Chapman + Delapp

Aim

Aim

To investigate whether BII phobia could be successfully treated using CBT and applied muscle tension

To provide insight into active mechanisms of change throughout a 9-week course of applied tension and manual used CBT for an adult male w a BII phobia

Case history

Mr T

Hispanic, male

42 years

More than 20 years of intense fear/panic in medical situations

Suffered from vasovagal synapse during blood tests + other procedures

T’s child has autism- he had guilt + shame he couldn’t attend regular medical appointments with his child

T’s grandmother suffered from anxiety relating to medical emergencies- listened to ambulance dispatch scanner + T exposed to this

Witnessed the deaths of his grandmother, uncle, aunt- illnesses ie cancer

Hadn’t been to the doctor in years except for a psychiatrist- prescribed anxiety med

What did he perceive other procedures as?

Dangerous + experiences distress relating to his physical symptoms

Racing heart, hot flushes, cold chills, dizziness

Methodology

CASE STUDY

Quantitative data self-report questionnaires: BAI, BDI, Q-LES-Q, BISS

Qualitative data- diagnostic interview

Blood injection symptom scale (BISS)

Was given to test if T met the criteria for a diagnosis of a BII phobia

Assessment

Experienced major depressive episode in college

Variety of self-report q’s

Diagnostic interview- for bii phobia

Treatment

9 sessions of CBT

Listed his thoughts, feelings + behaviour when exposed to blood

Completed his hw- reading assignments, practicing applied tension 5 TIMES a day

Completed gradual exposure tasks- watched vids of blood tests, finger-prick blood, tested his bp

Completed PHOBIC ENCOUNTER RECORD (PER)

Applied tension procedure

Find a comfy chair

Tense the muscle of torso, arms and legs

Hold tension for 10-15s

Release for 20-30s

Repeat 5 times

What happened after the 9th session?

T took his own bp at a drug store. Had his bp examined by nurse and doc

Didn’t need to use AT + described his SUDS as “rather low”.

Said he had “never felt better in my life”

Didn’t need anymore treatment sessions

Follow up

4 months: T thanked therapist + had several doc appointments booked

10 months: doing well

12 months: completed follow-up questionnaires- allowed comparisons

Results of self-report showed that his anxiety levels had dropped sig levels + could engage in med procedures w minimal symptoms

Last stage of hierarchy- having his bp taken

Initially: 40/100

Final: nothing

Conclusion

Psycho education, objective recording, cog restructuring + graduated exposure were highly effective when combined with AT in the treatment of a man w severe BII phobia.

Increase in self-efficacy achieved through a highly individualized treatment plan of a sufficient duration to meet his needs

Strengths

Qualitative and quantitative data: SUDS, BAI, BDI, Q-LES-Q, BISS- statistical analysis. Subjective experience of recovery- detailed interviews i.e history fo T’s life. Triangulation of data= increases validity of findings

Ethics- confidentiality + minimize harm: use of his initial. Therapists ensured progress through fear hierarchy occurred at his own pace- only moved on once he felt ready that T was protected. Therapy improved his life + attended med appt

Weaknesses

Self- reported data- SUDS: T have answers orally- may have given answers that he thought the therapist would want to hear. T suffered from social anxiety- more motivated to give +ve and. Data may not reflect T’s genuine anxiety levels

Lack of control group- RCT

Quantitative data

SUDS score: before + after and during treatment- exposed to items.

Changes in anxiety monitored within and between sessions.

BAI, BDI, Q-LES-Q, BISS