Chapman & DeLapp (2013): Treating BII Phobia with CBT & Applied Tension

What is Blood-Injection-Injury phobia (BII)?

A specific phobia characterized by an intense fear of blood, injections, or injuries.

What unique response is triggered in BII phobia?

The diphasic response, which includes an increase followed by a sudden decrease in blood pressure and heart rate.

What is vasovagal syncope?

A condition that leads to fainting due to reduced blood flow to the brain, often triggered in BII phobia.

How does disgust relate to BII phobia?

BII phobia sufferers have a heightened disgust response, which can trigger fainting.

What is 'animal reminder disgust'?

The repulsion felt when reminded of human 'animalness,' such as seeing blood or veins.

What was the aim of Chapman & DeLapp's 2013 study?

To provide insight into the active mechanisms of change in treating BII phobia through applied tension and CBT.

Who was the subject of the case study in the 2013 research?

A 42-year-old Hispanic male who self-referred after 20 years of intense fear in medical situations.

What symptoms did the subject experience related to BII phobia?

Panic, distress, racing heart, hot flushes, cold chills, dizziness, and fainting.

What therapeutic techniques were used in the treatment?

Cognitive therapy, behavioral therapy, and applied tension.

What is the purpose of applied tension in treating BII phobia?

To reduce the risk of fainting during exposure to blood or medical procedures.

What assessment tools were used in the study?

Beck Anxiety Inventory (BAI), Fear Survey Schedule II (FSS-II), and Blood-Injection Symptom Scale (BISS).

What were the baseline and follow-up BAI scores for the subject?

Baseline: 41 (severe anxiety); 12-month follow-up: 7 (low anxiety).

What was the FSS-II score at baseline for blood-related fears?

6 (terror) for blood and 5 (very much fear) for related fears.

What was the subject's BISS score at baseline?

The subject answered yes to all 17 items on the scale.

What was the outcome of the treatment after 12 months?

Significant reduction in anxiety and fear scores, with the subject able to book multiple doctor appointments.

What is the significance of psychoeducation in the treatment?

It helps patients understand their condition and contributes to effective treatment outcomes.

What is cognitive restructuring?

A technique in cognitive therapy aimed at challenging and changing irrational beliefs.

What role did graduated exposure play in the treatment?

It helped the subject gradually face feared situations, reducing avoidance behavior.

What percentage of participants showed improvement in Ayala et al.'s review of BII phobia treatments?

Around 75 percent of participants showed improvement.

What is the difference between fear and disgust in the context of BII phobia?

CBT is more effective in reducing fear, while additional sessions may be needed to address disgust.

What was the subject's experience with medical appointments before treatment?

He felt guilt and shame for avoiding medical appointments due to his phobia.

What was the role of homework in the treatment process?

Homework included practicing applied tension and completing exposure tasks between sessions.

How did the subject's family history contribute to his BII phobia?

His mother joked about heart problems, and he witnessed family members' deaths from illnesses.

What is the importance of setting weekly goals in therapy?

It helps track progress and keeps the patient engaged in the treatment process.

What emotional responses did the subject report during exposure tasks?

Anxiety, heart pounding, feeling nauseous, and sweating.

What is the significance of the 12-month follow-up questionnaires?

They allow for comparison of baseline and follow-up scores to assess treatment effectiveness.

What was the subject's perception of medical procedures after treatment?

He was able to book and attend several doctor appointments without significant fear.

What symptoms did T experience related to his BII phobia?

Racing heart, hot flashes, cold chills, dizziness, unsteadiness, and fainting.

What condition did T's child have?

Autism spectrum disorder.

What childhood experience contributed to T's anxiety about medical emergencies?

T's grandmother suffered anxiety relating to medical emergencies and listened to an ambulance dispatch scanner daily.

What was T's exercise routine?

Running, cycling, weight training, and swimming.

What type of medication was T prescribed by his psychiatrist?

Anti-anxiety medication.

What assessment tools were used to evaluate T's symptoms?

Self-report questionnaires and a diagnostic interview.

What treatment did T undergo for his BII phobia?

Cognitive Behavioral Therapy (CBT) including applied tension.

How many sessions of CBT did T complete?

Nine sessions.

What was one of T's homework assignments during therapy?

Practicing applied tension five times a day.

What did T rate on the Phobic Encounter Record (PER)?

His anxiety from 0 to 100 and listed his thoughts, feelings, and behaviors when exposed to medical stimuli.

What was T's experience after his ninth session?

He took his own blood pressure and felt he had never felt better in his life.

What was a significant outcome of T's treatment four months later?

He had several doctor's appointments booked.

What therapeutic approach was highlighted as effective in T's treatment?

The combination of psychoeducation, cognitive restructuring, and graduated exposure with applied tension.

What was a strength of the case study's data collection?

The collection of both quantitative and qualitative data to monitor T's anxiety.

What is a potential weakness of using self-reported data like SUDS?

It may not reflect T's genuine anxiety levels due to social anxiety and perceived expectations.

What is a limitation of the study regarding its design?

The lack of a control group to compare treatment effects.

What ethical considerations were taken into account in T's treatment?

Maintaining T's anonymity and allowing him to progress at his own pace.

What practical issue did T face in accessing therapy?

He had to travel 2.5 hours for his appointments, increasing financial costs.

What approach does this case study exemplify: idiographic or nomothetic?

Idiographic, as it focuses on T's individual treatment experience.

What is a potential benefit of a nomothetic approach in therapy studies?

It allows for understanding average treatment efficacy across a larger population.

What was T's mental health history prior to treatment?

He had experienced a major depressive episode in college.

What did T describe about his feelings towards medical appointments after treatment?

He felt significantly better and was able to attend them without anxiety.

What was one of the goals set during T's therapy sessions?

To complete graduated exposure tasks related to his phobia.

What did T's grandmother's behavior contribute to?

T's anxiety regarding medical emergencies.

What is the significance of the Phobic Encounter Record (PER) in therapy?

It helps track anxiety levels and responses to exposure tasks.

How did T's treatment impact his quality of life?

It massively improved his quality of life and allowed him to attend necessary medical appointments.

What was T's emotional state regarding his phobia after completing treatment?

He expressed that he had never felt better.

What is the role of applied tension in treating BII phobia?

It helps manage physiological responses to fear stimuli.