4.4 Review

The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm

Journal

INTERNATIONAL JOURNAL OF PSYCHOPHYSIOLOGY
Volume 78, Issue 1, Pages 50-67

Publisher

ELSEVIER
DOI: 10.1016/j.ijpsycho.2010.05.007

Keywords

Blood-injection-injury phobia; Diphasic response; Vasovagal syncope; Respiration; Hyperventilation; Applied tension

Funding

  1. NHLBI NIH HHS [R01 HL089761] Funding Source: Medline

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Blood-injection-injury (BII) phobia is an anxiety disorder that may be accompanied by vasovagal fainting during confrontation with the feared stimuli. The underlying pattern of autonomic regulation has been characterized as a diphasic response, with initial increases in heart rate and blood pressure that are typical of a fight-flight response, and subsequent drops in blood pressure and/or heart rate that may precipitate vasovagal fainting. Tensing skeletal muscles of the arms, legs, and trunk (applied tension) has been proposed as a technique to cope with this dysregulation. This review critically examines the empirical basis for the diphasic response and its treatment by applied tension in BII phobia. An alternative perspective on the psychophysiology of BII phobia and vasovagal fainting is offered by focusing on hypocapnia that leads to cerebral blood flow reductions, a perspective supported by research on neurocardiogenic and orthostatically-induced syncope. The evidence may indicate a role for respiration-focused coping techniques in BII phobia. (C) 2010 Elsevier B.V. All rights reserved.

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