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Background: Vasovagal reactions (VVRs) are the most common acute complications of blood donation. Responsible for substantial morbidity, they also reduce the likelihood of repeated donations, and are disruptive and costly for blood services. Although blood establishments worldwide have adopted different strategies to prevent VVRs (including water loading and applied muscle tension [AMT]), robust evidence is limited. The Strategies to Improve Donor Experiences (STRIDES) trial aims to reliably assess the impact of four different interventions to prevent VVRs among blood donors. Methods: STRIDES is a cluster-randomised cross-over/stepped-wedge factorial trial of four interventions to reduce VVRs involving about 1.4 million whole blood donors enrolled from all 73 blood donation sites (mobile teams and donor centres) of National Health Service Blood and Transplant (NHSBT) in England. Each site (“cluster”) has been randomly allocated to receive one or more interventions during a 36-month period, using principles of cross-over, stepped-wedge and factorial trial design to assign the sequence of interventions. Each of the four interventions are compared to NHSBT’s current practices: (i) 500ml isotonic drink before donation vs current 500ml plain water; (ii) 3-minutes rest on donation chair after donation vs current 2 minutes; (iii) new modified AMT vs current practice of AMT; and (iv) psychosocial intervention using preparatory materials vs current practice of nothing. The primary outcome is the number of in-session VVRs with loss of consciousness (i.e., episodes involving loss of consciousness of any duration, with or without additional complications). Secondary outcomes include all in-session VVRs (i.e., with and without loss of consciousness) and delayed VVRs (i.e., those occurring after leaving the venue). Discussion: The STRIDES trial should yield novel information about interventions, singly and in combination, for the prevention of VVRs, with the aim of generating policy-shaping evidence to help inform blood services to improve donor health, donor experience, and service efficiency. Trial registration: ISRCTN: 10412338

Background: Fear of blood donation is implicated in vasovagal reactions, donor recruitment, and retention. This study examined the extent to which fear among donors is associated with various donor outcomes in an Australian sample, and whether fear can be addressed on-site to reduce adverse reactions and improve the donation experience. Study design and methods: Six hundred and sixty-four donors (age M = 33.4, SD = 12.7; 55% female) participated in a two-center, pragmatic, parallel group, individually randomized controlled trial. Following donor registration and consent, whole-blood (n = 539) and plasma (n = 125) donors were assigned to one of four Conditions: control; fear assessment; fear assessment + brochure; fear assessment + brochure + tailored conversation focused on any self-reported fear and coping strategies. Post-donation questionnaires assessed the donors' experience including positive support, donor self-efficacy, anxiety, fear, venipuncture pain, and vasovagal reactions. Results: Fear among donors predicted higher venipuncture pain, post-donation anxiety, and vasovagal reactions and remained significant after controlling for other established predictors (i.e., total estimated blood volume, age, sex, and donation experience). Mediational analyses showed that exposure to brochures (with or without the tailored conversation) was associated with less pain, with this effect mediated by donor perceptions of more positive support. Venipuncture pain was also associated with vasovagal reactions, reduced likelihood of return within 6 months, and less satisfaction with the donation experience. Conclusion: The current results underline the importance of interventions to address fear among both whole-blood and plasma donors to secure the safety and well-being of donors and the blood supply.

Blood donor recruitment remains an important worldwide challenge due to changes in population demographics and shifts in the demand for blood. Various cognitive models help predict donation intention, although the importance of affective deterrents has become increasingly evident. This study aimed to identify fears that predict donation intention, to explore their relative importance, and to determine if self-efficacy and attitude mediate this relationship, thus providing possible targets for intervention. A total of 347 individuals (269 nondonors and 78 donors) living in Quebec responded to questionnaires assessing medical fears, psychosocial factors related to donation intention including the Theory of Planned Behavior (TPB) constructs, anticipated regret, and facilitating factors (i.e., time commitment and rewards). To examine the relative importance of these factors in the context of blood donation, the same questions were also asked about other medical activities that involve salient needle stimuli: flu vaccinations and dental examinations. Medical fears, especially blood-related fears, were significantly associated with donation intention. Bootstrapping tests confirmed that this relation was mediated by attitude and self-efficacy. Underlining the importance of medical fears in the blood donation context, these fears were not associated with attitudes and intentions for dental examinations or flu vaccinations. These results suggest that medical fears, especially blood-related fears, play a key role in predicting donation attitudes and intentions. Mediational pathways provide support for interventions to improve donation intentions by addressing specific fears while also improving a donor's belief in his or her ability to manage donation-related fears.

The overprediction and underprediction of fear, pain, and other constructs have been linked with etiology and maintenance of anxiety disorders. We aimed to extend this research to depression by investigating the overprediction of effort and the underprediction of reward and enjoyment associated with a simple task. Participants with depression (n = 20) and a control group (n = 40) predicted how much effort and reward/enjoyment would be experienced during a short walk around the university. Post-walk, participants reported the actual effort required and the actual experienced reward and enjoyment. Compared to the control group, who demonstrated accurate predictions, depressed individuals significantly overpredicted the required effort associated with the walk even though there were no between-group differences in actual effort required. There was no evidence to suggest that the depressed group underestimated or were inaccurate in their predictions of walk-related reward and enjoyment relative to the control group. Implications for cognitive and behavioral approaches to depression are discussed.

Background and objectives Moral threats, including threats to moral self-worth, have been associated with contamination concerns. Paradoxically, although self-cleansing provides temporary relief, it can worsen feelings of contamination. Self-affirmation might be an effective strategy, especially following obsessive type cognitions (e.g., responsibility beliefs) when moral threats are reactivated. Methods In Experiment 1, participants recalled an immoral deed and then self-cleansed (using a hand-wipe), completed a control task, or self-affirmed. Contamination concerns were subsequently measured by a washing task. In Experiment 2, the same procedure was used but obsessive-type cognitions were activated by asking participants a series of questions about obsessive beliefs. Results As expected, relative to the control condition, both self-affirmation and self-cleansing resulted in less subsequent repeated washing behaviour in Experiment 1. In Experiment 2, when the immoral recall was followed by activation of obsessive-type cognitions, self-cleansing led to more guilt and repeated washing than self-affirmation and control. Rather than alleviating feelings of contamination, physical self-cleansing led to more contamination concerns and guilt when in the context of activated obsessive-type cognitions, possibly because it paradoxically makes (moral) cleanliness goals salient. Limitations Future research needs to test clinical populations, for whom contamination concerns are all the more central. Conclusions This research provides further evidence of the influence of moral threat in contamination concerns, and the limits of moral cleansing. Self-affirmation resulted in less contamination concerns under both a neutral condition and activated obsessive type cognitions.

This study aimed to evaluate the relative contribution of psychosocial variables to donation behavior in a sample of primary healthcare users in a Brazilian municipality. Donor recruitment and retention continue to pose significant challenges to blood collection services worldwide and is especially important among low and middle income countries (LMICs), challenged with higher rates of stigma and low public awareness about donation. A cross-sectional study with randomized stratified sampling of 1055 primary healthcare users was conducted across 12 healthcare facilities in Ribeirao Preto, state of Sao Paulo. Participants completed measures assessing psychosocial variables, including religiosity, knowledge regarding blood donation process, overall quality of life, blood donation of peers, sociodemographic variables, and the fear of blood, injections, and fainting. The associations between psychosocial variables and donation behaviour was examined using structural equation modelling. Blood donation was more frequent in males and among individuals with higher socioeconomic and educational levels. The structural model indicated associations between blood donation behaviour and fear, knowledge, age, sex, socioeconomic status, and educational level. Fear of blood, injections and vasovagal reactions, and a lack of knowledge of the donation process were revealed as important barriers to the decision to donate blood. In addition, there is evidence that considering the population of primary healthcare users, the women, the youngers, and those with lower socioeconomic status and lower educational level are less likely to donate blood.

Political ideologies have also exploited this powerful symbol. “Blut und Boden” (i.e., “Blood and soil”) was an ideology supported by the Nazis that referred to the belief of an important and even mystical tie between ethnic descent and territory. According to this ideology, progress for the Country meant “keeping the blood pure” by rejecting those who are inferior by maintaining and promoting “proven blood” (Lovin, 1967: 285). In contrast, many cultures also associate strong feelings of danger and pollution with almost everything blood-related: a slain enemy, corpses, childbirth, menstruation, and so on (Douglas, [1966] 2002). Exceptions can of course be found, and this should not be unexpected given that these constructs, as Douglas argued, are largely socially constructed. Importantly, regardless of the meaning associated with blood, its valence is usually quite strong, often evoking dramatic reactions. There is probably something innate to our fascination with blood because it is such a universally powerful symbol, regardless of whether it is a symbol of purity, danger or pollution. Blood’s powerful symbolism is perhaps unsurprising when considering its direct links with basic human drives: security and predation.

Vasovagal reactions (VVR) are common, complicating and deterring people from various medical procedures. A recent perspective (R. R. Diehl, ) suggests that VVR developed from the adaptive process of hemorrhagic fainting, perhaps as a means of preparing for anticipated blood loss. The primary goal of this study was to compare vasovagal symptoms during intravenous-injection and blood-draw videos. Sixty-two young adults watched the videos. Vasovagal symptoms were assessed with self-report, blood pressure, and heart rate variability. As predicted, participants reported more vasovagal symptoms and anxiety following the blood-draw video. Sympathetic nervous system activity (low- to high-frequency ratio) decreased during both videos but significantly more during the blood-draw video, although this could be reversed by the Applied Tension technique. Results are discussed in terms of the relevance of specific stimuli and emotions in VVR.

Background and objectives The vasovagal response demonstrates a unique form of stress response, common in medical settings yet provoked by a variety of blood-injury-injection stimuli. This study aimed to better understand the psychophysiological mechanisms of the vasovagal response.. Methods 16 undergraduates with and 42 without a self-reported history of fainting watched five 3–5 min videos with different emotional content. One documentary clip (Neutral condition) described a campus environmental project while another (Blood/Injury) depicted portions of an open heart surgery. Three additional clips were also used, including Medical, Threat, and Contamination stimuli. Vasovagal symptoms and physiological variables were assessed during each video. Results As predicted, while the disgust-related stimuli (Blood/Injury, Medical, Contamination) were associated with generally lower heart rate, the Blood/Injury video produced the highest symptoms and the only significant difference between previous fainters and non-fainters. The physiological measures also revealed that participants with a fainting history experienced higher stroke volume and lower systolic blood pressure throughout, as well as several main effects of video. Limitations An additional decrease in systolic blood pressure and respiration produced by watching the Blood/Injury video may have been sufficient to trigger symptoms in some, though results also suggest that systemic variables do not entirely explain susceptibility to symptoms. More careful evaluation of regional blood flow may be required. Conclusions Participants who had previously experienced strong vasovagal responses displayed what appeared to be an anticipatory response to the Blood/Injury video. Finally, disgust stimuli may reduce heart rate but do not appear to contribute to vasovagal symptoms.

Memory phenomena associated with obsessive-compulsive disorder (OCD) have received increased attention in the recent literature. Some debate remains about whether OCD is characterized by deficits in memory per se, or by poor memory confidence. Following from a recent study that demonstrated memory distrust results from repeated checking of a virtual computerized stove, we asked 50 undergraduate students to repeatedly turn on, turn off and check either a real kitchen stove (relevant checking) or a real kitchen faucet (irrelevant checking) in a standardized, ritualized manner. All participants completed a final check of the stove following these 19 checking trials. Results indicated that following repeated relevant checking, participants reported significantly reduced memory confidence, vividness and detail. Repeated irrelevant checking did not produce these decreases. Results are discussed in terms of cognitive-behavioural formulations of OCD and in terms of the effects of repetition on memory and metamemory.

The vasovagal response (VVR) is a common medical problem, complicating and deterring people from various procedures. It is an unusual stress response given the widespread decreases in physiological activity. Nevertheless, VVR involves processes similar to those observed during episodes of strong emotions and pain. We hypothesized that heightened perceived control would reduce symptoms of VVR. Eighty-two young adults were randomly assigned to perceived control or no perceived control conditions during exposure to a stimulus video of a mitral valve surgery, known to trigger VVR in non-medical personnel. Perceived control was manipulated by allowing some participants to specify a break time, though all received equivalent breaks. Outcomes included subjective symptoms of VVR, anxiety, blood pressure, heart rate, and other measures derived from impedance cardiography. Compared to participants with perceived control, participants with no perceived control reported significantly more vasovagal symptoms and anxiety, and experienced lower stroke volume, cardiac output, and diastolic blood pressure. Participants who were more fearful of blood were more likely to benefit from perceived control in several measures. Perceived control appears to reduce vasovagal symptoms. Results are discussed in terms of cognition and emotion in VVR.

This study examined autonomic and hemodynamic processes associated with the development of naturally occurring vasovagal responses. Data from a study assessing the physiological correlates of an intervention to reduce vasovagal responses in blood donors were examined (Ditto et al., 2009). Ninety-eight participants were assigned randomly to groups that either practiced applied tension or not. Dependent variables included ratings of vasovagal symptoms, heart rate, blood pressure, and other parameters derived from ambulatory impedance cardiography. Participants who subsequently experienced vasovagal symptoms had a lower ratio between low and high frequency components (LF/HF HRV) of heart rate variability (HRV) before blood donation, suggesting lower sympathetic nervous system activity. They also showed sharper decreases in total peripheral resistance and lower respiration rates. The results suggest that vasovagal reactions that begin during anticipation of a medical procedure may be characterized by an inhibitory process from the outset and do not support the belief that reactions follow a diphasic pattern.

Vasovagal reactions (VVR) are common, complicating and deterring people from various medical procedures. A recent perspective (R. R. Diehl, ) suggests that VVR developed from the adaptive process of hemorrhagic fainting, perhaps as a means of preparing for anticipated blood loss. The primary goal of this study was to compare vasovagal symptoms during intravenous-injection and blood-draw videos. Sixty-two young adults watched the videos. Vasovagal symptoms were assessed with self-report, blood pressure, and heart rate variability. As predicted, participants reported more vasovagal symptoms and anxiety following the blood-draw video. Sympathetic nervous system activity (low- to high-frequency ratio) decreased during both videos but significantly more during the blood-draw video, although this could be reversed by the Applied Tension technique. Results are discussed in terms of the relevance of specific stimuli and emotions in VVR.

INTRODUCTION/RESULTS: This study examined whether a belief of significant blood loss may be associated with vasovagal symptoms, irrespective of actual blood loss. Individual differences in vasovagal symptoms among blood donors who had an equivalent amount of blood withdrawn were significantly associated with their rating of perceived blood loss.The anticipation or belief of blood loss, and perhaps more remotely associated ideas, may trigger processes similar to those induced by actual hemorrhage though further research is required to address other possibilities such as the inflation of ratings by vasovagal symptoms.

A recent theory proposes that emotional fainting developed from an earlier adaptive characteristic, fainting in response to hemorrhage. Despite potential loss of consciousness, a dramatic decrease in blood pressure improves chances of survival in animals with severe wounds by reducing blood loss and facilitating clotting. Humans may have developed the characteristic of emotional fainting as a response to anticipated blood loss. This idea suggests that people with stronger fears of blood should be especially susceptible to fainting and milder vasovagal symptoms such as dizziness and lightheadedness. Two samples of young adult blood donors (N = 276 and 663) who completed the Medical Fears Survey (MFS) were studied. Items from the MFS related to fears of blood, needles, and mutilation were used to predict self-reported dizziness and nurse-initiated treatment for vasovagal reactions. In both samples, fears of experiencing or seeing blood loss were more closely associated with both subjective and objective measures of vasovagal reactions, despite the fact that other fears (e.g., fears related to needles) were more common overall. Better understanding of the mechanisms of vasovagal reactions has both theoretical and clinical implications, such as improving means of coping with invasive medical procedures.