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Trypanophobia in the Era of COVID-19 Vaccinations
Tuesday 16 March 2021
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Trypanophobia in the Era of COVID-19 Vaccinations

Dr Amanda Albert

After such an unprecedented pandemic, the world at large breathed a collective sigh of relief when
hailing the advent of the COVID-19 vaccine this year. For those who fear getting a needle in the arm,
this relief is usually mixed with some anxiety regarding the process.

Fear or phobia?

Fear of needles is not uncommon – needles pierce the skin and cause pain, and some postulate that
avoidance of this pain is an evolutionary instinct. The human race survived by avoiding pain and
injury with a fear instinct, creating a human predisposition to this fear of needles. However, it is
when this fear reaches the extreme level of phobia, affecting one’s ability to obtain the vaccine or
undergo any other medical procedure involving needles, that a problem arises. A fear and a phobia
are not the same.

There exists several different medical terms for phobia of various kinds of needles, but the specific
phobia of medical procedures involving needles is called trypanophobia. It is one of the specific
phobias listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V),
one of the major references used by mental health professionals. This phobia is diagnosed when a
person has an immediate and marked fear response to medical needles. Symptoms include fainting,
dizziness, light-headedness, nausea, vomiting, sweating and palpitations. This fear continues for at
least six months and causes the person to avoid the trigger with intense fear and anxiety. This fear
response is usually out of proportion to the actual danger posed by the needle. It is also out of
proportion to the person’s sociocultural context, meaning his fear responses are different from the
fear responses of those in his social circles and cultural background. In certain cases, persons with
this phobia have been known to completely avoid going to clinics or hospitals, despite having
illnesses that require treatment.

There are no current statistics available in Malaysia, but global estimates indicate that at least one in
ten people suffer from trypanophobia. Even action film star Jackie Chan, who performs all of his own
stunts, reports suffering from it! Studies also show that four out of five people with trypanophobia
report having a first-degree family member with the same – however, experts believe this may be
due to learned behaviour more than actual genetic inheritance.

I think I have trypanophobia – what next?

Many people simply avoid the triggers to their phobias. This may be well and good if one has a
phobia of spiders, for example, but it is not always possible or practical, such as is the case with
some other phobias. It would be a challenge to go through life never having a vaccine, never
boarding a flight, or never entering a lift! The good news is that there is help available should you
suffer from trypanophobia, or any other specific phobias for that matter.

The main component of this is exposure therapy, a form of psychological therapy which can be
undertaken with a qualified therapist, usually a clinical psychologist. During a course of up to twenty
sessions, a person goes through gradual exposure to the triggers that cause their phobias together
with their therapist, while learning practical ways to deal with the fear responses.

In this context, the person may first learn to read about needles with their therapist, which
practising dealing with his fear. Once his fear response to reading about needles is under better
control, he may then look at pictures of needles, then later watch videos of procedures involving
needles. This may progress to attending a session where someone else is having a procedure done in
person, and the final step would be to have a medical procedure done involving needles himself.
The aim is to gradually reduce and hopefully eliminate the fear response, and in many cases, this
therapy has been found to be highly effective.

Medications are not usually used for specific phobias per se, but may be used in some cases to treat
unmanageable anxiety occurring as an effect of phobias. This is usually short-term, and the mainstay
of treatment is still psychological therapy.

But my vaccination slot is next week – I have run out of time for therapy!

Fear (or phobia) not – according to experts in the field, there are some practical things you can do to

  • Teach yourself to relax. This is a component of psychological therapy that can be self taught as well. There are abundant resources online on a particular relaxation technique called deep breathing exercises. This is a kind of breathing technique that slows down the bodily responses of fear in the body such as fast heartbeat and fast breathing, which in turn further helps one to feel more at ease. The key, however, is to practise deep breathing when in a relaxed state until able to perform it well; only then can it be practised when in a stressful situation.
  • Distract yourself. Find things that take your attention away from the procedure at hand. Bring a trusted family member/friend with you, or talk to them on the phone. Hold an ice pack – pain and temperature run along the same nerve pathways to the brain, so this is a form of “distraction” to your nerve pathway. Count the tiles on the ceiling. Listen to recordings of sounds of the sea or forest, or a specific song you like. If the room you are in has a piece of art or a cartoon that you appreciate, pay more attention to it than to the needle.
  • Prepare yourself. This is in essence a simplified version of exposure therapy that can be selftaught. It involves exposing yourself to medical needles, step by step, prior to your vaccination. Start by reading, then by watching videos, then perhaps accompanying someone to a vaccination prior to your own. All along, take the opportunity to practise relaxation and distraction techniques as above. In a nutshell, if you have trypanophobia, you do not have to live with it lifelong, and it should not prevent you from having access to the benefits of vaccinations. Whether it be self-help or more specific help from a therapist, there is help available today.