strategies for feeling less fear around needles

for about  1 in 10 people , this is their reality, and it matters for covid-19 vaccine campaigns. first, when we are highly anxious about something, we tend to avoid or delay it. second, experiencing high fear and a stress response can lead to escape behaviour (like leaving or acting aggressively), enduring the procedure under immense distress and experiencing symptoms of  immunization stress-related responses , such as  feeling dizzy or fainting . third, needle fears can, in turn, be increased by experiencing or hearing about an immunization stress-related responses from others.

the critical thing to know is that these immunization stress-related responses do not result from something being wrong with the vaccine itself. instead, they can occur  before, during and after  injections due to a stress response. nonetheless, they can disrupt vaccination campaigns.

needle fear and vaccine hesitancy

vaccine hesitancy is complex because people delay or refuse vaccination for many reasons. a  covid-19 poll  showed that of canadians who did not plan on being vaccinated or were not sure, six to seven per cent had delayed previous vaccinations because of needle fear.

as a clinical psychologist, i have researched and worked with individuals with different levels of needle fear from mild to extreme. some degree of fear of needles is common and occurs in  most children, up to half of adolescents, and 20 to 30 per cent of people aged 20 to 40 . much of my work focuses on children for three reasons:

1. they experience frequent needles due to recommended vaccination schedules;
2. they are vulnerable to negative experiences from undermanaged pain; and
3. these negative experiences can have lasting effects. in fact, most adults with high levels of needle fear report a negative previous experience.

needles are to some degree painful, and pain is subjective. there have been huge  campaigns to get evidence-based pain management strategies to the public . in 2015, we conducted a  series of rigorous reviews  to  make recommendations  on the best ways to make vaccinations comfortable.

science-backed strategies

the comfort, ask, relax, distract (card) system can  help clinics ,  individuals  and  parents make  the vaccination experience as comfortable as possible. if you are mildly to moderately fearful of needles and concerned about pain associated with covid-19 vaccinations, you will want to make a coping plan for before, during and after the injections.

• what will you wear for easy access to your upper arms?
• what will you do while waiting at the clinic (read, listen to music, play a video game)?
• do you need to purchase a topical anesthetic to numb your skin at the injection site?
• how do you want the clinician to indicate they are starting, such as “one, two, three, here we go”?
• during the injection, decide if you want to look at it or away and tell the clinician what you need.
• during the procedure, do you want to talk about something else, play on your phone or listen to guided imagery?
• afterwards, how will you reward yourself and remember what helped? you could take a short video describing what went well to help you next time.

exposure-based therapy is considered the gold standard approach for “specific phobias,”  which is what extreme needle fear falls under within the diagnostic and statistical manual of mental disorders. the technical term is “specific phobia, blood injection injury subtype,” estimated to occur in about 3.5 per cent of people.

i have argued elsewhere  that we need to care about the approximately 10 per cent who have high fear, whether or not they have a mental health diagnosis related to needles. this is because  up to 94 per cent ) of affected people won’t go to a professional to get that diagnosis, but are still suffering and in need of help.

exposure therapy can occur in person or through imagining the feared situation.  here’s an overview :

some individuals feel dizzy or faint during needles. this is more common in individuals with high levels of fear. a strategy called  muscle tension  — a technique of tensing and releasing muscles — can help avoid the sudden drop in blood pressure that leads to dizziness and fainting. someone with high needle fear can practise doing muscle tension when completing their fear hierarchy steps.

maximizing comfort and confidence

you can imagine how much motivation and bravery is required for an individual to willingly face their fears and this affects how  acceptable the treatment is . with my colleagues, i am working on creating more accessible exposure-based interventions for high levels of needle fear.  other treatments that may be promising , such as eye movement desensitization and reprocessing, also warrant investigation by researchers.