How can I overcome my fear of needles?

By Patrick J. McGrath, OC, PhD, FRSC

Dr. Pat

Question:

Hi Dr. Pat,

Ever since I was a young child I had always had the fear of going to the hospital. I get very nervous and scared whenever I get to the doctor's office or even see the doctor's face. Any time a needle is pointed at me, my heart beats really fast, and I start crying. This situation has been there for a long time, and I feel very embarrassed about it because I am already 18 years old, and feel I should have overcome the fear of injections. I will really appreciate any help you can render.

Dr. Pat responds:

You have a great imagination and a keen sense of finding any lurking danger. These probably work well for you most of the time. Your fear is normal in its focus but just excessive. Nobody really likes having injections. Injections hurt a bit but are a necessary and important part of health care. No need to feel embarrassed.

You have identified your problem, realize it is irrational, and are eager to overcome it. So already you have taken three important steps on the way to getting over it.

Your brain has conditioned your body to react with a fear response whenever you see or probably even think about having an injection, or anything connected to an injection. Your task is to use your brain to de-condition your fear response. To de-condition your fear, you need to be exposed to what you are afraid of and not escape by running away or freaking out. Expose yourself gradually.

Step 1: Change your thinking

The first step is to change your thinking about injections from irrational to rational. Write down your irrational thoughts about injections in one column and create more sensible or rational thoughts in the next. For example, if you think "Injections are horrible," change that to "Injections hurt a bit but keep me healthy." If you think "I can't cope with injections, they terrify me," change that to "I am afraid but I can overcome my fear." Speaking these out loud will help change them.

Another type of thinking that is important to change is the fear of fear. Your heart pounding and your sweating will not hurt you. Don't avoid these fear symptoms.

Step 2: Practice with pictures or images

The second step is to counter-condition your fear using pictures or images. Get some pictures of normal medical injections from the internet. Get 20 pictures on your computer or printed in colour. If you are too afraid, get some help from a friend.

Look at each picture and rate it from 0 to 100, with 0 being no fear and 100 being terror. Start with the lowest rated picture and really look at it. Notice your irrational thoughts and try and change them to more sensible ones. Breathe deeply and slowly. Spend at least 10 minutes with each picture or until the picture is much less fearful. Rate each again after you have finished looking at it.

You should do this for 20 minutes or so each day until the pictures are totally boring and don't cause you fear. Keep a record of how often you practice. Don't avoid practicing. It may help you to practice at the same time each day if you are avoiding doing it.

Step 3: Use your imagination

Step 3 is to use your fabulous imagination to think about situations around having an injection. Start with easier situations (rated low on the 0 to 100 scale) like seeing an ad for a flu shot. Make up 10 of them, rating each. Include some really frightening ones. Start at the low end and go over each in your imagination until they are not frightening. Use deep slow breathing and the more rational way of talking to yourself that you learned in Step 1. This will probably take a few days or even a few weeks. Don't give up.

Step 4: Handle real syringes

The fourth step is to get a couple of syringes without a real needle (for safety) from the pharmacy or from your doctor. Get little ones and big ones. Handle them every day for at least 20 minutes a session. Pretend you are giving yourself a needle. If you have any irrational thoughts, replace them with your more sensible thoughts. Breathe slowly and deeply. Your fear may start high but will gradually reduce. Don't avoid practicing.

Step 5: See the doctor or nurse

The fifth step is to arrange with your doctor or his/her nurse to have an appointment where he or she shows you a needle but does not give you an injection. Talk about the needle and tell the nurse or doctor how you are teaching yourself to overcome your fear. Again, you should stay with the needle until it does not cause fear.

Continue these de-conditioning exercises until you are bored. When you know you need to have an injection, such as for next year's flu season, go over them again for a few days. Don't avoid going to the doctor. You will be ready to have a needle when you can do these steps without too much fear.

Step 6: Get an injection

The final step is getting an injection. Best to do a little one like a flu shot. Make an appointment and don't cancel it. Tell your best friend that you are going to get a needle. It is OK to bring him or her with you if they will be supportive. You will still be afraid but you will know you can do it. Use your rational thoughts and deep breathing. Then DO IT and celebrate.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. Read more "Ask Dr. Pat" columns Ask Dr. Pat a question