Cardiovascular activity in blood-injection-injury phobia during exposure: Evidence for diphasic response patterns?

https://doi.org/10.1016/j.brat.2013.03.011Get rights and content

Highlights

  • Cardiovascular activity in blood-injection-injury phobia is thought to be diphasic.

  • In laboratory fear induction, only a minority of patients showed diphasic responses.

  • Diphasic responses in multiple cardiovascular parameters were associated with greater distress.

  • Reducing hyperventilation may be an additional target of BII-phobia treatment.

Abstract

Exposure to feared stimuli in blood-injection-injury (BII)-phobia is thought to elicit a diphasic response pattern, with an initial fight-flight-like cardiovascular activation followed by a marked deactivation and possible fainting (vasovagal syncope). However, studies have remained equivocal on the importance of such patterns. We therefore sought to determine the prevalence and clinical relevance of diphasic responses using criteria that require a true diphasic response to exceed cardiovascular activation of an emotional episode of a negative valence and to exceed deactivation of an emotionally neutral episode. Sixty BII-phobia participants and 20 healthy controls were exposed to surgery, anger and neutral films while measuring heart rate, blood pressure, respiratory pattern, and end-tidal partial pressure of carbon dioxide (as indicator of hyperventilation). Diphasic response patterns were observed in up to 20% of BII-phobia participants and 26.6% of healthy controls for individual cardiovascular parameters. BII-phobia participants with diphasic patterns across multiple parameters showed more fear of injections and blood draws, reported the strongest physical symptoms during the surgery film, and showed the strongest tendency to hyperventilate. Thus, although only a minority of individuals with BII phobia shows diphasic responses, their occurrence indicates significant distress. Respiratory training may add to the treatment of BII phobia patients that show diphasic response patterns.

Section snippets

Participants

Eighty participants between the ages of 18 and 50 were enrolled for a laboratory session of film viewing. Participants were recruited through flyers on university campus and community advertisements. BII-phobia recruitment targeted individuals that were “intensely fearful of seeing blood, injuries, or needles”, whereas recruitment of healthy controls targeted “healthy men and women to participate in a laboratory study investigating physiological responses to daily life experiences”. Of the

Overall emotional response to exposure

Psychological responses of BII-phobia participants versus healthy controls to film exposure protocol have been reported before (Ayala et al., 2010). Anxiety increased significantly in BII-phobia participants during exposure to the surgery film (M = 6.4, SD = 3.0) compared to neutral (M = 1.3, SD = 1.7) and anger (M = 3.5, SD = 2.9) films. No significant change in anxiety was observed in healthy controls during surgery (M = 2.0, SD = 2.7) compared to neutral (M = 0.7, SD = 1.1) and anger (M

Discussion

The presumed diphasic nature of cardiovascular responses in BII-phobia has been the dominant psychophysiological paradigm in past decades. Engel and Romano (1947) introduced the idea of two phases, which were interpreted as fight-flight followed by conservation-withdrawal. The latter was seen as dominated by parasympathetic discharge. Graham et al. (1961) viewed the diphasic response as the chief characteristic in vasovagal syncope. However, empirical support for diphasic responses has remained

Acknowledgments

We thank Jennifer Rosemore, Michelle Reyes, and Shawn White for their help with data reduction.

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