Treatments for blood-injury-injection phobia: a critical review of current evidence.

Blood-injury-injection (BII) phobia presents with a unique anxiety response that often involves blood pressure drops and pronounced bradycardia, which can culminate in fainting. The current recommended treatment for BII phobia is Applied Tension (AT), a tension technique that includes in vivo exposure. However, surprisingly little empirical evidence is available on the additive efficacy of tension beyond exposure alone. Our literature search yielded five controlled treatment studies for BII phobia, all from one research group. Beyond AT, these studies also tested Exposure only (E), Tension only, Applied Relaxation (AR), or a combination of AR and AT. Based on self-reported levels of anxiety, in-session avoidance and fainting, AT was superior over other conditions; however, when considering pre- to post-treatment effect sizes on BII-related questionnaires, E outperformed all other treatments. In addition, AT did not yield better results on physiological measures, and individuals with BII fears improved similarly within studies across treatment groups, regardless of fainting status. Heterogeneity in patient populations (e.g. extent of fainting-proneness), differential targeting of BII phobia manifestations, and small sample sizes may explain some of the variability in findings. Further research is needed to determine the efficacy of treatment techniques for BII phobia patients with and without fainting history.