Señales de amenaza y sesgo atencional en lafobia a la sangre, inyecciones y heridasy en la fobia a las serpientes

El objetivo de esta investigación fue estudiar el efecto de una señal que indica la aparición de una imagen fóbica sobre la actividad electrocortical provocada por el estímulo relevante para el trastorno en la fobia a la sangre por lesión en inyección (BII) y la fobia a las serpientes. Una muestra de 13 participantes con fobia BII, 12 individuos con fobia a las serpientes y 14 controles no fóbicos se sometieron a una tarea S1-S2, donde S1 era una palabra que describía el contenido de una imagen posterior (relacionada con la sangre, serpiente y neutral) que apareció 2 segundos después (S2). Obtuvimos las amplitudes ERP P200 y P300 provocadas por las imágenes. Nuestros resultados revelan que P200 no diferenciaba entre el contenido de las imágenes en la fobia BII mientras que, por el contrario, las imágenes relacionadas con la serpiente y la sangre provocaron las respuestas más grandes en los participantes con fobia a las serpientes. Tanto las imágenes relacionadas con la sangre como las de serpientes provocaron amplitudes de P300 mayores que las imágenes neutrales en todos los grupos. Las señales de amenaza redujeron la reacción electrocortical del BII, posiblemente por la provocación de respuestas anticipatorias o reguladoras. Estos resultados son indicativos de una baja atención automática exógena hacia los estímulos temidos en la fobia BII, como lo revela P200, probablemente relacionado con una falta de sesgo de atención al objeto fóbico. The aim of this research was to study the effect of a cue signalling the upcoming of a phobic picture on the electrocortical activity provoked by the disorder-relevant stimulus in in blood-injection-injury (BII) phobia and snake phobia. A sample of 13 BII phobia participants, 12 snake phobia individuals and 14 non-phobic controls underwent an S1-S2 task, where S1 was a word that described the content of a subsequent picture (blood-related, snake and neutral) that appeared 2 seconds later (S2). We obtained the P200 and P300 ERP amplitudes provoked by the pictures. Our results reveal that P200 did not differentiate between picture contents in BII phobia while, in contrast, snake and blood-related pictures provoked the largest responses in snake phobia participants. Both blood-related and snake pictures provoked greater P300 amplitudes than neutral pictures in all the groups. Threat cues reduced the electrocortical reaction of the BII, possibly by the elicitation of anticipatory or regulatory responses. These results are indicative of a low automatic, exogenous attention towards the feared stimuli in BII phobia, as revealed by P200, probably related to a lack of attentional bias to the phobic object.

Cognitive Biases in Blood-Injection-Injury Phobia: A Review

Blood-injection-injury (BII) phobia can lead to avoidance of crucial medical procedures and to detrimental health consequences, even among health workers. Yet unlike other specific phobias, BII phobia has been understudied. Specifically, while cognitive biases have been extensively investigated in other anxiety disorders, little is known about the same biases in BII phobia. The current article reviews cognitive biases in BII phobia and suggest future directions for further study and treatment. The reviewed biases include attention, expectancy, memory, perception, and interpretation biases. The investigation of these biases is highly relevant, as cognitive biases have been found to interact with anxiety symptoms. Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor perception biases. Mixed results were found for attention bias, as different studies found different components of attention bias, while others found no attention bias at all. Similarly, some studies found a-priori/a-posteriori expectancy biases, while other studies found only one type of bias. A better understanding of the cognitive particularities of BII phobia may lead to better treatments and ultimately reduce avoidance of needles and blood-related situations, thereby enabling individuals with BII phobia to undergo potentially life-saving medical procedures.

Creating a Computerized Instrument for the Assessment of Blood-Injury-Injection Phobia

A new computerized instrument (the Multimedia Behavioral Avoidance Test, or MBAT) for blood-injury-injection phobia (BII) assessment is presented. Analogous stimuli such as images and videos can also elicit anxiety responses; thus, they can be used for the assessment of phobia. The MBAT was applied to participants via computer, and subjective anxiety responses and time latency were recorded. The MBAT was composed of 30 original images and 30 videos related to blood, injury and injections. The MBAT was compared with other pencil-and-paper questionnaires for BII phobia, and heart rate was also measured with a pulsioximeter. The participants included 160 students and professionals (34.5% males, 65.6% females; mean 28.6 years old). The results showed a high reliability for internal consistency in images and videos (α = .98 both), with a single factor that groups all the items. In addition, the MBAT had high concurrent validity (r = .78 to .85) with the different anxiety scales compared. The MBAT diagnosed 12 participants with possible BII phobia. It is a useful instrument in the assessment of this kind of phobia because it is easier and quicker than pencil-and-paper questionnaires, it uses more objective measurements, and it is useful in planning subsequent exposure with images and videos.

Blood Injury and Injection Phobia: The Neglected One

Blood injury and injection (BII) phobia is a unique phobia associated with a diphasic cardiovascular response. The aim of this survey was to report the prevalence of BII phobia, its heritability, and clinical characteristics among the males and females in the Indian subcontinent. An interview and a survey were conducted using a developed BII phobia 21-item questionnaire among 3261 participant males (n=1648) and females (n=1613). Cronbach’ alpha (α) of 0.972 of internal consistency was reported. 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 avoidance behaviours involving hospital visits were reported for both males and females. The relative frequency of BII phobia among first and third degree relatives was found to be higher than among second degree relatives. Depression was found highly comorbid with BII phobia while a low rate of obsessive compulsion disorder (OCD) and social anxiety disorder (SAD) was reported. Morbidity associated with BII phobia may increase dramatically when other medical problems coincide with it.

Combined Case of Blood-Injury-Injection Phobia and Social Phobia: Behavior Therapy Management and Effectiveness through Tilt Test

The efficacy of behavior therapy based mainly on real-life exposure situations as well as applied tension was examined for a combined case of blood-injury-injection (BII) phobia and social anxiety disorder. Treatment involved 28 behavior therapy sessions, while applied tension technique was also described and practiced. The specific contribution of social skills techniques, fantasy, and real-life situations exposure was examined in a single case design. The subject was a 39-year-old male with anxiety symptoms when confronting an audience, as well as symptoms of the autonomic nervous system (bradycardia and syncope), which were better explained by BII. All self-report measures regarding fear, social phobia, and anxiety were reduced after behavior therapy and remained maintained at followup, while BII decreased further after applied tension techniques. The contribution of behavior therapy to the overall outcome of the case is considered significant for many reasons that are discussed in the pape.

The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls

BackgroundMost neuroimaging studies of specific phobia have investigated the animal subtype. The blood-injection-injury (BII) subtype is characterized by a unique biphasic psychophysiological response, which could suggest a distinct neural substrate, but direct comparisons between phobia types are lacking.MethodThis study compared the neural responses during the presentation of phobia-specific stimuli in 12 BII phobics, 14 spider (SP) phobics and 14 healthy controls using functional magnetic resonance imaging (fMRI).ResultsSubjective ratings showed that the experimental paradigm produced the desired symptom-specific effects. As in many previous studies, when viewing spider-related stimuli, SP phobics showed increased activation in dorsal anterior cingulate and anterior insula, compared to BII phobics and healthy controls. However, when viewing images of blood-injection-injuries, participants with BII phobia mainly showed increased activation in the thalamus and visual/attention areas (occipito-temporo-parietal cortex), compared with the other two groups. The degree of provoked anxiety and disgust by phobia-relevant images was strongly associated with activation in several common regions across the two phobia groups (thalamus, cerebellum, occipito-temporal regions) but only correlated with activation in the dorsal anterior cingulate gyrus and the anterior insula in the SP phobics.ConclusionsThese results suggest partially distinct neurobiological substrates of animal and BII phobias and support their current classification as two distinct subtypes in the DSM-IV-TR. Further research is needed to better understand the precise neurobiological mechanisms in BII phobia and particularly the fainting response.

A Preliminary Investigation of the Efficacy of Disgust Exposure Techniques in a Subclinical Population With Blood and Injection Fears

The current study examined whether a traditional exposure-based treatment for blood-injection-injury (BII) phobia would be effective at reducing disgust responses to BII stimuli and whether the addition of modules targeting disgust would provide incremental efficacy. Participants, many of whom reported subclinical BII phobia symptoms, underwent one of two single-session exposure protocols, one targeting fear alone, and the other targeting both fear and disgust. Both treatments consisted of education components (fear-only or fear-disgust) and in vivo exposure (fear-only or fear-disgust). Both the fear-only and the fear-disgust treatment groups significantly decreased fear and avoidance behaviour toward BII stimuli over time. The two groups also experienced similar reductions in disgust responses to BII-related stimuli and global as well as domain-specific disgust sensitivity. The effect sizes indicated that the fear-disgust group evidenced greater reduction in symptoms than did the fear-only group. The implications of the results for models of phobia maintenance and treatment are discussed.

Disgust Processing in Phobia of Blood-Injection-Injury

An elevated disgust sensitivity (DS) is considered to be a vulnerability factor for the development of a blood-injection-injury (BII) phobia. Within the present functional Magnetic Resonance Imaging (fMRI) study, 12 female BII phobics were scanned while viewing alternating blocks of 40 disgust-inducing, 40 fear-inducing, and 40 affectively neutral pictures. Each block lasted 60s and was repeated six times during the experiment. All scenes were phobia-irrelevant. Afterwards, the subjects gave affective ratings for the pictures and described their DS on a self-report measure for different areas (e.g., poor hygiene, unusual food, death/deformation). The responses were compared with those of 12 nonphobic females. The BII phobics showed a stronger occipital activation within the right cuneus and lingual gyrus during the first viewing of the disgusting pictures. Aside from this finding, which could be interpreted as reflecting increased attention, there was little evidence for a generally elevated DS in BII phobia. On the DS questionnaire, the patients had indicated a greater reactivity only for disorder-relevant contents (death/deformation). Further, both groups gave similar disgust ratings for the pictures and showed comparable brain-dynamic responses over all blocks of the disgust condition, which included the activation of both amygdalae and the left inferior frontal gyrus.

Cognitive-behavioural Treatment of Blood-Injury-Injection Phobia: A Case Study

This single case study examined the treatment of blood-injury-injection (BII) phobia in a 14-year-old female. Thirteen 1-hour sessions of cognitive behavioural therapy were conducted. The intervention included a combination of exposure, applied tension, and cognitive restructuring in an effort to produce clinically significant reductions in anxiety and fainting in response to BII stimuli. Results did indeed show dramatic reductions in subjective distress in BII situations from baseline to post-treatment. This was supported by small reductions in phobic anxiety and general anxiety on self-report measures. In contrast to baseline, fainting did not occur during treatment. The subject rated cognitive restructuring as the most effective treatment component for the latter half of therapy. It is suggested that, to date, the importance of cognitive therapy for the treatment of BII phobia has been overlooked.