Cerebral Circulation During Treatment of Blood-Injury Phobia: A Case Study

Mostly qualitative observations and case studies have reported hyperventilation or deep breathing in BII-phobia patients.

“Mostly qualitative observations and case studies have been published that reported hyperventilation or deep breathing in BII-phobia patients (e.g., Elmore et al., 1980; Foulds, 1993; Steptoe & Wardle, 1988).”

Foulds considered the possibility that the cerebral effects produced by muscle tensing were caused by increased metabolic production of CO2, partially reversing hyperventilation, rather than by reversing a decrease in heart rate and blood pressure.

“He considered the possibility that the cerebral effects produced by muscle tensing were “caused by increased metabolic production of CO2, i.e. partially reversing hyperventilation, rather than by reversing a decrease in HR and blood pressure” (p. 144).”

Some beneficial effects of muscle tension on cerebral blood flow may unfold through the increase in CO2 production by the accompanying increase in metabolic activity.

“It also must be considered that some of the beneficial effects of muscle tension on CBF may unfold through the increase in CO2 production by the accompanying increase in metabolic activity (Foulds, 1993).”

In Foulds's case, prior to treatment, the response to voluntary hyperventilation showed a marked increase in heart rate from 72 to 138 bpm accompanied by a 48% drop in cerebral blood flow.

“Prior to treatment, the response of the patient to voluntary hyperventilation was assessed, showing a marked increase in HR (from 72 to 138 bpm) accompanied by a 48% drop in CBF.”

When the patient was confronted with a phobic stimulus, cerebral blood flow decreased while both heart rate and reports of dizziness increased, eventually followed by a drop in blood pressure and heart rate.

“When the patient was confronted with a phobic stimulus, a response pattern similar to voluntary hyperventilation was seen - CBF decreased while both HR and reports of dizziness increased, which was eventually followed by a drop in BP and HR.”

At a seven-month follow-up test exposure to a venipuncture video, the patient showed again a heart rate increase and dizziness followed by pronounced bradycardia; initiation of muscle tension did not seem to abolish this response.

“However, at a seven-month follow-up test exposure to a venipuncture video, the patient showed again an HR increase and dizziness followed by pronounced bradycardia. Initiation of muscle tension did not seem to abolish this response.”

At the same time as the follow-up bradycardic response, the patient felt fully in control of the situation and only mildly anxious.

“Interestingly, at the same time the patient felt fully in control of the situation and only mildly anxious.”

Foulds (1993) suspected that muscle tension techniques in themselves would not be effective enough to raise cerebral blood flow levels sufficiently to avoid fainting.

“Foulds (1993) suspected that muscle tension techniques in themselves would not be effective enough to raise CBF levels sufficiently to avoid fainting.”

In Foulds's single-case report, combining respiratory control and muscle tension seemed sufficient to counteract fainting during the course of therapy.

“In his single-case report, Foulds (1993) used the pragmatic strategy of combining both techniques, respiratory control and muscle tension, which seemed to be sufficient to counteract fainting during the course of therapy.”

Following training in both muscle tension and respiratory control techniques, the patient gradually improved across five exposure sessions.

“Following training in both muscle tension and respiratory control techniques, the patient gradually improved across five exposure sessions.”