In episode 319, I received a question from a listener struggling with pharmacophobia, the fear of medication. In this post, I talk about this in more detail and offer my thoughts on how you can combat this through exposure and other techniques!
I recently enrolled in your online course. I am in the exposure therapy section. You talk briefly about phobia of injections. I currently am suffering from extreme pharmacophobia, the fear of medication. I have severe psoriatic arthritis and was prescribed injections. I also suffer from panic disorders and am medicated for ADHD. I am prescribed Adderall for nursing school to be less fidgety and concentrate. I have been too scared to start either prescription and have had these prescriptions for months now. How do I expose medication? In my perspective, it’s either I take it or I don’t. I’m afraid of the side effects or of dying. I am seriously stuck but don’t know how to use exposure therapy for injections. any advice is welcome.
Thank you for helping people who truly suffer from their own mind
This is a really good question. For those of you who don’t know, I have an online course that has been around for a while. In that course, there is an entire module on exposure. From describing the exposure process to developing a hierarchy to addressing common mistakes. You can also find out the basics of exposure in episode 195. You are totally right that this is a more difficult sort of thing to do direct exposure to, so I’m happy to dig into it a bit here. I may also add this to the course as a bonus resource.
There are a variety of exposure types. First off, there is a difference between in vivo exposure and imagined exposure. In some cases, exposure needs to start at the in-vivo level if even running through scenarios or imaging things in your head is enough to bring you to that moderate level of anxiety that is the target for exposure work. You can also use other resources to provide exposure. I have used flashcards of trigger words, videos, audio, and written resources to serve as stimuli for exposure work. On the in vivo exposure side, there are also options. Sometimes you are able to get exposure to the real thing yourself. In other cases, you might be doing something tangential to it or being around other people doing it. So for example, one thing you might use as an exposure exercise for blood and injection phobia is to be around other people that are getting their blood drawn, say at a blood drive. I’ve talked about this before as well, but I’ve also had someone that I was working with on pregnancy phobia go to a pregnancy yoga class. For your situation, you may need to get a bit creative. I still think there is a lot of exposure work that can be done as well as other things to make taking medication more of a possibility for you. Let’s start with the injections part, since you mentioned them at the end of your question.
Breaking things down
First off, for both of these and any exposure, it’s important to start breaking down what you are actually afraid of. I can’t give you the best advice here because I don’t know what that is. If the needle itself is a big anxiety generator for you, there are definitely some things you can do about that. You will want to go through and generate a bunch of ideas before categorizing them in terms of anticipated challenge as I describe in the course. But some ideas are watching videos having to do with injections, being around people getting injections or blood draws, having hands on time with a needle (doesn’t have to be a real one necessarily), or simulating the process of getting a shot without actually doing it.
There is also the coping skills side of things. Sometimes people are anxious about injections or any other sort of anxiety-provoking stimulus because they feel unprepared to deal with it. Many fall into what I call “the anxiety shuffle”, which is when you overestimate the likelihood of something bad happening and underestimate your capability to cope or deal with it. If this is the case, focusing on establishing better tools to deal with your anxiety or physical symptoms in the moment can be really helpful and make you feel more confident going into a situation that you know will be challenging. Remember, the goal for an injection is to get it done. It doesn’t matter if it’s a smooth process or not. You can cry, you can scream, you can hyperventilate. At the end of the day, if you get the injection, you won. The problem is the avoidance of the injection.
It doesn’t need to be perfect
Things like having a very well-practiced deep breathing exercise can help. When you KNOW you have the capability to lower the reactivity of your nervous system a bit because you’ve proven it to yourself over and over, you suddenly have a tool in your back pocket to take with you into this situation. Again, you don’t need to be totally chill and happy about it. You just need to get yourself down from a 10/10 anxiety level to like a 6 or whatever number lets you get the thing done. The idea here is that between your coping skills and your exposure work, you are able to bring your anxiety level to a tolerable point so that you can take the injection. Honestly, when it comes to things like this, I become a lot less picky about doing it perfectly. If you have to bring a loved one, put on sound canceling headphones and squeeze their hand while closing your eyes to get your injection, that’s fine. Your health is what matters here. Ideally, some work can be done to make it less of a torture for you each time, but the bottom line is getting the injection.
Focusing on meds
When it comes to medications that you take orally, that’s a little more tricky. One of the things about oral meds is that if you can stay consistent for a period of time, it has a build in exposure element where it does become easier and a lot of your fears will become reduced because you aren’t dead or experiencing serious side effects. With oral medications, this again really comes down to what exactly you are anxious about. For some people, it’s about the swallowing aspect or just the thought of pills in general. For yourself, you mentioned that you definitely have a component linked with the fear of side effects. Is there a reason for this? You’ll want to think back about whether this has ALWAYS been the case for you or if the phobia emerged at a certain time. Were you able to use medications as a kid before you had some sort of reaction or adverse event? Did you see a loved one suffer from what seemed to be medication-related effects? This will help you zero in on your thought process and emotions behind the phobic response.
This is probably obvious, but working with an individual therapist specializing in anxiety disorders and phobias would be the best way to dig into this and to get creative/specific with the treatment. There are some things you can do if the actual act of taking pills freaks you out. For example, getting used to taking mild supplements or sugar pills can be a good stepping stone to normalize the experience of taking things regularly. You can use pills and pill bottles in general as a stimulus.
Analyse the evidence and potential gains
On the side-effect side of things, you will probably have to do some cognitive work here. First off, there may be misinformation or irrational thinking that is a part of what is fueling your fear about medications. It is so very rare for someone to have such an extreme reaction to routine medications that it can’t be caught and treated. Most medications have some degree of side effects, that’s just how biology works. Most of them are really not that bad. Even the bad ones can sometimes be adjusted for. Other ones will be reason enough to discontinue a medication. There are so few circumstances where you are going to have an emergency situation. If this is not convincing for you, you can spend some time reading literature and learning more about the medications that you will be taking. You can also obviously talk to your doctor or pharmacist about your concerns and have them clarify.
When it comes to getting started, you can also adjust the approach. Some people find that it’s helpful to take their first doses with support. This can be done at the pharmacy, at a doctor’s office, or simply with loved ones who are watching your back and are available to intervene in an emergency situation. Ideally, this is an assist that you would fade over time. Rather than focus so much on the difficulty and the anxiety about taking the medication and possible bad consequences, you can also make a point to spend time focusing on the potential positives. What do you have to gain from this medication? From what you described about your situation, you have probably been struggling for some time now. What if you could gift yourself the ability to live and work in a way that isn’t so difficult? What would you be able to accomplish? How could you be good to yourself? How could you better help others? Even if there was the potential of side effects, could it be worth having them or at least trialing to see if more serious side effects are there so that you can try out the possibility of having a freer life?
I hope these thoughts are helpful for you. If you feel like you need additional help, please find a good therapist to work with. You likely wouldn’t need to work with them for a very long time. Just to get in the swing of things. I believe in you!
You can listen to this on Episode 319 of the podcast!
Thank you for the great question!
If you know someone else who might benefit from this, please do share it with them. Send them a link or shoot over a screenshot, and share it on social media to show your support – you never know who needs to hear this type of information.
Got a topic or a guest you’d like to appear on the show? Or interested in having Duff answer a question on the podcast? Please get in touch! Email Duff and maybe you’ll hear it on a future episode!
Want to help out the show and Duff the Psych?
- Subscribe to the podcast on iTunes.
- Leave a podcast review on iTunes. These reviews really help Duff reach potential listeners, and he appreciates every one!
- Share the show on Facebook or Twitter.
- You can also buy Duff a cup of coffee, which helps fuel the energy that goes straight back into creating more content for YOU!