Going to try this out along with my exposure therapy. Applied Tension (AT) Applied Tension (AT) is the name of the behaviour therapy approach developed by Öst, based on earlier work by Kozak & Montgomery (1981). The rationale for Applied Tension is that through gradual practice the client learns to spot the earliest signs of their blood pressure decreasing and to use special “coping skills”, involving tensing muscles, to counteract this by raising their blood pressure slightly, i.e., training their body to do the opposite of what normally happens until this becomes habitual. The tension coping skill therefore targets the second phase of the “biphasic” blood phobia response, i.e., the sense of fainting rather than the initial anxiety. This is combined with exposure to a range of feared blood-related situations, termed “exposure therapy”, which is a well-established form of behaviour therapy for phobia, and therefore targets the initial anxiety response that usually precedes the sense of feeling faint. In extreme cases where actual fainting seems likely, the subject may lie down on a couch during exposure as this normally prevents them losing consciousness. The steps of Applied Tension are as follows, An assessment of the problem is carried out and the sequence of sensations is discussed, e.g., anxiety, dizziness, sweating, nausea, faintness, etc. A simple tension “coping skill” is demonstrated by the therapist and then copied by the client. Seated in a chair, the muscles of the arms, chest, and legs are tensed until a slight feeling of warmth develops in the face, which usually takes 10-20 seconds, and signals an increase in blood pressure. The tension is released to return to a normal physical state, but no attempt is made to relax further than normal. After a brief, 20-30 second, pause this is repeated, about five times in total during a session, and five sets of five repetitions are completed each day for homework. At the second session, after a week of practice, the therapist begins systematically “exposing” the client to anxiety-provoking images of blood, etc. When the client notices the first sensations of faintness they immediately employ the tension coping skill above to prevent their blood pressure from decreasing. During subsequent sessions, and as homework, the client progressively faces more difficult situations, while using their tension coping skill. After the fifth session, the client continues to make an effort to face specific feared situations for at least the next 6 months, to maintain their improvement.