Portal de Periódicos da CAPES

Rapid Desensitization for Needle Phobia

2003; Elsevier BV; Volume: 44; Issue: 3 Linguagem: Inglês

10.1176/appi.psy.44.3.253

1545-7206

Praveen Fernandes,

Obsessive-Compulsive Spectrum Disorders

Received Aug. 7, 2002; accepted Oct. 24, 2002. From the Department of Mental Health and Behavioral Science, Omaha VA Medical Center; and the Department of Psychiatry, Creighton University School of Medicine, Omaha. Address reprint requests to Dr. Fernandes, Mental Health Clinic, Omaha VA Medical Center—116A1, 4101 Woolworth Ave., Omaha, NE 68105; Praveen.Fernandes@med.va.gov (e-mail). Copyright 2003 The Academy of Psychosomatic Medicine. Fear of needles, variously referred to in the literature as “needle phobia” or “blood-injury phobia,” is a curious type of specific phobia with distinct clinical features. For most phobias, exposure to phobic cues induces tachycardia. In contrast, patients with needle phobia typically experience a diphasic cardiovascular response of an initial tachycardia, followed by bradycardia, hypotension, shock, vertigo, syncope, diaphoresis, nausea, and, rarely, asystole and death. The vasovagal response and bradycardia, which may reflect a constitutional autonomic dysregulation, make needle phobia less responsive to strategies like relaxation exercises and sedatives, which can actually provoke fainting. While the incidence of needle phobia among the general U.S. population is estimated at around 3%– 4%, most patients do not present themselves to clinics or hospitals as part of the avoidance of the phobic stimulus. As a result, attention to health care is often neglected to a point where they seek treatment at a late stage in their physical illness. By then, management usually becomes urgent and often involves needle insertion for investigations or treatment. Behavioral techniques such as exposure and participant modeling have been successfully used to treat needle phobia. This report describes the management of severe needle phobia by using rapid desensitization in a patient who urgently needed regular vascular access for dialysis. Practical steps involving prolonged multimodal exposure and counter-response techniques are provided that are simple, easily replicable, and require minimal training.