No real ritual- I just gather up everything beforehand to make sure I'm ready, and when it comes time to bite the bullet I try not to let myself put it off too long. Once the needle is loaded and my leg is alcohol-ed, I try to just take one or two deep breaths and JUST DO IT. If I let myself get distracted for a while by TV or whatever, it just gives the anxiety time to build. I have been thinking I should keep a special treat around as a reward, maybe chocolate or something.