Managing Self-Injection Difficulties in Patients With Relapsing-Remitting Multiple Sclerosis

Darcy Cox; Jerome Stone


J Neurosci Nurs. 2006;38(3):167-171. 

In This Article

Autonomic Reaction, the Anxiety Response, and Development of Phobic Symptoms

Autonomic reaction refers to a number of physical changes, including increased respiratory rate or hyperventilation, palpitations, flushing, and gastrointestinal disturbance, which most frequently occur in response to anxiety-provoking or potentially dangerous stimuli. These physiologic reflexes depend greatly on cognitive interpretation. For example, people who enjoy riding roller coasters experience these physiologic changes as they ride but interpret them as "excitement" or "an adrenaline rush." People who have self-injection anxiety and phobia interpret these sensations, when they occur before injection, as a cue that something dangerous is about to happen. This feeling increases their physiologic arousal level, which produces an even stronger emotional feeling that something bad is going to happen. The result is a spiral of increasing experienced anxiety and physiologic arousal. The physiologic responses and the experience of anxiety frequently are reduced only when the patient avoids self-injecting. Thus, the experience of reducing autonomic reaction through avoidance reinforces avoidance: "I felt terrified and awful, so I didn't inject.... If I try to inject again, I will only feel even more terrified and awful."

The experience of autonomic reaction both punishes attempts to self-inject and reinforces avoidance of injecting. This reinforcement makes it progressively more unlikely that the patient will inject or persevere in attempts to inject. Even patients who are well-educated about the safety of injections and committed to their treatment may experience an autonomic reaction. It is important to help these patients understand that physiologic sensations are not, in fact, a cue that something dangerous is about to happen.


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