How can psychologists help with needle phobia, vaccination hesitation?

With a growing number of Americans being vaccinated, there has been renewed hope that life will soon return to pre-pandemic normal. Guidelines around mask wearing have been relaxed, public spaces are being further opened, and the travel industry is seeing renewed interest.

With all of this excitement, it can be easy to overlook the fact that, as of this writing, only 40 percent of Americans are fully vaccinated, and around 50 percent have had one vaccine.

With up to 25 percent refusing and 5 percent hesitating to be vaccinated, according to an NPR/Marist poll, the question is whether we will ever reach that range of 80 to 85 percent to reach ‘herd immunity.’

Until that happens, the virus will continue to threaten those who cannot take a vaccine or those for whom a vaccine won’t help them reach the same level of immunity because of weaker immune systems. And, without herd immunity, will the virus continue to mutate until it finds a way to threaten even those of us who are vaccinated?

There may be many reasons that someone will not take one of the vaccines. In a Kaiser Family Foundation poll done at the end of 2020, nearly 27 percent of respondents said they probably or definitely would not be vaccinated, mainly because of worries about side effects, distrust in the government, a desire to see how it works for others, or a belief that the overall risk of COVID-19 has been exaggerated.

There may also be those who simply don’t like needles. In a review of studies published in 2019, trypanophobia, a fear of needles, was shown to have contributed to about 16 percent of adults avoiding flu shots. If that number holds true with COVID-19 vaccines, addressing injection fear or hesitancy could help to increase the number of Americans vaccinated over the next few months.

What is the role of the psychologist in this situation? Are there things that the individual or that the profession can do to move that needle (pun intended)?

“I think that psychologists, in particular, should advocate around epidemiology and public health as much as possible,” said Marney White, Ph. D, MS, associate professor of psychiatry at Yale University. “It is very much a psychological crisis and it is hinging on individual behavior and acceptance of science and that is what we do; we try to help people modify their behavior towards improving their own well-being. We can’t attend to people’s mental health without simultaneously attending to physical health.”

It may feel like an uphill battle with the way public opinion has swung so widely during the past 15 months.

“We haven’t yet found out how to help people modify their behavior in this pandemic,” she added, “and I think psychologists do have a role in helping people overcome their fears in ways that will help them move forward.”

Helping patients who “don’t like needles” can be as simple as helping them to see the benefits over the negatives and giving them simple tricks to deal with their anxiety.

White, who works with eating disorders, previously ran a needle phobia group and said that the techniques used for those clients may be different from how one would work with someone with more of a needle aversion.

“While for some there may be a sense of fear or apprehension around needles and injections, that is a little different from a higher level or a true phobia where people might have a fainting response,” she said. “And the typical approach for treating someone with a phobia is through exposure to the feared stimulus and relaxation strategies.”

Typically, with phobias, a patient may be slowly introduced to the situation and taught to relax, breathe, and sit with their reaction while in the presence (from a distance at first) of their feared object. The goal, of course, is to get to the point where the reaction peaks and begins to fade while still exposed to the situation.

“Desensitization,” White said.

It can be trickier with needles, she added, because that person may be more likely to faint in reaction.

“What you have to do there is to teach the patient how to tense up,” she said, “because the vasovagal response leads to fainting. So, instead, teach techniques to raise the blood pressure, like making fists and doing large muscle group tension.”

In general, working with clients, or with the general public, to address vaccine resistance may mean taking a step back and putting on those listening ears.

“Understanding people’s fears about the vaccine is absolutely necessary before change can take place,” said Jennie M. Kuckertz, Ph.D., a postdoctoral fellow at the OCD Institute at McLean Hospital.

“If we skip the step of understanding exactly why people are anxious about getting vaccinated, then it will be very difficult to help allay their concerns or overcome them. I have certainly seen people in both my personal and professional life express anxiety about the vaccine, and some specifically, about fear of needles.”

Addressing the issue directly is the first step, Kuckertz explained.

“When we are open and direct about people’s fears about the vaccine, we can normalize those fears and offer suggestions that are more likely to be helpful,” she said.

“For example, someone with a needle [aversion] might feel better if we arm them with simple coping strategies, like deep breathing and distraction (looking away from the needle). Someone who is worried about their ability to cope might benefit from going to the vaccination site with a relative who can model staying calm and positive. Parents or guardians may find it beneficial to pair the vaccine trip with an immediate, exciting reward.”

Guiding patients towards taking the vaccine needs to be done gently, she added.

“I believe psychologists can do a lot to help with the next stage of vaccine uptake,” said Kuckertz. “I ask all my patients if they have received the Covid-19 vaccine. For those who have not yet received their vaccine, I think we should ask `how do you feel about it?’ because that creates space for people to feel understood and is not judgmental, as opposed to questions like ‘Why not?’ or ‘Are you planning to get it?'”

In the end, helping to increase vaccine uptake may fit in with how therapists often see their own roles in the world.

“I think psychologists have an ethics of duty to get involved in this,” said White. “As [APA President] George Miller said [in 1969], we should be giving psychology away. I feel the same about public health.”