Blood Phobia Impact on Fainting

Overseen By Vera E Lucci, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Simon Fraser University

Must not be taking: Cardiovascular medications

Disqualifiers: Cardiovascular, Neurological, Menopausal, Pregnant

Compensation: Varies

Number of Visits: 2

20 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores why some people faint when they see blood or receive an injection. It examines how the body's automatic responses to fear, such as changes in heart rate or blood pressure, contribute to this reaction. Participants will watch videos with either neutral or blood-related content (blood-injection-injury phobia stimuli) to observe their bodily reactions. This study may suit individuals who avoid medical visits due to a fear of needles or blood. As an unphased study, it offers a unique opportunity to contribute to understanding fear responses without the constraints of traditional clinical trial phases.

Do I need to stop my current medications to join the trial?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are taking medication for a cardiovascular condition.

What prior data suggests that this protocol is safe?

Research shows that some people may faint when they see blood or needles. The body reacts to stress by lowering blood pressure, which can lead to fainting. This type of fainting, called vasovagal syncope, is triggered by emotional stress.

Many people with a fear of blood, injections, or injuries experience this reaction. However, fainting usually doesn't cause serious health problems. It's a temporary response and isn't harmful in the long run. People with this fear often have a heightened sensitivity to these situations, making them more likely to faint.

In summary, while fainting can be alarming, it is generally safe and doesn't cause lasting harm. The study aims to better understand these reactions and possibly find ways to help those affected. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the impact of visual stimuli on fainting in people with blood phobia. Unlike traditional treatments like cognitive behavioral therapy or medication, this approach uses targeted visual exposure to desensitize individuals to blood-injury-related stimuli. The method is unique because it directly assesses physiological responses to controlled stimuli, offering insights into fainting triggers and potentially leading to innovative, non-invasive treatment strategies.

What evidence suggests that this trial's treatments could be effective for blood phobia?

Research shows that people with a fear of blood, injections, or injuries often struggle with their body's automatic responses, increasing their likelihood of fainting. This phobia can lead to fainting due to a drop in blood pressure when they see blood or receive an injection. Women are more than twice as likely as men to experience this type of fainting. The trial will compare the effects of viewing blood-injection-injury (BII) phobia-related stimuli with neutral stimuli. Some treatments have reduced anxiety and fainting by altering these automatic responses when exposed to blood or injections. However, the exact mechanisms behind these reactions remain unclear. ^{1 2 4 6 7}

Who Is on the Research Team?

Victoria E Claydon, PhD

Principal Investigator

Professor, Biomedical Physiology and Kinesiology

Are You a Good Fit for This Trial?

This trial is for English-speaking men and women aged 18 to 50 who either have or suspect they have a fear of needles (BII phobia) or do not. It's not open to those with heart or brain disorders, pregnant individuals, menopausal women, or anyone on heart medication.

Inclusion Criteria

Those without a suspected BII fear and those with a suspected fear

English speaking

I am either male or female.

Exclusion Criteria

I have gone through menopause.

Pregnant

I have been diagnosed with a heart or brain disorder.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Testing

Participants undergo a tilt test to assess cardiovascular reflex control and orthostatic tolerance on two separate days with different stimuli

2 days

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after testing

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Blood-injection-injury (BII) phobia stimuli
• Neutral stimuli

Trial Overview The study aims to understand how people with needle phobia react physically when upright and exposed to stressful situations like seeing needles (BII stimuli) compared to neutral ones. Researchers will monitor the body's response in participants both with and without this phobia.

How Is the Trial Designed?

Group I: Image and video data set shown with BII stimuli. Experimental Treatment 1 Intervention

Participants will undergo this test on two separate days. On each day, participants will be asked to watch a series of videos and images. For this arm of the study, participants will view the BII phobia-related stimuli.

Group II: Image and video data set shown with neutral stimuli. Placebo Group 1 Intervention

Participants will undergo this test on two separate days. On each day, participants will be asked to watch a series of videos and images. For this arm of the study, participants will view the neutral stimuli.

Who Is Running the Clinical Trial?

Simon Fraser University

Lead Sponsor

Trials

59

Recruited

12,500+

Published Research Related to This Trial

Individuals with blood-injury phobia experience heightened anxiety, disgust, and embarrassment during venipuncture, with significant psychophysiological responses such as increased heart rate and respiration rate.

The study found no evidence that disgust sensitivity or parasympathetic activation contributes to the fainting response in blood-injury phobia, suggesting that fainting may be a conditioned response rather than linked to these factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blood-injury phobia with and without a history of fainting: disgust sensitivity does not explain the fainting response. Gerlach, AL., Spellmeyer, G., Vögele, C., et al.[2006]

In a study of 446 blood donors, those with a fear of injections reported higher levels of anxiety and disgust before donating blood, which correlated with more fainting symptoms during the donation process.

While both anxiety and disgust predicted fainting symptoms in nonfearful donors, only anxiety was a significant predictor for those with injection fear, suggesting that anxiety plays a more critical role in the fainting response for this group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disgust, anxiety, and vasovagal syncope sensations: a comparison of injection-fearful and nonfearful blood donors. Viar, MA., Etzel, EN., Ciesielski, BG., et al.[2015]

In a study of 259 participants, both disgust sensitivity and blood-injection-injury (BII) fears were found to independently predict fainting symptoms, highlighting their roles in BII phobia.

The relationship between disgust sensitivity and fainting symptoms was fully mediated by BII fear, suggesting that BII fear is a key factor in understanding fainting responses related to BII phobia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disgust, anxiety and fainting symptoms associated with blood-injection-injury fears: a structural model. Olatunji, BO., Williams, NL., Sawchuk, CN., et al.[2015]

BII phobia, which involves intense fear of blood, injury, or illness, is linked to a specific vasovagal fainting response, indicating a unique physiological reaction compared to other phobias.

The study of 15 individuals with BII phobia suggests that this condition may require its own diagnostic category due to its distinct clinical and demographic characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blood-injury-illness phobia: a review. Thyer, BA., Himle, J., Curtis, GC.[2019]

The Medical Fear Survey (MFS) identified seven reliable factors related to fears of blood, injury, and injections in a study of 934 participants, highlighting the complexity of these phobias.

The factor 'fear of injections and blood draws' was the strongest predictor of fainting, accurately classifying 72% of individuals who fainted, indicating its significance in understanding and assessing these medical fears.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factorial dimensions and correlates of blood, injury, injection and related medical fears: cross validation of the medical fear survey. Kleinknecht, RA., Thorndike, RM., Walls, MM.[2019]

In a study of 60 participants with blood-injection-injury (BII) phobia, diphasic cardiovascular responses were observed in about 20% of them, indicating a significant distress response when exposed to feared stimuli.

Participants exhibiting diphasic patterns reported greater fear of injections and blood draws, suggesting that these responses are clinically relevant and may benefit from respiratory training as part of their treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cardiovascular activity in blood-injection-injury phobia during exposure: evidence for diphasic response patterns? Ritz, T., Meuret, AE., Simon, E.[2013]

A study of 1479 first-time blood donors found that fear of blood draws and donation-related anxiety led to fewer donation attempts, highlighting the importance of addressing these fears.

The negative impact of fear and anxiety on donation behavior was linked to lower confidence and more negative attitudes towards donating, suggesting that support strategies could improve donor retention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fear is associated with attrition of first-time whole blood donors: A longitudinal examination of donor confidence and attitude as potential mediators. France, CR., France, JL., Himawan, LK., et al.[2022]

Blood-injection-injury phobia (BII-phobia) is characterized by a unique psychophysiological response that includes a biphasic vasovagal syncope, where initial sympathetic activation is followed by parasympathetic activation leading to fainting, often triggered by disgust.

Behavioral psychotherapy techniques, including exposure therapy and applied relaxation, have shown efficacy in treating BII-phobia, with no significant differences in effectiveness among the various techniques used.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Blood-injection-injury phobia: Physochophysiological and therapeutical specificities]. Ducasse, D., Capdevielle, D., Attal, J., et al.[2018]

Applied Tension (AT) is currently the recommended treatment for Blood-injury-injection (BII) phobia, showing superior results in reducing self-reported anxiety and in-session avoidance compared to other techniques.

However, Exposure only (E) was found to be more effective than AT when measuring pre- to post-treatment changes on BII-related questionnaires, indicating that exposure therapy alone may be sufficient for some patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatments for blood-injury-injection phobia: a critical review of current evidence. Ayala, ES., Meuret, AE., Ritz, T.[2009]

In a study of 60 patients with blood-injection-injury (BII) phobia, significant respiratory changes were observed during exposure to surgery-related stimuli, indicating that hyperventilation plays a key role in the phobic response.

Patients showed a rapid recovery after viewing disgust-inducing films, but not after surgery films, suggesting that the type of emotional stimulus affects physiological responses and may explain why fainting occurs after the phobic stimulus is removed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Confrontation with blood and disgust stimuli precipitates respiratory dysregulation in blood-injection-injury phobia. Ayala, ES., Meuret, AE., Ritz, T.[2015]

Blood-injection-injury (BII) phobia is characterized by a unique diphasic autonomic response, where individuals initially experience increased heart rate and blood pressure followed by a dangerous drop that can lead to fainting.

The review suggests that while applied tension techniques may help manage this response, focusing on respiration techniques could also be beneficial in treating BII phobia and preventing vasovagal fainting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The psychophysiology of blood-injection-injury phobia: looking beyond the diphasic response paradigm. Ritz, T., Meuret, AE., Ayala, ES.[2021]

An adult with blood-injection-injury (BII) phobia successfully overcame her fear by using self-directed exposure techniques and muscle-tension practice, leading to her ability to donate blood for the first time.

This case suggests that individuals with specific phobias may benefit from a treatment approach that combines initial professional guidance with self-arranged gradual exposure, offering a new option for managing phobias.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-arranged exposure for overcoming blood-injection-injury Phobia: a case study. Pitkin, MR., Malouff, JM.[2020]

Participants with high disgust sensitivity and trait anxiety experienced greater symptoms of faintness when exposed to pain scripts during blood-injury scenarios, indicating a strong interaction between these individual differences and fear responses.

The study suggests that understanding the roles of trait anxiety and disgust sensitivity can inform treatment approaches for blood-injury-injection phobia, potentially leading to more effective interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of cognitions, trait anxiety and disgust sensitivity in generating faintness around blood-injury phobic stimuli. Exeter-Kent, HA., Page, AC.[2015]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4094700/

Blood Injury and Injection Phobia: The Neglected One - PMC The prevalence of BII phobia and associated fainting in females was slightly more than double in the males with a significant gender related effect. Similar ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0022395609000880

Review Treatments for blood-injury-injection phobia Based on self-reported levels of anxiety, in-session avoidance and fainting, AT was superior over other conditions; however, when considering pre- to post- ...

3. ahajournals.org ahajournals.org/doi/10.1161/hc3301.094910

Predisposition to Vasovagal Syncope in Subjects With ... Subjects with syncope related to blood/injury phobia have an underlying autonomic dysregulation predisposing them to neurally mediated syncope.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6688615/

The psychophysiology of blood-injection-injury phobia Self-reported history of fainting to BII stimuli (partial or complete, with loss of consciousness) did not influence the outcome. Feelings of faintness ...

5. frontiersin.org frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.678891/full

Cognitive Biases in Blood-Injection-Injury Phobia: A Review Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8313757/

Cognitive Biases in Blood-Injection-Injury Phobia: A Review Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor ...

7. centerwatch.com centerwatch.com/clinical-trials/listings/NCT06336031/impact-of-blood-phobia-on-fainting-susceptibility

Impact of Blood Phobia on Fainting Susceptibility The primary purpose of this study is to characterize cardiovascular autonomic function to emotional stimuli (blood-injection-injury phobia ...