Treatment for specific phobias of medical and dental procedures in adults
- Yujuan Choy, MD
Yujuan Choy, MD
- Assistant Clinical Professor of Psychiatry (volunteer faculty)
- University of California, Irvine
Acute procedural anxiety is an excessive fear of medical, dental, or surgical procedures that results in acute distress or interference with completing necessary procedures. Patients may experience anxiety in anticipation of or during procedures used for screening (eg, mammography), diagnosis (eg, amniocentesis or endoscopy), and treatment (eg, angioplasty or major surgery). Avoidance of clinical procedures due to acute procedural anxiety can have negative health consequences [1-7].
Specific phobias are a subset of the varied manifestations of acute procedural anxiety, diagnosed under DSM-5 criteria only when the patient’s fears are specific to the procedure and its immediate effects (eg, fear of suffocation during an MRI) rather than fears not specific to the procedure itself (eg, a fear of the underlying illness that might be diagnosed) . Specific phobias related to clinical procedures include: blood-injection-injury phobia, dental phobia, and MRI claustrophobia.
This topic addresses the treatment for specific phobias of clinical procedures. Treatment of acute procedural anxiety in adults that does not constitute a specific phobia is discussed separately. The epidemiology, clinical manifestations, course, screening, assessment, and differential diagnosis of acute procedural anxiety are also discussed separately. The epidemiology, clinical manifestations, course, diagnosis, and treatment of other specific phobias are also discussed separately. (See "Treatment of acute procedure anxiety in adults" and "Acute procedure anxiety in adults: Epidemiology and clinical presentation" and "Acute procedure anxiety in adults: Course, screening, assessment, and differential diagnosis" and "Specific phobia in adults: Epidemiology, clinical manifestations, course and diagnosis" and "Psychotherapy for specific phobia in adults" and "Pharmacotherapy for specific phobia in adults".)
Presentations of acute procedural anxiety are diagnosed as a specific phobia, under DSM-5 criteria, only when the focus of the patient’s fears are specific to the procedure or its immediate effects (eg, fear of suffocating during an MRI scan) rather than a focus that is not specific to the procedure itself (eg, a fear of the underlying illness that might be diagnosed) . Interventions for three specific phobias of clinical procedures are discussed below:
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- SPECIFIC PHOBIAS
- GENERAL TREATMENT PRINCIPLES
- Blood-injection-injury phobia
- - Applied tension
- - Other interventions
- Dental phobia
- - Psychotherapies
- In vivo exposure therapy
- Eye movement desensitization and reprocessing
- Cognitive restructuring
- Systematic desensitization
- Coping strategies
- - Medication
- Nitrous oxide
- Other medications
- - Duration of treatment effects
- - Treatment selection
- MRI claustrophobia
- - Positional adjustment
- - Benzodiazepines
- - Psychotherapies
- SUMMARY AND RECOMMENDATIONS