Hypnotherapy and Needle Phobia

As hypnotherapists, when clients ask if we can help them overcome a phobia they may be talking about flying, or spiders. These phobias are upsetting and limiting, but not a case of life or death. However, there is a phobia that carries fatal consequences; needle phobia. Hypnotherapists may not see this very often day-to-day, but it is something that medical staff encounters much more frequently.

 

People with needle phobia strive to avoid needles or medical procedures, just as a person with a fear of flying chooses not to get on a plane. However, avoiding medical procedures can mean vital tests are not carried out, and conditions go either undiagnosed or untreated. If you see your own symptoms in this blog, please feel able to contact us or your GP to discuss further.

 

Previous research in this area suggests that there are 4 main types of needle phobia; vasovagal, associative, resistive and hyperalgesic. These groups are not mutually exclusive; patients may present with symptoms from more than one.

Jenkins (2014) suggests that the very nature of needle phobia makes it very hard to determine incidence. By definition, people who suffer from needle phobia will avoid healthcare settings and so any population estimate is likely to underrate the true number, but estimates range from 3.5 to 10% of people as having some type of needle phobia.

At North Cardiff Hypnotherapy, we pride ourselves in understanding the subgroups of needle phobia. This helps us know how to adapt our usual 3 step process of helping a client overcome their fear. As with all our work, getting to know you is key, so we use an Initial Consultation to assess what type of needle phobia seems to be present and all the background information of your likes and dislikes, hobbies and interests.

The first type of needle phobia is called Vasovagal.  This is where a patient has an immediate fainting response to an needle procedure. Vasovagal needle phobia has very high familial links; up to 80% of people with needle phobia report a close relative with a strong phobic response. As we know, with most specific phobias, exposure to the simulus (e.g. spiders, heights) causes blood pressure and heart rate to increase, as the body gets ready for fight or flight, which is our usual survival technique. People with Vasovagal phobia differ in that they will experience an initial increase in heart rate and blood pressure, followed by an often almost immediate decrease, leading to fainting.

 

Sadly, in turn, the fear of fainting itself can then lead to the development of a more standard phobic response. Needles produce fainting; fainting is anxiety provoking; and anxiety produces feelings of nausea, breathlessness, light-headedness, that can mimic the signs of fainting (Jenkins, 2014).

Because the vasovagal phobic response is as much about physiology as it is psychology, it is useful to have some practical tips that can help. For example, lying down instead of standing up can minimise the effect of a drop in blood pressure. Whereas usually in hypnotherapy we encourage our clients to relax all their muscles, in this instance we would be encourage them to apply tension to the muscles; squeezing them and releasing them repeatedly to maintain a level blood pressure and heart rate. This applied tension technique is one used by fighter pilots to keep them from passing out when they were flying at such speeds and changes in altitude.

Associative fear of needles is the second most common type, affecting 30% of needle phobics (Morgan, 2001). This type is more like a fear of flying or spiders; a traumatic event, such as an extremely painful medical procedure, causes a person to associate all procedures involving needles with the original negative experience. Associations can be formed not only with the needles but also with the hospital building, smell of clinic, sight of nurse's uniform etc. This form of fear of needles causes symptoms that are primarily psychological in nature, such as extreme unexplained anxiety, insomnia, preoccupation with the coming procedure and panic attacks.

Something interesting to note is that it does not necessarily have to be a real experience that triggers this association. We know that an imagined negative experience is stored in the same way as an actual negative experience, which is why we can see a client with a fear of snakes who has never even seen one in real-life. Or, a client can learn to be phobic of an object vicariously. This happens more often in a hospital setting; a patient who previously showed little fear towards needles or medical procedures develops a phobia after watching a negative experience of their peer. Nursing staff report that often people who watch others have an injection misunderstand the procedure, and become fearful about the size of the needle, or whether or not it touches the bone. In these cases, vicarious phobias can often be alleviated with an empathetic but clear and rational explanation of what the procedure is and how it will be carried out. Distraction techniques can also be useful for an immediate alleviation of the fear, but the effect of distraction will only be short term.

With associative phobias, we are able to tackle them similarly to any other specific phobia; like flying. This involves a 3 step process of firstly relaxation; encouraging the patient to relax their muscles and focus their awareness to a safe and secure environment. Then, a Rewind. A Rewind is a dissociative technique that allows the patient to reprocess their memories and store a new, altered version of them without the traumatic emotional component. We guide the patient to imagine themselves watching a film of their previous negative experiences, or imagined negative future experiences; fast-forwarding and rewinding that film over and over to desensitise them to its contents. Research has shown that using a dissociative technique- directing the patient to imagine themselves as merely a spectator, watching these events in a safe place- helps the client establish a therapeutic distancing from the previously aversive situation, facilitating their ability to work on it without becoming unduly distressed (Griffin, 2005). Then, we can Reframe. A Reframe means the hypnotherapists asks the client to visualise a positive experience of needles, creating a new positive memory template on which future experiences of needles will be based.

The third category is a Resistive fear of needles. Resistive needle phobia occurs when the underlying fear involves not simply needles or injections but also being controlled or restrained. This form of needle phobia affects around 20% of those afflicted. Often these are older patients who perhaps were restrained for an injection or procedure as a child, which at the time was seen as acceptable practise. Symptoms include aggression, panic and anxiety. We can easily imagine how the Primitive Brain would react if we were tied down whilst the polar bear walked towards us! In the face of potential danger, being able to escape is key and not being able to escape can cause us additional stress.

In these cases, rewinding those negative experiences is essential. In addition, we can help engage rational thought to be able to determine the difference in modern day practise compared to 10, 20, 30 years ago. We can reframe the experience for the client to remind them that they will not be forced into any procedures and they are in control.

 

The final type of needle phobia is Hyperalgesic. This is another form that does not have as much to do with fear of the actual needle. Patients with this form have an inherited hypersensitivity to pain, or hyperalgesia. To them, the pain of an injection is unbearably great and many cannot understand how anyone can tolerate such procedures.

The recommended forms of treatment include some form of anaesthesia, either topical or general. There is little cause for hypnotherapy to be used in these cases; such a strong physiological response to the pain of a needle would require input from a pain clinic or anaesthetist. However, we are able to encourage such sufferers to seek the help that is needed.

 As ever, with solution focused hypnotherapy, our skill lies in using the initial consultation to take a careful history so we can work in the best way to meet the individual client’s needs. At North Cardiff Hypnotherapy, we strive to give you the best possible service and our ongoing learning and research means we are able to understand complex feelings such as a needle phobia more easily.

If you are worried, want more information, or would like to book an initial consultation, go to www.hypnotherapy-wales.com or email Dorothea or Jade at northcardiffhypnotherapy@gmail.com.

References

Griffin, J. (2005). The role of dissociation. Human Givens journal, 12, 3.

Jenkins, K. (2014). Needle phobia: A psychological perspective. British Journal of Anaesthesia, 113, 1, 4-6.