Needle Phobia (Exposure without needles)

Needle phobia, like aeroplane travel, poses a practical difficulty when attempting to apply exposure therapy. Ideally, the anxious person undertakes a series of gradually escalating steps before attempting to encounter their specific fear. But the procedure of actually receiving a needle is quite dichotomous, you either get one or you don’t. It is not possible to have “half a needle” (or a quarter, a tenth, etc). So typically, a client might do imaginary exposure, some doctor role plays, watch videos of people getting injected perhaps. Unfortunately, I’ve never felt that any of these provided adequate preparation but left a client having to jump from step 4 all the way to step 10 on the exposure hierarchy.

Luckily, it may be that the needle itself isn’t all that relevant to needle phobia in which case exposure therapy might not require needles.

But firstly, what actually makes needles scary?:

Is it the pain?

Probably not entirely. We can easily pinch the loose skin on our forearm between thumb and fingernail to achieve a level of piercing pain equivalent or beyond that of a needle and people are typically not hesitant to do this. I would guess that some portion of people reading this will trial it now including those with significant needle phobia.

Is it getting stabbed?

That would make sense. But when people get IVs inserted, following the terror of the initial insertion, they’re typically okay with the sharp piece of metal left protruding from their arm. This wouldn’t make sense if the fear was all to do with having a sharp, metal object embedded in the flesh.

Looking like a wuss?

I think we’re getting closer. The fear is definitely about the moment itself and something to do with one’s possible reaction to it. But I’ve never had a client primarily agree with this as the concern, that is – predicting it likely that they would fall to pieces during the procedure.

For such a specifically labelled phobia it’s hard to completely pin down what the exact fear is. Rather, getting a needle is just this terribly annoying thing that we have to get done. I’ve heard many people say they wish they didn’t have to anticipate it, but that if they suddenly just got jabbed out of nowhere it would probably be okay. While this solution raises too many ethical issues to be taken seriously it does give us a clue:

The anticipation.

Once while working with a young client along with their parent, we agreed to role play the procedure on one another using a Pikachu-themed chopstick as the needle. On a whim I told the child that this time I would keep my eyes closed while they walked across the room toward me to administer the needle.

To my surprise my own SUDS shot up considerably. From a 0 to a 3.5 out of 10.

The child also reported a significant jump in anxiety when they kept their eyes shut. The increased loss of control of the situation and the heightened anticipation. For the rest of the session, we competed to psych each other out into opening our eyes by prolonging the moment, by feigning an approach before backing away to do some important doctor stuff. It was hard to just sit there. In my last blog I took a shot at breathing exercises and muscle relaxation, but they are perfect for this situation where they can be used proactively and when the only real option we have is to completely surrender to the coming moment.

Options are in abundance once we move the target of exposure away from needles and to the emotion of suspense itself. It’s a genre of movie as well as of children’s games; Pop the Pirate, Jenga, etc. The highest-SUDS challenge for myself so far has simply been blowing a balloon up until it bursts in front of my face.

Just as with receiving a needle, each of these exercises conclude with the reflection “Hey, that wasn’t so bad”, which with enough repetition will hopefully lead to our appreciation of this in advance.

Ned Dickeson is a clinical psychologist based in Adelaide, Australia.

‍This is a short essay and not intended as an adequate explanation for an evidence-based treatment approach, especially given all the nuances that each individual experiences.

I have used AI for artwork, research and proofreading but not for ideas or prose .