Let’s face it, just like people try to avoid getting stung by wasps, they also avoid getting shots. A large-scale study by the University of Oxford found that twenty-six percent of adults screened positive for injection phobia, with those in this group twice as likely to report hesitancy to get the Covid-19 vaccine. Rates of needle phobia are even higher in children and adolescents. If all needle phobia was adequately addressed, it’s possible that general vaccination rates could increase by up to sixteen percent. With Covid-19 vaccination rates worldwide stalling, this is a key area to address to reduce the spread of variants and save lives.
Skepticism, politicization, and distrust of the Covid-19 vaccines exist, certainly. But what is likely underreported is the wide prevalence of needle phobia and medical anxiety underlying vaccine hesitancy. It’s much less vulnerable to say, “I’m healthy, I don’t need a vaccine,” than “Truth is, I’m terrified of needles.”
If you’re among the millions who are afraid of needles or injections, you’re likely familiar with the feelings of dread and anxiety that come with getting shots. You may have experienced symptoms like heart racing, nausea, or insomnia the night before your appointment. Some people also experience a sudden drop in blood pressure (called vasovagal syncope) that leads to lightheadedness and fainting before, during, or after injection. Others have had dismissive or traumatic medical experiences that exacerbate needle discomfort. Naturally, people who have had any of these experiences are more likely to avoid shots. It’s also hereditary, so a person with needle phobia has an eighty percent chance of having a close relative with the same condition.
Most people with needle phobia, also known as trypanophobia, rationally know the moment of injection itself is safe and brief, which is why it can be hard even to acknowledge the anxiety. But even though the “head” may know it’s safe, the body can still exhibit a stress reaction to needles and medical settings, which for most people, includes an automatic urge to flee, avoid, or procrastinate.
Here’s the good news: unlike many other factors contributing to vaccine hesitancy, there is evidence-based treatment for needle phobia, and it’s relatively brief (one to eight sessions). The issue is not that we can’t treat it, it’s that there are multiple barriers to treatment: affordability, stigma, lack of access, and lack of awareness (including within the medical field). Exposure therapy with applied tension has been shown to be safe and effective for the treatment of needle phobia. For example, in a 2018 study among highly needle phobic individuals, seventy percent completed a successful blood draw after just one group exposure therapy session.
In exposure therapy, you create a hierarchy of small steps in line with your goal. For example, you might start with simply looking at a picture of a small syringe or applying rubbing alcohol to your arm. Over time, facing the fear in a manner in which you feel safe and in control allows the fear to attenuate. Exposure therapy leverages a simple tenet: avoidance maintains fear; approach, when done in a safe and supportive context, lessens fear. Applied tension, on the other hand, is a simple technique involving tensing your leg and torso muscles to prevent the sudden drop in blood pressure that leads to fainting.
To address one of the key barriers to effective treatment, i.e., cost, I launched the Free Needle Phobia Pilot Program, which offers free exposure therapy to anyone who wants to get vaccinated and struggles with needle phobia. Over two sessions, participants learn effective tools for managing the symptoms of needle phobia and practice exposure-based exercises to begin reducing the automatic fear response to needles.
As a mother and a clinical psychologist specializing in phobias, I’ve seen how powerful needle phobia can be. I have such a vivid image of my daughter, typically so fierce and confident, reacting with terror at the sight of a nurse with needle in hand. Acting on instinct, she leapt off the examination table, ran to the corner of the pediatrician’s office, and wedged herself into the corner of the room so the nurse could not access the part of her arm just cleaned with rubbing alcohol. My little girl suddenly had the strength of a rhinoceros as she rammed her body against the wall in defiance. We gave up on her flu shot that day. Later, by walking her through basic exposure steps (in a nutshell, gradually exposing her to the different components involved in vaccination in a way in which she felt in control and understood), she now feels a sense of pride and mastery in how she handles this unpleasant but important part of taking care of her body.
Of course, needle phobia is not just on the child or the individual to figure out. Policy makers and healthcare leaders need to do better to articulate a more inclusive and empathic approach to healthcare that considers different people’s needs and acknowledges the problems of pain and fear involved in vaccine injections. First, developing accommodations such as the intranasal Covid-19 vaccine should be prioritized. Second, administration of the vaccine by injection could be made more tolerable. For example, looking away from the injection may reduce fear. Third, primary care settings could provide brief psychological treatments such as exposure therapy with applied tension that show large treatment effects. Finally, we also must acknowledge our country’s deep-seated history of medical mistreatment and apathy, which has disproportionately affected people of color and contributes to medical anxiety (as a corollary, rates of needle phobia are higher among people of color than among white people).
Over the course of a lifespan, needle anxiety can lead to chronic avoidance of essential medical care and worse health outcomes. The vast majority of Covid-19 deaths in the U.S. are now among the unvaccinated. Because people with needle phobia often avoid medical care, healthcare systems tend to ignore this sizable group of the population, and the cycle continues.
With up to one in four people suffering from fear of needles, someone you know is having a hard time getting vaccinated because of it. Start talking about needle phobia with others. Know that it can be treated in as little as a few hours. Be a support person for someone with needle phobia by asking them if you can help with scheduling or driving them to and from the appointment. Let’s normalize it, team up, and better support this largely misunderstood factor contributing to vaccine hesitancy.