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.

Expositionstherapie mit Virtual Reality bei Blut-, Verletzungs- und Spritzenphobie. Eine Fallstudie

This case study describes the treatment of a patient with a blood-injection-injury type phobia including fainting and severe avoidance behavior, with the use of Virtual Reality Exposure Therapy (VRET). The patient has been treated over the course of 10 sessions. A variety of techniques from Cognitive Behavioral Therapy such as psychoeducation, cognitive restructuring, relaxation exercises and exposure therapy with pictures, videos and a Virtual Reality (VR) blood draw have been used. Results: Over the course of the treatment, the fear was significantly reduced leading to a successful blood draw two days after the last session. In the year following the treatment the patient did several successful blood draws, all without fainting and without a significant fear response.

Using Virtual Technology for Fear of Medical Procedures: A Systematic Review of the Effectiveness of Virtual Reality-Based Interventions

Background Innovations in virtual reality (VR) technologies have improved the adaptability of its use in therapeutic settings, and VR has shown to be a promising treatment for fear of medical procedures, with research increasing in this area in recent years. Purpose This review aims to collate evidence for the impact of VR on fear of medical procedures. Methods CENTRAL (Cochrane), MEDLINE, EMBASE, and PsychINFO databases were searched up to October 2020. A mix of experimental and case–control studies were included for review, which evaluated the effectiveness of VR for fear, anxiety, and pain of medical procedures for people with needle phobia, dental phobia, claustrophobia of medical scans, and burn wound care anxiety. Risk of bias (RoB) was assessed by Cochrane and ROBINS-I tools. Results Twenty-eight studies were selected. Some studies included mixed participant groups of young people adults. The interventions varied, with VR used for distraction, hypnosis, or exposure. These were shown to be effective for reducing fear of medical procedures. However, effectiveness for blood-injection-injury phobias and burn wound care patients was unclear. Conclusions Evidence on the effectiveness of VR suggests that it does decrease fear of medical procedures in some situations. However, the RoB assessment illustrated a poor quality of studies across those included in this review, limiting the ability to draw firm general conclusions from the study findings. There is a need for further research exploring the use of VR technologies in the management of anxiety in physical health care settings.