Management of Blood-Drawing Fears in Adolescents with Comorbid Anxiety and Depressive Disorders

Abstract

As more pharmacologic treatment and research on child and adolescent psychiatric patients are conducted, the common problem of blood-drawing fears will need to be addressed. Avoidance of blood-drawing could jeopardize an individual's physical and mental health, and inhibit the collection of data aimed at furthering the study of psychiatric disorders in youth. This report describes the naturalistic application of specific techniques for managing severe blood-drawing fears in adolescent subjects undergoing a clinical trial. The adolescents (ages 12-18) were 44 consecutive school refusers with comorbid anxiety and major depressive disorders. Of the school-refusing adolescents, 27% (12 of 44) were observed to have a severe fear of blood-drawing. A management strategy comprised of providing information, distraction, supportive reassurance, and exposure appeared successful in managing the fears of blood-drawing in all of the adolescents, except two. These 2 adolescents refused to enter the treatment study due to a marked fear of blood-drawing. All 10 subjects who exhibited a fear of blood-drawing and were able to complete the initial blood test, using the interventions noted, were able to obtain subsequent venipunctures with minimal or no avoidance behavior. These preliminary findings suggest that blood-drawing fears can be effectively managed in most cases, though controlled studies of these interventions are needed.

Interfaces That Heal: Coupling Real and Virtual Objects to Treat Spider Phobia

“…Desensitization, a treatment based on gradually and systematically exposing the phobic person to the feared object or situation and calming them, has proved to be an effective treatment for a wide range of phobias (Marks & Gelder, 1965). Exposure therapy has been involved in the successful treatment of claustrophobia (Ost, Alm, Brandberg, & Breitholtz, 2001); fear of public speaking (Kozasa & Leite, 1998); fear of flying in airplanes (Ost, Brandberg, & Alm, 1997); spider phobia (Ost, Ferebee, & Furmark, 1997); fear of blushing, sweating, or trembling (Scholing & Emmelkamp, 1996); fear of getting blood draws (Bernstein, Peterson, Perwien, Borchardt, & Kushner, 1996); panic attacks (Williams & Falbo, 1996); insects (McGlynn, Rose, & Lazarte, 1994); childhood water phobia (Menzies & Clarke, 1993), other phobias not mentioned here; and obsessive-compulsive disorder (Jenike, 2001).…”

Interventions for Individuals With High Levels of Needle Fear

“…Notable sources of exclusion were as follows (note that some citations could fall within more than 1 category but for clarity of reporting are described in the most applicable category): (1) nonrandomized design including case studies investigating exposure-based interventions (n=37) 21 , 53 – 88 or case series (n=5) 31 , 89 – 92 ; (2) incorrect population including RCTs with children with nonspecific phobias (n=2; eg, social phobia, agoraphobia) 93 , 94 or adults with general or global dental fear, which is seen as a distinct issue 29 (n=2) 95 , 96 ; (3) incorrect population including muscle tension techniques explored in nonfearful populations (n=3), 97 – 99 as well as a series of studies examining the muscle tension technique in voluntary blood donors (individuals who would volunteer to give blood are seen as unlikely to have high levels of needle fear 100 ; n=9) 101 – 109 ; (4) insufficient levels of fear, unsystematic screening process, or the potential that the fear was adaptive (ie, presence of a fear of water when it was unclear whether participants knew how to swim; n=3) 110 – 112 ; and (5) treatment did not match clinical questions, dismantling trials, or no relevant outcomes (n=21). 113 – 133 …”