We must address needle anxiety to get to herd immunity

  • With up to 1 in 4 suffering from needle anxiety, someone you know is avoiding vaccination because of it.
  • People can exhibit a stress reaction to needles, including an automatic urge to avoid.
  • Later, we rationalize the avoidance with a story like, “I’m healthy, I don’t need the vaccine.”
  • Exposure therapy can effectively address this key contributor to vaccine hesitancy.

Let’s face it, just like people try to avoid getting stung by wasps, they also avoid getting shots. A large-scale study by the University of Oxford found that 26% of adults screened positive for injection phobia, with those in this group twice as likely to report hesitancy to get the Covid-19 vaccine. If all needle anxiety was eradicated, it’s possible that vaccination rates could increase by up to 16 percent. With Covid-19 vaccination rates worldwide stalling, this is a critical area to address to reach herd immunity and prevent further surges, reduce the spread of variants, and get on with our lives.

Skepticism, distrust, and politicalization of the vaccine exist, certainly. But what is likely underreported is the wide prevalence of needle phobia and medical anxiety underlying vaccine hesitancy. It’s much less vulnerable to say, “I’m fine, I don’t need a vaccine,” than “Truth is, I really don’t like needles.”

Here’s the good news: unlike political distrust, needle anxiety is treatable. The issue is not that we can’t treat it, it’s that there are so many barriers to treatment: affordability, stigma, lack of access, and lack of awareness (in both the medical field and public). Cognitive Behavioral Therapy (specifically, exposure therapy with applied tension) has been shown to be effective for the treatment of needle phobia. For example, in a 2018 study among highly needle fearful individuals, 70% completed a successful blood draw after just one group CBT session. Exposure-based CBT is a method of empowering you to confront your fears safely and gradually, always with you in control.

Importantly, needle anxiety is not just on the individual to figure out. We must figure out how to deliver healthcare in more equitable and empathic ways that take into account different people’s needs. We also must acknowledge our country’s history of medical mistreatment and apathy, which has disproportionately affected people of color and contributes to medical anxiety. While CBT is in no way a solution to these systemic root causes, it provides a practical, targeted treatment to empower access to healthcare for the millions with needle anxiety. The Covid-19 vaccine nasal spray, which is being developed for those with needle anxiety, will be available in about two years, but we simply don’t have the time to wait.

For millions of Americans, vaccinations are not “just a poke.” Don’t judge or dismiss people who aren’t yet getting vaccinated; let’s work together to deliver inclusive care for all.

What is Needle Anxiety?

If you’re among the millions who are afraid of needles or injections, you’re likely familiar with the feelings of dread and anxiety that come with getting shots. You may have experienced symptoms like heart racing, nausea, or insomnia the night before your appointment. Maybe you just relate to the statement, “I don’t like needles.” Some people also experience a sudden drop in blood pressure that leads to lightheadedness and fainting before, during, or after injection. Others have had negative, dismissive, or traumatic medical experiences that exacerbate needle discomfort. Naturally, if you’ve had any of these experiences, you’re more likely to avoid shots. It’s also hereditary, so if you have needle phobia, there’s an 80% chance you have a close relative with the same condition.

Most people with needle anxiety rationally know the moment of injection itself is safe and brief, which is why it can be hard to acknowledge one’s own anxiety about injections. But even though the brain may know it’s safe, the body can still exhibit a stress reaction to needles and medical settings, which for most people, includes an automatic urge to flee or avoid. Later, we might rationalize the avoidance with a story like, “I’m just not even sure the vaccine is effective.” Exposure therapy is a safe, effective, and confidential way to overcome needle anxiety, and you can find out how to sign up for free below.


To the Public, here’s your call to action:

We need to bang some pots and pans to raise awareness about needle anxiety. An estimated 10-25% of adults have needle anxiety, and these numbers are even higher in children and adolescents. Start talking about needle anxiety with others. Know that it can be treated in as little as two hours. Be a support person for someone with needle anxiety by holding their hand and walking them through these strategies. With up to 1 in 4 people suffering from needle anxiety, you likely (unknowingly) know someone who is avoiding vaccination because of it. Let’s normalize it, team up, and get on with our lives. 

Over the course of a lifespan, needle anxiety can lead to chronic avoidance of essential medical care and poor health outcomes. Because people with needle anxiety often avoid medical care, healthcare systems tend to ignore this sizable group of the population, and the cycle continues. Nearly all Covid-19 deaths in the U.S. are now among the unvaccinated. People with needle anxiety deserve access to life-saving healthcare just as much as everyone else.

Don’t like needles?

If you’re interested in free, confidential therapy for needle anxiety, you can find more information on our Public FAQ. Your time commitment will involve two 50-min sessions of exposure-based teletherapy and two brief pre/post measures. If your needle anxiety is relatively mild (and/or motivation very high), these self-help strategies may be sufficient to get you vaccinated.

A personal story: As a mom and a psychologist, I’ve seen how powerful needle anxiety can be. I have such a vivid image of my daughter, typically so fierce and confident, reacting with terror at the sight of a nurse with needle in hand. Acting on instinct, she leapt off the examination table, ran to the corner of the pediatrician’s office, and wedged herself into the corner of the room so the nurse could not access the part of her arm just cleaned with rubbing alcohol. My little girl suddenly had the strength of a rhinoceros as she rammed her body against the wall in defiance. By walking her through basic CBT steps (in a nutshell, gradually exposing her to the different components involved in vaccination: the needle, the smell of rubbing alcohol, etc. in a way in which she felt in control and understood), she now handles her routine vaccinations like a champ. 


CBT therapists, here’s your call to action:

Getting to herd immunity is a collective, wartime effort that requires you, with your unique expertise, to pitch in where you can. 

Our goal is straightforward: to get a shot in the arm of someone who would otherwise go unvaccinated. Many of the “early vaccine adopters” in the spring of 2021 were likely those without significant needle anxiety. Vaccination efforts are stalling, and targeting needle anxiety is one of the main areas in which we can now make an impact. Based on population estimates of needle phobia and current vaccination rates, we could boost current vaccination rates by 4-15% by amassing enough public awareness and ready access to exposure therapy for adults and children. Those numbers make all the difference in successfully managing the pandemic worldwide.

If you’re a CBT therapist interested in participating (hooray and thank you!), you can find more information on our Therapist FAQ. A minimum of two volunteer hours total is required: two 50-min sessions of exposure-based teletherapy per every person treated (you choose how many people you would like to see).


Impatient to begin?

Currently we are registering participants and therapists with the aim to launch our pilot program by October 1st, 2021. If you’d like to begin your journey of overcoming needle anxiety right away, you can check out our top strategies as well as our directory of helpful videos and stories. If you have a needle phobia and are able to watch some our videos successfully, you’ll have just completed your first CBT step of exposure (exposure = reverse the urge to avoid)!


References

Freeman, D, Lambe, S, Yu, L, Freeman, J, Chadwick, A, Vaccari, C, . . . Loe, B. (2021). Injection fears and COVID-19 vaccine hesitancy. Psychological Medicine, 1-11. doi:10.1017/S0033291721002609.

Love AS, Love RJ. (2021). Considering Needle Phobia among Adult Patients During Mass COVID-19 Vaccinations. J Prim Care Community Health. 2021;12:21501327211007393. doi:10.1177/21501327211007393.

McLenon J, Rogers MAM. (2019). The fear of needles: A systematic review and meta-analysis. J Adv Nurs. 75(1):30-42. doi: 10.1111/jan.13818. 

McMurtry, CM, Noel, M, Taddio, A, Antony, MM, Asmundson, GJ, Riddell, RP, Chambers, CT, Shah, V, & HELPinKids&Adults Team (2015). Interventions for Individuals With High Levels of Needle Fear: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials. The Clinical journal of pain, 31(10 Suppl), S109–S123. https://doi.org/10.1097/AJP.0000000000000273.

McMurtry CM, Taddio A, Noel M, Antony MM, Chambers CT, Asmundson GJ, … Scott J. (2016). Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cogn Behav Ther. Apr;45(3):217-35. doi: 10.1080/16506073.2016.1157204. 

Orenius T, LicPsych, Säilä H, Mikola K, Ristolainen L. (2018). Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors. SAGE Open Nurs. Mar 14;4:2377960818759442. doi: 10.1177/2377960818759442.

Wannemueller, A, Fasbender, A, Kampmann, Z, Weiser, K, Schaumburg, S, Velten, J, & Margraf, J (2018). Large-Group One-Session Treatment: A Feasibility Study of Exposure Combined With Applied Tension or Diaphragmatic Breathing in Highly Blood-Injury-Injection Fearful Individuals. Frontiers in psychology, 9, 1534. https://doi.org/10.3389/fpsyg.2018.015.