What We Get Wrong When Treating Medical Phobias Part 1

Medical phobia treatment can be misguided, even when it is technically evidence-based.

The treatment of phobias of blood, injuries, injections, hospitals, dentists, and medical procedures are not interchangeable with the treatment of fear of dogs, elevators, or airplanes.

This is especially true when we treat medical phobia as though it were simply an exaggerated fear of a “harmless object.”  In this series, we’ll explore common misconceptions and missed opportunities, and how to correct them.

1. We Underestimate the Vasovagal Syncope Risk

Blood-injection-injury phobia is unique because the client may not only feel anxious; their blood pressure and heart rate have a higher chance of dropping, causing them to lose consciousness. Tunnel vision, muffled hearing, nausea, pallor, weakness, confusion, convulsions, memory loss, and a sudden sense of doom all add to the distress of the experience. And, they change what safe and effective treatment requires.

The obvious risk is that our client can be injured in a fall. They may also convulse, become disoriented, feel humiliated, and remain feeling unwell for hours to days afterwards. The less obvious risk is that a sudden loss of consciousness can confirm the client’s worst fear: My body is not under my control, and medical situations are dangerous. One poorly managed scenario leading to a faint can deepen the phobia we intended to treat.

This is why vasovagal syncope risk should not only be assessed, but assumed. We should ask about previous fainting, near-fainting, warning signs, and triggers. And, we should be aware that a faint can happen at any time, to anyone – even if it has never happened before. As clinicians, we certainly do not want to contribute to a client’s first faint because we assumed our client “wasn’t the type.” There is no fainting “type.”

We must also be extremely cautious with generic relaxation advice. Prescribing a technique such as “take a deep breath” might backfire quickly.

We should teach and rehearse evidence-based physical counter-manoeuvres such as Applied Tension before treatment even begins. We may also want to encourage coordination with medical professionals when the client’s fainting history is unclear, atypical, or medically concerning.

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