For many people with diabetes, injections are simply a necessary part of life. Yet for many, both newly diagnosed and those who have been managing the condition for many years, the injection process can be very distressing.

But what turns a plain dislike of injections into a phobia? Well, a phobia is an irrational fear of a particular situation, which is exaggerated and cannot usually be explained away.

Dislike of needles

A small degree of dislike of needles is perfectly normal – most people would avoid them if they possibly could. But this fear is heightened in people with needle phobia, to the point where they cannot bear the thought of injections

Needle phobia is common in the general population – some studies suggest the rate of occurrence is as high as 10%. When you consider that only 7% of the population have diabetes, it is evident that there are many people with diabetes out there having to contend with both!

Symptoms of needle phobia

The symptoms of needle phobia can vary greatly from one individual to another. The main feature is anxiety at the thought of injections, leading to avoidance of injections.

This may be associated with:

  • feeling dizzy and light-headed
  • a dry mouth
  • palpitations
  • sweating
  • trembling
  • over-breathing
  • feeling sick
  • even fainting

Why does it occur?

Although it can be difficult to be entirely sure what causes a phobia, the most common causes are thought to be:

  • An upsetting experience of needles when young, for example, a painful procedure at the hospital or at the dentist
  • A fear that has been ‘modelled’ by an adult close to the child, either through actual observation of their fear, or being told a story that implied injections and needles were very painful.
  • There is also evolutionary value to a fear of needles. In the past, an individual with a fear of being stuck with a thorn or a knife was less likely to die in accidents or in encounters with hostile animals or other humans.
  • Prior to the 20th century, even an otherwise non-fatal puncture wound had a reasonable chance of causing a fatal infection.
  • So a trait that had positive survival value prior to the 20th century now has the opposite effect as it means people struggle to engage in valuable healthcare regimes.

How to cope

Gaining skills of relaxation and confidence is the key to making injections less painful. You will develop confidence over time and with practice, using a combination of relaxation and developing your own personal ‘Fear Hierarchy’.

  • Create your own ‘Fear Hierarchy’ – a series of steps of actions that you could take to over come your fear. Write down a list of these, beginning with the least feared action and progressing to the most feared. The first could be something you find relatively easy, e.g. perhaps watching someone else inject.
  • Rate your fear associated with each of these on a scale of 0-10, where 0 is no fear at all and 10 is the most fear you could possibly experience.
  • Use the relaxation exercise described below as you engage in the feared activity and continue to practice it on a number of different occasions until you can do it with a fear level of 3 or below. Then move onto the next step on your fear hierarchy.

Try the following relaxation exercise:

  • Sit comfortably in a chair
  • Close your eyes
  • Take a slow, deep breath in so your lungs are full
  • Hold this breath for the count of 3 seconds
  • Breathe out as fully as possible for a count of 5 seconds
  • Repeat this sequence for two more breaths
  • Open your eyes and notice any subtle differences in how you feel, both in your body and your mind
  • With a bit of practice, over time you will be able to notice a feeling of relaxation
  • Once you feel comfortable with the technique, begin to practice this when you are working through your fear hierarchy

Examples of Fear Hierarchy steps could be:

  • Hold the insulin syringe or pen in your hand until you don’t feel any anxiety.
  • Practice drawing up the correct dosage of insulin until you no longer experience fear.
  • Act ‘as if’ you are going to inject, without actually doing so
  • Inject (perhaps into the stomach first as many people find it less painful as there are few nerve endings there)
  • Inject in other parts of body – thigh, buttock – also known as alternate site testing
  • Inject in different geographical locations– at a friend’s house, in a restaurant, on a train.

This is one of series of Psychology articles by Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

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