Applied tension

Domain II · Behavioural & cognitive · Lars-Göran Öst, Ulf Sterner · 1987 · Sweden

What it is

Applied tension is a brief, skills-plus-exposure treatment for people with blood, injury or injection (BII) fears who faint or nearly faint. Most phobias show only rising arousal. BII phobia often shows a biphasic response: heart rate and blood pressure first rise, then drop sharply (vasovagal…

Format

• Phases. Session allocation follows secondary descriptions of the five-session format.
• The one-session format packs phases 1, 3 and 4 into a single long session. Home practice and maintenance then carry the rest].

Who practises it, and how they are trained or regulated

• Format: individual, outpatient. Original version: 5 sessions of about an hour, plus a self-exposure maintenance programme. Compressed version: one longer session, which Hellström et al. (1996) found to work about as well as five. AT has also been delivered as a one-session large-group format, with about 20 minutes of tension training inside a session of about 160 minutes. A therapist demonstrated the technique, and…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• cognitive work turning into a way to avoid exposure.
• high disgust ratings that are not falling. Extend exposure rather than moving on.
• missed practice (see section 5); practice done lying down only; headaches building up across the day.
• the client stiffening the target arm without meaning to; the procedure being harder for the clinician.
• fatigue; the skill being under-practised before high-risk items. Build in rehearsal cycles throughout.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.