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Interventions for Individuals With High Levels of Needle Fear: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials

McMurtry, C. Meghan PhD, C Psych*,†,‡; Noel, Melanie PhD§; Taddio, Anna BScPhm, MSc, PhD∥,¶; Antony, Martin M. PhD, C Psych#; Asmundson, Gordon J.G. PhD, RD Psych**; Riddell, Rebecca Pillai PhD, C Psych¶,††,‡‡; Chambers, Christine T. PhD, R Psych§§,∥∥; Shah, Vibhuti MD, MSc¶¶,##HELPinKids&Adults Team

doi: 10.1097/AJP.0000000000000273
High Needle Fear Interventions

Background: This systematic review evaluated the effectiveness of exposure-based psychological and physical interventions for the management of high levels of needle fear and/or phobia and fainting in children and adults.

Design/Methods: A systematic review identified relevant randomized and quasi-randomized controlled trials of children, adults, or both with high levels of needle fear, including phobia (if not available, then populations with other specific phobias were included). Critically important outcomes were self-reported fear specific to the feared situation and stimulus (psychological interventions) or fainting (applied muscle tension). Data were pooled using standardized mean difference (SMD) or relative risk with 95% confidence intervals.

Results: The systematic review included 11 trials. In vivo exposure-based therapy for children 7 years and above showed benefit on specific fear (n=234; SMD: −1.71 [95% CI: −2.72, −0.7]). In vivo exposure-based therapy with adults reduced fear of needles posttreatment (n=20; SMD: −1.09 [−2.04, −0.14]) but not at 1-year follow-up (n=20; SMD: −0.28 [−1.16, 0.6]). Compared with single session, a benefit was observed for multiple sessions of exposure-based therapy posttreatment (n=93; SMD: −0.66 [−1.08, −0.24]) but not after 1 year (n=83; SMD: −0.37 [−0.87, 0.13]). Non in vivo e.g., imaginal exposure-based therapy in children reduced specific fear posttreatment (n=41; SMD: −0.88 [−1.7, −0.05]) and at 3 months (n=24; SMD: −0.89 [−1.73, −0.04]). Non in vivo exposure-based therapy for adults showed benefit on specific fear (n=68; SMD: −0.62 [−1.11, −0.14]) but not procedural fear (n=17; SMD: 0.18 [−0.87, 1.23]). Applied tension showed benefit on fainting posttreatment (n=20; SMD: −1.16 [−2.12, −0.19]) and after 1 year (n=20; SMD: −0.97 [−1.91, −0.03]) compared with exposure alone.

Conclusions: Exposure-based psychological interventions and applied muscle tension show evidence of benefit in the reduction of fear in pediatric and adult populations.

Supplemental Digital Content is available in the text.

*Department of Psychology, University of Guelph, Guelph

Children’s Health Research Institute

Department of Paediatrics, Western University, London

Leslie Dan Faculty of Pharmacy

‡‡Department of Psychiatry

##Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto

The Hospital for Sick Children

#Department of Psychology, Ryerson University

††Department of Psychology, York University

¶¶Mount Sinai Hospital, Toronto, ON

**Department of Psychology, University of Regina, Regina, SK

§§Departments of Pediatrics, Psychology & Neuroscience, Dalhousie University

∥∥Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada

§Department of Psychology, University of Calgary, AB, Canada

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HELPinKids&Adults (Help ELiminate Pain in Kids&Adults) Team: N.E. MacDonald, J. Rogers, L. Bucci, P. Mousmanis, E. Lang, S.A. Halperin, S. Bowles, C. Halpert, M. Ipp, M. Rieder, K. Robson, E. Uleryk, V. Dubey, A. Hanrahan, D. Lockett, J. Scott, E. Votta Bleeker.

Supported by the Canadian Institutes of Health Research (CIHR), Ottawa, ON, Canada (KRS 132031). Open access funding was provided by the Mayday Fund in the United States. A. Taddio declares a grant from Pfizer, and study supplies from Natus and Ferndale. C.T. Chambers declares consultation fees from Abbvie. E. Lang is a member of the GRADE working group and declares consultation fees from the International Liaison Committee on Resuscitation (ILCOR). L. Bucci declares a relationship with government agencies and grants from Merck, GSK, Novartis, Sanofi, and Pfizer. S.A. Halperin declares grants from GSK, Sanofi, Novartis, Pfizer, Merck, PREVENT, ImmunoVaccine, NovaVax, Janssen, and Folia. The remaining authors declare no conflict of interest.

Reprints: C. Meghan McMurtry, PhD, C. Psych, Department of Psychology, University of Guelph, 87 Trent Lane, Guelph, ON, Canada N1G 2W1 (e-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Received April 12, 2015

Accepted June 18, 2015

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