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.

• Authors: Thomas Ritz, Alicia E Meuret, Erica Simon
• Journal: Behaviour research and therapy (Behav Res Ther) Vol. 51 Issue 8 Pg. 460-8 (Aug 2013) ISSN: 1873-622X [Electronic] England
• PMID: 23747585 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Carbon Dioxide

Topics

• Adolescent
• Adult
• Blood Pressure (physiology)
• Carbon Dioxide (metabolism)
• Cardiovascular System (physiopathology)
• Case-Control Studies
• Emotions (physiology)
• Female
• Heart Rate (physiology)
• Humans
• Hyperventilation (complications, physiopathology, psychology)
• Injections (psychology)
• Male
• Middle Aged
• Phobic Disorders (complications, physiopathology, psychology)
• Photic Stimulation
• Respiratory Rate (physiology)