Emetophobia treatment –
Interested in learning about emetophobia treatment ? In this blog we look at the pharmacological and psychological therapies which have been used to treat emetophobia. The body of research into treating Emetophobia is in its infancy and there is a genuine dearth of quality studies. In this blog we will look at the current evidence for these and assess their usefulness.
Emetophobia treatment – pharmacology
Although there is good reason to suspect that Emetophobia is being treated, and often successfully with pharmacological approaches there is a surprising lack of evidence for this. There are reports of sufferers benefiting from gastrointestinal medications, which may include antiemetics and psychotropic drugs (antidepressants) (Lipsitz et al 2001). However, the fear of being sick due to side effects prevents many emetophobics from risking medication (Lipsitz et al 2001).
Emetophobia treatment – psychological therapies
Most of the reported treatments have been on a single person (a case study), (for example Maack, Deacon and Zhao 2013, Paulus & Norton 2016, Fix, Proctor & Gray 2016, Roy (2017). These have limited value as they only show that it is possible that a person can get better whilst receiving this treatment. We cannot even say for certain that the treatment was the active element in their getting better, it’s possible that they just got better for some other reason. We do however possess three larger scale trials which provide some insight. Each of these was a cognitive based therapy.
Emetophobia treatment – Cognitive based approaches
The first of these is Kelly & Allen (2103). They developed a cognitive programme for Emetophobia which they tested on 35 paying clients. A cognitive approach concentrates upon changing the patients thinking about their problem. It gets them to examine their assumptions of what gastrointestinal signals may mean. A typical challenge may be;
- Asking how often they have been sick when triggers arise.
- To identify what they believe about the trigger.
They would be invited to change negative thinking about their digestion to something neutral. So;
‘My stomach is doing something, that means I am going to be sick!’
‘My stomach is doing something, this is typical of normal digestion.’
Overall, they reported a substantial and significant decline in symptoms over an average of 7 sessions. This study looks very promising but there are several reasons to be cautious.
- It does not appear to have gone through a peer review process or oversight for quality although the work itself does look through.
- There is no control group for comparison purposes.
- All the participants were paying subjects which means the results may not be generalisable.
None the less it looks promising.
Emetophobia treatment – Cognitive Behavioural Therapy
The second study of interest is Ahlen et al (2015). Ahlen et al conducted group Cognitive Behavioural therapy (CBT). CBT combines cognitive approaches with behavioural approaches such as exposure therapy. In exposure therapy the patients are exposed to various triggers to their emetophobia. Often exposure is in combination with relaxation to allow their bodies to relearn to be comfortable with the triggers. 2/3rds of the group reduced their symptoms below clinical thresholds by the 1 month post treatment follow up. Sadly, they had no control group.
The third larger scale trial is Riddle-Walker (2016). Riddle-Walker conducted a randomised controlled trial of CBT. A randomised controlled trial is considered the ‘Gold standard’ of clinical research. As an RCT Riddle-walker can be considered the most accurate evidence to date. Of the group who received CBT, 50% achieved clinically significant improvements. Compare this to 16% in the waiting list control group. Although this is a very promising set of results it is worth noting that only 34% (50%-16%) can be said to be clinically ‘cured’ from the treatment.
Emetophobia treatment – other psychological approaches
The literature only provides three other forms of psychological therapies. These are Eye Movement Desensitization and Reprocessing (EMDR) Transactional Analysis (TA) and Acceptance and Commitment Therapy (ACT). For all of these the evidence is sparse as all are based on a single case only.
EMDR is a trauma protocol which looks to stimulate information transfer between the left and right sides of the brain. It was used successfully by De Jongh (2012) to treat traumatic memories of events which were believed to be causal to the development of the phobia in a 46-year-old woman. The most interesting element of this study is that only 4 sessions were required. This is the shortest intervention seen in any of the studies.
TA is a therapy which looks at relationship styles to understand the ego-state of the individual. Kerr (2013) used TA to successfully treat a 19-year-old male. It took 39 sessions to do so.
Bogusch, Moeller, & O’Brien (2018) used ACT to treat one case. They achieved ‘large and clinically significant’ results. ACT uses mediation techniques to enable the patient to dis-engage from their internal thoughts and sensations. Effectively to be aware of thoughts and feelings whilst not having to engage with them. To add to the potential validity of this approach Simons & Vloet (2016). Used a metacognitive approach, which has substantial overlaps with the ACT approach, successfully with 3 adolescent girls.
Emetophobia treatment – psychological approaches with children & adolescence
A number of research papers report successful treatment of the young using various types of exposure therapy (Williams et al 2011 Graziano, Moran and O’Brien 2005 Callueng & Geffken 2010 Dosanjh, Fleisher & Sam 2017, Faye et al 2013). As is common with the research with adults these are all reports of single cases. As such not that much can be taken from them other than as a body they suggest that exposure therapy has potential.
What is interesting to note is that with children a single traumatic casual event is more obvious than in adults. Williams et al reported that the child developed emetophobia following an illness. Dosanjh, Fleisher & Sam (2017) that emetophobia developed following a bout of vomiting induced by excessive consumption. Faye et al (2013) reported its development following acute-appendicitis related vomiting.
Emetophobia treatment – overview
Back in 2009, Hunter & Antony identify exposure therapy as the common thread binding many previously successful therapies. This conclusion appears to hold true today. It seems likely that any therapy which either employs exposure therapy or similar is likely to have a positive impact on symptoms. However, there is also evidence to suggest that tackling past traumatic experience, as with EMDR, and some form of cognitive change, such as de-coupling from the cognitions or altering those cognitions is likely to have a positive impact.