Fear of blood, injections and/or injuries (SIH)

Fear of blood, injections and/or injuries (SIH)

The phobia of blood, injections, and/or injuries, also known by the acronym SIH, is a type of anxiety disorder. Within the group of these, it is found in the specific phobias. In summary and following the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), specific phobias can be understood as intense and persistent, excessive or irrational fear, which is triggered by the presence or anticipation of specific objects or situations in which avoidance and/or escape behaviors are adopted.

Unlike other types of phobias such as those of animals, natural environments, or situations, the phobia of SIH has some peculiarities. The most special one is the appearance of dizziness and subsequent fainting.

Apart from the obvious fact that fainting poses a danger to physical integrity, the main problem for those who suffer from SIH phobia is the avoidance of many significant situations such as important medical interventions for health, pregnancies, neglecting certain health studies or not being able to visit or care for injured people even if they may be very significant.

Therefore, in this article, we will explain the reason for the particularity of the SIH phobia mentioned above, as well as what is the best treatment to deal with it since there are great possibilities of overcoming this phobia and thereby achieving greater well-being.

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Why do dizziness and subsequent fainting occur in SIH phobia?

The main reason is due to the psychophysiological level of the person, specifically the pattern known as biphasic response. This response begins when facing the phobic stimulus (blood, injection, wounds) and ends once exposed. In detail, the first phase is characterized by an increase in the three most relevant psychophysiological measures (increased heart rate, blood pressure, and respiratory rate), and a second phase in which a drop or decrease in these parameters occurs, especially a slowing of the heart rate and a decrease in blood pressure, which can lead to dizziness and subsequent fainting.

How can I overcome it? What treatments are effective?

As with all specific phobias, the ultimate goal is to get the person exposed to the phobic stimulus in the most manageable way possible. In particular, with SIH phobia, to manage the aforementioned biphasic response to prevent the person from fainting.

For this, the most effective treatment is cognitive-behavioral, which, leaving aside the evaluative part, consists of a package with the following phases:

Psychoeducation of the emotion of anxiety. In this phase, the triple level of response that people have (cognition-emotion-behavior) is first explained, and then the emotion of anxiety itself is explored in depth. It is very important to understand the causal structure, the functional role that it has in us, as well as its subordination to another primary emotion, fear. And where there is anxiety, there is always fear in the background. Once all this is understood, these emotions are linked to the specific phobia in particular.

Psychophysiological deactivation for anticipatory anxiety.

This is where a key behavioral technique comes into play: diaphragmatic breathing with counting. Anxiety, within the complexity it has, if reduced from an organic point of view is still a hyperactivation of the organism derived from hyperventilation. That is why this technique will be an important piece in the pre-exposure. However, as will be explained later, it will not have to be put into practice in the post-exposure. And this is one of the peculiarities of the phobia of SIH.

Cognitive restructuring and self-instruction training. Once the theory and practice of the above have been internalized, the patient is then worked on with the original component of everything, the cognitions/thoughts. Using restructuring techniques, an attempt is made to reverse those distorted thoughts of the situation, as well as complement them with self-instructions. These are a cognitive technique that seeks to replace negative internal self-verbalizations with more adaptive ones. All of this is aimed at enhancing the person’s feeling of competence.

Gradual exposure. By moving through the phases, we reach the realm of exposure. As it is not a question of creating a flood, the patient is empathetically explained the need to gradually expose themselves to the feared situation, since it will be the only way to be able to handle it. Therefore, in gradual exposure, a hierarchy of anxiety-provoking situations is established to which the person must gradually expose themselves (always from less to more). For example, when faced with the exposure of having a blood test, before doing so, one can go to see a treatment room, smell disinfectant alcohol, see a syringe, etc.

Applied tension training.

This technique is the hallmark of all other treatments for specific phobias. It controls the second phase of the biphasic response that is responsible for the possibility of fainting. A series of steps of muscle tension and relaxation control vasovagal activation. Paradoxically, once exposed to the phobia of SIH, one must seek out the anxiety rather than reduce it.

Gradual enriched exposure and applied tension. In this penultimate phase, anxiety-provoking images are mixed with the applied tension technique.

Live exposure. In this last stage, for example in a needle phobia, the patient is accompanied to the blood draw while putting into practice everything that has been worked on previously. Once the exposure is finished, the positive aspects of the experience are reinforced, as well as an emphasis on possible points to improve. Once this is done, the idea is that in future exposures the person can do it without any accompaniment except in the event of a relapse.

Conclusion

As has been seen throughout the article, there is knowledge as well as well-established treatments for SIH phobia. Therefore, the reader who identifies with this problem (the most common among the specific phobias in the population) is encouraged to seek professional help, as there is a solution for it.

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