Blood-injection-injury phobia differs from other specific phobias because it is associated with parasympathetic arousal. Applied tension, designed specifically for blood-injection-injury phobia, requires the patient to tense different muscle groups instead of relaxing them, thereby countering parasympathetic arousal. The first trial of applied tension(l22) demonstrated that persons with phobias for blood, wounds, and injuries responded equally well to applied tension, applied relaxation, or their combination. A later study demonstrated that a higher percentage of persons treated with applied tension were clinically improved post-treatment and at 1-year follow-up than were patients treated with in vivo exposure alone.(l23) Similar positive effects were reported for those treated with one versus five sessions of applied tension.(124)
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