Blood-injection-injury Phobia Research Articles

Prevalence and stability of blood-injection-injury phobia in childhood-A prospective community study in Norway.

An individual with a blood-injection-injury (BII) phobia often avoids exposure to triggers, such as blood tests and clinic appointments, leading to potentially serious health complications. This population-based study examined the prevalence, stability and course of BII phobia in children and adolescents. The data came from the Trondheim Early Secure Study, conducted from 2007 to 2018. All children born in Trondheim, Norway, in 2003 and 2004 were invited to attend. Clinical interviews were conducted by trained personnel to assess BII phobia in 1042 children (51% female) every 2 years from 4 to 14 years of age. Latent growth curves and logistic regression analyses were used in the data analysis. Just under 20% of the cohort experienced a BII phobia at least once, with no significant sex differences. The prevalence of BII phobias increased from 3% at 4 years of age and peaked at about 8% at 10 years of age, before levelling off. The two-year stability increased as 12-14 years of age approached. The prevalence of BII was affected by age, but not sex. Early BII phobias often recede with time, but children may need treatment if they persist from 8 years of age.

The role of fear, disgust, and relevant experience in the assessment of stimuli associated with blood-injury-injection phobia

Individuals with high levels of blood-injection-injury (BII) fears are more likely to avoid health screenings, vaccination, and even minor medical interventions. This could result in more serious health issues, lower quality of life, and even shorter life expectancy. However, still little is known about how various emotions (i.e., fear and disgust) affect subjective evaluation on phobia-related stimuli, and what are the potential risk and protective factors that may change the perception of such stimuli throughout these emotions. We investigated the role of fear of medical interventions and the degree of disgust sensitivity in the evaluation of BII phobia-related content and whether previous relevant experience and age may provide protection against the development of a phobia. We collected online survey data from multiple university sources. Participants (N = 228) completed measures of medical fear, disgust sensitivity, prior relevant experience and medical knowledge. Participants were also asked to rate images related to medical settings on dimensions of valence, arousal, disgust, and threat. Our results suggest that high disgust sensitivity and fear of medical interventions may be a risk factor for avoiding medical settings. However, previous relevant medical experience may function as protective factor. The pandemic of recent years underscored the importance of medical intervention and screening tests. These results have implications for professionals helping (e.g., as counselors) people with BII phobia, and physicians and nurses in informing and treating patients.

A comprehensive group-based cognitive behavioural treatment for blood-injection-injury phobia.

A key feature of blood-injection-injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group-based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention. Participants took part in an 8-session, group-based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting). There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre-treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre-treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others. Despite the heterogeneous nature of BII phobia, this group-based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting. Disgust is a key maintaining factor in blood-injection-injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard. This study examined a novel group treatment for blood-injection-injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting. The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment. Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach.

Cognitive Biases in Blood-Injection-Injury Phobia: A Review.

Blood-injection-injury (BII) phobia can lead to avoidance of crucial medical procedures and to detrimental health consequences, even among health workers. Yet unlike other specific phobias, BII phobia has been understudied. Specifically, while cognitive biases have been extensively investigated in other anxiety disorders, little is known about the same biases in BII phobia. The current article reviews cognitive biases in BII phobia and suggest future directions for further study and treatment. The reviewed biases include attention, expectancy, memory, perception, and interpretation biases. The investigation of these biases is highly relevant, as cognitive biases have been found to interact with anxiety symptoms. Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor perception biases. Mixed results were found for attention bias, as different studies found different components of attention bias, while others found no attention bias at all. Similarly, some studies found a-priori/a-posteriori expectancy biases, while other studies found only one type of bias. A better understanding of the cognitive particularities of BII phobia may lead to better treatments and ultimately reduce avoidance of needles and blood-related situations, thereby enabling individuals with BII phobia to undergo potentially life-saving medical procedures.

Long-term effectiveness of eye movement desensitization and reprocessing in children and adolescents with medically related subthreshold post-traumatic stress disorder: a randomized controlled trial

Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). Seventy-four children (including 39 with congenital or acquired heart disease) aged 4-15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood-injection-injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child's symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.

A Freshening Breath of Insight

A Freshening Breath of Insight

A randomised wait-list controlled pilot trial of one-session virtual reality exposure therapy for blood-injection-injury phobias

Virtual reality exposure therapy (VRET) has been recognized as an effective treatment for specific phobias and has the potential to overcome the limitations of traditional in vivo exposure therapy (e.g., acceptability). No past research has evaluated the efficacy of VRET for the treatment of blood-injection-injury (BII) phobia. Therefore, we conducted a randomized controlled trial to examine the acceptability and efficacy of a single-session VRET intervention for BII phobias. Participants who met DSM-5 criteria for BII phobia (N = 43) were randomized to VRET or a waiting list control group, and completed self-report measures of BII severity (Medical Fear Survey [MFS] and Multidimensional Blood Phobia Inventory [MBPI]) and dental anxiety (Modified Dental Anxiety Scale), as well as clinician ratings of BII phobia severity and catastrophic cognitions at baseline, one-week post-treatment, and 3-month follow-up. We found medium to large differences in catastrophic cognitions (probability [g = 0.88] and cost [g = 0.66] ratings), favouring VRET. We found moderate to large differences favouring VRET on the MBPI Injection and Injury fears subscales (g's=0.64–1.14) at one-week post-treatment and 3-month follow-up, and on the MBPI Fainting subscale (g = 0.84) and Injections subscale of the Medical Fear Survey (g = 0.63) at follow-up. There were no other significant group differences. These findings provided some initial evidence to suggest that a single-session VRET may provide some improvements in fears of injections, injury, and fainting. While it may be a useful adjunct or interim step before in vivo exposure therapy, it is not sufficient as a standalone treatment for BII phobia.

Effects of repeated exposure to fearful and disgusting stimuli on fear renewal in blood-injection-injury phobia

Although exposure is effective for blood-injection-injury (BII) phobia, fear often returns after treatment. While disgust has been implicated in BII phobia, its effects on fear renewal are unclear. To address this knowledge gap, the present study examined the effect of repeated video exposure to fearful and disgusting stimuli in multiple contexts on fear renewal in BII phobia. Individuals with BII phobia (N = 57) were randomized to Disgust-Specific Exposure (DSE) which included exposure to disgusting but threat-irrelevant stimuli (i.e., vomit), Fear-Specific Exposure (FSE) which included exposure to threat-relevant stimuli (i.e., injections), or General Negative Exposure (GNE) which included exposure designed to elicit negative affect (i.e., tornado) without being disgusting or threat-relevant. During session one, participants watched a pre- and post-exposure assessment injection video (“pre/post assessment”), and a novel injection video after exposure to assess renewal effects (“novel 1”). Participants came in one week later to rate the same videos, and a new injection video (“novel 2”). For week one outcomes, comparisons of covariate adjusted means indicated the fear-specific group reported significantly lower levels of anxiety than the general-negative group to the post-exposure and novel 1 stimulus. When presented with the post-exposure stimuli during week two, the disgust-specific and fear-specific groups reported significantly lower levels of anxiety than the general negative group. The fear-specific group also reported significantly lower levels of anxiety than the disgust-specific and general-negative groups when presented with novel 1 and novel 2 stimuli at week two. These findings suggest that repeated exposure to threat-relevant cues in multiple contexts does reduce the return of anxiety. However, repeated exposure to disgusting but threat irrelevant stimuli may also produce some therapeutic effects. The implications of the integration of disgust-relevant processes into exposure-based treatment of BII phobia are discussed.

Applied muscle tension and exposure during the cognitive behavioral therapy of a adolescent with blood- injection -injury phobia: a case report

Blood-injection-injury phobia (BII) is a specific type of phobia that includes anxiety and avoidance behaviors against blood, injection, injuries or medical practices. Children and adolescents are seen with a frequency of 0.8% to 1.5% and the median age of onset is 5.5. It has been shown to have some unique factors (fainting, disgust, physiological symptoms, and pain) compared to other phobia subspecies. The increase in heart rate and blood pressure follows a sudden decrease, and this condition is called vasovagal syncope. Cognitive Behavioral Therapy (CBT) is one of the most effective treatment methods in BII. CBT can be applied for one session or 8-12 sessions. CBT includes psychoeducation, automatical thoughts detection and restructuring, prevention of exposure and avoidance. Blood pressure increasing techniques, especially applied muscle tension technique, to prevent syncope during exposure, increase the effectiveness of therapy. In this case report, the treatment process of adolescent patient admitted with blood-injection-injury phobia successfully completed using CBT techniques will be discussed. After ten sessions of cognitive behavioral therapy, the patient's blood concerns and avoidance behaviors were completely gone. He managed to give blood, which he stated the highest degree of discomfort in the hierarchy of fear, without experiencing syncope. It has been demonstrated with the fact that CBT, which involves exposure, especially in combination with blood pressure raising techniques, is effective in the treatment of BII in children and adolescents, as in adults.

Autonomic reactivity in blood-injection-injury and snake phobia

ObjectiveThis research aimed to study the salivary flow and other autonomic reactions -heart rate (HR) and skin conductance response (SCR)- in blood-injection-injury (BII) phobia and snake phobia participants, under the assumption that exposure to blood-related pictures in BII phobia will provoke an increase in parasympathetic activity that, in turn, will lead to a greater saliva production than other affective contents. MethodsWe selected 18 BII phobia and 14 snake phobia participants along with 22 non-phobia individuals. All participants were exposed to 3 blocks of pictures (12 pictures per block) depicting either mutilations, snakes or neutral, household objects. Saliva samples were taken in the 2-min interval before and after each block. ResultsIn comparison to other contents, blood-related pictures provoked an increase in salivary flow in BII phobia participants, as well as an increase in the number of SCRs. In the snake phobia group, snake pictures provoked HR acceleration, but the SCRs they elicited did not differ from the SCRs provoked by the blood-related pictures. ConclusionBII phobia individuals react to their phobic object with a series of physiological changes resulting from a sympathetic-parasympathetic co-activation. This is in contrast with other specific phobias (e.g., small animal phobias) that usually show a sympathetically mediated, defensive reactivity when exposed to their disorder-relevant stimuli. These data support the use of therapeutic interventions in BII phobia that may differ in some respect from those used in other specific phobias.

A gender invariant model of disgust propensity in blood-injection-injury phobia in Latina/o individuals

ABSTRACTLatinas/os have been underrepresented in research investigating the role of disgust propensity in phobias. The current study was the first to examine associations between disgust propensity and Blood-Injection-Injury (BII) phobia, when acculturation was controlled for, in Latina/o Americans (n = 376). A structural model was developed with a BII fear latent variable consisting of fears of injection, blood, and sharp objects (causing injuries). The disgust propensity latent variable was formed with three domains of core, animal reminder, and contamination disgust elicitors. In the model, disgust propensity predicted BII fear when controlling for acculturation. A series of measurement and structural invariance tests demonstrated that the model was invariant between males and females. The current findings supported the hypothesis that disgust plays a role in BII fear symptoms similarly in Latinas and Latinos. The findings are expected to improve our understanding of mechanisms and treatment approaches for BII phobia symptoms in this underserved cultural group.

Etiology and prognosis of children and adolescents with situational syncope

Objective To retrospectively analyze the etiology and prognosis of the children and adolescents with situational syncope in a single center. Methods There were 4 274 cases of children and adolescents [aged from 2 to 18 years old, the average age being (10.82 ± 3.13) years old], male 2 208 cases, female 2 066 cases with orthostatic intolerance syndromes, such as unexplained syncope or symptoms of presyncope, etc, who were treated at Children′s Syncope Outpatient Department or Inpatient Department in the Second Xiangya Hospital, Central South University from January 2000 to November 2017.All subjects underwent detailed history investigation, careful physical examinations, routine 12-lead electrocardiogram, Holter electrocardiogram(ECG), chest X-ray, echocardiography, electroencephalogram(EEG) and head computerized tomography(CT) or magnetic resonance imaging(MRI), blood biochemical examination (including fasting glucose, myocardial enzymes) and organic diseases in the heart, brain, blood vessels were excluded, but the cause of syncope was still not clear.The head-up tilt table test (HUTT) was performed after the patients or/and the families wrote the informed consent agreement. Results A total of 177 (4.14%) patients with situational syncope were diagnosed among 4 274 cases.Etiology included the abdominal musecle exercise (35.59%, 63/177 cases), urination (24.29%, 43/177 cases), bathing (9.60%, 17/177 cases), defecation (7.34%, 13/177 cases), singing (5.08%, 9/177 cases), rides (4.52%, 8/177 cases), blood-injection-injury phobia (3.95%, 7/177 cases), swallowing (3.39%, 6/177 cases), and hair-grooming (2.82%, 5/177 cases), syncope during acupuncture treatment (2.26%, 4/177 cases), and cough (1.13%, 2/177 cases). The common positions were upright position (84.18%, 149/177 cases), squatting to standing position (8.47%, 15/177 cases), sitting position (5.08%, 9/177 cases), and squatting position (2.26%, 4/177 cases). HUTT positive rate was 69.49% (123/177 cases), common type of hemodynamic were the vasodepressive type of vasovagal syncope (45.20%, 80/177 cases), mixed type of vasovagal syncope (19.77%, 35/177 cases), postural orthostatic tachycardia syndrome (3.39%, 6/177 cases) and the cardiac suppressive type of vasovagal syncope (1.13%, 2/177 cases). In 35 cases of situational syncope, the number of children and adolescents with syncope was significantly reduced by health education and upstanding training.By the first follow-up review, the cases were reduced from (2.69 ±1.81) times to (0.59 ± 0.96) times after healthy education of 2-16 weeks [(4.97±3.16) weeks]. By the second follow-up review, 3 out of 8 cases did not faint, 3 cases fainted 1 time, 1 case fainted 2 times, and 1 case fainted 4 times.The outcomes of the first reexamination of HUTT in 16 cases were negative, and other 3 cases were negative by twice visit. Conclusions The etiology of children and adolescents are flag-raising(abdominal muscle exercise), urination, bathing, defecation, singing, riding, blood-injection-injury phobia, swallowing, hair-grooming, syncope during acupuncture treatment and coughing.Healthy education is good for situational syncope. Key words: Situational syncope; Head-up tilt table test; Etiology; Healthy education; Prognosis; Child; Adolescent

Cognitive Behavioral Treatment of Blood-Injection-Injury Phobia: A Case Report

Blood-injection-injury phobia (BII) is a type of specific phobia that includes intensive anxiety and accompanying avoidance behaviors against medical procedures such as getting blood drawn, vaccination, having an injection and injuries. Unlike other specific phobias, physiological responses (e.g., fainting), called vasovagal syncope, are encountered in blood-injection-injury phobia. Cognitive Behavioral Therapy (CBT) which is based on alleviating avoidance of the feared stimuli through exposure, modifying erroneous beliefs with realistic and adaptive ones in the treatment of blood-injection-injury phobia offers a highly effective approach. In addition to cognitive behavioral techniques, the use of applied muscle tension technique developed to prevent fainting response that may occur during exposure is suggested as an effective method of treating blood-needle-phobia. In this case study, formulation and the cognitive behavioral therapy process including gradual exposure combined with applied muscle tension techniques of a patient, diagnosed as injection phobia, is reported. Behavioral techniques such as applied muscle tension technique and gradual exposure; cognitive restructuring, imagery techniques, psychoeducation and homeworks were used in cognitive behavioral therapy process. After completing 16 sessions of cognitive behavioral therapy, it was observed that the patient started to get blood drawn, to have injections; patient’s anxiety level and avoidance of medical procedures decreased considerably and she did not experience syncope during medical procedures. As a result, it is thought that the applied muscle tension is a key factor for the efficacy of the exposure steps, and is important to combine it with other cognitive behavioral techniques.

Sympathetic and parasympathetic cardiac responses to phobia-relevant and disgust-specific emotion provocation in blood-injection-injury phobia with and without fainting history.

The autonomic regulation in blood-injection-injury (BII) phobia has received particular attention due to the unique link between fear and fainting in this anxiety disorder. However, systematic exploration of sympathetic and parasympathetic cardiac activity during exposure to phobia-relevant emotional stimuli has remained rare and inconclusive, including with regard to disgust, a frequent response to BII stimuli. Existing studies using respiratory sinus arrhythmia (RSA) as a noninvasive index of parasympathetic cardiac activity also have not accounted sufficiently for effects of respiration. We compared 60 participants with BII phobia (27 with and 33 without history of loss of consciousness) and 20 healthy controls during emotion induction with films, including a disgust and a BII-relevant surgery film. Cardiorespiratory activity was measured continuously, with RSA (controlled for respiration) and T-wave amplitude (TWA; as a noninvasive index of sympathetic cardiac activity) extracted. Significant increases in RSA during the surgery film were observed for participants with a history of loss of consciousness compared to others, but controlling for respiration eliminated these differences. Sympathetic effects with heart rate accelerations, which were most pronounced for the disgust film, did not differentiate groups. However, substantial increases in RSA and TWA, suggesting parasympathetic excitation and sympathetic withdrawal, were observed in five participants that became presyncopal during the surgery film. Thus, parasympathetic excitation and sympathetic withdrawal appear to be cardinal autonomic features in BII phobia, but larger studies of participants reaching presyncopal states in BII-relevant stimulus exposure are needed to consolidate these findings.

Ultra-brief behavioral skills trainings for blood injection injury phobia

Blood injection injury (BII) phobia is common, with debilitating consequences to the health and well being of many of its sufferers. BII phobia presents with a unique fear response that can involve drops in blood pressure and ultimately fainting. The aim of this study was to provide proof of concept for a line of brief, easy to implement, video-based interventions for reducing phobic avoidance and fears in BII sufferers. One of the interventions was a novel Hypoventilation Respiratory Training (HRT) aimed at reducing the exaggerated ventilation response (hyperventilation) seen in BII phobia. The response has been linked to cerebral vasoconstriction and fainting symptoms. Sixty BII patients were randomly assigned to one of three 12-min video-guided trainings: Symptom-Associated Tension (SAT) training, Relaxation Skills Training (RST), or HRT. Experiential and cardiorespiratory activity to phobic stimuli was assessed before and after training. Both SAT and HRT resulted in overall greater reductions of phobic fears and symptoms than RST. SAT significantly increased heart rate during exposure, and HRT led to significantly reduced ventilation, increases in PCO2 , and elevated blood pressure throughout exposure and recovery. Treatment expectancy was rated equally high across conditions, whereas credibility ratings were highest for HRT. Brief, video-based instructions in muscle tension and normocapnic breathing are effective in reducing BII symptom severity and require minimal time and expertise. HRT may be particularly helpful in reducing fainting caused by cerebral vasoconstriction.

Initial and sustained brain responses to threat anticipation in blood-injection-injury phobia.

Blood-injection-injury (BII) phobia differs from other subtypes of specific phobia in that it is associated with elevated disgust-sensitivity as well as specific autonomic and brain responses during processing of phobia-relevant stimuli. To what extent these features play a role already during threat anticipation is unclear. In the current fMRI experiment, 16 female BII phobics and 16 female healthy controls anticipated the presentation of phobia-specific and neutral pictures. On the behavioral level, anxiety dominated the anticipatory period in BII phobics relative to controls, while both anxiety and disgust were elevated during picture presentation. By applying two different models for the analysis of brain responses to anticipation of phobia-specific versus neutral stimuli, we found initial and sustained increases of activation in anterior cingulate cortex (ACC), insula, lateral and medial prefrontal cortex (PFC), thalamus and visual areas, as well as initial activation in the amygdala for BII phobics as compared to healthy controls. These results suggest that BII phobia is characterized by activation of a typical neural defense network during threat anticipation, with anxiety as the predominant emotion.

“I Don’t Want to Give Birth”: Clinical and Ethico-Legal Dilemmas and the Role of Graded Exposure Therapy on an Urgent Basis in a Post-Term Pregnant Woman with Blood-Injection-Injury Phobia

Introduction: Blood-injection-injury (BII) phobia is a common anxiety disorder that is non-fatal in most cases. Nevertheless, BII phobia in pregnancy can pose intricate medico-legal management issues. Case Presentation: A 24 year-old post-term (40 weeks + 9 days) primigravida refused induction of labour because of BII phobia, thereby presenting a serious obstetrical dilemma due to the precarious balance between patient’s autonomy and the pressing risk of intrauterine death. Caesarean section was successfully performed after sessions of urgent graded exposure therapy. Conclusions: This case highlights the importance of close multidisciplinary teamwork.

Blood-Injection-Injury Phobia and Dog Phobia in Youth: Psychological Characteristics and Associated Features in a Clinical Sample

Blood-Injection-Injury (BII) phobia is a particularly debilitating condition that has been largely ignored in the child literature. The present study examined the clinical phenomenology of BII phobia in 27 youths, relative to 25 youths with dog phobia—one of the most common and well-studied phobia subtypes in youth. Children were compared on measures of phobia severity, functional impairment, comorbidity, threat appraisals (danger expectancies and coping), focus of fear, and physiological responding, as well as vulnerability factors including disgust sensitivity and family history. Children and adolescents with BII phobia had greater diagnostic severity. In addition, they were more likely to have a comorbid diagnosis of a physical health condition, to report more exaggerated danger expectancies, and to report fears that focused more on physical symptoms (e.g., faintness and nausea) in comparison to youth with dog phobia. The present study advances knowledge relating to this poorly understood condition in youth.

Blood-injection-injury phobia in older adults.

This study aims to (i) estimate the prevalence of blood-injection-injury phobia (BIIP) diagnosed as present at any time during the life prior to the interview, with or without another Specific Phobia diagnosed as present during the 12 months prior to the interview, (ii) characterize types and frequencies of co-occurring fears, (iii) evaluate the association with chronic medical conditions and lifetime psychiatric comorbidity, and (iv) explore medical service use associations in a nationally representative sample of older adults. A sample of 8,205 older adults, aged 65 years or older, was derived from Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The weighted lifetime prevalence of BIIP with and without 12-month Specific Phobia was 0.6% (95% CI: 0.4-0.8) and 4.2% (95% CI: 3.7-4.8), respectively, and these two groups ranked similarly in terms of sociodemographic, health, and psychiatric characteristics. BIIP most frequently co-occurred with other lifetime fears, and was positively associated with hypertension and lifetime history of anxiety and personality disorders after controlling for sociodemographic and psychiatric confounders. Our findings suggest that lifetime BIIP may bear mental and physical health significance in older adults.

One session treatment for pediatric blood-injection-injury phobia: A controlled multiple baseline trial

The present study evaluated the effectiveness of a modified One Session Treatment (OST), which included an e-therapy homework maintenance program over 4 weeks for Blood-Injection-Injury (BII) phobia in children and adolescents. Using a single case, non-concurrent multiple-baseline design, 24 children and adolescents (8–18 years; 7 males, 17 females) with a primary diagnosis of BII phobia were randomly assigned to a one, two or three week baseline prior to receiving OST. Primary outcome measures included diagnostic severity, diagnostic status, and child and parent fear ratings. Secondary outcome measures included avoidance during behavioural avoidance tasks (BAT), global functioning and self and parent reported anxiety, fear and depression. Efficacy was assessed at post-treatment, 1-month, and 3-month follow-up. BII symptoms and diagnostic severity remained relatively stable during the baseline periods and then significantly improved following implementation of the intervention. Treatment response was supported by changes across multiple measures, including child, parent and independent clinician ratings. At post-treatment 8 of the 24 (33.33%) children were BII diagnosis free. Treatment gains improved at follow-ups with 14 (58.33%) children diagnosis free at 1-month follow-up and 15 (62.5%) diagnosis free at 3-month follow-up. Preliminary findings support the effectiveness of a modified OST approach for BII phobic youth with treatment outcomes improving over follow-up intervals.