Notes for Psychotherapists who want to work with needle phobic patients.

On the main Needle Phobia Page, I have always cautioned psychotherapists about working with needle phobia patients.  The reason for this is simply that, in the past, most people with needle phobia had a sub-type of blood-injury-injection phobia that often caused them to faint, sometimes with convulsions and (more rarely) with cardiovascular problems.  In at least 23 documented cases, this vasovagal fainting has resulted directly in death (although these rare deaths are nearly always in individuals with pre-existing cardiovascular problems).  This vasovagal fainting with blood-injury-injection phobia is completely unique among phobias.

Most psychotherapists are simply unprepared for a patient to become unresponsive, and possibly begin convulsing.  This reaction can be, and often is, precipitated by simply talking about, or having the patient imagine, a needle procedure.  No needles have to be present at all.

There are ways, however, for a psychotherapist to work with a needle phobic patient with a high degree of safety.  It is vitally important, of course, to first try to determine whether your patient has the vasovagal (fainting) type of needle phobia, or has needle phobia as a classic phobia that can be treated by the tools that you normally use for treating phobias.   One matter that seriously complicates the issue is that many patients with more serious cases of needle phobia have both types of needle phobia.   They may never have fainted before, but may experience their first fainting episode in your office while talking about needle procedures.

If a patient is known to have a problem with fainting, he should always be checked out by a physician to rule out another physical cause for the problem.  In many cases, though, the previous cases of fainting will have occurred in a physician's office, in which case such a checkup should have already been done.

Of course, it is always helpful if you, as the psychotherapist, have some basic medical (or at least CPR) training.   If a patient does faint, immediately, but gently, get the patient in a head-down legs-up position.   The vasovagal fainting caused by blood-injury-injection phobia is caused by very low blood pressure in the brain; therefore, you want to use the full assistance of gravity in returning normal blood flow and blood pressure to the brain.

When a patient has returned to consciousness after fainting, the patient's first impulse is to sit up or stand up, but this is completely the wrong thing to do.  The patient's head should be held by the therapist firmly flat against the seat cushion or the floor (depending upon where he has fainted) for at least a full minute after he has regained both consciousness and the ability to converse lucidly.  The important thing is to keep his head down in a position that is no higher than the rest of his body until his blood pressure has returned to normal.

A blood pressure cuff is ideal for measuring blood pressure, but the "one full minute of lucid conversation" can be a substitute for blood pressure measurement in this particular instance.

Most people who faint will usually return to consciousness rather quickly, but if the patient does not quickly return to consciousness, or if the patient has convulsions, then it is time to call the emergency number for medical help.   Another very useful device for telling when to call for medical help is the pulse oximeter.

The pulse oximeter is a device that clips over the end of the finger and measures both pulse rate and hemoglobin oxygen saturation.   Just a few years ago, pulse oximeters were terribly expensive, but now they can be purchased for as little as 20 U.S. dollars from places like Amazon.com.   The pulse oximeters for hospital use are still quite expensive; but the ones sold for occasional consumer use are quite good and can literally be a lifesaver.   Normal hemoglobin saturation is 95 to 99 percent, although it may be lower in some people at higher altitudes.   If a patient has a hemoglobin saturation below about 85 percent for more than a minute or so, or especially if it is steadily dropping, it is time to get help from the paramedics.

Some people will tell you that you should always call the medical emergency number if a patient faints in your office.  That may be the policy of your organization or your governing community or locality.  If you have the option, however, for minor cases where the patient immediately returns to consciousness, he may simply have gotten very tired of people calling for the paramedics every time that he faints (especially when he faints often).

Even if your needle phobic patient is a fainter, as long as you exercise due care, and you know that your patient is generally in good cardiovascular health, there are several things that you can do to work with them with a fair degree of safety.  One is to help your patient learn the Applied Tension technique.  This helps to prevent the sudden plunge in blood pressure that lead to fainting.

For people with vasovagal fainting, relaxing too much is exactly the wrong thing to do.  The patient has to learn to maintain normal blood pressure without overdoing the body tension.

The Anxiety BC web site that I mentioned on the Needle Phobia Page has some excellent instructions for learning the Applied Tension technique.   Actually, the web page on teaching Applied Tension to children is more informative than the page for adults when you are helping another person to learn this technique.

See:   http://www.anxietybc.com/sites/default/files/blood_and_needles.pdf

Also see:   http://www.anxietybc.com/applied-tension-technique-people-who-faint-sight-blood-or-needles

Please thoroughly learn all of the material on both of the above brief Anxiety BC pages.

I think that the Anxiety BC site is an excellent web site overall.

Desensitization by having your patient actually handle a real needle helps in many cases.  This can be very useful for all needle phobics.  If the patient is a fainter, you may have to be very careful with this one, or you might actually cause the patient to faint while actually handling a needle for the first time.

The best thing to do is to get something like a small insulin syringe (which is not a very scary looking object, even to most needle phobics) and have the patient hold it in his hands, take off the cap, look at the needle, push the plunger, etc.   All of this should be done while the patient is lying down.

The part about lying down is very important.   If the patient is lying down, even the frequent fainter is very unlikely to faint; and if the patient does lose consciousness, the patient will usually recover quickly without any problems as long as he continues to lie down.

For people with needle phobia, the dangerous part about fainting generally comes if they are sitting up or standing up.   This can include physical injury while falling, or simply sustained loss of blood pressure to the brain (which can be very dangerous).

I must repeat what I said earlier:   If anyone does have vasovagal fainting while you are treating them, they may feel the overwhelming urge to stand up after they return to consciousness.  This is exactly the wrong thing to do.  You may have to hold their head down for a minute or longer after they return to consciousness, and encourage them strongly not to get up too soon.

So, just knowing a few basic things to do if a person does faint in your presence, or even just begins to faint, can make a huge difference.

Of course, before treating anyone with needle phobia, you should make yourself thoroughly familiar with everything on the main Needle Phobia Page.

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