What helped when I had a phobia

I no longer have a phobia. I still have a fear of the thing I used to have a phobia of (needles), but I’ve brought it down to a level that is manageable. I challenge myself with it every few months by donating blood, just to remind myself that I can do it now.

It used to be that needles would make me throw up, pass out, and cry. Not necessarily in that order. At its worst, I often refused medical treatment and made decisions on what activities I wanted to do because of the fear. I refused to get treatment for dehydration from a stomach bug because it would involve a needle. I refused treatment for a broken bone because it would involve needles. I had dentistry done without anesthetic because anesthetic would require needles (having a cavity filled without anesthetic is not something I would recommend). I didn’t go rock climbing even though I love to climb because I was worried that if I fell, I’d need a needle. I couldn’t watch needles even on TV, and if I was surprised by a photo on a newspaper during flu season (y’know, the seemingly-obligatory restrained screaming toddler  getting their immunization), it usually would induce a panic attack.

Just to give perspective. It was all-encompassing.

The reasons for the phobia are immaterial to what I want to talk about. Which is fear. And what worked for me in overcoming it. Snagglebox has a good post up on the topic from a professional/parenting point of view. Here’s my take:

Things that help me with fear:

  • A plan – knowing what’s going to happen is huge. Having a plan for what happens when and what to do if something goes wrong really reduces anxiety, because if something happens, you already know how to handle it. Makes the general “Something unusual is happening!” anxiety reduce a lot in severity.
  • Validation – of the “Yes, I realize you’re scared and that’s okay” variety.
  • Mitigation – if you find something that helps reduce fear, do it. The scarier an experience was for me, the more likely it would end up worsening the phobia and making it that much harder the next time. Even if nothing bad happened to an outsider, being made to watch the nurse wave around the needle as xe cleaned the injection site, or even just watching it as it sat out open on the counter on its own was a “bad thing” to me, and enough to make the fear worse. By contrast, if the nurse even just put a sterile cover over the tray when xe wasn’t getting stuff off it, or if the nurse put the tray behind me so I wasn’t looking at it, it made it a bit easier. It’s not enabling wimpiness to make something terrifying into something just scary. It’s enabling bravery.
  • Encouragement – Just like most people need a pep talk before giving a speech, I need a pep talk before I get a needle. Likewise, someone who’s afraid of dogs will probably need a pep talk before they meet a new dog.
  • Distraction – Get me monologing on something that interests me. Doesn’t matter what. Key is to get me thinking about something that isn’t the sharp thing that’s going to pierce my flesh in a few minutes. YMMV for this one – when my fear was more severe, you couldn’t distract me from it.
  • Physical comfort – ensure the room isn’t too hot/cold, sensory stuff is kept to a minimum, etc. For me, too hot is better than too cold – I shiver easily, and I also shiver in response to being afraid, so if I get cold and start shivering, my body thinks I’m more scared than I am and it feeds into my mental catastrophizing loop. YMMV with that, though.
  • Patience – If I’m talking myself in circles and not going in there, I’m probably trying to work up the nerve. Encourage me, but let me get myself ready.
  • Listening – Related to mitigation. If I say it helps me to do X, listen. Don’t do Y instead because it’s what most people prefer. Yes, I know most people like a warning before you give the needle. Don’t give me one unless you want me to tear my own shoulder muscle to pieces on your needle as I jerk away. Listen.
  • Something sweet and cold for after fear – Probably unique to people with hyperactive vaso-vagal response, but sweet and cold stuff like apple juice helps me to not feel like I’m about to pass out. Less time my vision is greyed out and my balance is wonky and my stomach is trying to turn itself inside out, less likely my fear will worsen. If I actually pass out, I can guarantee that I’m going to have a harder time of it next time.
  • Self-led desensitization – What it sounds like. I worked with a therapist who respected my need to work at my pace with tackling this fear. It took 4 years to get me to the point where I usually don’t cry at a needle, and I always go through with getting it.

Things that don’t really help or hurt:

  • Reassurance – yeah, you’re saying it’s okay, but my instincts are telling me otherwise. Likewise reassurance of the “you’ll be fine!” variety is completely unhelpful when your fear is a phobic one. I know I’ll be fine. That doesn’t stop me from being afraid.
  • Company – Other people being around have generally been neutral on the fear front, mainly because while some of them are helpful, some do things that make the situation worse, and most pull from both helpful and harmful things to do enough that the good they do and the bad balance out to neutral.

Things that are actively harmful

  • Minimization/dismissal of fear – “That’s not scary!” No. You lie. I’m scared of it. Therefore, it’s scary.
  • Teasing & ridicule – “You aren’t scared of a widdle needle are you?”
  • Browbeating – “Just get in there and do it!”
  • Shaming – “You’re such a baby!”
  • Rushing – My no reflex hits whenever I feel rushed or pressured into something. Don’t coerce me into facing my fear, particularly if I’m already planning to face it – the result will be counter-productive.
  • Trying to desensitize me against my will and without warning me – I’ll be charitable and assume you actually want to help me with the fear and aren’t just terrorizing me for your own amusement. All that exposing me to a phobia unexpectedly does is reinforce the phobia. Flight-or-fight kicks in, I run away, fear goes away, I feel better. Running away from phobia -> feel better. Phobia reinforced. Good job. */sarcasm* Don’t do that. Don’t do that as a joke (it’s an asshole thing to do to make someone feel that level of fear because you think it’s funny), and don’t do it “for my own good” (because 1, I should be the one who decides when I’m going to tackle this thing, and 2, it doesn’t work unless I have control, and 3 “for my own good,” isn’t).
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10 thoughts on “What helped when I had a phobia

  1. alexforshaw says:

    Thanks for posting this: it’s really useful, practical advice and corresponds very well with what I learned in CBT (graduated exposure) for anxiety.

    • ischemgeek says:

      A lot of it is what I learned from my therapist, who had a mixed-model of therapy. CBT was completely unhelpful for my situational depression as a kid (changing the situation to one where I wasn’t being verbally abused on a several times a day basis cured that), but it really helped for phobia.

      My phobia was a bit complicated by the fact that it is actually tied to trauma (well, several traumatic experiences. Long story). From what she told me, non-trauma-linked fears are a lot easier to deal with because you don’t have the brain going, “But a bad thing happened that time!” in response to you trying to tell yourself, “a bad thing won’t happen.”

      • autisticook says:

        “non-trauma-linked fears are a lot easier to deal with” <– THIS. This is what I keep telling these psych types who want to convince me that CBT is going to help me. It isn't. Because the bad thing happened to me over and over and over. I simply don't think it's likely that it won't happen again. Judging by past experiences, I have a fucking 80% chance of it happening.

      • ischemgeek says:

        Yeah. I call my needle phobia irrational as an adult because as an adult, I have the power to walk out if I feel bullied. I didn’t have that as a kid, so it was rational for me to be afraid of medical stuff in general.

        I think people who diagnose autistic people with social phobia or similar fail to recognize that for us, social anxiety is entirely rational. Bad shit happens when we do unexpected social things.

  2. autisticook says:

    The “that’s not scary” thing gets me every time. I’m finally learning how to say “fuck you, it is scary to ME”. Which is sort of still mixing my fear and aggression responses but hey. It’s better than just aggression.

  3. Great points – this is very helpful. Thanks for posting it. Validation and planning are huge for me, as is the whole “if it goes well this time, it will help reduce fear for next time” think (I think of it as keeping a good track record). Recently I was pretty scared, though not anywhere near phobia level, of going grocery shopping. I would avoid it as much as possible, and I would have a very hard time getting myself out the door. After some validation, planning, and mitigation, my boyfriend and I ended up with a few good experiences grocery shopping in a row. Now, it’s not my favorite thing and it’s still bothersome to the senses, but I can consistently do it without a problem. Not trying to compare that to your phobia – just showing that those things work for lesser fears too.

    Interesting that you mention trauma-based fear too – that is harder to overcome. I’ve a lot of that surrounding seeing or talking to my dad. Put simply, I had an awful and traumatic childhood. I’ll write about it bit by bit on my blog when I’m ready. I’m still working on how to deal with that fear, though I think many of the things you list would work for that too. Along with limited exposure.

  4. Thanks for this 🙂 Great explanations; I’m terrible at articulating stuff like this, so it’ll probably come in handy in future!!

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