WCG). After treatment, the scores on the psychometric self-report scales were significantly reduced and higher levels in the BAT were achieved. The results were maintained at 1-year follow-up. Of the 67 patients, 70.1% received intra-oral injections during CBT treatment, whereas 69.4% of those completing the CBT, in need for further dental treatment, managed to receive the necessary intra-oral injections at their regular dentist. CONCLUSIONS The 10- to 16-year-olds diagnosed with intra-oral injection phobia benefitted positively on CBT performed by specially trained dentists.
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Affiliation(s)
- Karin G. Berge
- Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maren Lillehaug Agdal
- Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Margrethe Vika
- Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Marit Slåttelid Skeie
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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12
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Berge KG, Agdal ML, Vika M, Skeie MS. High fear of intra-oral injections: prevalence and relationship to dental fear and dental avoidance among 10- to 16-yr-old children. Eur J Oral Sci 2016; 124:572-579. [PMID: 27689943 DOI: 10.1111/eos.12305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Karin G. Berge
- Oral Health Centre of Expertise in Western Norway; Hordaland Bergen Norway
- Department of Clinical Dentistry; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
| | - Maren L. Agdal
- Oral Health Centre of Expertise in Western Norway; Hordaland Bergen Norway
| | - Margrethe Vika
- Oral Health Centre of Expertise in Western Norway; Hordaland Bergen Norway
| | - Marit S. Skeie
- Department of Clinical Dentistry; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
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13
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McMurtry CM, Taddio A, Noel M, Antony MM, Chambers CT, Asmundson GJG, Pillai Riddell R, Shah V, MacDonald NE, Rogers J, Bucci LM, Mousmanis P, Lang E, Halperin S, Bowles S, Halpert C, Ipp M, Rieder MJ, Robson K, Uleryk E, Votta Bleeker E, Dubey V, Hanrahan A, Lockett D, Scott J. Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cogn Behav Ther 2016; 45:217-35. [PMID: 27007463 PMCID: PMC4867871 DOI: 10.1080/16506073.2016.1157204] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022]
Abstract
Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.
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Affiliation(s)
- C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Canada
- Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, Canada
- Children’s Health Research Institute, London, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Canada
| | | | - Christine T. Chambers
- Department of Pediatrics, Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- The Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | | | - Rebecca Pillai Riddell
- The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Vibhuti Shah
- Mount Sinai Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Noni E. MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
- Canadian Center for Vaccinology, Halifax, Canada
| | - Jess Rogers
- Centre for Effective Practice, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Lucie M. Bucci
- Immunize Canada, Ottawa, Canada
- Canadian Public Health Association, Ottawa, Canada
| | | | - Eddy Lang
- Alberta Health Services and the Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott Halperin
- Department of Pediatrics, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
- Canadian Center for Vaccinology, Halifax, Canada
- Department of Microbiology & Immunology, Dalhousie University, Halifax, Canada
| | - Susan Bowles
- College of Pharmacy, Dalhousie University, Halifax, Canada
| | - Christine Halpert
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, Canada
| | - Moshe Ipp
- The Hospital for Sick Children, Toronto, Canada
- Faculty of Medicine, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Michael J. Rieder
- Departments of Paediatrics, Physiology & Pharmacology and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Kate Robson
- Canadian Family Advisory Network, Toronto, Canada
| | | | | | | | - Anita Hanrahan
- Communicable Disease Control, Alberta Health Services, Edmonton, Canada
| | - Donna Lockett
- Bodhi Seed Center for Healing and Conscious Living, Milton, Canada
| | - Jeffrey Scott
- Department of Emergency Medicine, IWK Health Centre, Halifax, Canada
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14
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One session treatment for pediatric blood-injection-injury phobia: A controlled multiple baseline trial. Behav Res Ther 2015; 73:131-42. [PMID: 26313620 DOI: 10.1016/j.brat.2015.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/01/2015] [Accepted: 08/11/2015] [Indexed: 12/19/2022]
Abstract
The present study evaluated the effectiveness of a modified One Session Treatment (OST), which included an e-therapy homework maintenance program over 4 weeks for Blood-Injection-Injury (BII) phobia in children and adolescents. Using a single case, non-concurrent multiple-baseline design, 24 children and adolescents (8-18 years; 7 males, 17 females) with a primary diagnosis of BII phobia were randomly assigned to a one, two or three week baseline prior to receiving OST. Primary outcome measures included diagnostic severity, diagnostic status, and child and parent fear ratings. Secondary outcome measures included avoidance during behavioural avoidance tasks (BAT), global functioning and self and parent reported anxiety, fear and depression. Efficacy was assessed at post-treatment, 1-month, and 3-month follow-up. BII symptoms and diagnostic severity remained relatively stable during the baseline periods and then significantly improved following implementation of the intervention. Treatment response was supported by changes across multiple measures, including child, parent and independent clinician ratings. At post-treatment 8 of the 24 (33.33%) children were BII diagnosis free. Treatment gains improved at follow-ups with 14 (58.33%) children diagnosis free at 1-month follow-up and 15 (62.5%) diagnosis free at 3-month follow-up. Preliminary findings support the effectiveness of a modified OST approach for BII phobic youth with treatment outcomes improving over follow-up intervals.
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