Applied tension to help prevent fainting related to phobias
More than half of people with needle phobias and almost three-quarters of people with blood phobias have fainted when they are faced with their feared stimulus (Ost, 1982). In this post, I’m going to talk about what’s going on when you faint, the possible reasons behind it, and discuss the applied tension technique, which was developed to help prevent fainting or speed up the recovery time if you do faint.
What causes you to faint?
Both the cardiovascular and nervous systems are involved in fainting. Let’s look at the cardiovascular system first. Our brain needs a constant supply of oxygenated blood for us to remain alert and awake. The blood needs to be under pressure so that it can be pumped up to the brain (and the rest of your body). This pressure is maintained by the muscles in the walls of blood vessels in addition to the rate at which your heart beats. When the muscles in the walls of blood vessels contract, your blood pressure is increased, and when they relax, your blood pressure is decreased. When your blood pressure drops, the blood pools in your legs, as without the pressure it is affected by gravity. Your brain doesn’t get the blood it needs to stay alert, and so you faint. Now the nervous system tells the heart how fast to beat and the muscles in the walls of the blood vessels to contract or relax. This is done via the vagus nerve. When the vagus nerve is activated, the heart slows down, and the muscles in the walls of the blood vessels relax, leading to a lowering of your blood pressure and potentially fainting. Fear, anxiety, and other strong negative emotions, as well as the threat of physical pain or injury, are known to activate the vagus nerve. So you can see how fainting can occur in people with strong fears and phobias.
Can fainting be a good thing?
Feeling fainting and the act of fainting is not a pleasant experience. So it’s easy to understand how people can start to fear it when it's a problem for them. It can be pretty scary when you know you are prone to fainting. It’s hard to believe that there might be a good reason why it happens. The jury is still out on the actual reason for fainting in relation to medical phobias, but there are several theories.
When we lived in caves and were surrounded by lots of wild animals, if we were bitten by a sabre-toothed tiger and started to bleed, a drop in blood pressure would be a good response for our body to have. This would mean the blood escaping would be under less pressure, so there would be less blood loss allowing the wound to clot more quickly. Many wild animals hunt live prey and tend not to attack someone or something unconscious. So fainting in the face of danger may enable you to survive in these circumstances. Fainting in response to certain stimuli acts as a way of creating fear towards said stimuli. When we fear things, we tend to avoid them, and therefore we are kept safe. So fearing objects that might cause pain or harm in addition to blood makes a lot of sense. But these days, an injection isn’t going to kill you. It’s not a threat against your body. It’s administered in a controlled way. And therefore, there is no need to be fearful of it or for your body to respond in that way.
Whilst fainting is fairly common amongst blood and needle phobias, it is quite rare for people with general anxiety to faint, as anxiety typically raises blood pressure. Sure, they may well feel faint, but that’s as far as it goes.
When someone has a fear of needles or blood, they are often told to relax, perhaps even learning various relaxation techniques for themselves or being taught them by well-meaning therapists or healthcare providers. However, relaxation in this situation often has the opposite effect, reducing blood pressure further and increasing the chances that you’ll faint. So what should you do instead of relaxing? That’s where Applied Tension comes in.
What is Applied Tension?
Applied Tension, developed by Lars-Göran Öst, is a behavioural technique that has been demonstrated to be effective for the treatment of injection and blood phobia. (Ost, Fellenius & Sterner, 1991; Ost, Hellstroem & Kaver, 1992)
You can’t have direct control of your cardiovascular and nervous systems to lower your blood pressure. However, tensing your muscles applies some pressure to the blood vessels causing them to contract, which temporarily increases blood pressure. This temporary increase helps to prevent vasovagal syncope (fainting). Interestingly, a variation of this kind of muscle tensing is used by fighter pilots to avoid fainting when flying due to the speed and g-force.
How to do Applied Tension
Sit in a comfortable chair and tense the muscles in your arms, legs and trunk of your body for about 10 to 15 seconds. You should hold the tension until you start to feel a warm sensation in the head. But don’t overdo it, you don’t want to do yourself mischief! Then, relax your body for 20 to 30 seconds. Let your body return to a normal state that is not overly tense or completely relaxed. Then repeat this process 5 times. You must practise this technique several times a day for at least a week to familiarise yourself with the process before you need to use it in a situation where you might typically faint.
So there you have it, a tool that you can use to help prevent fainting. Knowing that you have something that you can do to help yourself in situations that in the past you felt out of control will help to reduce your fear of fainting. I teach all my blood and needle phobia clients applied tension in their first session with me so that they feel more able to engage in desensitisation and exposure-type tasks, both imaginally and in reality, which will help address their main fear. Research has found that after this combination of treatment (applied tension and exposure), people no longer need to use the applied tension as the vasovagal response is no longer triggered by the situations that it once used to be. (Peterson & Isler, 2004)
References:
Ost, L.G., Hellstroem, K., Kaver, A. (1992). One versus five sessions of exposure in the treatment of injection phobia. Behaviour Therapy. 23: 263–82.
Öst, L.G. (1992). Blood and injection phobia: Background and cognitive, physiological, and behavioural variables. Journal of Abnormal Psychology 101:68–74.
Ost, L.G., Fellenius, J., & Sterner, U. (1991) Applied tension, exposure in vivo, and tension only in the treatment of blood phobia. Behav Res Ther. 29: 561–74.
Peterson, A.L. & Isler, W.C. (2004). Applied tension treatment of vasovagal syncope during pregnancy. Mil Med. 169(9): 751-3.
Related articles: