CBT and nausea
 

I am looking for suggestions for treating very persistent nausea with CBT.

Nausea is apparently a very common side effect of Hepatitis C. I have a client who has nausea, including both nausea with what he calls 'flopping fish' and actual vomiting. About 80% of the time he only has nausea, but the flopping, which is almost seizurelike, interferes with his daily life. This is a daily symptom. He has been worked up medically to no avail and he is taking the standard medications for Hep C and attendant nausea.

My observation is that the client's nausea is increased when he is anxious, under stress or having problems with his partner. That has me thinking that some portion of his nausea could be ameliorated with therapy. I am seeking suggestions of a routine or protocol for addressing nausea with CBT.

Any suggestions would be much appreciated. Thanks!

Re: CBT and nausea
 

There appears to be remarkably little stuff around on this.

This however from 1993 Oncology provides a brief review

Oncology (Williston Park). 1993 Dec;7(12):83-9

Nausea and vomiting associated with chemotherapy most commonly occur after administration of the drug regimen, but a substantial proportion of patients also develop these symptoms in anticipation of treatment, after one or more courses of chemotherapy have been given. Currently available pharmacologic agents are unable to provide complete protection from either anticipatory or post-treatment nausea and emesis associated with cancer chemotherapy. Since anticipatory nausea and vomiting are believed to become conditioned responses through the learning process of classical conditioning, behavioral treatments may be particularly appropriate. Progressive muscle relaxation training is effective in preventing as well as decreasing the frequency of postchemotherapy nausea and vomiting, whereas systematic desensitization has been found to be more effective against anticipatory nausea and emesis. Hypnosis and cognitive distraction have been used mainly in children and adolescents.

Regards
Chris Allan
In the Room

Re: CBT and nausea
 

Yes, I don't think much has been written about CBT with nausea. However, much of what has been written about CBT with chronic pain will be relevant. Here are a few thoughts:

The first question is to think through what the goal of CBT is. Are we trying to eliminate the nausea, to do what can be done to reduce the intensity of the nausea, to help the client cope more effectively with the nausea, or to help the client lead as good a life as possible despite the nausea. From the summary you've presented, it doesn't sound as though there is any reason to think that CBT can eliminate the nausea, but it may well be possible to reduce the intensity, help him cope more effectively, and help him live a more satisfying life despite the nausea.

If the client is trying to control the nausea, avoid the nausea, make the nausea go away, etc., this is likely to result in his constantly being vigilant for GI sensations and in his constantly focusing on the nausea when it is present. Unfortunately, being vigilant for sensations and focusing on them will result on more frequent and more intense nausea. If he is able to shift to a mindset of accepting the nausea and coping with it as best he can, this is likely to result in a decrease focus on the nausea and decreased distress.

If stress and anxiety aggravate the nausea, stress management techniques may be useful. These could include rational responses to any cognitions that intensify the stress, relaxation exercises, assertion, and taking a problem-solving approach to dealing with stressful situations.

It probably will be useful to pay attention to his automatic thoughts about the nausea. Cognitions such as "I can't stand it! I can't go on like this!!!" can amplify distress and increase the risk of depression.

I suspect that ACT/Mindfulness interventions would also be useful as well.

Re: CBT and nausea
 

also important to do good psychoeducation on the psychphysiology of anxiety, because it does have effects on the gut.