Emetophobia - A Fear of Vomiting:

Recently emetophobia, or the fear of vomiting, has been something cited by quite a few clients as either the main thing they are struggling with, or as part of their wider anxiety and panic issues.

While most of us can happily and calmly eat whatever we chose and go from place to place relatively worry free, someone with a phobia of vomiting can find their life becomes pretty restricted and filled with the potential for panic. There may be worry about going places where people may be sick (or places associated with themselves or others having vomited in the past), you may worry about contact with others and look to see whether they may look ill or likely to vomit (e.g. if they are vigorously coughing) and you may restrict what you will eat and worry that you may be sick.

A phobia of vomiting can manifest itself in three main ways: a fear that you may vomit yourself, a fear of others vomiting (which could lead to you catching something that makes you vomit) and a fear of vomiting in front of others and being embarrassed or judged negatively by them.

Certainly clients I've helped have described avoiding foods to reduce the risk of being sick, staying away from people who have had a bug and panicking if they think someone near them may vomit. For most of us casually saying we feel sick or mimicking vomiting is just a bit of fun; for someone with emetophobia it could add to a whole spiral of worry, tension and fear.

Assessing Emetophobia 

As mentioned above, emetophobia is an intense, irrational fear of vomiting which includes the fear of feeling nauseous and of seeing or hearing another person vomit, or seeing vomit itself.

Many clients I've helped have been parents where their fear is amplified by the possibility of their child being sick or passing on something that makes them vomit and they may get very anxious and fearful if they hear news of a sickness bug making its way around the school. Others have reported how it isn't the being sick that is the issue but more the worry about it that creates the panic and they may have even coped fine with previous episodes where they've been actually sick. And many clients with a fear of vomiting may have gone years without actually being sick yet with the constant fear about the possibility of it restricting their lives.

The fear of vomiting can lead to behaviours such as excessive hand washing, or cleaning things touched by others. There is a high level of worrying that occurs as well as reassurance seeking and restricting food to try and reduce the risk of vomiting. And as feeling nauseous can be a symptom of anxiety, it can become an ongoing cycle of worry leading to feeling sick leading to even more worry (and not wanting to eat). 

One way that emetophobia can be assessed and measured is using the Emetophobia Questionnaire. This covers issues such as the avoidance of travel, movement and locations, the severity of fear about seeing, smelling or being exposed to vomit, and about the avoidance of others who may vomit.

There is also the specific phobia of vomiting inventory that covers issues of avoidance and threat monitoring. The inventory asks you to rate how your fear of vomiting has affected you over the past week and includes factors such as worrying about vomiting, avoiding others because of your fear of vomiting, how much you have focused on whether you feel ill or could vomit, restricting the amount or type of food you eat because of your fear and reassurance seeking and escaping from situations due to fear about you or others being sick. 

Nobody wants or likes to be sick, yet with a fear of vomiting there can be a whole world of worry, panic, vigilance and restriction.

Treating a Fear of Vomiting 

As for many fear and phobias, hypnotherapy can be a very effective way of helping you to overcome your fear of vomiting.  

When I work with clients who have emetophobia, we work together to start calming that fear and anxiety and interrupting those unwanted thoughts that re-enforce unhelpful thinking patterns and associations around vomiting. Rather than being hyper-vigilant about it and avoiding things, you can learn to get on with your life knowing that should you, or someone else be sick, you can and will calmly handle, deal and cope with it. 

Riddle-Walker et al (2016) carried out the first randomised controlled trial to valuate a protocol of cognitive behavioural therapy for a specific phobia of vomiting compared to a wait list (remembering that people often improve simply from being added to a wait list). At the end of the treatment, CBT was significantly more efficacious than the wait list with a large effect size. 

Some of the interventions in their work included psycho-education about vomiting as normal and adaptive, information about the experience of anxiety and an assessment of safety seeking and avoidance behaviours. They addressed traumatic memories to do with vomiting and dropping the safety seeking behaviours and cognitive processes contributing to the fear. These thought processes include 'an over inflated belief in the ability to control vomiting or events that might lead to vomiting, the need for certainty and control over thoughts and feelings around vomiting.' They also developed a hierarchy of feared situations and activities (including avoided foods) and used this for graded exposure.

As they concluded, "This is the first randomised controlled trial of individual CBT delivered by a therapist for SPOV, which demonstrated that CBT is superior to a waiting list on rating scales, which are specific for a SPOV. There was a large effect size in the main outcome measure, with significantly lower scores by the end of treatment for patients in the CBT group compared to those in the wait list group, and by the end of treatment 50% achieved reliable and significant change. Treatment gains were maintained at follow-up. The most common outcome was of reliable improvement suggesting that nearly 2/3 of participants can expect as a minimum a change from a phobia to a fear of vomiting and to be significantly less distressed and more functional in their life."

If you have been reading my blogs for a while you'll know that research has demonstrated that hypnotherapy enhances the outcomes of cognitive behavioural therapy so this approach is certainly good news. By changing your thoughts, feelings and behaviours that contribute to your fear, you can change how you respond to seeing, hearing or being around anything associated with vomit. 

In another case study, Graziano et al (2010) carried out cognitive behavioural treatment with an eleven year old boy presenting with emetophobia. The eleven year old in this study worried about the possible reoccurence of seeing someone else vomit as well as extreme avoidance. He would avoid engaging in any activities where a vomiting incident had occurred and would try and avoid saying or hearing the word 'vomit' or other similar terms (e.g. 'puke' or 'throw up'). He would worry daily about vomiting and would monitor those around him for fear they may vomit (e.g. if they were coughing or clearing their throat). He would also excessively ask his parents for reassurance about whether someone would vomit or not.

Treatment included graduated exposure and cognitive restructuring (e.g. monitoring his thoughts and restructuring them). One of the noteworthy aspects of this case study were the use of parent training, that is, educating his parents about how physical and mental reassurance can support the maintenance of anxiety and so need to be refrained from.  Another interesting aspect from this case study was the use of technology to support the treatment. It can be difficult to create vomit situations (and certainly unethical to induce sickness in a person!) so the researchers used online videos to simulate incidents of other people burping and vomiting and online pictures of vomit as visual aids. They also drew upon simulated vomit recipies available online as part of the treatment.

Help To Overcome Your Fear of Vomiting

As described above, emetophobia is something that you can overcome so that it no longer impacts or limits your life. Instead of worrying about you or others vomiting and trying to avoid or control it, you can just get on with doing what you want to do. No one wants to vomit and experience being sick yet, following your hypnotherapy, you can relax about it, focus on other things and know that, should you or someone else be sick in the future, you'll handle it ok.  

If you'd like to have a chat about how hypnotherapy could help you to overcome your phobia of vomiting then please do contact me and we'll arrange a time to chat about how we can work together to achieve your goal.

To your success,

Dan Regan

Hypnotherapy in Ely & Newmarket

 

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References:

Graziano, P.A., Callueng, C.M. and Geffken, G.R., 2010. Cognitive-behavioral treatment of an 11-year-old male presenting with emetophobia: A case study. Clinical Case Studies, 9(6), pp.411-425.

Riddle-Walker, L., Veale, D., Chapman, C., Ogle, F., Rosko, D., Najmi, S., Walker, L.M., Maceachern, P. and Hicks, T., 2016. Cognitive behaviour therapy for specific phobia of vomiting (Emetophobia): A pilot randomized controlled trial. Journal of anxiety disorders, 43, pp.14-22.