Facing My Needle Phobia with CBT: 10 Things I Learned as a Therapist Along the Way

Cognitive Behavioural Therapy (CBT) is a recommended treatment for phobias, and a key part of this approach is exposure—facing the feared thing in a planned, supported (and usually gradual) way.

Exposure therapy is hard, and it is effective. I’ve been using exposure in my personal life for about six years to address a needle phobia, and I just booked an appointment with the blood donors for next week. So, partly to share the science and partly to psych myself up, here are 10 things I’ve learned along the way:

1. Values Matter

Nobody is going to put themselves in a situation that causes extreme fear and anxiety without a good reason. So finding a reason that matters to you is key. I had lots of good, logical reasons to face my needle phobia over the years, but they just didn’t quite get me there.

It was only during my CBT training that I realised I didn’t want my own phobia to get in the way of being able to offer effective treatment to others. That was the motivation that led me to make my first appointment—and it worked because it felt important to me at that time.

2. Exposure Allows You to Learn Something New

Exposure isn’t just about doing something repeatedly until you get used to it. The fear reduces when you learn something new about the situation or object.

That’s why, in CBT for phobia, we often work first with your thoughts, to help you feel ready to begin exposure. Sometimes, we know something in our mind but don’t really believe it in our body. This is because we learn most powerfully through experience; and that’s why working with your thoughts alone usually isn’t enough. We need to learn through action too.

When I first gave blood, I learned that nothing dangerous happened, that I can tolerate really high levels of anxiety, and that I can choose to do what matters to me, even when I’m anxious.

3. Celebrating Your Success Is Important

Not just because you deserve it (and you do!), but because it helps to strengthen the new beliefs you are trying to establish. By making positive associations with the feared situation, you add weight to the idea that it is safe, manageable, or even good.

4. You Have to Repeat the Exposure

This one hit me after my first donation. Usually in CBT, we build up exposure gradually because it’s more manageable that way. But the bigger the difference between what you predict and what happens, the more impactful the learning experience.

So, the most effective exposure will be the scariest thing that’s still manageable for you. You still want to set yourself up for success.

After my first blood donation, I felt a huge wave of relief—which told me the fear was still there, and I had more learning to do. I’m proud of that version of myself, but I now realise that expecting one exposure to "cure" me was unrealistic.

5. No One Will Think Badly of You for Being Anxious in Public

And if they do, it really doesn’t matter. I’ve cried twice at the blood donors. Most people didn’t notice, and the few who did, offered kind words or said nothing.

6. Progress Isn’t Linear

When I first started exposure, I assumed it would get easier each time. And it sort of has - if I zoom out.

There are lots of things in life that contribute to our stress and our ability to face challenges. This means that there have been times when showing up to the blood donors has felt too much. I had to use my energy elsewhere. I could beat myself about that, I’ve had the thought that “if I don’t do this today, I’ll be back to square one”. But that’s not true, or helpful.

When I keep an eye on the bigger picture, I can give myself grace and commit to doing what I can, when I can. Giving blood has become easier over time, even if I can’t always do it. And now, how I feel about giving blood can be a helpful check-in with myself, it tells me how stressed I might be in other areas of life.

7. White-Knuckling Doesn’t Work

And yet, it’s what helped me show up sometimes.

To learn something new, it helps to stay open and curious. If you can stay present and allow your feelings to exist, rather than push them away, exposure will be more effective. If you can’t do it perfectly, try to do it anyway. Every bit adds up.

8. Coping Strategies Can Help

If you know that taking deep breaths, bringing a friend, or chatting about holidays will help you stay in the situation, it’s okay to do those things.

Try to pivot your attention between your coping strategy and the feared experience. This will maximise learning. And whenever possible, try to let go of your coping strategies so they don’t become safety behaviours (more about that in a future blog). Know that you can always return to them if needed.

9. I Can Do Hard Things

And I can feel positive emotions alongside fear. I still feel anxious when I go to the blood donors. I also feel grateful towards my past self for showing up, making it easier for me today. I feel proud of myself for acting with courage. And I feel glad that I can do something that helps other people.

Avoiding negative emotions often means shutting ourselves off from the positive ones too.

10. Exposure Works

I still feel anxious when faced with needles. Therapy doesn’t get rid of unpleasant emotions. It teaches us how to live with them. And that often softens them.

Importantly, that anxiety no longer gets in the way of how I choose to live my life.

My blood donor badge, recieved after my 5th donation - a small symbol of big personal growth

Are phobias holding you back? 

You don’t have to face it alone. Please reach out if you’d like to discuss evidence-based treatment like CBT to help you move forward.

👉 Get in touch today to book a free 15mins consultation and take the first step toward living life on your terms.