AT was specifically developed for patients with blood-injury phobia and it has turned out to be the treatment of choice for this subgroup of specific phobia. In DSM-IV injection phobia is included in the same diagnostic category and about 50% of patients with injection phobia have a history of fainting in their phobic situations. For these I recommend teaching them the tension technique, but this is not enough; they also must be exposed to various injections, venipunctures, and pricking of fingers so that they acquire the skill of differential tension of the muscles (if necessary) while the nurse carries out these procedures.
Since very few patients with other anxiety diagnoses have a history of fainting when encountering their phobic stimuli there is very little need for AT in other instances. Patients with panic disorder often experience dizziness in their panic attacks, but they do not have a drop in blood pressure. Whether AT could have a beneficial effect on this subjective feeling of dizziness requires systematic research. However, there might be a risk of increasing the BP too much in patients who have a normal or elevated BP to start with.
If a patient has a diagnosed hypertension, temporal arthritis, or previous stroke one should be cautious with the tension training and assess the BP frequently to make sure that the BP does not rise to a level that is too high. However, it may be the case that blood phobic patients with essential hypertension do not react as readily with the drop in blood pressure that is characteristic of blood-phobic patients.
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