Specific phobia — structured clinical viva

This is specific phobia (animal type) with additional blood-injection-injury features and occupational impairment. Request for indefinite tablets and refusal of exposure is a common engagement problem, not a reason to abandon evidence-based care or to collude with lifelong benzodiazepines.^[1][5]

Criteria spine. Marked cue-bound fear, almost always immediate, avoided or endured with intense distress, out of proportion, typically ≥6 months, impairing — not better explained by SAD, OCD, PTSD or agoraphobia.^[1]

Why exposure first. Meta-analytic and review evidence supports psychological/exposure approaches; maintenance is driven by avoidance blocking extinction. OST (Öst) is a concrete intensive option: therapist-guided massed graded exposure with modelling and overlearning in a prolonged session.^[2][3][5][6]

BII strand. Near-fainting with blood draws → teach applied tension and integrate with graded exposure; do not lead with applied relaxation alone.^[4]

Engagement. Validate distress; reframe exposure as controlled, collaborative, stepped skill-building (not cruelty); offer choice of multi-session hierarchy versus intensive OST pathway; discuss short-term medication only as bridge with stop rules if needed — not "forever."^[3][5]