Phobias: fear of needles, blood, heights, dogs and flying
A phobia is an intense, lasting fear of a particular thing or situation — needles, blood, heights, dogs, flying, enclosed spaces — that is out of proportion to the real danger and leads a person to avoid it. Specific phobias are very common and usually start in childhood. Needle and blood phobia is unusual because it can cause fainting, which a technique called applied tension prevents; it matters because it stops people having vaccinations and blood tests. The treatment of choice is exposure therapy, facing the fear gradually and safely, which helps most people, often in a few sessions. Medicines are not the main treatment.
Health writers · Aslam Clinic
A is an intense, persistent fear of a specific object or situation that is far greater than the real danger, strong enough that a person goes out of their way to avoid it, and severe enough to limit their life. Most people are wary of a snarling dog or a sheer drop. A phobia is when the fear is triggered by a picture of a dog, or stops you climbing to the second floor, or means you refuse a blood test your doctor says you need.
Specific phobias are among the commonest mental health problems of all: in the United States roughly one adult in eleven has one in a given year, and they are about twice as common in women. They usually start in childhood, sometimes after a frightening experience, sometimes by watching a parent's fear, and sometimes with no clear cause. Most people who have one never seek help, even though the treatment is quick and effective.
Common specific phobias
| Type | Examples | What it can cost |
|---|---|---|
| Animal | Dogs, cats, lizards, snakes, insects | Avoiding streets, relatives' homes, the outdoors |
| Natural environment | Heights, water, storms, the dark | Avoiding rooftops, upper floors, travel, swimming |
| Blood–injection–injury | Needles, blood, injuries, medical procedures | Missing vaccines, blood tests, dental care, antenatal checks |
| Situational | Flying, lifts, enclosed spaces, driving, bridges | Missing jobs abroad, Hajj or Umrah, family events |
| Other | Vomiting, choking, loud noises | Restricted eating, avoiding children or illness |
Some fears have a sensible core. Stray dogs in Pakistan do bite, and a bite needs prompt wound washing and rabies vaccination. Being careful around an unfamiliar dog is sensible; being unable to walk to the mosque or school because a dog might be on the street is a phobia.
Why phobias last
A phobia keeps itself going through . Every time you cross the road to avoid a dog, take the stairs to avoid a lift, or leave the room when blood is mentioned on television, you feel immediate relief. That relief is powerful, and it teaches the brain that avoiding was the right thing to do and that the danger was real. You never stay long enough to discover that the fear would have faded on its own and that nothing terrible would have happened. Over time the list of avoided things often grows.
Fears in children
Young children are naturally afraid of many things — the dark, strangers, animals, loud noises, being separated from their mother — and most of these fears fade on their own as they grow. A fear is more likely to be a phobia when it is extreme for the child's age, has lasted for six months or more, and is stopping them from doing ordinary things such as sleeping in their own room, going to school, playing outside or visiting relatives.
Frightening a child into obedience with threats of dogs or injections ("the doctor will give you an injection") can plant a fear that lasts into adulthood. Describing vaccinations and blood tests honestly, staying calm yourself, and praising the child for coping works better.
Needle and blood phobia: the one that makes you faint
Blood–injection–injury phobia behaves differently from other fears. In most phobias the heart rate and go up. In this one they typically rise briefly and then drop sharply — the vasovagal response — and the person goes pale, sweaty and dizzy, and may faint. Many people with this phobia are not afraid of the pain; they are afraid of fainting, or of the horrible sensation that comes before it.
This phobia has real health consequences. People skip vaccinations, avoid blood tests for diabetes or thyroid problems, delay dental treatment, and in pregnancy may dread antenatal bloods and injections. People with diabetes who fear needles can find insulin very hard to start.
The standard technique for fainters is applied tension, developed by the Swedish psychologist Lars-Göran Öst. It works by raising blood pressure on purpose:
- Sit comfortably. Tense the muscles of your arms, chest and legs together, and hold the tension for about 10 to 15 seconds, until you feel warmth rising in your face.
- Release and relax for 20 to 30 seconds — but do not go completely floppy.
- Repeat about five times. Practise several times a day for a week before you need it.
- Use it just before and during an injection or blood test, keeping the arm that is being used relaxed.
A review of the research found that applied tension reduces fainting and in-session avoidance, but also that gradual exposure on its own does about as well for reducing the fear itself. The practical message is that both help, and a therapist will usually combine them.
Agoraphobia: a more complex phobia
is not simply a fear of open spaces. It is a fear of being in places where escape would be hard or help would not be available if something went wrong — buses, markets, crowds, queues, or simply being out of the house alone. It often develops after , when a person starts avoiding wherever an attack happened. At its most severe a person may not leave home at all, or only with a family member. It is treated in much the same way as panic disorder, with CBT, gradual exposure and sometimes an SSRI, and is covered in more detail on the panic attacks page.
Exposure therapy: how phobias are treated
The treatment with the strongest evidence is : facing the feared thing gradually, in planned steps, and staying with it until the fear begins to fall. Each time you stay rather than escape, the brain collects evidence that the thing is less dangerous than it predicted, and the fear response weakens. does the opposite — it brings relief, and the relief teaches the brain that avoiding was necessary.
Exposure helps most people with a specific phobia, and for many specific phobias a single extended session of up to about three hours with a trained therapist produces a large improvement. It is part of , and it is always collaborative: nothing happens without your agreement, and you move up the steps at a pace you can manage.
| Step | Example ladder for a fear of dogs |
|---|---|
| 1 | Look at photos of calm dogs |
| 2 | Watch videos of dogs playing |
| 3 | Watch a calm, leashed dog from across a road |
| 4 | Stand closer to a calm, leashed dog with its owner |
| 5 | Touch a known, friendly dog while the owner holds it |
| 6 | Walk a route where dogs are sometimes seen |
Why medicines are not the main treatment
Medicines do not teach the brain that the feared thing is safe, so their effect ends when the tablet wears off. For a single unavoidable event — a necessary flight, a dental procedure — a doctor may occasionally prescribe a short-acting sedative or a beta-blocker, but this is a one-off measure, not a treatment. such as alprazolam and bromazepam are habit-forming, and in Pakistan they are too easily bought without a prescription; they should be used only short-term and under a doctor. Antidepressants are used when a phobia sits alongside depression or another anxiety disorder.
When to get help
A GP can refer you to a clinical psychologist; if there is none nearby, exposure-based CBT can be delivered online and through structured self-help, with the steps carried out in your own surroundings.
What you can do today
- Write down exactly what you fear will happen when you meet the thing — faint, be bitten, fall, panic.
- Build a ladder of eight to ten steps from mildly uncomfortable to your hardest situation.
- Start at the bottom and stay until the anxiety has clearly dropped, then repeat before moving up.
- Practise often — short, frequent practice works better than one big effort.
- If you faint with needles, practise applied tension this week, before your next appointment.
- For children, model calm and encourage small brave steps; do not force them, and do not let them avoid everything either.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
