Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

Abstract

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non- in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.

Ultra-brief behavioral skills trainings for blood injection injury phobia

“…The injection theme was included for both films because of its relevance in medical populations (McMurtry et al, 2016). At session 1, patients were told that the films served as a baseline assessment to measure their physiological and experiential responding to feared BII stimuli, while the films shown after skill training would assess their ability to apply their newly acquired techniques.…”

“…The film scenes shown after skill training showed an initial blood draw followed by opening of the chest for heart surgery. The injection theme was included for both films because of its relevance in medical populations (McMurtry et al, 2016). Patients were asked to view films for their entire length and not to look away.…”

Initial validation of a virtual blood draw exposure paradigm for fear of blood and needles

“…Considerable evidence suggests that in-vivo exposure is among the most effective interventions for blood-injection-injury phobia, as well as variety of other feared experiences or stimuli [4,23,24,37]. During in-vivo exposure an individual is asked to come into contact with the feared stimulus, usually progressing from the least to most anxiety-provoking aspect of the stimulus [4].…”

The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake

“…This and the seeming resilience in children who got one injection multiple times supports exposure desensitization therapies for needle fear reduction. 25 …”