Applied Tension Treatment of Vasovagal Syncope during Pregnancy

Military Medicine, Sep 2004 by Peterson, Alan L, Isler, William C III

The next phase of the treatment session was conducted in the immunization clinic of the hospital. Initially, the patient was asked to remain seated while watching others receive injections. While the patient was observing the first injection, her SUDs level quickly increased to a 9. With vigorous encouragement, she used the applied tension and successfully avoided a syncopal episode. During subsequent observations, her SUDs level never increased above 3. After watching five patients receive injections, the patient moved to the hospital laboratory to observe patients having their blood drawn. She observed 12 blooddrawing trials without experiencing a syncopal episode, using the applied tension technique as needed. The patient then reported that she was confident she could have her own blood drawn. She successfully underwent a blood draw and reported that her SUDs level had reached only a 3. The patient reported that she was confident she could undergo more such tests in the future.

A follow-up visit with the patient 6 months later indicated that she had successfully delivered her child and had undergone numerous injections, blood draws, and other medical procedures without experiencing a single syncopal episode. In most cases, she no longer needed to use the applied tension technique because exposure to the needles did not trigger the syncopal symptoms. She did note that the first set of four immunizations received by her new infant led her to feel as if she were going to faint. However, she was again able to use the applied tension technique to avoid syncope. The patient reported that subsequent immunizations of her child were somewhat anxiety provoking but did not require her to use the applied tension technique to prevent syncope.

Discussion

This case study reports the successful use of behavioral treatment for blood phobia with vasovagal syncope. The case is noteworthy because it is the first published report of the use of applied tension for treatment of vasovagal syncope during pregnancy. After completion of the treatment, the patient was able to undergo numerous medical procedures involving exposure to needles, with significantly reduced anxiety and no episodes of syncope.

Applied tension is an effective and relatively inexpensive treatment for patients with vasovagal syncope related to injection phobia. The use of applied tension for other types of syncope, not related to injection, blood, or injury phobia, has not been evaluated. Previous research suggested that the pathophysiological features of vasovagal syncope related to blood/ injury phobia might be similar to those of syncope related to a variety of other medical conditions. One study found that 82% of patients with vasovagal syncope related to blood/injury phobia demonstrated positive head-up tilt table test results.9 It is not known whether the applied tension treatment approach may be useful as an adjunct or alternative to medications or cardiac pacing for other types of syncope. Additional research is needed to assess the potential application of applied tension treatment to other cases of syncope.