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The fear of needles can overpower the fear of death. Here's how to overcome the phobia

Miami Herald - 2/22/2021

Feb. 22—Caridad Galastica is aware that some four million COVID-19 vaccine doses have been administered in Florida so far.

The 37-year-old Miami mom of four would love to be included in those numbers. She wants to serve as an example for her kids — a 17-year-old son and daughters ages 13, 10 and 9 — when it's her turn.

But Galastica, who got COVID in October and who still hasn't fully recovered her sense of smell, doesn't want her turn.

A bad experience she had with a Miami pediatrician when she was 5 still torments her. And that fear of needles is so overwhelming that it overrides her fear of death from the virus.

"I would love to be vaccinated and protected against this virus because I know firsthand what it does — it basically shut my entire immune system down for two weeks," she said. "I never want to go through that again."

Galastica says she is not against vaccines. Her children all have had their school-age vaccinations.

"I'm super pro-vaccine. It it's recommended by a doctor they are the professionals. They know what's good for my children or myself. I want to take full advantage of that," she said. "But, for me, I have neglected myself completely because of my fear and I know this can hurt me in the long run. I tell myself that all the time that there's amazing people out there risking their lives every day to help everyone else's health and why can't I push a little harder and try a little harder?

"I get emotional every time I think about this," Galastica said. "I want this so badly. I want to be healthy and I want to live a normal life again. And I'm afraid I let my fear consume me. It's so heartbreaking to know that you want to be different. To know you want to stop that fear. It terrifies me and make me want to lock myself in a shell."

Galastica's fear of needles isn't a case of "vaccine alarmism," a misguided belief that the current Pfizer or Moderna vaccines are ineffective or can give recipients the virus, a trend which has caused many to shrug off accepting the two doses, the New York Times recently reported.

"When they make it available for kids I'll be one of the first parents in line to make sure my kids are safe and vaccinated," Galastica said.

Just don't put her in the same room when they have the injections. She can't even watch someone else get a shot.

Galastica, a patient of Coral Gables psychiatrist Dr. Arthur Bregman for about three years, confided something recently to him that she'd held back. That is, until all the talk about COVID vaccinations made the conversation unavoidable.

Bregman, who has been vaccinated, along with members of his family, asked if she'd be getting hers when the time came.

"I told him, 'Dr. B., no matter how much I want to, my fear overcomes even my fear of death.' At this point in my life I wish I wasn't like that. 'OK, a shot by a needle that can potentially save your life or you can die? My fear of needles is so much more than my fear of you telling me I can die if I don't get this vaccine.'"

What is trypanophobia?

Galastica, a Miami Jackson Senior High grad who has worked as an insurance agent from home during the COVID pandemic, is one of about 7% of Americans who suffer from trypanophobia —a fear of needles, and avoid getting immunized, according to Healthline. That's among those who will talk about the fear.

The actual number nationwide who are frightened is even higher, according to experts, including Bregman, an American Psychiatric Association Diagnostics and Statistical Manual of Mental Health Disorders report, and the Centers for Disease Control and Prevention. The debilitating fear of needles can affect about 25% of Americans, or about 50 million people.

"It sounds like a dinosaur — trypanophobia. This is a phobia that few are discussing right now. It can be all-consuming for patients like Caridad," Bregman said.

"If we think of it in Darwinian terms, human beings have been around for millions of years. We were averse to scratches from animals and things and are very adaptable. [Trypanophobia] could be a remnant of some of that. There's some biological basis for it so it's not like the weirdest thing."

But its relative commonality doesn't make it any less horrible for those who suffer from needles phobia.

How a bad experience in childhood lasted into adulthood

The doctor's dinosaur analogy isn't far off the mark for Galastica. She likens the image in her mind to a "monster" in the form of a "mean doctor" that will cause her pain. She traces its origin to a checkup she had when she was 5 as she and her five siblings lined up for childhood vaccinations.

"This doctor was different from any of the other doctors I had seen before," Galastica recalls. "Really mean. Not nurturing at all. Kind of rough."

Her father had taught her to speak up if she felt uncomfortable around strangers. "Stranger danger." Galastica remembers telling her mom in Spanish at the time, "He looks so mean. I don't want to see this doctor." Se ve tan malvado. No quiero ver a este doctor.

"I guess he was the only doctor available and we were a big family," Galastica said. "It petrified me. It scared me to the point to where it took me awhile to trust a doctor again."

Galastica likens her fear of needles to post-traumatic stress disorder, or PTSD. Since then, she's only accepted a vaccination for whooping cough and only then did she do so because she was in the hospital to have one of her children. Nurses were able to administer the vaccine when she was otherwise distracted. That way, she was able to avoid the dreaded anticipation.

Galastica has since stopped going to her primary care doctor, she said, because the subject of adult vaccinations, like the flu, shingles and others, came up.

Living with fear

For years, Galastica would only tell a few about her fear. Well-meaning people would tell her she was "too old" to hold on to childhood fears. Now, she's talking publicly, and ibregman says that's a major step forward. She wants to do it for her children. She says she finds sessions with Dr. Bregman are helping her.

Bregman thinks Galastica will be able to conquer her fear and take the vaccine when the state opens it to her age group. Galastica will only say, "We are working on it. It's a work in progress." Baby steps, she allows. It's a start.

"This is something you should not let override your life because at the end it hurts you more than anyone else," Galastica said. "It completely takes over you and becomes this overbearing monster that just sits on your shoulder and you see everyone else moving on in life and this something is just holding you back and it hasn't allowed me to fully move forward."

Talking about her problem with trypanophobia is emotional, Galastica said. Tears well up as she explains.

"I wouldn't want that happen to someone else," she said. "Living with fear is the worst feeling in the world. Regardless of what that fear is — whether it's needles or someone that's hurt you in the past or you fear anything, the boogeyman, whatever the case will be — living with fear is not living at all."

Tips on how to deal with the fear of needles

So what should you do if you find yourself in a situation similar to Galastica's?

— Seek care from a mental health specialist or your primary care doctor if you have the means to do so.

"The No. 1 thing is you have to have a trusting relationship with the individual," Bregman suggests. "That is what mental health is about if people go to practitioners. They have to feel safe and in trusting relationships. For people with phobias you have to have that."

— Can't afford a psychiatrist or a medical professional? Consider reading up on relaxation techniques or even learning how to self hypnotize, Bregman said. People should become knowledgeable about the good benefits of the [COVID] vaccines and read about the procedure."

Bregman has posted a gallery of coping videos on his website at Galastica has viewed many of them, she said.

— Remind yourself why you are doing this — such as getting the vaccine despite how it's administered. Tell yourself why getting the vaccine is good and how it helps not only you but those you love and who care for you.

"Caridad has little kids and an older mother. 'I got to do this to take care of my family.' An intelligent, smart, reasonable person reminds themselves why they are doing this," Bregman said. "Most people, even though they are terrified, they will go through something to take care of someone else because they are a good person."

— Go with a companion. "One of the things I do with all phobias, especially things like this, is I say you've got to go with a companion, someone you really trust. That is so important. And go to an environment you trust. By the time you want it, there'll be vaccine around so go to the nice hospital you like. They are usually better trained. And with a companion you'll feel safe," Bregman said.

Some vaccination locations do not allow guests inside unless the patient needs assistance If that's the case, consider getting your companion on the phone with you to talk you through the experience.

Or "speak to the people giving you your vaccine," Bregman said. "Make an alliance with the people giving it to you. Tell the administrator about your fears. Say, 'I have trouble with this.' Usually they are trained to help people feel comfortable."

— Don't look. Glance the other way as the health care person gives you your injection. Galastica said at this time this technique wouldn't help her because she has built up so much fear she said she knows what's coming. But, in general, the advice is sound.

— Practice mindfulness techniques. Not just for fear of needles, but all sorts of issues that hold you back and for which you can improve your overall well-being. Breathing exercises to calm yourself down. Listen to your breathing. Distraction visualizations. The ol' "think about being on a beach somewhere" trick.

— Anticipation is worse than the problem, Bregman said. This is easy to say but hard to put in practice. But if you can, try not to dwell on the upcoming appointment. Distract yourself with other activities or conversations. Practice the mindfulness techniques. Thinking about the injection, or watching the needle approach your arm, conjures all the old "it's going to hurt" fears in your mind. The reality? It's a split second and really doesn't hurt anywhere as much as you imagine. But we hear you, the anticipation feels like an eternity.

— Treat yourself afterward. "Go buy yourself an ice cream cone after," Bregman said, chuckling. But really it can be any treat you'd look forward to after completing a task you find unpleasant. "When we were kids they gave us ice cream cones."

— Talk to people you really respect. Especially if they have been through the experience of making and keeping a vaccine appointment through to completion.

Bregman recounts a recent conversation he had with a patient.

"A lady who I have been seeing for years called me and said, 'I don't know if I'm going to get the vaccine. I'm afraid to get it.' I told her, 'Trust your doctor. I got it. My son got it. My wife got it. My brother got it. His wife got it. We are all fine. And I am telling you it's the right thing to do. She said, 'I'm going to do it.' "


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