Systematic Desensitization in the Treatment of Needle Phobias for Children with Diabetes

Rainwater, Nancy; Sweet, Andrew A.; Elliott, Lynne; Bowers, Michael R.; McNeill, John H.; Stump, N. F.

doi:10.1300/j019v10n01_03

Cited by 22 publications

(9 citation statements)

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“…However, research concerning the etiology, prevalence, and treatment of FSI and fear of selftesting (FST) in patients with diabetes is scarce. To date, only a few studies, mostly case reports, have been published on the subject of FSI (3)(4)(5)(6)(7)(8), and no research is known to us on FST.…”

mentioning

confidence: 99%

Diabetes Fear of Injecting and Self-Testing Questionnaire: a psychometric evaluation.

et al. 2000

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Daily self-injecting of insulin and frequent self-monitoring of blood glucose (SMBG) are essential to adequately manage insulin-requiring diabetes. Extreme fear of self-injecting (FSI) insulin (injection phobia) is likely to compromise glycemic control as well as emotional wellbeing. Likewise, fear of SMBG (finger prick) can be a source of distress and may seriously hamper self-management. There is evidence to suggest that fear of blood and injury is associated with less frequent self-testing (1,2) and poor glycemic control (2). However, research concerning the etiology, prevalence, and treatment of FSI and fear of selftesting (FST) in patients with diabetes is scarce. To date, only a few studies, mostly case reports, have been published on the subject of FSI (3-8), and no research is known to us on FST.To quantify the level of FSI as well as FST in adults with insulin-requiring diabetes, we developed a diabetes-specific questionnaire, the Diabetes Fear of Injecting and Self-Testing Questionnaire (D-FISQ), which consists of 2 subscales, FSI and FST (9,10). Subscale scores and a total score are obtained. Preliminary results suggested satisfactory psychometric properties. In the present study, stability of the D-FISQ was assessed over different periods of time, and construct, discriminant, and convergent validity were examined. Criterion-related validity was tested by means of a behavioral avoidance test (BAT), in which the actual self-injecting and self-testing behaviors of extreme scorers on the D-FISQ were examined. Moreover, we investigated the latent factor analytic structure of the D-FISQ. RESEARCH DESIGN AND METHODSStudy subjects and procedure Reliability: internal consistency and testretest reliability. A composite questionnaire including the D-FISQ was sent to a random sample of 3,000 patients (with type 1 or 2 diabetes) drawn from ϳ40,000 members of the Dutch Diabetes Association (DVN, Diabetesvereniging Nederland). Inclusion criteria were 1) age Ͼ16 years and 2) being on insulin therapy for a minimum of 6 months. The latter criterion was chosen because we were interested in FSI/FST that persists beyond the early adaptation period. In total, 1,484 questionnaires were returned (49.5%); 12 questionnaires were excluded from data analyses because they were not complete. After exclusion of subjects not using insulin (n = 197), 1,275 subjects remained, from which a group of 252 subjects (sample A) was randomly selected. In this sample, internal consistency was assessed, as well as several aspects of validity. A second set of questionnaires, once more including the D-FISQ, was sent to this sample after ϳ3 months to determine test-retest reliability of the D-FISQ. RESULTS -Test-retest correlations ranged from 0.50 to 0.68 (P Ͻ 0.001). Correlations between D-FISQ and fear of hypoglycemia, trait anxiety, and fear of bodily injury, illness, or death ranged from 0.28 to 0.45 (P Ͻ 0.001). Patients who refused to do a BAT for self-injecting or self-testing had higher scores on FSI (P = 0.095) and FST (P = 0.01). EFA y...

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confidence: 99%

Diabetes Fear of Injecting and Self-Testing Questionnaire: a psychometric evaluation.

et al. 2000

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“…The participant modelling may in clude the manipulation of needles and syringes, but, sur prisingly enough, we found only one study in which injec tion phobics were allowed to practise self-injection and finger lancing with their therapist's and their own fingers [18], Since the patients in this study were diabetic, being able to inject oneself may have been a matter of course. On the other hand, one would expect that the skill to inject oneself would result in an optimal sense of control and personal efficacy [19][20][21], especially in the resistant type, even if injections and venipunctures are usually per formed by professionals.…”

Section: Behavioral Treatmentmentioning

confidence: 80%

Exposure and Participant Modelling in a Case of Injection Phobia

Trijsburg

Jelícic

Broek

et al. 1996

Psychother Psychosom

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Background: From the literature it appears that there may be two types of injection phobia, (1) the ‘vasovagal’ type, and (2) the ‘resistant’ type. The first type is characterized by a diphasic cardiovascular response during or after injection and by a tendency to react in a passive, nonresisting way when injected. The second type is characterized by strong, sometimes violent resistance and no vasovagal reaction to an injection. Characteristics of blood injury phobia apply to the first type, but not to the second. The possibility is considered that exposure may be an effective treatment in the first type, and participant modelling in the second type. Method: A single case study was carried out with a case of injection phobia of the second type in which exposure with modelling, followed by participant modelling of the injection, was applied. Measures of state anxiety (STAI) and heart rate were obtained. Results: According to expectation, participant modelling of injections was effective in eliminating the fear of injections in a patient of the second type of injection phobia. Conclusions: The results of this study warrant further investigation of the model in a group design in which the differential treatment effects of exposure and participant modelling are tested.

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“…Numerous studies have demonstrated the effectiveness of systematic desensitisation to treat circumscribed fears in analogue and clinical populations. Although in vivo exposure is generally regarded as the exposure modality of choice in systematic desensitisation, procedures using imaginal exposure have proven effective in treating a range of fears (Crits & Singer, 1984;Denney & Sullivan, 1976;McConaghy, Armstrong, Blaszczynski, & Allcock, 1983;Rainwater et al, 1988). In outlining the application of systematic desensitisation to phobias, Wolpe (1963) originally declared that there is a one to one relationship between what the patient can imagine without anxiety and what a person can experience in reality without anxiety.…”

Section: Discussionmentioning

confidence: 99%

An experimental study of the role of vulnerability related perceptions in spider fear: Comparing an imaginal and in vivo encounter

Armfield

2008

Journal of Anxiety Disorders

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Systematic Desensitization in the Treatment of Needle Phobias for Children with Diabetes

Cited by 22 publications

References 0 publications

Diabetes Fear of Injecting and Self-Testing Questionnaire: a psychometric evaluation.

Diabetes Fear of Injecting and Self-Testing Questionnaire: a psychometric evaluation.

Exposure and Participant Modelling in a Case of Injection Phobia

An experimental study of the role of vulnerability related perceptions in spider fear: Comparing an imaginal and in vivo encounter

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