“I’m not a wimp, I’m brave”

Purpose This paper aims to explore the use of adapted CBT for addressing needle phobia in an individual with a learning disability, autism, and histories of trauma related to medical interventions. Anxiety of needles can result in avoidance of preventive treatments such as vaccinations, resulting in poorer health outcomes for people with diagnoses of a learning disability and autism spectrum disorder (autism). Cognitive behavioural therapy (CBT) is recommended for needle phobia. However, there is limited research documenting effective treatments for needle phobia for people with a learning disability and autism. Design/methodology/approach This case study presents adapted CBT for needle phobia, with a 35-year-old man with diagnoses of a mild learning disability, autism and anxiety. Findings Although therapy helped the individual to become more confident about having injections, he did not have a COVID-19 vaccination during the time he was attending therapy. He also reported consistently high fear and pain appraisal on ratings of subjective units of distress, despite graded exposure therapy. Originality/value This paper highlights the long-lasting impact of needle phobia and trauma related to negative experiences of vaccinations. It also presents evidence for the importance of person-centred, collaborative approaches and involvement of loved ones during therapy to improve outcomes. Recommendations include training and awareness for staff carrying out injections and development of intervention programmes to reduce distress for people with a learning disability and autism. Limitations, ethical considerations, power and implications for clinical practice are also discussed.