Coping with vaccination (in real-time)

For many, the Covid-19 vaccination program represents the light at the end of the pandemic tunnel. For others, it represents fear. Trypanophobia or an acute fear of needles is a very real phenomenon, affecting up to 10% of people in the UK who are vaccine-hesitant. Trypanophobia is experienced as ‘excessive extreme fear in reaction to ‘aversive stimuli’ or the feared object (hypodermic needles) and anything related to it (person(s), place, context)’. Sufferers might feel panic and unable to breath at the sight of a needle.  

What’s happening is an enhanced stress response, as if contemplating a real or perceived threat of external danger. This is the body’s innate defence mechanism, designed to help protect us against acute stress in dangerous or stressful situations, intended as a short-term high-arousal state. Such as calling your child back from a busy roadside, or slamming on the brakes to avert a car crash, whereby the physiological sensations usually subside following the stressful event. 

In phobia, however, this heightened state of alertness for threat can persist beyond the original stressor, and combined with the dysregulation of fear and its inhibition, the defence mechanism stops being protective and turns maladaptive. So, the phobic response can be triggered in generalised situations, such as walking home from work and catching a glimpse of a hospital setting. In the midst of a phobic panicked response, the sensation of time may disappear and you may not remember ‘what just happened’, feeling teary and shakey after the fact.

Particular territories of the brain regulate different aspects of this fear conditioned response, including modulating fear-potentiated startle and freezing responses via the midbrain and autonomic (parasympathetic) nervous system. Acting as a brake to dampen the stress response, with symptoms you might notice of behavioural avoidance or hesitation. And the autonomic (sympathetic) nervous system fight-flight response modulated through the lateral hypothalamus, also regulating the release of cortisol. Ultimately directing the body’s rapid involuntary response to mobilise, rather like a foot on an accelerator pedal. 

Other parts of the brain are involved in the associative processing or learning and memory, thought to link previously neutral stimulus (such as a hypodermic needle or the attending nurse) with an unconditioned stimulus (past shock, pain or trauma). Resulting in the acquisition of a  conditioned stimulus or phobic fear, presenting anytime, anywhere, and without warning (i.e., outside of consciousness) in conjunction with a particular person, place or context.

Some may have particular strategies for management. This might be bringing someone trusted with you to the vaccination centre, or a comfort item for children. The distraction of listening to music can help, or looking away and counting backward during the actual vaccination. Or even focusing on breathing exercises, especially if your breathing has deepened and quickened causing symptoms related to hyperventilation, such as dizziness and faintness.

The *physiological sigh is one such focused breathing exercise that can help calm breathing and hyperventilation symptoms. involving ‘two inhales through the nose, followed by an extended exhale through the mouth’ one to three times (or for as long as needed). Turning on the autonomic (parasympathetic) nervous system dampening effects, it works to immediately help reduce the symptoms without having to disengage from the stressful activity (so you can remain in the vaccination queue). *If suffering from heart related conditions, please see your GP before trying this particular breathing technique.

Where Trypanophobia has been lifelong and severe, individuals may seek professional help through their General Practitioner (GP) as a good first step. Pending diagnosis, the GP may refer on to Cognitive Behavioural Therapy (CBT) or other approved talking therapy, such as Counselling. Solutions for at-home use include NHS Apps (wellbeing focus) or other commercial Apps such as Headspace (meditation) and Yoga Nidra (easy relaxation). All of these options are evidence-based. NOTE that if you have suffered from any kind of early trauma, please check with your GP or healthcare professional before trying any of these at-home solutions. There are also a number of established charities such as  MIND and SHOUT. 

Author: Treesje Verlinden