The use of systematic desensitization in the treatment of blood phobia

doi:10.1016/0005-7916(80)90071-3

Journal of Behavior Therapy and Experimental Psychiatry

Volume 11, Issue 4, December 1980, Pages 277-279

https://doi.org/10.1016/0005-7916(80)90071-3 Get rights and content

Abstract

A phobia for blood in a 23-yr-old male was treated with systematic desensitization. Anatomical slides, objects associated with blood, and slides of the patient going through the process of giving blood were later incorporated into the treatment procedure. Following treatment, the patient was able to give blood himself with “minimal anxiety”. An 8 month follow-up revealed no evidence of return of blood-related anxiety.

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A case of blood-illness-injury phobia treated behaviorally
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Changes in intensity of blood phobia as a function of instructional differences in locus and level of arousal

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Cited by (11)

Respiratory and hemodynamic contributions to emotion-related pre-syncopal vasovagal symptoms
2017, Biological Psychology
Citation Excerpt :
Subsequent reference to hyperventilation by Engel and Romano (1947) indicated that they considered it a component of the vasovagal response. However, until recently, aside from observational and case studies (Elmore, Wildman Ii, & Westefeld, 1980; Foulds, 1993; Steptoe & Wardle, 1988; Thyer & Curtis, 1985), the influence of change in respiration preceding emotion-related vasovagal responses was largely unexplored in favour of investigation of cardiovascular indices (Ritz et al., 2010). Several experimental studies involving Blood-Injection-Injury (BII) phobia patients exposed to a surgery video indicated a significant association between hyperventilation and vasovagal symptoms (Ritz et al., 2010).
Vasovagal reactions are conventionally understood as resulting from systemic changes in cardiovascular activity; however, there exists a complementary perspective focused on specific changes in cerebral vasoconstriction associated with hyperventilation-induced hypocapnia. The present study investigated the role of cardiovascular and respiratory activity in self-reported pre-syncopal vasovagal reactions to a surgery video in a sample of 49 healthy women. Participants who indicated more previous real-life episodes of dizziness reported experiencing significantly more symptoms in the laboratory consistent with a vasovagal response. They also showed lower total peripheral resistance and higher pre-ejection period in general, suggesting lower sympathetic nervous system activity. Significant decreases in end-tidal carbon dioxide (P_ETCO₂) occurred during the surgery video among susceptible participants, without significant increases in respiration rate. Further, participants who experienced reductions from the neutral video in P_ETCO₂, systolic blood pressure, or both, reported vasovagal symptoms during the surgery video. The results suggest that patterns of respiration associated with decreases in P_ETCO₂ may contribute to vasovagal symptoms reported in non-clinical groups as well as those with blood-injection-injury phobia and are associated with susceptibility to dizziness.
The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm
2010, International Journal of Psychophysiology
Citation Excerpt :
However, subsequent work has focused on the cardiovascular regulation and not considered respiratory adjustments in exposure to BII phobia-relevant stimuli in greater depth. Mostly qualitative observations and case studies have been published that reported hyperventilation or deep breathing in BII-phobia patients (e.g., Elmore et al., 1980; Foulds, 1993; Steptoe and Wardle, 1988). Thyer and Curtis (1985) estimated on the basis of behavioral observation that approximately half of their patients hyperventilated during exposure sessions.
Blood-injection-injury (BII) phobia is an anxiety disorder that may be accompanied by vasovagal fainting during confrontation with the feared stimuli. The underlying pattern of autonomic regulation has been characterized as a diphasic response, with initial increases in heart rate and blood pressure that are typical of a fight-flight response, and subsequent drops in blood pressure and/or heart rate that may precipitate vasovagal fainting. Tensing skeletal muscles of the arms, legs, and trunk (applied tension) has been proposed as a technique to cope with this dysregulation. This review critically examines the empirical basis for the diphasic response and its treatment by applied tension in BII phobia. An alternative perspective on the psychophysiology of BII phobia and vasovagal fainting is offered by focusing on hypocapnia that leads to cerebral blood flow reductions, a perspective supported by research on neurocardiogenic and orthostatically-induced syncope. The evidence may indicate a role for respiration-focused coping techniques in BII phobia.
The effect of video game violence on physiological desensitization to real-life violence
2007, Journal of Experimental Social Psychology
Past research shows that violent video game exposure increases aggressive thoughts, angry feelings, physiological arousal, aggressive behaviors, and decreases helpful behaviors. However, no research has experimentally examined violent video game effects on physiological desensitization, defined as showing less physiological arousal to violence in the real world after exposure to video game violence in the virtual world. This experiment attempts to fill this gap. Participants reported their media habits and then played one of eight violent or nonviolent video games for 20 min. Next, participants watched a 10-min videotape containing scenes of real-life violence while heart rate (HR) and galvanic skin response (GSR) were monitored. Participants who previously played a violent video game had lower HR and GSR while viewing filmed real violence, demonstrating a physiological desensitization to violence. Results are interpreted using an expanded version of the General Aggression Model. Links between desensitization, antisocial, and prosocial behavior are discussed.
Applications of exposure techniques in behavioral medicine
2007, Handbook of Exposure Therapies
The pain anxiety and emotional disclosure literatures are much more recent than those of blood-injection-injury (BII) and dental phobia and concomitantly less developed. A well-designed set of small-sample replication studies suggests that in chronic pain rehabilitation programs, based on instrumental learning principles, targeting pain anxiety directly with in vivo exposure to pain-related fear stimuli extinguishes pain anxiety and facilitate increasing functional capacity. In the migraine headache literature, a case has been made for prolonged exposure to headache triggers to facilitate desensitization of trigger-sensitization hypothesized to develop through long-term avoidance. Viewing the emotional disclosure protocol as an exposure technique rather than as a means to reduce the stress of inhibition and bring about insight has implications for modifying the protocol in a way that may potentially enhance its efficacy.
Blood-injury phobia
1994, Clinical Psychology Review
Blood-injury phobia is an atypical specific phobia. Sufferers exhibit irrational or excessive anxiety and a desire to avoid specific feared objects and situations, to the point of avoiding potentially life-saving medical procedures. In addition, blood-injury phobies are liable to faint in the presence of blood or injury. Such fainting complicates the clinical picture, the etiological models, and the forms of treatment offered. This article reviews evidence for the etiology of blood-injury phobia and concludes that the disorder is the product of two separate but related etiologies: one underlying fearful avoidance, the other fainting. The vulnerability to blood-injury fears and avoidance may involve elevated trait anxiety and the vulnerability to faint in the presence of blood and injury may involve elevated disgust sensitivity. Available treatments are discussed in light of the separation of fear and fainting.
Exposure in vivo vs applied relaxation in the treatment of blood phobia
1984, Behaviour Research and Therapy
Eighteen patients with phobia for bloodt, wounds and injuries were treated with exposure in vivo or applied relaxation. They were assessed on different self-report, behavioral and physiological measures before and after treatment. The patients were treated individually for 9 sessions, 1 per week. The within-group comparisons showed that both groups had improved significantly on most of the measures and that these improvements were sustained or furthered at the 6-month follow-up. Furthermore, 10 of the 16 who completed the treatment became blood donors. The between-group comparisons showed exposure to be better than applied relaxation on three of the self-report measures at post-treatment assessment, but not at follow-up. The groups did equally well on the behavioral and physiological measures. The conclusion that can be drawn is that the coping-orientated method of applied relaxation is as effective as exposure in vivo in the treatment of blood phobia.

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The use of systematic desensitization in the treatment of blood phobia

Abstract

A case of blood-illness-injury phobia treated behaviorally

J. Nervous Ment. Dis.

Changes in intensity of blood phobia as a function of instructional differences in locus and level of arousal