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  #1  
Unread July 24th, 2004, 09:00 AM
Carl Robbins Carl Robbins is offline
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Default Emetophobia

Has anyone had success treating emetophobia (fear of vomiting)? What has been helpful?

I am bewildered by how much difficulty I have had helping clients de-catastrophize the possibility or the past experience of vomiting. Emesis seems to take on the valence of a life-threatening assault, an attitude/belief that seems immune to cognitive challenges.
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  #2  
Unread July 25th, 2004, 11:50 PM
Gary Mitchell Gary Mitchell is offline
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Default Re: Emetophobia

Carl, treatment can be difficult, but many do get better. A good reference for the consumer is Zurcher-White and Pollard's "the agoraphobia workbook". The wide variation of fears, stimuli, and avoidance strategies between these patients patients is fascinating, and, of course, will guide your restructuring and selection of exposure activities. Best of luck. Gary Mitchell
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  #3  
Unread July 26th, 2004, 03:30 PM
JustBen JustBen is offline
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Default Re: Emetophobia

Sorry that you're running into a brick wall with cognitive techniques, Carl, but that seems like a pretty common obstacle with emetophobia. Have you tried anything along behavioral lines? For example: exposure to preciptitating events or even to emisis itself?
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  #4  
Unread August 31st, 2004, 09:56 PM
James Pretzer James Pretzer is offline
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Default Re: Emetophobia

Often, a good starting point is to find out what "gets to them" about vomiting? (Is it the feeling of nausea and the sensation of vomiting? Is it their being unable to control the impulse to vomit? Is it a fear of illness and contamination? Is it the anticipation of being the focus of attention if they vomit in public? etc) Suppose they did vomit... What do they anticipate happening? What disaster do they fear? What's the worst that they can envision happening? Not everyone who fears vomiting fears the same thing.

It is also useful to find out what they do in an attempt to avoid vomiting. Do they avoid certain situations, stimuli, or foods that they think might lead to vomiting? Do they engage in "safety behaviors?" For example, one of my wife's clients always carried a plastic bag in her purse in case she needed to throw up, another avoided anyone who seemed "sick" for fear of becoming ill and throwing up.

The usual approach is to first develop a good understanding of the client's fears regarding what will happen if they vomit and of their avoidance and safety behaviors. Next, we address their fears regarding what will happen if they vomit. Our goal is to get them to shift from believing that vomiting is seriously dangerous in some way, to seeing vomiting as scary but not dangerous. Once this is done, we can help them understand the importance of voluntarily facing fears in order to become less afraid and can plan exposure-based treatment. Our goal is to get them to accept that vomiting is a normal part of life and that they need to tolerate vomiting when they vomit rather than worrying about vomiting or trying to avoid vomiting.

For exposure, we can use imaginal exposure (imagining vomiting), video exposure (watching movies that feature scenes of vomiting), proprioceptive exposure (intentionally inducing sensations that they associate with vomiting), and/or in-vivo exposure (intentionally facing situations/stimuli/foods that they currently avoid. Remember, we are not trying to convince them that they will not vomit. We are trying to get them to accept that vomiting is a normal part of being human that we need not avoid, worry about, or try to control. Our experience has been that treatment takes persistence but that, when we persistently work to eliminate avoidance and safety behaviors, the results are pretty good.

Some therapists have experimented with intentionally inducing vomiting as part of in-vivo exposure (for example by administering Ipecac). However, the reports I have heard have not been encouraging. Reportedly, it is difficult to convince clients that inducing vomiting is a good idea, it is difficult to get them to follow through on the plan, and they find the experience of taking Ipecac to be quite aversive.

Since humans easily develop conditioned aversion to anything associated with nausea, induced vomiting could easily result in conditioned aversion to stimuli associated with the induced vomiting. If this happened, we'd need to do additional in-vivo exposure to extinguish the conditioned aversion.
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  #5  
Unread September 29th, 2004, 08:58 PM
Melody Victor, Ph.D. Melody Victor, Ph.D. is offline
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Default Re: Emetophobia

I've just seen this thread today - not been online for a while. I have a history of this disorder myself, and it took years to find someone who finally helped me to successfully treat it. In my practice I've had a few emetophobic clients over the past 12 years as well. Jim's insights were pretty much right on.

I just want to add that most therapists (and this was my personal experience) just don't seem to "get" how terrified some of these clients are. Even mentioning the idea that inducing vomiting might help would send most of them running. And I agree that inducing vomiting is not a helpful part of treatment. Mainly I think because it would be a "one time event" - it's so tricky because it's not like you're going to have them exposed over and over to this stimulus...are they going to have to come into your office every week, drink ipecac and vomit? (don't laugh - several therapists suggest such a thing). Even when emetophobes vomit "naturally", the experience is so overwhelming that it often just retraumatizes them. So saying something like "you just need to vomit once and then you'd know it's nothing to fear" is unenlightened foolishness (again, don't laugh...these therapists are out there) The problem is that it's tough to find an in-vivo situation when it comes to vomit. You can sit in a hospital emergency ward for a week and you might see someone vomit once - for 5 seconds - if you're "lucky". Not like exposure to dogs or snakes where you can gradually approach one in a cage...


I reassure my clients right at the beginning that the goal of treatment is not for them to vomit, it is for them to stop being afraid of it. Once they feel safe in treatment itself, the fear can be gradually extinguished and then eventually...nature itself will see to it that they vomit.

I feel compelled to add that even I, who understand this disorder intimately, have not had much success with my own clients. My own treatment was about 200 hours of committed, determined focus - and it was hell. (well worth it, of course - and the reason I became a psychotherapist - as a second career)

We must understand that the "hell" is that these clients are desperately trying to avoid their own bodies and there is nowhere to "run" or "hide" to avoid the stimulus (which is usually normal gastrointestinal feelings) so their anxiety level is often through the roof. Also, the nature of our adult bodies is that we only vomit once every 10 years so actual "avoidance" is a neatly packaged convenience. (Having said that, most emetophobes avoid others who may be sick or vomiting, and this can be worked on in the traditional way)

So far, I haven't treated anyone willing to really make this sort of commitment - as Jim said, they all fear vomiting for different reasons and this disorder seems to be particularly complex.

On another related note, there's a place called Ambassador Video in the UK that has an "exposure to vomit" tape. It was made by a CBT group in Sheffield, England. I think the link is www.ambassadorvideo.com or something like that.

Let me end with...thanks again Jim, for so succinctly summing it up. I feel like I have so much to say on this topic that I'm just throwing in a few incoherent bits and pieces to add to your original post.
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  #6  
Unread November 1st, 2004, 10:45 PM
James Pretzer James Pretzer is offline
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Default Re: Video exposure for Emetophobia

The video described in the previous post sounds useful. Unfortunately, the Web site suggested seems to feature adult videos which some might find interesting but which won't be useful with emetophobia. If anyone knows the correct Web site, please post it.

Thus far, when we've used videos for exposure we've used films such as Monty Python's Meaning of Life and The Exorcist that include scenes of vomiting. This has worked OK.
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  #7  
Unread November 5th, 2004, 03:37 PM
Melody Victor, Ph.D. Melody Victor, Ph.D. is offline
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Default Re: Emetophobia

Sorry, James. It's www.ambassadorvideo.co.uk But when I tried the link yesterday and today, it doesn't seem to be operational. I looked on my video, and it was produced by Barry-Ann Stoute, Behavioral Psychotherapist, Cognitive Behavioural Psych Services at Northern General Hospital, Sheffield (England) S5 7AU
Ambassador Video's phone number is 0121 434 3847

Here's another link from a Dutch site on emetophobia that has still pictures from simple, funny drawings to graphic depictions of vomiting: http://www.achternamen.net/emetofobie/supportgroup/

If you're using films, Meaning of Life and The Exorcist may be too overwhelming to start with. Here are some suggestions of mine, in order of intensity from least to most (which is only in my opinon! different clients will experience some of these in a different order for various reasons):

South Park - The Movie (cartoons of a little dude vomiting in a funny situation)
Monster's Ball - opening scene - (sounds only...quite realistic) later in the film there's a vomiting scene that isn't too disturbing
The Piano - little girl on the beach
Ya Ya Sisterhood - scene with a mother and several sick children
Doc Hollywood - opening scene in an emergency ward
Appollo 13 - rather nasty scene, but staged
Saving Private Ryan - opening scene - fairly graphic
The Matrix (#1)
Kingpin - quite graphic, but sort of funny in an off-colour way
Any Given Sunday - rather realistic-looking
Witches of Eastwick (quite horrible)
Stand by Me (fake, but horrifically graphic with a whole crowd of people vomiting eventually) As a personal note, I had to watch this film 100 times to get SUD levels to 0. The 99th time I watched it, I still felt some anxiety - a twinge, and noted it down. Then the 100th time I watched it - and laughed. I guess that was the writer/director's intention!
Jackass - The Movie is the "best" one because it's real. There are two scenes - one where a guy snorts wasabi in Japan until he pukes, and another where a guy eats "yellow snow" and eventually vomits. It's very graphic and not staged. But the other advantage of using this clip is that everyone including the "sick" man are laughing. These idiots do things in order to vomit and then laugh about it...which may help the client to see that vomiting is indeed not something that's indicative of impending death.

I hope this helps yourself and others...
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  #8  
Unread September 9th, 2005, 09:40 PM
Kelly Rice Kelly Rice is offline
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Default Re: Emetophobia

Melody, congratulations on beating emetophobia. I have been suffering from it for nearly 16 years, and am finally embarking on therapy. My question involves the obsessive thoughts about vomiting and the misinterpretation of gastrointestinal feelings. Are there any ways to combat these issues? My obsessive thoughts about vomiting are almost constant, and challenging by saying "So what?" just further inflames the fear. Any input, especially from a recovered emetophobe, would be helpful.
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  #9  
Unread September 10th, 2005, 08:56 PM
James Pretzer James Pretzer is offline
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Default Re: Emetophobia

Please see For non-professionals seeking information or advice at the beginning of this forum.
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