Background

Blood tests. This combination of words elicits a sense of dread in many individuals. But let’s be clear, it’s not the lab results that folks are afraid of - in most cases - but rather the act of drawing blood via a hypodermic needle. This aversion to needles is known as Trypanophobia. Consensus polling conducted by the British Heart Foundation (BHF) estimates that a surprising 1 in 10 people are subject to the debilitating effects of Trypanophobia.

In this article, we explore the psychology behind this apprehension of needles, why blood tests are important and the steps you can take if you have this phobia.

The psychology of Trypanophobia

The term Trypanophobia is derived from a Greek word, Trypano, which translates to punching or piercing. With that said, nobody in their right mind would be excited by a foreign object punching through their veins.

So why do some people see venepuncture - the process of obtaining intravenous access - as a mild inconvenience, whereas others experience extreme anxiety? It is worth dispelling from the outset the toxic myth that only the “tough” don't fear needles.

There may be a genetic component involved in this phobia, as evidenced by research performed at The Libin Cardiovascular Institute of Alberta, University of Calgary. Although exploring genetic predispositions for Vasovagal Syncope - a medical term for fainting, the most extreme manifestation of Trypanophobia - the study still highlighted the high probability of genetic factors versus environmentally “learnt” factors.

Additionally, there is also an element of Algophobia, which is a fear of pain. So, does this mean for those with this phobia that you’re doomed to a life of avoiding needles?

Not really a feasible option, as the average person experiences 165 injections throughout their lifespan, and that estimate doesn't take hospitalisations into account.

How to deal with the fear of needles

Unfortunately, there isn’t a simple one-stop solution to combating and controlling this fear, but rather logical steps one can take to manage the effects of the phobia.

Practice deep breathing techniques well in advance of your appointment: Take a long, deep breath through your nose, and let it flow into your belly as far as you comfortably can. Slowly exhale through your nose and repeat the exercise for three to five minutes every day.

Once you get used to this method of deep breathing, you can use it during your appointment to manage your sympathetic and parasympathetic nervous system reactions, which control your fight-or-flight response and your body’s ability to relax, respectively.

1. Bring a friend or member of your family

This may seem excessive, but we are talking about a phobia here. Research shows that the sound of a loved one can generate a sense of calm, triggered through neurochemical reactions within the parasympathetic nervous system. It’s not just a psychological “trick” but rather a physiological consequence.

2. Talk it through

For many people talking it through is an obvious step, but you’ll be surprised. At the risk of controversy, I personally feel this is advice geared more towards men rather than women. Not to say that all men adhere to an archaic paradigm of machismo, but this gender-specific trepidation is research-backed.

The point in consideration here is that the healthcare professional is trained in dealing with this fear and the steps to take to alleviate any psychological barriers. Let the person who is treating you know if you are feeling nervous. They will ensure you are as comfortable as possible, answer any questions and take measures to reduce your anxiety or stress.

3. Reduce discomfort

Ask the healthcare professional if they have any numbing cream or freezing spray to reduce pain when they are conducting the procedure. You may also find it pragmatic to purchase some before your appointment. If you do the latter, please ensure you inform the healthcare professional, as in some cases, these creams may affect laboratory results and should be avoided.

4. The age-old distraction technique

It works. It really does. The trick is to conduct it properly and with an element of positive association. Try focusing on a positive memory or object in the clinic that has positive connotations, such as the jar of lollipops on the clinician’s desk. Or if you would rather not taint a pleasant memory, simply perform some mental arithmetic.

5. Psychotherapies

This step only applies to extreme cases and not to those with a healthy fear of needles. For this category, the two most commonly employed psychotherapies are Cognitive Behavioural Therapy (CBT) and exposure therapy.

CBT aims to reframe negative ways of thinking and build coping strategies. Exposure therapy necessitates a gradual and supervised increase in exposure to needles, which can help to reduce the anxiety they cause.

If the phobia is mild to moderate, CBT is the way to go; if it is moderate to extreme, then exposure therapy may be the preferred method. In the most extreme cases, a Psychotherapist may adopt a combined CBT and exposure therapy treatment plan.

The importance of regular blood tests

The value of blood tests, in general, cannot be understated. They allow healthcare professionals to monitor and diagnose a variety of diseases, from issues with blood glucose control to hormone imbalances.

Discounting diseases, blood tests also allow for an appreciation of optimal levels of blood components such as lipids. With this particular example, one might feel perfectly fine, but steadily increasing levels of Low-Density Lipoprotein (LDL) - the “bad cholesterol” – could be increasing the risk of heart disease. The reality is you can never know what’s going on under the hood unless you check.

It’s certainly not a case of ignorance is bliss; continuing with lipoproteins, for example, a laboratory result outside the reference range can be easily rectified, by a change in diet or exercise regimen.

Future prospects

There is hope on the horizon for alternative sample collection methods, such as the OneDraw™ blood collection device, which is a small, single-use device that draws, collects and stabilises a capillary blood sample from the upper arm.

Contrary to the traditional hypodermic needle to puncture a patient’s vein, the device is placed on the skin, and blood is gently collected using tiny lancets with light vacuum suction. The process is very similar to capillary blood collection – such as finger prick testing – but introduces an automated element that eliminates human error.

At the moment, however, it is primarily used for blood glucose monitoring, and more comparison studies are required to determine its suitability as a substitute for venepuncture. It’s still an evolution of the classic finger-prick, and once enough data is acquired, it may lead to the replacement of venous samples for routine blood testing.

Conclusion

It is human nature to avoid practices that lead to pain and trigger anxiety. The bottom line here is that blood tests are a necessary evil required for monitoring health and diagnosing diseases.

The operative word for those who question if they need regular blood tests is monitoring. Clinicians cannot base diagnoses or treatment on a single result. When teaching students about clinical diagnostics, I always include a slide that stipulates that a single result means nothing but that serial measurements are the way to go.

If you have a fear of needles, take solace in the fact that you are not alone and that there are techniques that one can employ to ease the process.

Blood tests can enhance one’s quality and longevity of life by improving underlying health issues and through early diagnosis of diseases. A small price to pay for such an advantageous outcome.  

Written by Sadakat Syed