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Needle Phobia May Be Contributing to Vaccine Hesitancy More Than We Realize

Black man waiting to get a vaccine

Marko Geber / Getty Images

Key Takeaways

  • Some people who want the COVID-19 vaccine have avoided the series of shots because of their needle phobia, which can be the fear of needles or of injections.
  • Planning and practice is key for those who are afraid to get vaccinated.
  • Evidence-based interventions with the support of a mental health professional can also help.

I stood in line at a vaccine mega-site behind dozens of others awaiting their COVID-19 shot. I drove 40 minutes to get there, and honestly, if it were closer to home, I might have tried to run away already. When I suggested leaving, my wife squeezed my hand and told me to relax.

I qualified for the vaccine with the first priority group, but I put it off for months, justifying the delay with a variety of excuses that weren’t all valid or reasonable. Really, I was just avoiding the injection.

Although I never previously thought of my needle avoidance as a fear, I’ve always experienced anxiety about shots and blood work, and I’ve even had panic attacks before procedures. I never sought a formal diagnosis, but I know I have a needle phobia.

What Is Needle Phobia?

Jeffrey Cohen, PsyD, says according to the DSM, needle phobia is a blood-injection-injury type of phobia. Phobias are anxiety disorders. He explains that like many other phobias, evolutionary causes could contribute to needle phobia. For instance, the fear of being punctured could be associated with the lack of medical care and increased danger of such an injury thousands of years ago.

Cohen says that phobias can also be conditioned and noted that I could have developed an adverse reaction to needles after hearing my own children cry when they were vaccinated as babies. For me, the phobia started even earlier—in my own childhood—but trying to support my kids through their vaccinations, blood draws, and medical procedures have made my anxiety worse.

Cohen says that people with needle phobia might have visceral reactions. They might feel suddenly hot or sweaty, their hearts could beat faster, and their extremities might tingle as blood moves away from those areas. I also feel restless and have trouble concentrating. My legs bounce, I’m light-headed, and my body sometimes shakes. I’ve even vomited in anticipation.

He explains that this is because the fear system is activated. We might not have a full-blown panic attack, but our sympathetic nervous system ramps up in an attempt to help us recognize a danger. But because the threat isn’t a real danger, in this case, there’s no way to put all that energy to use.

As many as two out of three people are afraid of needles, but their fear might not rise to the point of avoiding vaccination. Estimates project that as many as 66 million adults in the United States and as much as 20% of the world population might share this fear at the level of a phobia. One in six adults has avoided the flu vaccine due to this phobia in previous years. Before getting the COVID-19 vaccine, I hadn’t gotten a flu shot in many years and I even put off bloodwork pertaining to a serious illness.

Jeffrey Cohen, PsyD

Whenever we’ve had an aversive or scary experience, it encodes that stimulus—in this case, the needle—into our brain as scary. Fears and traumas are encoded much more deeply in the brain, so I think it’s a learned response.

— Jeffrey Cohen, PsyD

Some people with needle phobia might not recognize their anxiety as a fear, but avoiding medical care or injections is a sign. “If they’re still avoiding [the vaccine] even though they’ve run out of reasons, that’s often anxiety,” he adds.

Experts think vaccine avoidance could delay the nation’s ability to achieve herd immunity against COVID-19 and put others who cannot be vaccinated at unnecessary risk of infection. People with needle phobia tend to avoid seeking medical care altogether, which also places them at increased risk for poor outcomes should they experience complications if they contract COVID-19.

How to Conquer the Fear

When attempting to combat needle phobia, make short-term and long-term goals. For folks preparing on their own for an upcoming appointment, having a personal plan for the day of the injection is important. For those who need professional intervention, Cohen recommends meeting with a specialist who can develop a plan that is unique to personal needs and goals.

Cohen suggests cognitive-behavioral interventions, which help people change the thoughts and behaviors that are causing mental health issues and emotional challenges by learning about the connections between those thoughts and behaviors.

In Cognitive Behavioral Therapy (CBT), a patient could recognize the thought that’s leading to their avoidance and disrupt that distortion by attempting to change the thought. A therapist would help the patient fact-check fears even in tangible ways—like looking up statistics or other important information online—in order to promote more helpful thoughts.

Another option is Acceptance and Commitment Therapy (ACT) which encourages people to compassionately acknowledge unwanted thoughts while choosing actions that align more with their values and beliefs. Although I didn’t seek professional support when developing my own action for vaccination, I practiced ACT skills I’d learned in the past by clarifying my values (that I believe the COVID-19 vaccine is important) and developing a strategy to support that belief.

Patients could go to a single session of CBT, which is available virtually if they’re especially motivated to pursue their vaccine goal or just need to reinforce coping skills they’ve already learned—but this is more practical for promoting psychoeducation. Cohen underlines that four to six sessions is more ideal if a patient has more time.

Because annual boosters will likely be needed due to the nature of COVID-19 variants, long-term plans are still relevant. Cohen explains that people need to want to shift their mentality for interventions to work but that a technique called motivational interviewing could help someone who is less motivated to change than others. Family therapy could help loved ones work through a conflict if they hold different values or beliefs about the vaccine.

Medical traumas and negative experiences with vaccines during childhood could cause the phobia, and these experiences can lead to a refusal to get vaccinated in the future. Exploring possible causes and processing trauma in psychotherapy could help diminish the anxiety.

Exposure therapy also could be part of a long-term plan. During this intervention, patients are exposed to needles in more benign settings such as watching videos of injections, visiting medical centers and being near needles without being vaccinated. To be successful, people should be exposed to a feared stimulus somewhat frequently and for long durations. He says, “This works because your brain takes in new information about the stimulus and realizes it’s not as scary as it thought.”

What to Expect at a Vaccination Site

Cohen underlines that it’s important not to force anyone—including children—to comply during an appointment. For example, holding someone down or tricking them could be traumatic and lead to a more intense needle phobia that causes an even stronger impact in the future.

Sara Forgione, who administers vaccines at COVID-19 clinics, says she asks each patient directly how to best offer them support. She offers options, such as watching as she preps the syringe, announcements, and countdowns, and ignoring or distractions. She says the conversation should be short and anti-climactic, and patients can make additional requests they need.

Cohen says that a good distraction is whatever works well for the individual and could include using music, watching a video, or playing a game on a mobile device. My wife read me a news article. For those who tend to faint, Cohen says pressure techniques, including acupressure, can reduce the risk. For those who want to try medication, a short-acting benzodiazepine or other anxiolytic drugs will help promote relaxation.

Sara Forgione, Vaccine Clinician

It’s important to establish consent and to allow patients to control the parts of the experience that they can.

— Sara Forgione, Vaccine Clinician

Because my wife couldn’t go with me for my second vaccine and I have a tendency to be nonverbal when I panic, I brought a pre-written card explaining my anxiety that also requested the use of yes-or-no questions that I could reply to with sign language or a head shake. The clinicians were supportive and accommodating, and I practiced mindfulness skills to ignore the injection when it was time.

Forgione reinforces her patients’ values by asking them to tell her why they’re getting vaccinated and how they think their lives will change after vaccination. She says, “It helps to focus their thoughts on something other than the needle and gives them a moment to share what this experience has been like for them.”

One shaking and anxious teen explained to Forgione that despite her fear of needles, she’d never wanted something so badly. Forgione says she almost cried when the patient was finished, “I was so proud of this kid’s bravery!”

What This Means For You

If you have a needle phobia, develop an immediate plan for your COVID-19 vaccine and a long-term plan for future vaccinations. Consider professional help if you need it and enlist the help of a supportive loved one for the day of your injections. Remind yourself why you feel vaccination is important to promote success.

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  1. Love AS, Love RJ. Considering needle phobia among adult patients during mass COVID-19 vaccinationsJ Prim Care Community Health. 2021;12:21501327211007390. doi:10.1177/21501327211007393