Snapshot Update: A Year in the Life

It’s been over a year since I posted, largely because not much upheaval has occurred with regards to my phobia, so I haven’t had much to process. But I thought I might share a few experiences from the last year, and the varied insights that have come from them.

After my first successful vaccination in summer 2015, I was an emotional wreck. Through an unfortunate combination of factors, I had broken up with my first boyfriend the night before my appointment. Needless to say, that week won the award for Worst Week Ever. In the following weeks, the recovery from the breakup had to happen at the same time as my recovery from the stress of the appointment (and the months leading up to it), and this unfortunate timing complicated the healing process for both events.

That fall and winter I had several nightmares about injections, and I also had an unexpected tearful meltdown at church during a prayer for mental health, and another later in the spring for no apparent reason. I developed an on-and-off habit of rubbing my arms whenever I thought about needles. It was clear to me that although I’d made it through an appointment successfully, I wasn’t “cured.” On the contrary, I felt that all the mixed negative emotions from that week had reinforced my fears of injections and medical appointments. Although logically I knew the successful appointment should have boosted my confidence, my emotional response to thinking or talking about injections hadn’t improved.

Last summer I saw my therapist for a couple of follow-up appointments. She identified an important factor in how I left my last appointment: I didn’t celebrate. I couldn’t celebrate, really, given what a mess of emotions I was feeling. So she suggested I ask whatever people I trust to do a belated celebration with me — throw a party, if I wanted to. I asked my family if they would do it with me, and they enthusiastically agreed. We went out for dinner, then back home for dessert, and they all gave me heartfelt toasts. My brother-in-law even wrote me a poem:

 

poem

It reads:

 

Lauren’s Song

Though you do not like the beatles
You’re still my superhero
For you have conquered needles
That dark and awful foe

You are an inspiration
Your stories are the best
You give me great frustration
When you treat me like a pest

And yet I call you sister, and that I grant is rare
A younger sibling to annoy is a joy beyond compare
But there’s one thing I have to do, I must at once confess
Your mighty deeds prove perfection, and absolutely nothing less

Although that night didn’t cure my phobia, it did help me look back on the appointment with a more positive perspective. Rather than remembering the fear, sadness, and anxiety that all came to a head that week, I was reminded of the success, and all the hard work that went into it.

Last fall brought about more challenges. Fall is flu season, which means it’s aggravating for needle phobics as they’re bombarded with “GET YOUR FLU SHOT” wherever they go. But last fall, on top of the flu shot advertising, my university had an outbreak of another more serious disease, which meant double the vaccination advertisements offering boosters. Along with the “BOOSTER CLINICS IN THE MPR” emails, people were constantly talking about the outbreak and whether or not they were immunized. I work at the front desk of my department building, which is often a prime location for idle conversation, and multiple times I had to quietly leave my desk because professors were standing around talking in great detail about getting their vaccinations. My anxiety reached a breaking point when the campus announced that booster shots would be mandatory for anyone who hadn’t been immunized after a certain age, and I wasn’t sure if I made the cutoff. I tearfully called my mom and had her look up my vaccination records, and it took me a while to calm down after finding out I was in the clear.

Looking forward, I don’t anticipate any needle procedures any time soon, although it will be interesting to see what happens with the outbreak on campus this spring. Day to day, I still feel tense and anxious when discussion of injections come up, and I’m still terrified of the fact that, no matter how healthy I stay, I will have to deal with some needle procedures in my adult life. But I’m trying to keep what my therapist has said in mind, that I have been successful in the past, and others have too, so my situation is not hopeless. I’ve assembled a toolbox of coping mechanisms that I can draw from at any time.

I think what I’ve learned from this year is that I may always have ups and downs, and that’s okay. I’m better than I was in high school.  As my therapist would say, I don’t need to “future trip” about challenges and possibilities that aren’t even here yet, and may never be. I should just focus on the day-to-day thinking habits that will build my confidence and peace, so when the day comes that I do need to face a needle procedure, it will be just a little bit easier.

My experience isn’t the only experience. Helpful comments are welcome.

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What Can I Do: Caring for Someone with Needle Phobia

Being close to someone with needle phobia is challenging. If you can’t talk someone out of their phobia, what can you do? Such intense fear is hard to comprehend, and when the person is in the middle of a phobic reaction, whether during an appointment or just a conversation about injections, it can feel like nothing you’re doing is helping.

But caring, supportive friends and family make a huge difference in the healing process. Here are my suggestions for caring for needle phobics, both during the everyday difficulties and the big challenges.

Listen. Listen, listen, listen. Let them describe their feelings to you, and don’t necessarily try to dispel the anxiety right away. Listen to their fears, their frustrations, their own internal experience. Don’t say, “I know what you’re feeling,” “You’re going to be fine,” “There’s nothing to be afraid of,” or “You’ve already told me this.” Let them verbally process as much or as little as they need to. “I’m so sorry,” “That really sucks,” or “That sounds awful” are basic indicators of sympathy and understanding. Remember, acting like you already completely understand what they’re going through and have nothing left to learn just diminishes their experience because, unless you also have a fear-related mental disorder, you don’t know fear like this. Fear that feels inescapable, that is harrowing and paralyzing, but also embarrassing because it is irrational. 

For me, listening and sympathizing are paramount. I can’t trust someone to care for me properly until I know that they understand how my phobia works, and that they aren’t going to try to talk me out of it or tell me I can just reason it away. (For more on what to say and what NOT to say, see my previous post.)

Be a cheerleader. If they are actively trying to overcome their phobia or get through an appointment, cheer them on! Remind them of their own strength, the milestones they’ve already reached, and the hope that they can beat it. Don’t give them empty promises like, “I’m sure this will work,” “You’re going to be fine,” or “It’ll be easy.” But genuine optimism is encouraging, and you can at least say with certainty that they will get through their next appointment and come out the other side, whether it goes well or not.

Encourage treatment. This is crucial and it can make a huge difference, but I want to include a word of caution. Pressing a needle phobic to seek therapy or other treatment can produce a bad response. Before I started therapy, if anyone tried to talk me into it, I would completely melt down – crying, retreating to my room, lashing out, the works. But you have to understand that the phobic is not being weak or lazy. They are responding to the prospect of therapy like they would respond to an upcoming appointment, with fear and avoidance, because the idea of therapy is frightening. Having to spend an hour in a room with a stranger talking about needles sounds almost as bad as an actual procedure.

Given that, most needle phobics probably won’t seek treatment without gentle persuasion from friends or family. So absolutely encourage them, just be prepared to deal with the repercussions and be patient. It will take some time to bring them around. (For more on the topic of therapy, see my previous post.)

Research for them. The Internet has some (but not much) good information on needle phobia, the vasovagal response, and ways to treat both. But for a needle phobic, searching terms like “needle phobia,” “needle phobia treatment,” and “vasovagal syncope” is a difficult task. Images, descriptions, and bad advice can be unintentional triggers, and a needle phobic will click away at the first sign of triggers. So if they’re trying to find more information, do it for them! It’s a simple way to relieve some anxiety, and you might come up with information that makes a big difference in their road to recovery. (For needle phobia and the vasovagal reflex, I recommend desensitization therapy and applied tension.)

Take charge when they can’t. If you are a primary caregiver and have been helping them with their phobia for a long time, you might have to make some decisions for them. A needle phobic might refuse to make appointments, discuss treatment strategies, or make commitments, and when it comes to their health and well-being, they might be incapable of making the best choice for themselves. At the beginning of the summer, when I knew I had to get a vaccination by the end of August, I wanted to prepare myself for it but couldn’t stand talking about it. The avoidance instinct prevented me from agreeing to go back to therapy or deciding how to prepare myself – I just wanted to put everything off until it eventually disappeared. So my mom stepped in and made my first therapy appointment – without waiting for my consent – and I was grateful because I wasn’t capable of giving my consent.

Save this as a last resort, and follow up afterwards by asking them if it was okay. Try to work with them before taking over the decision-making. Ask things like, “Do you want to get the appointment over with now, or take time to prepare?” “Do you want me to just make an appointment with your therapist so you don’t have to worry about it?” “Do you want to look through a list of counselors and pick one that you like, or just have me choose?” The needle phobic might appreciate having someone shoulder the responsibility and decisions so they don’t have to deal with it, but they also might want to have as much control over their situation as possible. Finding these things out will help you figure out what will work best.

The key to caring for a needle phobic is identifying their needs. Sometimes we don’t want advice or encouragement, we just want to be comforted, to know that someone feels for us and sympathizes with our distress. Other times we need to be reminded that there’s hope of overcoming our condition, so encouragement and treatment options will give us a boost. And other times, when our health and well-being are on the line, we need someone to step in and make the decisions we’re not able to make ourselves. Start by finding out what will help the person the most, and then go from there.

My experience isn’t the only experience. Helpful comments are welcome. 

It’s All in Your Head: What NOT to Say

Over the years, I’ve had people offer painfully unhelpful advice to me when they hear about my phobia. I know they are well-intentioned and have my best interests in mind, but saying the wrong thing can mean the difference between soothing me as I struggle with my phobia, and significantly raising my anxiety. Below, I list some of the most unhelpful things people have said to me, and better alternative sentiments that will calm someone rather than stress them out.

1. “It’s all in your head.” This is a Captain Obvious kind of comment. It’s true, there is no actual danger to substantiate my intense fear, which is a product of my mind rather than of my circumstances. But, as I explained in a previous post, that doesn’t mean I can just will the phobia away. Saying something like “It’s all in your head” suggests that my phobia is my fault, or that it isn’t as big a problem as it seems to me, so I should be able to just think my way out of it.

If you are trying to encourage someone to take control of their phobia and believe they can beat it, try saying something like this instead: “I believe you have a strong will and a powerful mind. I know you are capable of overcoming this.” Rather than telling the person the phobia is a smaller problem than they make it out to be, tell them that they are stronger than they give themselves credit for.

2. “Remember, vaccinations are important for the safety of the community.” When someone is having a confrontation with their needle phobia, it is not the time to have a discussion about the merits or drawbacks of immunizations. Chances are, if this person has a full-blown needle phobia, he or she has already had some vaccinations, and doesn’t have a philosophical objection to them. I would advise against bringing up the importance of vaccinations at all. One of the principal symptoms of a phobia is avoidance, so trying to reason someone out of avoiding health care is like trying to reason someone out of their phobia, which, as I have said several times on this blog, will not work.

However, if you are trying to encourage someone to look on the “bright side” of an upcoming injection, you could try saying something like, “I know the appointment is really, really going to suck, but think about it this way: you’re going through one really crappy day to prevent weeks of really crappy days.” I must emphasize, though, that you have to be very mindful of the timing of a comment like this, and how you say it.

3. “Just get it over with.” It’s true that, at some point, you do have to stop preparing for an appointment and get it over with. But ultimately, it should be up to the person with the phobia to decide whether to put it off and take time to prepare, or just do it quickly so they don’t have to spend months worrying about it. If the person wants to put it off, they should not be discouraged from it. Doing things like relaxation routines, desensitization, and visualization in advance can mean the difference between a traumatic, anxiety-filled appointment and a calm, successful one.

A better approach to this might be to say, “Do you want to just get it done tomorrow or this week? So it’s out of your life finally?” My mom asked me this a few times when I was struggling with an upcoming appointment. My answer was no, because I thought having time to desensitize myself and practice applied tension would make a difference. And my mom respected my decision. But I appreciated the offer, and someone else with needle phobia might decide it would be the best strategy for them.

4. “It’s just a little pinch.” Much like saying “It’s all in your head,” this trivializes the problem and implies that the person is making a bigger deal out of it than they should. A comment like this assumes that what’s causing the person anxiety is just one little moment, one little bit of pain, when in fact it’s the whole experience: driving to the clinic, having their named called in the waiting room, seeing the medical equipment, along with all the emotional and psychological strain in the weeks or months beforehand. So no, it’s not just a little pinch. It’s a vortex of anxiety and dread, wrapped up in all the details of an appointment for a vaccination or blood draw.

Maybe you just want the person to know that it will be quick and relatively painless. In that case, I would suggest that you say something like, “In just a few hours it will all be over,” or, “Focus on all the great things we have planned after the appointment.” Encourage them to remember that life will go on after the procedure, that they will get through it one way or another, and that the dread and stress won’t last forever.

When giving advice to someone with needle phobia, follow these rules of thumb: maximize their confidence rather than minimizing their problems, encourage rather than chastise them, and, whatever you say, demonstrate sympathy. For me, I just want to know that the person believes I’m not being dramatic, and that they understand I can’t get rid of my fear quickly and easily. After we’ve established that trust, I can listen to their encouraging advice.

Just ask yourself: “Is it helpful? Is it encouraging? Is it kind?” If you can answer yes to all of those questions, you’re probably in the clear.

A Long-Awaited Victory

Well, everyone, this is the blog post I’ve been hoping I would be able to write. For the first time in about 10 years, I got through a vaccination without fainting.

It’s hard to fully express the significance of this. For years, the vasovagal response and my seemingly ingrained phobia of needles have been combining forces to make injections a living hell for me. Each time we tried something new – lying down, desensitization therapy, etc. But on Thursday August 20th, 2015 we proved I could make it through without all the trauma of fainting and its aftermath.

I’ve mentioned in previous posts that I would be getting a meningitis booster. All summer I’ve been hoping and practicing and seeing my therapist, holding on to the possibility that the applied tension technique, plus whatever else we could do to draw blood to my head, would keep me from passing out. And the good news is, yes, it did. 

You can read about the vasovagal reflex in detail in this post, but the short explanation is that it’s an automatic response, completely unrelated to someone’s state of mind, that causes a drop in blood pressure and a traumatic seizure-like fainting episode. This was the main crux of my problem; I’d gotten to the point where I could handle the dread that the phobia brought on, but I couldn’t stand the idea of passing out again. The appointment made my summer a somewhat stressful one, and every once in a while I would feel crippled with dread or panic, but the ending was ultimately a happy one.

I want to describe everything I did, in detail, before and during the appointment, in the hope that this might help other people overcome their phobias and vasovagal responses.

I used a two-pronged approach. The first prong was emotional, meant to deal with the phobia. While I knew that this wouldn’t stop me from passing out, it would help me stay in control of the panic and stress so I could focus on the second prong, the physical techniques to actually fight my body and keep me conscious through the procedure.

A Few Months Before

Almost as soon as I got home for the summer, I started seeing my therapist, C. She helped me build my confidence, deal with the meltdowns I had a couple times this summer, and make a plan to maximize my success. The meetings with C kept me on track and gave me a chance to vent all my fears and frustrations and come out renewed. They also helped me with decision-making about what would be most beneficial leading up to and during the appointment.

I met with my doctor about halfway through the summer to talk about good techniques to prevent the vasovagal response. My doctor’s main recommendation was isometric counterpressure, or “applied tension.” You can get a good concept of the technique with this video, but I will describe it here. When doing applied tension, you cross your legs, clasp your hands in front of your chest and pull as hard as you can, tensing all the big muscles of your body – abs, glutes, thighs, etc. You can do this sitting up or lying down (I would recommend lying down), and hold it as long as you can. I practiced this technique regularly in the month or so leading up to my appointment, which helped me strengthen my body so I could hold it longer and tighter.

My therapist encouraged me to practice desensitization as well during the summer. This was more difficult for me, because I knew that no matter how desensitized I was to syringes and clinics, it wouldn’t stop me passing out. However, I would still recommend it as a good way to get control over your emotions. The less fear automatically produced by your phobia, the more focused and in control you will be during the appointment.

After fighting my stress for a few weeks and trying to feel “relaxed” about the appointment, I concluded I wouldn’t be able to be totally calm if I knew I might faint after the procedure. So instead of trying to make myself relaxed and content, I channeled my energy into having a “warrior” attitude of determination. I wanted to go into the appointment resolved to put up my best fight and beat the vasovagal reflex. I did power poses, visualized myself going through the appointment composed and self-assured, and sang Roar by Katy Perry around the house. This shift in attitude really helped – if I couldn’t expect myself to feel serene and at peace, I could at least be tough and determined.

The Week of the Appointment

My mom made the appointment two weeks in advance, and gave specific instructions for the doctor and nurse. This is something I highly recommend: have a speech to give to any medical professional doing your needle procedure, so the appointment can go as smoothly as possible. Mine goes something like this: “I have a severe needle phobia and a high risk of passing out after the injection/blood draw/etc. When I come in, please do not talk about the injection more than you absolutely have to. Do not bring the syringe into the room until it’s time to give me the injection. I would like to request numbing cream for the skin if you have it. When you give me the injection, don’t say, ‘Here it comes,’ ‘Get ready,’ or anything like that. I will be using techniques to help with my emotional state and prevent the fainting. I would like to have the room booked for at least an hour in case I do pass out and need to recover. Please just let me do my thing and make the injection as quick and straightforward as possible.” This can make a big difference – I’ve had a lot of nurses try to be helpful but actually just heighten my stress. If they know what you need, everything will be much easier.

About a week before the appointment, I visited the clinic where I would be getting my vaccination to desensitize myself to the environment as much as I could. My mom and I sat in the parking lot for a while, then moved into the waiting room. I sat in a chair and did deep breathing while my mom asked the receptionist if we could go into a room. Eventually a nurse came out and called my name (that was a bit of a shock). We spent some time in the exam room, practiced applied tension on the table, and then I went home. Managing to get all the way onto the table was a big boost for me.

A few days before appointment I had another session with C to regroup. Not a lot of new discussion happened – mostly we just reaffirmed the plan. That same day we bought compression stockings from a local medical supplies store. Compression stockings are usually worn by the elderly to reduce swelling, but we wanted to use them to prevent the dilation of blood vessels in my legs and squeeze the blood upwards. I bought the ones that go all the way up my thighs, and also bought tube sleeves for my arms, though I ended up not wearing them because I am sensitive about my arms, especially during a medical appointment.

The Appointment

My vaccination was at 4:00 that Thursday. We had chosen late afternoon so if it went south, I could come home and sleep it off. I worked from 8:30 to about 11:30, just to keep busy so I wouldn’t be thinking constantly about the upcoming appointment. When I came home, I ate lunch, did progressive muscle relaxation, and then about an hour before the appointment put on my compression stockings.

I wore headphones through the whole thing, starting with the car ride. My music of choice was “Flying With Mother” from the How To Train Your Dragon 2 soundtrack. (I also played “Together We Map the World” and “Valka’s Dragon Sanctuary” in case you were wondering.) The music got me to the clinic and into the waiting room no problem, which was surprising. If you think music would be helpful, I would recommend choosing a song that is relaxing and happy, or that brings back good memories and associations. Music that you can move to in some way can keep your muscles from locking up with tension.

In the waiting room, the panic started to set in. I think it was triggered by the door opening and closing; every time it did, I was expecting my name to be called. My mom held my hand, and I turned the music up full blast. When my name was finally called, I made it back to the exam room on pure adrenaline. I let my mom answer most of the nurse’s questions. This is another time when music comes in handy – turn it up, and pull an earphone out only when you have to. It’ll prevent you from hearing any unhelpful comments the nurse might make.

They put on the numbing cream (this did nothing for me but it was a good idea) and the physician’s assistant came to check in with us and answer questions. We wanted him present during the procedure to make sure I stayed on the table if I passed out. Waiting for the numbing cream to set in took a long while, so in the meantime I got in position for the applied tension. I turned around so my legs were on the headrest, raised almost vertical. My head was on the tray that slides out from the other end of the table, bringing it below the edge of the cushion.

Finally the physician’s assistant and the nurse came in with the vaccine. I let my right arm lay loose (injections in relaxed muscle hurt less than tense muscle) and pulled on my mom’s hand with my left. I closed my eyes, turned my music way up, and started the applied tension.

This is where you have to take complete control. Don’t be afraid to be bossy. Do what you need to do. I felt the injection, and when I thought I was feeling the band-aid I asked, “Is it done?” The nurse said yes and I told my mom to let go so I could pull with both arms. The physician’s assistant kept an eye on the time and my mom coached me to keep holding the tension.

If my body tried to pass out, I didn’t feel it. I held the position for several minutes, then relaxed briefly and started again. As the minutes rolled by and I didn’t feel anything, I started tensing just my arms or just my legs. After about ten minutes the physician’s assistant left to see another patient. Gradually over the course of half an hour, I lowered my legs and then raised my head. I did the tension whenever I felt something strange, and finally I stood up and went home.

For me, this felt like a miracle. I don’t know what did the trick – the compression stockings, the elevated legs, or the applied tension, but I would recommend all three to maximize your chance of success. I’ve read in a few places that applied tension prevents or delays the vasovagal response, so taking your time to sit up and leave is important. But the two pronged approach – emotional and physical – is what worked for me, and I hope that each time I will feel a little less stressed and scared, because now I know I can get through an injection safely and calmly.

I sincerely hope that this post will help other people overcome this frustrating and complicated issue. Even if my personal process doesn’t work for you, perhaps with a little tweaking you can find a solution. I am overjoyed to be able to write this saying I succeeded, and at least for the time being I can put my phobia behind me. I know needle procedures will still be stressful, and a lot more trouble for me than for most people, but at least they will no longer be traumatic, and that’s what counts.

My experience isn’t the only experience. Helpful comments are welcome. 

The Fear Ladder: Desensitization Therapy

The task of finding a treatment option for a phobia can be daunting. When you’re experiencing a fear that doesn’t make any sense to you, it often feels like there is no sensible cure. But I am living proof that it is possible to alleviate the fear, so that what once was an insurmountable wave of anxiety becomes perfectly manageable .

By far the most effective technique I’ve used for my phobia is called “desensitization therapy.” I worked with a counselor on it, and I would recommend that others do the same, but it’s not hard to try by yourself.

If you have read Harry Potter and the Prisoner of Azkaban, you will remember that Harry Potter confronts his worst fear, the dementors, and finds himself powerless against the force of their happiness-sucking abilities. Whenever he runs into them, he is overwhelmed with fear and despair, so he asks a mentor, Professor Lupin, to equip him with the tools to overcome them. Lupin has him practice on a lesser version of the dementors, a shape-shifting creature in dementor form. The technique Lupin gives Harry is to use the happiest memory he can muster to help him perform the incantation that drives the dementor away. Harry practices on the boggart until he can overcome it without a problem, and then he is ready to face the real thing – and he succeeds.

Desensitization works in much the same way. You practice on a lesser version of the trigger, like a picture of it or a description of it, and pair exposure to the trigger with relaxation and calming techniques. Eventually, your brain is tricked into associating the frightening thing with happiness and peace.

The first step in desensitization is to create a “fear ladder.” This is a hierarchy of things that trigger your phobia, in increasing order of severity. My fear ladder looks something like this (I’ve omitted a few steps for brevity):

  • Looking at a cartoon drawing of a syringe
  • Looking at a photograph of a syringe
  • Reading a description of an injection
  • Looking at a real syringe
  • Holding a real syringe
  • Touching the tip of the syringe to my arm
  • Receiving an injection

Starting with the first item on the list, you pair exposure to the item with relaxation. This is where calming techniques become vital. When treating my phobia, I did progressive muscle relaxation on a regular basis, especially when I had meltdowns or before an upcoming appointment. (You can read more about progressive muscle relaxation here.) During desensitization sessions I did deep breathing and retreated to my “happy place” when it became too much.

The happy place is a useful aid to desensitization. This is where you go when you start to feel overwhelmed, almost like a “reset” button. The happy place can be real or fictional, as long as it gives you a sense of peace and you can absorb yourself in it. I have two that I alternate between. In one, I’m on a horse I used to ride, going down a leafy trail during the summer. In another, I’m in the car with my family driving home after a great meal at a restaurant, and we’re getting an intense rainstorm where the rain is drenching the windshield. When I go to my happy place I try to distract myself from my distress by focusing on all the tiny details to make the scene feel real: the birds singing, the rhythm of my horse’s footsteps, and the rough leather of the reins, or my big fluffy coat, the hot air on full blast, and the pattern of the raindrops sliding across my window. The happy place allows me to slough off some anxiety, think about something else for a while, and feel refreshed when I go back to the desensitization.

The process of pairing exposure to the trigger with deep breathing, conscious relaxing, and going to the happy place will gradually break down your fear of the trigger until you can face it with little to no anxiety. My counselor used a number system with me to gauge how badly I reacted to the exposure, with 10 being absolutely terrified and 1 being completely calm. I usually went from a 7 or an 8 to a 3 or a 2, and then we would move on to the next step.

I worked my way up the ladder, from barely being able to look at a crude drawing of a syringe to playing and poking myself with a real one. It took the better part of a year, with therapy appointments every three weeks or so, but it worked. When I finally went to get a shot, I was calm, confident, and in control. (The fainting episode I experience when I receive an injection has made desensitization more complicated for me, but does not throw out the success of desensitization with my emotional and psychological state. You can read more about vasovagal syncope in one of my previous posts, or in My Story.)

For me, one of the best parts of desensitization was that I could see plain evidence of my progress. Every time I moved to the next step, it was a small success, and boosted my confidence more and more. When I was getting to the end of the process, I could look back and say, “Wow! This used to terrify me, and now it doesn’t bother me at all!”

I have a few tips from my own experience with desensitization, and I hope they are helpful.

Start when you’re ready. This is pretty common advice when people talk about therapy, and I can vouch for it. Don’t bother with desensitization until you have the determination to overcome your phobia. I didn’t start until I had an upcoming appointment to get my wisdom teeth pulled and knew I would need an IV, and I doubt desensitization would have worked if I wasn’t motivated to be cured before the deadline. So wait until you are prepared to put the work in, and determined to beat your phobia.

Do your homework. It’s important to remember that desensitization will work best if practiced regularly, so if you only meet with a therapist every few weeks, working on it at home will significantly accelerate your improvement. Put on calming music, go somewhere with few distractions, and spend enough time on it that you feel a significant reduction in anxiety.

Start small. Really, I mean it. Start with the least stressful stimulus you can think of. The smaller triumphs at the beginning will build you up for the bigger challenges at the end. And if, at the end of the last session, you were able to hold a syringe in your hand but it took a lot of effort, don’t start with that the next time. Just look at it for a while, and build yourself back up to that point. It’s okay to backtrack a little so you set yourself up for success.

Desensitization therapy may not be the only way, but I stand behind it as one of the best hopes for people with needle phobia, or with any phobia. A few years ago I probably couldn’t have written this article or started this blog, but now I can talk about my phobia and things that trigger it with minimal anxiety. The most important thing is to not give up. Keep trying and keep looking, and give techniques like desensitization time to set in. There is no magic, instant cure for phobias. It’s an uphill battle, but it can be won.

My experience isn’t the only experience. Helpful comments are welcome. 

How Does That Make You Feel: The Benefits of Therapy

While I was in the period of my life where I put my phobia in a little black box in the corner of my mind and refused to open or even acknowledge it, therapy was out of the question. If anyone brought it up, I would completely shut down. It wasn’t that I thought I could get along fine with my phobia and didn’t need any help – I just couldn’t stand the idea of being shut in a room with a stranger and asked to talk about needles for an hour straight.

It took a pretty big kick in the pants to get me to agree to therapy. When my dentist informed me that my wisdom teeth needed to come out, I wanted to be put under, and that meant getting an IV. Figuring that seeing a counselor was better than suffering through the procedure with all my anxiety, my mom and I started hunting around.

We started with a therapist who tried EMDR (Eye Movement Desensitization and Reprocessing). This involved following her finger with my eyes in certain patterns, while monitoring my body and mind for any sign of change. This technique is normally used for people with PTSD (I really have no idea how the eye movement does anything), and we thought it might work since the vasovagal syncope (fainting episode) that always accompanied my vaccinations was traumatic. But after a few sessions, the only results were some weird tingly feelings, so the psychologist recommended that we seek different treatment.

We decided to try a conventional therapist, which brought us to C. And C has made a huge difference.

I want to backtrack and explain some of the barriers that kept me from therapy, and what I’ve learned from five years of going in and out of C’s office. For those who are seeking to understand needle phobia better, I hope this can give you some insight into what keeps people from going to therapy, or why the person you’re caring for might have such an aversion to it. And for those who do suffer from needle phobia, I hope this post can clear up some misconceptions and show how you can overcome the barriers.

Barrier 1: Going to therapy is embarrassing. This was a big reason why I put off therapy for so long. I started going in ninth grade, so the word “therapy” in my age group was often used derisively. “You’re crazy, you need therapy.” “What, are you going to go to therapy for it?” Even if you’re not a tween/teen, though, therapy and counselors can have some bad connotations. I thought only crazy or seriously dysfunctional people went to see counselors, so if I went, that meant I was crazy myself.

Even when I started going, I still felt embarrassed about it. I was pulled out of class for appointments, and it took me a while to be comfortable telling someone I was seeing a counselor. I was afraid that if someone knew I was going to therapy, they would think I was dangerous or had an issue like anger management or addiction. It also felt like a sign of weakness, that I needed therapy when so many other people didn’t. I didn’t want to be perceived as weak or crazy, so I was embarrassed that I was seeing a counselor.

However, the more I’ve gone to see C, the less embarrassed I’ve become. I’ve come to understand that therapy is not just for “crazies,” it’s for anyone with an issue weighing on them that they just need to talk through. And for me, the more open I am with other people about it, the better. I’ve become totally okay with just telling someone, “I’m seeing a therapist because I have a needle phobia.” When I tell them the reason, I know there won’t be any misunderstandings or weird looks.

Barrier 2: Going to therapy is uncomfortable. Before I went, I really had no concept of what therapy would be like. I imagined myself lying on my back on a sofa with the therapist sitting in a chair with a clipboard, asking questions and scribbling notes while I gave my answer. It’s a very unsettling idea, and I don’t blame people for avoiding therapy if that’s what they think it’s going to be like.

But that’s not what therapy is like at all, at least not the kind I’ve attended. When I meet with C, I sit on a comfortable chair or couch across from her. She only wrote on a clipboard in the first session or two, when she was gathering information about my situation. Sometimes she eats a snack, because she doesn’t get a lunch break. Sometimes we chat for a little while before we get started, and sometimes we cut right to the chase. We might spend the whole hour talking about my phobia, or we might talk about other things that are causing anxiety in my life. C is fashionable, friendly, and easy to talk to, and after a few sessions I felt completely safe telling her exactly what I was thinking. Therapists aren’t far-removed, intimidating figures trying to probe the deep, unfathomable recesses of your subconscious. Having a therapist is more like having a built-in best friend who will always keep your secrets and always knows exactly what to say.

I will add that it’s important to find a therapist that’s the right fit. One of the first things C told me was that if, after a few sessions, I felt like it just wasn’t working, I didn’t need to worry about switching to a different counselor. And I can definitely say that I would not have felt as comfortable talking with my EMDR therapist as I do with C. So finding someone you can tell everything to is a big part of your success.

Barrier 3: Going to therapy is against my instincts. Even if you are comfortable with the idea of going to a therapist, for people with phobias the idea of sitting for an hour and talking about the thing that triggers so much anxiety is practically unthinkable. The most natural response to a phobia is avoidance, so willingly subjecting yourself to therapy for a phobia goes directly against that “flight” instinct.

It’s extremely difficult. For some people, sitting in that office and talking about needle procedures for an hour might be equivalent to actually going through one. If you have a good therapist, it shouldn’t be. Sometimes going to see C is exhausting, especially if I’ve been struggling in the weeks before the appointment. But it lowers my anxiety more than it heightens it, and it lifts a lot of weight off my shoulders.

All I can say is that it’s worth it. It might take time to get to a place where you’re ready for it. It might take a powerful motivator, like an upcoming procedure. But I have made enormous progress with C, and she’s helped me in other areas of my life too. During the first couple of months the sessions became progressively easier, and now I look forward to my appointments with her, since it gives me a chance to reorganize my thoughts and deal with whatever questions, insecurities, or deeply-rooted fears have been plaguing me.

I highly encourage anyone with needle phobia, or any phobia, or even just something that’s been weighing on them, to try therapy. With the right person, it can mean the difference between loads of fear, anxiety, and confusion, and a deeper sense of peace about what you’re going through. You can choose your therapist, you can choose how often you go, and you can choose never to go back at all. But giving it a try could be the biggest step you take toward conquering your phobia, and that’s something you don’t want to pass up.

My experience isn’t the only experience. Helpful comments are welcome. 

Vasovagal Syncope: The War with My Body

When you think of fainting, you probably think of ladies in period costume swooning because their corsets are too tight. You might also think of someone blacking out after too much physical strain, or because they stood up too fast. But there is a lesser-known type of fainting that commonly goes hand-in-hand with needle phobia, and it is a very different experience.

Vasovagal syncope, also known as the vasovagal reflex or vasovagal response, is an automatic response to a certain trigger, frequently a blood/injection procedure. It involves a sudden drop in blood pressure (caused by a slowed heart rate and the blood vessels in the legs dilating so blood pools in the lower half of the body) that results in loss of consciousness, and often in convulsions. Most people, myself included, find this experience traumatic and dread needle procedures all the more because of it.

I first experienced vasovagal syncope when I was four years old. Surprisingly, it was not in response to an injection – I saw a row of staples down my grandmother’s knee during a followup appointment after her knee surgery. Since then, it has been triggered by injections and once by a badly infected ear piercing. I have not gone through an injection without passing out since I was seven or eight years old.

For those of you who want to understand vasovagal syncope better, I want to describe exactly what it feels like. If you suffer from needle phobia or have experienced the vasovagal reflex before, you may find the following paragraph distressing, but it may be good to read so you know you’re not alone.

I pass out about 10-20 seconds after the injection. When I’ve had two in a row, my blood pressure didn’t drop until after the last one was over. I see lights and my head swims, so I can give the nurse a warning before I’m out. When I’m unconscious, sometimes I dream. I’ve dreamt I was being chased, or that I got through the injection and went home. It usually lasts 30 seconds to a minute, but it’s gotten longer every time. All of my muscles seize up, my eyes roll back in my head, and the last time I passed out I was convulsing so much I almost rolled off the table. Waking up is the worst part. I forget where I am, and experience a strange time distortion which makes me very confused when my mom and the nurse tell me I fainted. The room actually spins, so it takes me a while to be able to reorient myself and adds to my panic. Once the room stops spinning, I experience all the repercussions of the episode. I always feel nauseous, although I haven’t thrown up yet. It takes me 10-15 minutes to regain my color. I always wet myself, so my mom has started bringing a change of pants and underwear to my appointments. On top of my disorientation and exhaustion, the disappointment and emotional trauma of the episode is always the worst just when I wake up, and I usually want to cry. I stay in the room for almost an hour until I’ve recovered enough to walk. I go home, maybe eat a tiny meal, take a shower, and go to bed. The syncope exhausts me so much that I can’t do anything else.

I couldn’t tell you whether the phobia or the syncope came first, and I think it’s different for everyone. I would say that at this point, I am more afraid of fainting than I am of needles, but it wasn’t always that way. My phobia and the syncope certainly exacerbate each other, but I don’t know how they worked together in my mind to create the problems I’m facing now.

When I went through desensitization therapy, I believed it would cure my syncope. Since I had a phobia of needles, we just assumed the intense anxiety I experienced during needle procedures was the cause. If I wasn’t anxious, the vasovagal response wouldn’t be triggered. So I practiced the desensitization and went into the appointment confident, calm, and relaxed. I listened to calming music on headphones, closed my eyes, and went to my “happy place.” I sincerely believed I wouldn’t faint. But about ten seconds after the injection, I was out, and it was as bad as ever.

That last procedure has led me to conclude that the vasovagal reflex has no correlation to my state of mind. I thought that being relaxed and minimizing my anxiety would prevent it, but I’ve been forced to look for a new method, and I’ve been amazed at how little medical and mental health professionals seem to know about this phenomenon. My therapist truly believed that desensitization could prevent the syncope. A nurse once told me that if I lay down it was impossible to pass out (this was proven false). My doctor did not have a ready solution for me until the last time I went in for a consultation (after years of dealing with it). So it’s been a long war with my body and a process of trial and error.

It is important to understand that you cannot expect someone who suffers from vasovagal syncope to be able to “will” themselves to not pass out. I have absolutely no mental control over my syncope. However, there is one technique I’m working on now that I intend to try at my next appointment.

It’s called “applied tension.” It involves crossing your legs, pulling on your hands, and clenching all the muscles you can. The idea is that by clenching the big muscles of your body, you stop the blood from rushing out of your head when the blood pressure drops, and by crossing your legs, you squeeze the dilated blood vessels. The research I’ve read reports a high success rate (over 90%), but if you are trying to solve your vasovagal syncope, I encourage you to do more research yourself and talk to your doctor about it. I’ve been practicing this technique almost daily, and it’s the best hope I’ve got. I will be receiving an injection in mid-to-late August and I will be posting more before and after. I will be sure to detail what I did to prevent the syncope, and what the results were.

There is no nice and neat solution to vasovagal syncope. My best advice is to have a plan. Make sure the doctor and nurse know your risk of passing out. Talk to your doctor about ways to minimize your chance of fainting. Make sure that all other factors are taken care of so you can focus your energy on getting through the procedure.

Know that you’re not alone. Vasovagal syncope is more common than you think, especially for people with needle phobia. Do some research, or have someone else do it if it causes too much anxiety. Most importantly, don’t give up! Try something new every time, until you find something that works for you.

Update: On August 20th, 2015 I finally got through an appointment without fainting. I used compression stockings along with the applied tension technique described above. You can read the details and my recommendations in this post.

My experience isn’t the only experience. Helpful comments are welcome.

Rationality and Irrational Fear: Untangling Phobias

Over the years, I’ve had so many people try to give me helpful advice when they simply do not understand how phobias work. They will say things like, “It’s just a little pinch,” “My kid hates needles and he did fine last time,” “You know it’s not going to hurt you, right?” I know they’re trying to help and they believe they’re reassuring me, but comments like these trivialize what I’m going through, and show me that the person really doesn’t know what they’re talking about.

Dictionary.com defines a phobia as “a persistent, irrational fear of a specific object, activity, or situation that leads to a compelling desire to avoid it.” Persistent, irrational fear means that you cannot reason someone out of their phobia. No amount of explaining, reassuring, or encouraging will make the anxiety go away. The best things you can do are to comfort, sympathize, and gently encourage them to seek treatment.

However, just because it’s an irrational fear does not mean the person is delusional. This might not be the same for everyone, but I have always been perfectly aware that vaccinations and syringes are not going to hurt me. I know they’re incredibly beneficial, they don’t hurt that much, and there is absolutely no reason for me to be afraid.

Unfortunately, some neurons in my brain didn’t get the memo.

In one of my first few appointments with my therapist, we spent a lot of time talking about why, even though my rational mind knows there’s nothing to be scared of, I still feel the constricting hand of anxiety when I think about injections. There’s no satisfying answer. Essentially my mind has lost control of my emotions, so the task at hand was to bring them back in line with my logical thinking. It was a “heart over mind” problem, and it would take months of work to fix.

I do think that shots are creepy. I hate the sterile, whitewashed environment in a doctor’s office. I have a low pain threshold, so sitting still for something I know will hurt is hard. But a phobia is beyond that. A phobia means feeling paralyzed with anxiety at the very idea of getting an injection, crying when someone tries to talk to you about it, and considering jumping out of the car when you’re driving down the highway on the way to your appointment, or debating whether going back to your university is worth getting that meningitis booster shot.

Many people with needle phobias know that immunizations are important for the safety of the community. They know that no one is going to hurt them when they’re in the doctor’s office. They know it will all be over in half an hour. But the phobia causes a disconnect between what they know and what they feel, and often the emotional and psychological strain brought on by an impending needle procedure is as frightening as the procedure itself.

I do not expect myself to ever be happy about injections. My goal is not to be able to waltz into the doctor’s office with a smile on my face and say “Whenever you’re ready!” I hope that someday, I will be like everybody else: a little uncomfortable, ready to get it over with, and wondering if the nurse will let me have a Spiderman Band-Aid instead of a boring brown one. But for now, I just want to get through one without trembling or passing out, and I think that’s all anyone with needle phobia can ask of themselves.

Be patient. Be understanding. Don’t try to fix it with a quick reassurance. Just offer your sympathy, listen, and remember that we’re just as frustrated with our emotions as you are.

My experience isn’t the only experience. Helpful comments are welcome.