Hello, friends! In this Q&A I answer three really great listener questions including treating a phobia of blood, chronic suicidality, and how to help a partner be more supportive of you. Plus, if you’d like to get a 4th bonus question, check out my patreon.
I suffer from blood phobia, and so I wanted to ask: what is the best and most effective way to treat this and hopefully live a normal life?
Blood injury and injection phobia, or BII, is a unique type of phobia because it involves the normal aversion to the stimulus and intense anxiety, but it also often causes a sudden drop in blood pressure that can cause fainting. This makes a little more problematic than other kinds of phobias. If you have a phobia of cats and you are near a friendly cat – there is absolutely no danger to you beyond feeling really strong anxiety and panic. It won’t physically harm you and that’s an absolutely essential understanding if you are going to challenge the phobia and try to reduce the response. But when you suddenly faint, there is a little bit more danger. You could fall and hit your head, it could be at an inopportune time, etc. So you need a tool to help you endure not only the anxiety of it, but the blood pressure drop as well.
Luckily there is a tool called the applied tension technique. I will preface this by saying that you should talk with your doctor about other issues that could be going on and contributing to any fainting that occurs and make sure that this technique is safe for you to use. But the applied tension technique basically involves tensing certain muscle groups to help raise your blood pressure to counteract the sudden drop. This can prevent fainting or help you recover more quickly if you do faint.
I want to be clear that fainting itself is generally harmless. But as I said, situational factors can present a little more of a risk than just straight-up anxiety. So to use the technique, you first need to practice it. The best way is to sit in a chair comfortably and tense the muscles in your arms, legs, and trunk for 10-15 seconds. You hold the tension basically until you can start feeling the pressure raise, which most people describe as a warm feeling in the head. Then you rest for 20 seconds or so and repeat it again. Do this about 5 times to raise your blood pressure significantly. When you relax your muscles after tensing them, you don’t want to try to sink deeper into relaxation as you would with a guided muscle relaxation, that would be counter-productive. You are just giving your muscles a break and returning to a more normal/neutral state.
As with most coping skills, when you are learning this technique, you are going to want to practice it several times per week (the more the better) before you employ it in the moment. After you have practiced for a while, you can start using it in combination with exposure strategies. Exposure is something that I have covered extensively on the podcast, on the blog, and in full detail in the Kick Anxiety’s Ass online course. You’re going to want to make an exposure hierarchy then gradually expose yourself to the stimuli that give you anxiety. With this one, you are going to want to take it slow and consider just how graphic you need to be. You can start with trigger words, then maybe simple pictures of scrapes without blood, etc. It’s best to work with a therapist for this so they can help you craft the protocol and any materials that you might use. For instance, I’ve used power points in the past with images and words to help the person with their exposure work. Work your way up gradually and try to get to know the signs of your body starting to get significant anxiety and feelings of faintness so that you can use the technique before the fainting occurs. Also, don’t be afraid to ask if a particular therapist has any experience with your phobia.
Thanks for the great question and I hope this helps!
Dear Dr. Duff,
Thank you for your work.
I’ve struggled with chronic suicidality for over 20 years. Both my therapist and I believe that I’m strong enough to keep surviving it, but there’s periods of time when this symptom wears me out. How does one overcome this chronic symptom and feel good enough and safe enough to just be alive?
Thanks for accepting & considering this question.
Thank you for writing in and so sorry to hear this. It is extremely tough and I think it’s great to hear from someone like you because a lot of people don’t think of suicidality as a chronic issue. They think of it as a more acute issue that needs to be resolved. Having suicidality as a chronic issue over time can absolutely be exhausting. Just like any symptom it will wax and wane over time, but it’s totally normal when this is a long term symptom of yours to wonder if you will ever just have some peace.
I’m glad to hear that you are in therapy. Having that contact and someone you can always be accountable to is super important here. Do you feel like you are continuing to make progress in therapy? Sometimes you can become so comfortable with a therapist that it’s more of a safety net and check in and so you’re not continuing to improve. It could be the case that your therapist is great at a specific kind of intervention, but you need to balance that out with something else. For instance, maybe you have some great coping skills and nuts and bolts techniques, but you need someone that can help you dive into the deeper work a bit with the hopes of creating some lasting change.
I’m also not sure if you are on medication or not, but potentially integrating the help of a psychiatrist would be another factor to bring into the mix. I feel like I’ve been talking about these approaches a lot lately, but there are also medical interventions for suicidality that can be very helpful. Ketamine is the one that I’ve talked about most recently in the past couple of episodes, but there is also ECT and TMS. There are also psychedelic experiences such as the retreats we talked about on the Mycomeditations episode. All of these things are things that you would need to consider extensively and talk about with your care team before pursuing, but there seems to be something about each of these treatments that can help to provide a reset for those that struggle with treatment-resistant issues and suicidality.
Another possibility is that the focus could be TOO much on the suicidality. At this point, you may know what it is and how to cope when it gets stronger. But are you also giving yourself the chance to focus on other things? Intentionally focusing your attention on what makes you a worthwhile person or things that you have done well? And allowing yourself to become engrossed in hobbies and other leisure activities?
Lastly, taking a good look at your life and circumstances overall, such as are there any major structural changes to your life that could be helpful? Whether this is setting boundaries, changing a job, moving to another location, or something else entirely. If the environment or circumstances that you are in are continuously perpetuating the suicidality, it might be that one major change can make many other things easier.
How can I help my partner be more supportive with my anxiety?
My partner and I come from different cultural backgrounds and were raised very differently. He is very affectionate and comfortable with public displays of affection. I, on the other hand, was not raised in an affectionate household, and on top of that, I have a moderate amount of social anxiety. My senses are heightened in public and I feel very self conscious, especially with public displays of affection. I make an effort to be affectionate in public because it’s important to my boyfriend, and he sees my willingness to show PDA as a sign of love. I have tried to express why it’s very difficult for me, however, he continues to see my inability to show PDA as something that’s a simple barrier to overcome and that I am not making enough progress in overcoming it.
Do you have any tips as to how I can become more comfortable with PDA. Also, how I can help him to understand how social anxiety affects my ability to show PDA and help him to be more of a partner in the process of overcoming anxiety? Thank you for your time and the great work you are doing!
Thanks for writing in! This is a much more common issue than you might think. Having trouble showing physical affection, especially in certain situations like in public.
A few things that I like about what you wrote: I like that you have some awareness of the whole situation. You understand that you have social anxiety that you are working with, you understand that you have different upbringings, and you understand the way that your body tends to react in social situations. I also like that you’ve started to communicate about this. I think that continued communication will be really important here. This is one of those situations where the specific issue may not be the most important thing in the world, but it’s an opportunity to practice communicating and the give and take that comes with being in a relationship.
To start off with, do you feel like he has a good grasp on what anxiety is and how it works? If not, I have a letter for that. There are also tons of resources out there that provide nice, pared-down explanations of anxiety. It sounds like it’s something that he does not significant experience in how own life, so it’s hard for him to empathize with what you are going through. On your side, you need to continue letting him know that your heightened physiology makes it hard for you to accept or give affection in public, but that’s NOT a sign that you don’t feel affection and love toward him. On his side, he needs to work to not personalize and feel like he is being rejected when you are not able to be fully comfortable in public. It takes an effort on both sides.
I’m not sure what level of PDA you’re talking about here either. Are we talking holding hands, a peck, full-on making out? If you are totally on different ends of the spectrum with this, I think there could be a middle ground that you agree upon and agree to not try to push it beyond that.
Working on the social anxiety overall is a good first step here. The affection itself isn’t the issue, it’s just one of those activities that make you feel most exposed and embarrassed probably due to the personal nature of it. You could go out and observe other people. Think about the last time you were in a public space. Do you remember seeing anyone engaging in PDA? Probably not. You, like most people, were probably just focused on yourself and the situation at hand. If you go out again with the intention of spotting examples of PDA, you can probably find some. Notice the difference though – this is something that naturally other people are not caring that much about. If you see a couple showing some love to one another, notice how nobody around them stares, laughs, or really reacts at all. Prolonged exposure is also something that could be helpful. Start from the bottom, though. If you are simply uncomfortable being in a public space by yourself, challenge yourself to do that more often without escaping into your phone. Maybe you could make a point to try holding hands for a prolonged period of time.
Overall, this is something that doesn’t need to be “fixed”. It’s an effort that you are making on behalf of your relationship and your partner needs to understand that. If they are unwilling to be empathetic and give you some grace about the fact that you can’t show them the kind of affection that they would like all the time, that’s going to be a problem. You don’t need to feel like this is your fault or that there’s something wrong with you.
Keep communicating about it, check in when you are in public about how you are feeling so that you can help with expectations, and if he isn’t able to let this happen naturally, you may need to set some boundaries.
Bonus Patreon question:
I have recently started listening to your podcast and I LOVE it! I am currently a student pursuing my Master’s in Social Work, so I work in the field as well and admire the work you do as a psychologist.
I have gone through a life change from leaving a marriage where I was comfortable in a “pattern” or routine with my ex. I am now in a relationship with another man that I love so so much. We are in a newer relationship but I have been in love with him for months, and vice versa. We are currently living together and I know we both want a future with each other. The issue I am having is that he has borderline personality disorder and I want to help him so badly.
I want to know from a professional standpoint, what are some things I can be doing to make sure that I am being as supportive as possible for him? Due to his BPD, he struggles with poor self image and thinks so low of himself. And to me, he is just the best. What are some healthy ways I can show him that I love and care for him deeply and want him forever? Also, how do you gain or re-gain the trust of someone with BPD?
If you would like to hear my advice on this week’s bonus question, check out my patreon!
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