The Paradoxical Fear Response to Blood, Injury and Illness—A Treatment Report

Cognitive-behavioural Treatment of Blood-Injury-Injection Phobia: A Case Study

This single case study examined the treatment of blood-injury-injection (BII) phobia in a 14-year-old female. Thirteen 1-hour sessions of cognitive behavioural therapy were conducted. The intervention included a combination of exposure, applied tension, and cognitive restructuring in an effort to produce clinically significant reductions in anxiety and fainting in response to BII stimuli. Results did indeed show dramatic reductions in subjective distress in BII situations from baseline to post-treatment. This was supported by small reductions in phobic anxiety and general anxiety on self-report measures. In contrast to baseline, fainting did not occur during treatment. The subject rated cognitive restructuring as the most effective treatment component for the latter half of therapy. It is suggested that, to date, the importance of cognitive therapy for the treatment of BII phobia has been overlooked.

Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury

OBJECTIVE

The present study was designed to investigate the psychophysiologic effects of "Applied Tension" (AT) on the emotional fainting response to blood and injury in a controlled experiment.

METHOD

Twenty-two persons reporting to generally feel faint or to have fainted at the sight of blood or injury and 22 participants classified as Non-Fainters were randomly allocated to a treatment or control condition. Psychophysiologic responses were continuously monitored while individuals watched a video depicting open-heart surgery and a control film. Prior to the surgery film, participants in the treatment condition were instructed in the use of AT.

RESULTS

All participants classified as Fainters showed a diphasic response pattern while watching the surgery film. This response, however, was significantly attenuated in Fainters in the treatment condition.

CONCLUSIONS

These results suggest that AT provides an effective treatment strategy for the prevention of fainting responses in persons with a fear of blood and injury.

Fear and the startle reflex: blink modulation and autonomic response patterns in animal and mutilation fearful subjects

The present study was designed to examine the pattern of startle reflex modulation and autonomic responses for individuals high in animal or blood-injury fear when viewing pictures of their feared objects. Sixteen individuals in each fear group and 16 low-fear control individuals viewed 32 color slides depicting fear-relevant, unpleasant but fear-unrelated, neutral, and pleasant scenes. Free viewing times were assessed in a second phase of the procedure as an index of avoidance behavior. Exposure to pictures of feared objects resulted in a consistent startle reflex potentiation and behavioral avoidance in both fear groups. This activation of the basic aversive system was independent of the autonomic pattern of the fear responses, which differed for the high-fear groups. These results suggest that the probe startle response indexes the organism's basic motivational disposition and add new information to the assessment of fear.

One versus five sessions of applied tension in the treatment of blood phobia

Thirty patients with blood phobia, fulfilling the DSM-III-R criteria for simple phobia, were assessed with behavioral, physiological and self-report measures. They were randomly assigned to 3 different conditions: (1) 5 sessions of applied tension; (2) 1 session of applied tension (maximum 2 h); and (3) I session of tension-only (maximum 2 h). The results showed that the patients in the 3 treatments were all significantly improved at post-treatment and the effects were maintained at the 1 yr follow-up. At post-treatment and follow-up the proportions of clinically improved patients were: AT5 50 and 60%, AT1 0 and 70%, and T1 30 and 60%, respectively. The conclusion that can be drawn is that I-session therapist-directed applied tension or tension-only is the treatment of choice for blood phobia, but completed with a maintenance program of self-exposure.

Genetics of blood-injury fears and phobias: a population-based twin study

Data on unreasonable fears of blood, needles, hospitals, and illness (BNHI) were collected by telephone interview from 541 MZ and 388 DZ pairs of female twins from the population-based Virginia Twin Registry. BNHI phobia was defined as the presence of fear accompanied by interference. Age at onset of phobia was found to be very similar to that of situational phobias previously assessed in the sample. Using a multiple threshold model, we found no evidence for qualitative differences between BNHI fears and BNHI phobia. The familial aggregation of fears appears to be entirely due to additive genetic variance. The possible exception to this is fear of illness, which, like BNHI phobias, seems to aggregate within families because of shared environmental factors. Although power to discriminate between the causes of familial resemblance is low, results suggest that random traumatic events and some social learning may be responsible for the onset of BNHI phobias. About two-thirds of variance is individual-specific environmental, and could include genotype x environment interaction and measurement error.

Blood-injury-illness phobia: a review

The empirical literature that pertains to phobias of blood, injury, or illness (BII) is surveyed. BII phobia is selectively associated with a vasovagal fainting response upon exposure to phobic stimuli, and the clinical entity may represent an exaggeration of a response that is relatively prevalent in the general population. Clinical, demographic and etiological information obtained from a series of 15 BII phobics is presented, and the suggestion is made that this disorder warrants a diagnostic category separate from simple phobia.

The psychophysiological process of therapy in a case of injury-scene-elicited fainting

In a single case study, the psychophysiological process of change was studied during treatment of fainting with exposure to blood/injury stimuli. Therapy involved two procedures: a muscle-tensing maneuver and a cognitive coping strategy, each applied in A-B-A format. During therapy, bradycardia was associated with reports of greater fear. Muscle tensing brought higher heart rate and lower fear ratings. In contrast, the cognitive strategy produced lower fear ratings without affecting heart rate. At termination and at 6- and 30-month follow-up, the patient reported problem-free exposure to injury stimuli. Results supported the efficacy of the treatment approach, differentiated the effects of separate components of the intervention, and clarified its physiological basis.