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Cogn Behav Ther. 2016 Apr;45(3):217-35. doi: 10.1080/16506073.2016.1157204. Epub 2016 Mar 23.

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.

Author information

1
a Department of Psychology , University of Guelph , Guelph , Canada.
2
b Pediatric Chronic Pain Program, McMaster Children's Hospital , Hamilton , Canada.
3
c Children's Health Research Institute , London , Canada.
4
d Department of Paediatrics , Schulich School of Medicine & Dentistry, Western University , London , Canada.
5
e Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Canada.
6
f The Hospital for Sick Children , Toronto , Canada.
7
g Department of Psychology , University of Calgary , Calgary , Canada.
8
h Alberta Children's Hospital Research Institute , Calgary , Canada.
9
i Department of Psychology , Ryerson University , Toronto , Canada.
10
j Department of Pediatrics, Department of Psychology and Neuroscience , Dalhousie University , Halifax , Canada.
11
k The Centre for Pediatric Pain Research, IWK Health Centre , Halifax , Canada.
12
l Department of Psychology, Faculty of Arts , University of Regina , Regina , Canada.
13
m Department of Psychology , York University , Toronto , Canada.
14
n Department of Psychiatry , University of Toronto , Toronto , Canada.
15
o Mount Sinai Hospital , Toronto , Canada.
16
p Faculty of Medicine , University of Toronto , Toronto , Canada.
17
q Department of Pediatrics , Dalhousie University , Halifax , Canada.
18
r IWK Health Centre , Halifax , Canada.
19
s Canadian Center for Vaccinology , Halifax , Canada.
20
u Centre for Effective Practice , Toronto , Canada.
21
v Institute of Health Policy, Management, and Evaluation, University of Toronto , Toronto , Canada.
22
w Immunize Canada , Ottawa , Canada.
23
x Canadian Public Health Association , Ottawa , Canada.
24
y College of Family Physicians of Canada , Toronto , Canada.
25
z Alberta Health Services and the Cumming School of Medicine , University of Calgary , Calgary , Canada.
26
t Department of Microbiology & Immunology , Dalhousie University , Halifax , Canada.
27
aa College of Pharmacy , Dalhousie University , Halifax , Canada.
28
ab Immunization Programs and Vaccine Preventable Diseases Service , BC Centre for Disease Control , Vancouver , Canada.
29
ac Faculty of Medicine, Department of Paediatrics , University of Toronto , Toronto , Canada.
30
ad Departments of Paediatrics, Physiology & Pharmacology and Medicine, Schulich School of Medicine & Dentistry , Western University , London , Canada.
31
ae Canadian Family Advisory Network , Toronto , Canada.
32
af Uleryk Consulting , Toronto , Canada.
33
ag Science Directorate, Canadian Psychological Association , Ottawa , Canada.
34
ah Toronto Public Health , Toronto , Canada.
35
ai Communicable Disease Control, Alberta Health Services , Edmonton , Canada.
36
aj Bodhi Seed Center for Healing and Conscious Living , Milton , Canada.
37
ak Department of Emergency Medicine , IWK Health Centre , Halifax , Canada.

Abstract

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.

KEYWORDS:

Fear; blood–injection–injury; clinical practice guideline; exposure; needle; phobia

PMID:
27007463
PMCID:
PMC4867871
DOI:
10.1080/16506073.2016.1157204
[Indexed for MEDLINE]
Free PMC Article

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