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Just thinking about needles conjures up what Noles admits are irrational fears. In the weeks before his first COVID-19 shot in February, he worried that he would be confronted with a needle the width of a meat injector, or that the nurse would trip while administering the injection, sending the needle deep into his arm.
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Such anxieties are not rare, and they can discourage important medical care. One meta-analysis found that 8% of health care workers in hospitals and 18% of workers in long-term care facilities avoid the influenza vaccine due to needle fears (McLenon., J., & Rogers, M. A. M., Journal of Advanced Nursing, Vol. 75, No. 1, 2019). A Canadian study, based on a survey of Toronto parents and children, found that 7% of adults and 8% of children reported needle fears as the primary reason for not receiving recommended immunizations (Taddio, A., et al., Vaccine, Vol. 30, No. 32, 2012).
Now people like Noles must weigh long-standing fears about needles and injections versus the life-saving benefits of an effective vaccine against a highly contagious virus. For patients who seek help, psychologists can provide exposure therapy for the most fearful and pain management strategies, including distraction, positive reframing, and the use of numbing creams, for those with lower-level fears.
More significant injection fears may be connected to a negative experience, more likely in the preschool years when vaccines are common, Birnie said. Children, in particular, can be influenced by fearful talk from those around them, such as siblings, parents, or clinicians. Imagery in popular media and news reports can also spark fears, she said. In 2019, Self magazine partnered with the American Academy of Pediatrics to compile a resource of free stock photos that media can use that lack depictions of crying children and oversize needles.
Adults with significant anxiety may postpone or skip a vaccine or blood procedure, and children may outright refuse to have one, McMurtry said. Those patients with an even higher degree of fear or a diagnosable phobia may experience a vasovagal response like Noles did.
One challenge with easing injection fear compared with other phobias, such as a fear of dogs, is that people can avoid vaccines or other needle interactions for many years, said Lindsey Cohen, PhD, chair of psychology at Georgia State University in Atlanta.
Given the urgency of vaccine uptake right now, Cohen advises that psychologists talk to patients who are struggling with injection fears about their values and goals to increase motivation. Do they want to master their injection fears because they are interfering with their life or do they want to learn strategies to simply get through the COVID-19 vaccination process?
Studies indicate that 3% to 4% of people qualify as having a needle phobia, which is characterized by avoidance behavior, intense irrational fear, and the risk of becoming dizzy or fainting, either during or in anticipation of a procedure (Wani, A. L., et al., Behavioural Neurology, 2014). But that figure is likely underestimated given that such individuals often avoid the health system in the first place, McMurtry said.
For individuals who want to overcome a diagnosable phobia or high levels of fear, research indicates that exposure therapy is likely the optimal approach, McMurtry said. She helped write a clinical guideline that recommended using exposure-based therapy to treat high levels of injection fear in children age 7 and older and in adults (McMurtry, C. M., et al., Cognitive Behaviour Therapy, Vol. 45, No. 3, 2016).
The number of people with iatrophobia may have increased as a result of the COVID-19 pandemic. People may fear going to their doctor due to the risk of virus exposure. They also may have heard that the nasal swab test for COVID-19 was uncomfortable or painful, making them afraid of the test. People with iatrophobia may be less likely to get tested even after a known virus exposure or the onset of COVID-19 symptoms.
You may also develop iatrophobia if you smoke or have a substance use disorder. You may fear seeing your doctor because they might give you bad news about your health or suggest you quit using these substances.
Exposure therapy: Your provider gradually exposes you to dogs. Some providers offer virtual reality therapy using special goggles that mimic interacting with a real dog. Over time, your sensitivity to dogs decreases and you become less fearful. This therapy may include:
A note from Cleveland ClinicIf you or your child is going out of your way to avoid dogs, or if anxiety and panic attacks are causing you distress, talk to your provider. When cynophobia is severe, it can have a significant impact on your quality of life. Therapy can help you learn to control your response to fear and think about dogs in a different way. Relaxation techniques and meditation are beneficial to people with cynophobia. Be sure to tell your provider if you have other phobias or a history of mental illness in your family.
Anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and diagnosis. If you have obsessive-compulsive disorder (OCD), for example, your treatment will be different from someone who needs help for anxiety attacks. The length of therapy will also depend on the type and severity of your anxiety disorder. However, many anxiety therapies are relatively short-term. According to the American Psychological Association, many people improve significantly within 8 to 10 therapy sessions.
While many different types of therapy are used to treat anxiety, the leading approaches are cognitive behavioral therapy (CBT) and exposure therapy. Each anxiety therapy may be used alone, or combined with other types of therapy. Anxiety therapy may be conducted individually, or it may take place in a group of people with similar anxiety problems. But the goal is the same: to lower your anxiety levels, calm your mind, and overcome your fears.
Accessing help online can help you avoid the expense and inconvenience of having to meet in-person and being in a familiar, comfortable environment can make it easier to talk openly about your issues. For many people with anxiety, online therapy can be just as effective as traditional, in-person therapy.
Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.
For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.
Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That's why cognitive behavioral therapy includes practicing on your own at home as well.
Anxiety isn't a pleasant sensation, so it's only natural to avoid it if you can. One of the ways that people do this is by steering clear of the situations that make them anxious. If you have a fear of heights, you might drive three hours out of your way to avoid crossing a tall bridge. Or if the prospect of public speaking leaves your stomach in knots, you might skip your best friend's wedding in order to avoid giving a toast. Aside from the inconvenience factor, the problem with avoiding your fears is that you never have the chance to overcome them. In fact, avoiding your fears often makes them stronger.
Exposure therapy, as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you'll feel an increasing sense of control over the situation and your anxiety will diminish. The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioral therapy.
Rather than facing your biggest fear right away, which can be traumatizing, exposure therapy usually starts with a situation that's only mildly threatening and works up from there. This step-by-step approach is called systematic desensitization. Systematic desensitization allows you to gradually challenge your fears, build confidence, and master skills for controlling panic.
Hypnosis is sometimes used in combination with CBT for anxiety. While you're in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.
There is no quick fix for anxiety. Overcoming an anxiety disorder takes time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you'll feel worse before you get better. The important thing is to stick with treatment and follow your therapist's advice. If you're feeling discouraged with the pace of recovery, remember that therapy for anxiety is very effective in the long run. You'll reap the benefits if you see it through.
You can also support your own anxiety therapy by making positive choices. Everything from your activity level to your social life affects anxiety. Set the stage for success by making a conscious decision to promote relaxation, vitality, and a positive mental outlook in your everyday life.
Learn about anxiety. In order to overcome anxiety, it's important to understand the problem. That's where education comes in. Education alone won't cure an anxiety disorder, but it will help you get the most out of therapy.
Background: Traditional face-to-face cognitive behavioural therapy (CBT) has been successful at reducing fear of falling (FOF) in older people but can be labour-intensive and costly. Online CBT has been suggested as a cost-effective alternative but has not yet been tested in the context of FOF. This study evaluates the effectiveness of a readily available, self-guided and generalised online CBT program (myCompass) on reducing FOF in older people. 041b061a72