Injection phobia is a “specific phobia” (American Psychiatric Association, 1994) in which affected individuals display an atypical physiological response pattern resulting in vasovagal hypotensive fainting on prolonged exposure. Between 50–60% of people with injection phobia report a history of fainting when confronted with their phobic situation. Applied tension has been demonstrated to be an effective therapeutic intervention for blood phobia in which similar vasovagal responses occur (Öst, Fellenius and Stelner, 1991). It has been shown that cognitive factors can prevent engagement with the treatment of phobic disorders. A case meeting DSM-IV criteria for specific phobia, blood-injection-injury type (American Psychiatric Association, 1994) is described. It illustrates that cognitive factors may prevent full compliance with applied tension and that behavioural experimentation is a useful strategy for dealing with such phenomena.