Peter Mackereth provides three rapid ‘toolbox’ interventions to help take the stress out of receiving a vaccination.
April is Stress Awareness Month and this is a great opportunity for therapists to contribute to helping friends, family, colleagues and clients/patients at this significant time in all our lives. With approaching 130,000 lives lost in this pandemic and over 30 million people now vaccinated in the UK, we can as therapists dig into our ‘therapeutic toolbox’ and assist others to ease stress and promote calm.
As we work through providing vaccinations to the rest of the population to protect them against COVID-19 disease and reduce transmissibility, the issue of needle anxiety and phobia has come into, excuse the pun, sharp focus. (By the way, my absolute number one tip to all vaccinators – and acupuncturists – is to never use the phrase ‘sharp scratch coming’ – it only causes people to tense more.) I worked as a nurse at a major vaccination centre in Manchester, which sees approximately 3,000 people a day – the staff are brilliant at putting people at ease and we are all sharing our own top tips.
Importantly, attending for vaccination can also be exciting, with people typically saying; ‘I really want to get this done and get back to normal’. Others, particularly those who have been shielding, can be overwhelmed and anxious about the experience. For approximately 10% of the population, needle anxiety and distress can create enormous stress and may even deter attendance for a vaccination. An even smaller group, less than 2% of the population, can experience needle phobia, or trypanophobia, to give it its correct term. Needle phobia is typically described as an overwhelming fear of injections, resulting in a vasovagal episode or a faint, triggered when seeing or being in close proximity to a medical needle. Context is everything, so for example, needle anxiety/distress, and even needle phobia, may not necessarily be triggered by tattooing or piercing.
Rapid ‘toolbox’ interventions
In my video, ‘Stay calm and vaccinate’, which is about staying calm while being vaccinated, I look at three rapid ‘toolbox’ interventions for you to share with your clients, friends, family and colleagues. These techniques can be used individually, so there is the option to test them all and select a preference or they can be stacked together, one after another, to work synergistically. Ideally, you can practice them ahead of a vaccination (or other stressful situation, e.g. public speaking) or whilst queuing, or even discreetly, when receiving your vaccinations (don’t forget the second dose).
1.The Mudras Position
The thumb area is associated with reflex points for the brain and pituitary gland, with gentle pressure associated with a calming response. Bringing the thumb and first finger together is also used in yoga postures and Indian dancing. In clinical hypnotherapy, I often use it to anchor confidence, good feelings and helpful interventions, so the steps or instructions are:
First, on both hands, bring the tips of your thumb and first finger together (see Picture 1) and I now invite you to take in a comfy breath. The pressure should be sufficient to lightly blanch the nails (make the nailbeds go white). As you take a gentle slow breath out, lighten the pressure. And when you are ready begin to take another comfy breath in, tighten the pressure again between the thumb and first finger. Now, as you soften the pressure between the thumb and first finger, release the outbreath gently… letting go of any tension in your shoulders and arms. Now, for the third time, repeat the technique, taking a comfy breath in and a slower breath out. On the fourth cycle of tensing and then letting go with the outbreath, just notice the lottery numbers coming into your mind’s eye (humour interrupt*) … continue to fifth press and release… now practice this at home, then in the queue and then whilst actually receiving the vaccination.
*Humour interrupt works to cut across anxiety and tension and can be very useful, but any comical idea most not make light of how someone is feeling or what they are going through.
2. Tightening and releasing the feet and ankles
This technique is derived from a longer progressive muscle relaxation (PMR) training protocol – I call this a mini PMR. The technique involves combining a comfy breath in during tensing of the feet and an elongated breath out when letting go of tension in the feet (see Pictures 2 & 3). It is useful to focus on the feet as this can be done discreetly, whilst sitting, and without disturbing the arm receiving the vaccination. The instructions are:
Bring your attention to your feet and gently draw them towards you, so that you feel tension in your feet, ankles and even calves (see Picture 2 & 3). Now, take a comfy breath in as you hold the tension momentarily. And now, very gently and slowly, lessen the tension as you release a longer outbreath, letting the feet soften and sink fully to the ground. With the second breath in, repeat the tensing of the feet, drawing them towards you, and then release the breath slowly and allow your feet to soften and return fully to the floor. (As with the first technique, you can guide the person to complete five cycles and include the humour interrupt suggestion, if appropriate.
3. Aromastick using ‘3 Breaths to Calm’
For those qualified aromatherapists who are able to blend and provide aroma sticks, these portable inhalers are great for engaging anxious clients via a simple to learn ‘3 Breaths to Calm’ technique. I would recommend including a citrus oil (e.g. lemon) within your proffered blends. Many aromatherapists will offer a choice of pre-prepared blends – perhaps three – so a patient experiences the empowering process of making a personal choice.
Including a citrus oil within an essential oil blend can be calming, but importantly it encourages a moist mouth. A dry mouth is associated with anxiety and distress, so banishing it can support a sense of calm. As with the previous rapid ‘toolbox’ techniques, the client is encouraged to take in a calming aroma breath using the inhaler (see Picture 4) and then breathes out more slowly, again letting go of tension each time. The client can be encouraged to reflect on the aromas and any pleasant memories that might emerge, for example, an association between the aroma and a holiday or a garden visit.
4. Calming aroma stick breath
For those situations where an aroma stick is unavailable or outside of the therapist’s scope, the inhaler technique can be replaced by the client by taking three soothing, mindful sips of cool water, pausing between
As therapist I would encourage you to practice the techniques for yourself, maybe select your preferred option and a back-up for a suitable situation that might require a calming intervention(s). As with any new skill, its benefits come with repeated use, particularly outside of a stressful situation so that you can fine tune the activity. Teaching someone else will reinforce the skill and provide further feedback on its acceptability and usefulness as a therapeutic tool.
Peter Mackereth is an honourable lecturer and researcher at The Christie Hospital, Manchester, where he was formerly the complementary therapy lead; a volunteer complementary therapist as his local hospice; an international speaker and author of numerous papers and books; and a registered nurse, currently helping to provide more than 3,000 COVID-19 vaccines at a vaccination centre in Manchester. You can find videos made by Peter on his YouTube channel, Peter the Pandiculator.
Carter A Mackereth P (2019) Combining Touch and Relaxation Skills for Cancer Care: the HEARTS process Jessica Kingsley Publications. London.
Carter A Mackereth P (2017) Aromatherapy, Massage and Relaxation in Cancer Care: An Integrative Resource for Practitioners. Jessica Kingsley Publications. London
Cawthorn A Mackereth P (2010) Integrated hypnotherapy: a complementary approach to clinical practice. Elsevier Science.
Mackereth P Carter A Maycock P (2020) Aromasticks and aromatic memories: a HEARTS Process approach to installation. Aromatherapy Times IFA 124:38-41
Mackereth P Tomlinson L (2016) Considering the relationship between the needle, patient and cannulators. British Journal of Nursing. 25 (2) 2-3.
Mackereth P Hackman E Knowles R Mehrez A (2015) The value of stress relieving techniques. Cancer Nursing Practice. 14(4): 14-21.
Mackereth P Tomlinson L (2014) Procedure-related anxiety and needle phobia: rapid techniques to calm. Nursing in Practice. 80:55-57.
Mackereth P, Tomlinson L Orrett L Manifold J Hackman E (2012) Needle with Ease: rapid stress management techniques British Journal of Nursing. 21(14): S18-22.
Tiran D Mackereth P (2010) Clinical Reflexology. 2nd Edition. Elsevier Science