Cardiovascular activity in blood-injection-injury phobia during exposure: evidence for diphasic response patterns?
Abstract
Exposure to feared stimuli in blood-injection-injury (BII)-phobia is thought to elicit a diphasic response pattern, with an initial fight-flight-like cardiovascular activation followed by a marked deactivation and possible fainting (vasovagal syncope). However, studies have remained equivocal on the importance of such patterns. We therefore sought to determine the prevalence and clinical relevance of diphasic responses using criteria that require a true diphasic response to exceed cardiovascular activation of an emotional episode of a negative valence and to exceed deactivation of an emotionally neutral episode. Sixty BII-phobia participants and 20 healthy controls were exposed to surgery, anger and neutral films while measuring heart rate, blood pressure, respiratory pattern, and end-tidal partial pressure of carbon dioxide (as indicator of hyperventilation). Diphasic response patterns were observed in up to 20% of BII-phobia participants and 26.6% of healthy controls for individual cardiovascular parameters. BII-phobia participants with diphasic patterns across multiple parameters showed more fear of injections and blood draws, reported the strongest physical symptoms during the surgery film, and showed the strongest tendency to hyperventilate. Thus, although only a minority of individuals with BII phobia shows diphasic responses, their occurrence indicates significant distress. Respiratory training may add to the treatment of BII phobia patients that show diphasic response patterns.
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Only about 20% of BII patients display the diphasic response.
“novel research indicates that only about 20% of BII patients display this diphasic response.”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [53]
Fainting BII patients appear to be more severely affected than non-fainting BII patients.
“Interestingly, these patients appear to be more severely affected than non-fainting BII patients (26, 43, 53).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [53]
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- Authors
- Ritz, T., Meuret, A. E., & Simon, E.
- Affiliations
- Southern Methodist University (US)
- Corresponding author
- Ritz, Thomas
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 51
- Issue
- 8
- Pages
- 460-468
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1983451646
- Cited by
- 15
- References
- 41
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2017: 2 · 2016: 2 · 2014: 3
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
- Keywords
- blood-injection-injury phobia, cardiovascular reactivity, heart rate, blood pressure, hyperventilation, vasovagal syncope, fear of injection, breathing exercises, phobia treatment
- MeSH terms
- Adolescent, Adult, Blood Pressure, Carbon Dioxide, Cardiovascular System, Emotions, Female, Heart Rate, Humans, Hyperventilation, Injections, Male, Middle Aged, Phobic Disorders, Photic Stimulation, Case-Control Studies, Respiratory Rate
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