Article

A Cognitive Behaviour Therapy For Specific Phobia of Vomiting (Emetophobia): A Pilot Randomized Controlled Trial

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Abstract

Method: 24 participants (23 women and 1 man) were randomly allocated to either 12 sessions of CBT or a wait list. Results: At the end of the treatment, CBT was significantly more efficacious than the wait list with a large effect size (Cohen's d=1.53) on the Specific Phobia of Vomiting Inventory between the two groups after 12 sessions. Six (50%) of the participants receiving CBT achieved clinically significant change compared to 2 (16%) participants in the wait list group. Eight (58.3%) participants receiving CBT achieved reliable improvement compared to 2 (16%) participants in the wait list group. Conclusions: A SPOV is a condition treatable by CBT but further developments are required to increase efficacy.

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... There were n = 20 single case intervention studies that were excluded from the review as quality could not be rated based on the criteria used. Only two of the included treatment studies scored in the moderate range (Ahlen, Edberg, Di Schiena, & Bergström, 2015;Riddle-Walker et al., 2016) and the other two scored in the weak range (Klonoff, Knell, & Janata, 1984;Philips, 1985), demonstrating the lack of high quality research exploring effective interventions for SPOV. ...
... Only four treatment studies were included in the review (Ahlen et al., 2015;Klonoff et al., 1984;Philips, 1985;Riddle-Walker et al., 2016) (Table 6). Twenty published single case studies were identified in the search and excluded. ...
... Twenty published single case studies were identified in the search and excluded. There is only one published RCT (Riddle-Walker et al., 2016). Two studies explored the effectiveness of group CBT (Ahlen et al., 2015;Philips, 1985); one explored individual CBT including imagery rescripting (Riddle-Walker et al., 2016) and one explored contingency management, parent training and relaxation (Klonoff et al., 1984). ...
Article
Specific Phobia of Vomiting (SPOV) is an under-researched disorder compared to other Specific Phobias. A systematic review was conducted to synthesise existing research across areas of phenomenology, aetiology, epidemiology, co-morbidity, assessment measures and treatment. Online databases (Psychinfo, Embase, Medline, Pubmed and Cochrane Library) were searched using terms related to SPOV and ‘emetophobia’. A manual search of reference lists of included papers was also conducted. In total, 385 articles were found and 24 were included in the review. The review was registered on the PROSPERO register (CRD42016046378). The review presents a qualitative synthesis of identified studies exploring the features of SPOV including locus of fear, feared consequences of vomiting, and common safety and avoidance behaviours. It also identified articles describing aetiological factors involved in the development of SPOV, co-morbid disorders and the epidemiology of the disorder. Further studies focused on valid and reliable measures to assess SPOV, and treatments that are effective at reducing symptomatology of SPOV and psychological distress. There are relatively few published research articles on SPOV, and particularly high quality studies exploring effective treatment options for SPOV. Further research should focus on RCTs for comparing different approaches to reducing symptomatology and distress in people with SPOV.
... The applications of CBT, along with its different forms, have been highly efficient so far; by evaluating previous studies, we can deduce that an average of 50% of patients managed to decrease their phobia-related anxiety [12][13][14][15][16][17]. Nonetheless, certain studies reviewing CBT results [18,19] indicate that it is still unclear whether the phobia returns after a short period of time or not. ...
Chapter
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Exposure Therapy (ET) is one of the most widely-used methods for treating Specific Phobias, and, over the past few years, Virtual Reality (VR) has contributed significantly in this field, since the birth of what we call “Virtual Reality ET” (VRET). However, VR systems used in VRET so far do not fully integrate ET characteristics; the reason behind this is that they do not provide sufficient, or occasionally not any at all, interaction with the feared stimulus, which is a key factor for full ET implementation. Objective: The aim of our study is to propose a way to include natural interaction between the patient and the system during the treatment procedure. Method: We propose an addition to current session protocols for mental health professionals through which they can apply ET in full extent with the use of motion tracking sensors. Specifically, we added a Motion Recognition Camera, which tracks the patient’s movements and places their physical body within the virtual environment, increasing their feeling of presence and making the system more immersive. Therefore, clinicians can assign interactive tasks for their patients to practice within a controlled virtual environment. Results: We present the feedback we received regarding the system’s potential utility and efficiency by a group of psychiatry professionals who tried the system. Impact: With real-time interaction and VRET, patients stand a better chance to truly acquire the necessary skills to overcome their phobias.
... Emetophobia is commonly treated by cognitive behavior therapy combined with exposure therapy (Riddle-Walker et al., 2016). However, there is no standardized treatment for emetophobia. ...
Article
Until recently, the treatments for emetophobia (the fear of vomiting) have not been well studied. In Japan, Morita therapy is a known, excellent treatment option for emetophobia, but to our knowledge, there is currently no case report of Morita therapy for the treatment of emetophobia in English. Here, we present a case of emetophobia that was treated with Morita therapy and discuss its effectiveness and characteristics.
... This feeling of excessive fear and anxiety is also called a phobia. The term "phobia disorder" [16,17] is composed of the words "phobia" and "fear." ...
Article
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This research applies exposure to the visual appearance technology of virtual reality (VR). The motivation for this research is to generate a creative intervention by using regular smartphone devices and implementing them in VR using Google Cardboard as a medium visual display for exposure therapy at high altitudes. The VR application in this research is called acrophobia immersive virtual exposure (AIVE), which utilizes the Unity3D software to develop this treatment therapy application. The utilization of exposure therapy was carried out as a therapeutic medium for acrophobia sufferers. A commissioner was given to measure the usefulness of applications and devices in the VR environment created, and as many as 20 users had tested the VR device. The existing questionnaire was revised to develop a questionnaire for acrophobia sufferers, which was then used as an index measurement in the VR environment. The research is expected to be used to design a simulator and as a therapeutic medium using immersive VR devices in future studies.
... 4,7 There is one randomized controlled trial of 24 adult patients with SPOV receiving CBT that found the intervention to have positive effects on patients' long-term symptoms. 8 There are a few reported cases of adults with emetophobia who were given SSRIs in conjunction with CBT with positive results; however, with the exception of one case report describing successful treatment with an SSRI for a 16-yearold individual with emetophobia, they do not pertain to the adolescent population. [9][10][11] Our treatment approach for the patient described in this case focused on a combination of medical and psychological interventions. ...
Article
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Emetophobia is defined as the specific fear of vomiting and avoidance behaviors related to vomiting situations; the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, specifies this condition as a Specific Phobia: Other type: Vomiting (SPOV). Our case report describes an adolescent presenting with medical complications, specifically notable dehydration, due to new onset Specific Phobia: Other type: Vomiting after experiencing a bout of viral gastroenteritis. In this patient’s case, her severe anxiety served as the root cause for a significant decrease in her quality of life for a year and was not identified by healthcare providers until after an extensive medical workup had taken place. Treatment involved alleviating her dehydration with slow introduction of foods with high water content into her diet and addressing her anxiety with hydroxyzine as a short-term intervention and a selective serotonin reuptake inhibitor for long-term management. This treatment plan allowed for our patient’s symptoms to resolve over the course of a few months and she was able to return to her usual activities of daily living. With discussing emetophobia, this case highlights a topic that is not largely discussed in the literature surrounding adolescent health.
... The SPOVI has been implemented in several studies as a measure of emetophobic symptoms, including two case studies detailing emetophobia treatment where SPOVI scores were the main clinical outcome ( Fix, Proctor, & Gray, 2016;Paulus & Norton, 2016), a group design pilot study of a cognitive behavioral intervention for emetophobia (Riddle Walker et al., 2016), and as an analogue measure to assess clinical correlates of emetophobia in a college sample ( Wu, Rudy, Arnold, & Storch, 2015). Additionally, it has been used to distinguish between individuals who restricted food on the basis of fear of vomiting and those exhibiting similar eating pathology who did not endorse such fear ( Veale, Costa, Murphy, & Ellison, 2012). ...
Article
Objective: A diary study was conducted to investigate the relationships between headache activity and basic psychological needs satisfaction. Methods: One hundred sixteen young adults (M age = 19.17 (SD = 2.90); 81.7% female; 75.9% Caucasian) completed an online daily diary of headache activity and needs satisfaction for 3 weeks. Data were analyzed using hierarchical linear modeling. Results: On days when headache occurred, participants reported decreased needs satisfaction of competence (γ10 = -0.18, P = .014) and relatedness (γ10 = -0.24, P = .003), and a marginal but not significant reduction in autonomy (γ10 = -0.13, P = .067). Additionally, more severe headaches were associated with decreased needs satisfaction in autonomy (γ10 = -0.08, P = .009), competence (γ10 = -0.08, P = .011), and relatedness (γ10 = -0.09, P = .005). Presence of a headache diagnosis did not moderate the relationship between headache occurrence and basic needs satisfaction (all Ps ≥ .24). Conclusions: This preliminary study is the first to show that headache is related to reduced basic psychological needs satisfaction, providing a potential account for one mechanism by which headache may negatively affect quality of life. Further research is needed to extend these findings to larger samples of migraine sufferers to enable more thorough between-group comparisons of headache-related burden on basic needs satisfaction. These findings may be informative for treatment approaches that focus on outcomes beyond mere symptom reduction.
... Diğer taraftan Chandrashekhar (9) ve Lankton (20) iki farklı olgu sunumunda hipnoterapinin psikojenik kusma tedavisinde etkili olduğunu ortaya koymuştur. Diğer bir araştırmada ise özgül kusma korkusu tedavisinde BDT'nin etkili olabileceği gösterilmiştir (8). Bununla birlikte, olgu sunumu şeklinde bir bildiri olarak özgül fobi olan bulantı fobisinin (emetofobia) tedavisinde EMDR'nin etkinliği gösterilmiştir (21). ...
Article
Full-text available
Psychogenic vomiting is an uncommon medical condition that usually occurs with severe and recurrent vomiting without an underlying organic cause. Although various pharmacological and therapeutic methods have been tried in the treatment of this condition, there is no clear treatment method. Eye Movement Desensitization and Reprocessing (EMDR) can be considered a good treatment alternative if there is a traumatic event in the underlying formation of psychogenic vomiting. To the best of our knowledge, there are no cases of efficacy of EMDR in psychogenic vomiting in the literature. The aim of the present case was to investigate the clinical usefulness of EMDR due to the presence of traumatic memories which may be associated with the symptom of psychogenic vomiting. As a result; as seen in our case, it should be considered that EMDR may be a treatment alternative in cases with psychogenic vomiting of traumatic origin.
... Although a number of case studies have documented successful symptom reduction with few instances of relapse using exposure-based, and cognitive-behavioral, treatment strategies (e.g., Ahlen, Edberg, Di, Schiena, & Bergström, 2015;de Jongh, 2012;Graziano, Callueng, & Geffken, 2010;Hunter & Antony, 2009;Maack, Deacon, & Zhao, 2013;Paulus & Norton, 2016; see also Riddle-Walker et al., 2016, for a cognitive behavioral randomized control study), Emetophobia remains a difficult disorder to treat. Fix, Proctor, and Gray (2016) utilized cognitive strategies, such as challenging distorted thoughts about vomiting, and graded exposure to vomit-related stimuli (e.g., videos of other people vomiting) to successfully reduce emetephobic symptoms in an adolescent girl. ...
Article
Full-text available
The fear of vomiting (i.e., Emetophobia) causes substantial distress for affected individuals, and is associated with hypervigilance to somatic sensations, panic attacks, and behavioral avoidance. Interventions for Emetophobia have traditionally relied heavily on exposure to vomit, vomiting, and vomit-related cues, providing some challenges in identifying appropriate graded exposures for Emetophobia due to medical and hygiene concerns. Recent efforts have been made to treat psychopathology transdiagnostically; however, very few efforts have been made to reduce Emetophobia symptoms in such a fashion, without the explicit use of vomit-related exposures. The current case study describes the cognitive-behavioral, transdiagnostic treatment approach utilized to treat a young woman with Emetophobia. We report significant symptom reduction at the end of therapy, as well as at a 7-month follow-up. The current study provides further evidence that emetophobia can be effectively resolved utilizing transdiagnostic strategies and without direct exposure to vomit or vomit-like stimuli.
... Research on emetophobia is considered to be limited; however, knowledge of the condition has accumulated (Keyes, Gilpin, & Veale, 2018). A pilot, random- ized controlled trial for emetophobia was conducted, and the efficacy of cognitive behavioral therapy was confirmed ( Riddle-Walker et al., 2016). Moreover, exposure therapy is considered a key component for effectively treating specific phobias (Davis, Ollendick, & Öst, 2012). ...
Article
This case study illustrates a clinical behavior analytic intervention for a female client with emetophobia, the fear of vomiting. Clinical behavior analysis is a recently developing branch of empirically supported psychotherapy, derived from behavior analysis. This case study presents modified case formulations and changed intervention strategies according to the results of repeated measuring. The intervention was six sessions and three gradual follow-up sessions; the effect of the intervention was monitored by a single-case design. The intervention strategies were changed from symptom-focused interventions, which are based on exposure, to value-focused gradual follow-up sessions. The client’s phobia and depression were alleviated through the intervention and gradual follow-up phases. Moreover, her value-based activities increased through the gradual follow-up phase. The Reliable Change Indexes (RCIs) were calculated to evaluate changes between the intervention and follow-up phases. There were large and clinically significant decreases on measures. The results highlight the utility of repeated measuring and importance of a value-focused approach.
Article
Well-validated, standardized measures are lacking for the assessment of emetophobia, the specific phobia of vomiting. The Specific Phobia of Vomiting Inventory (SPOVI) was recently developed and shows promise as a useful measure of emetophobia. The goal of the present study was to further examine and investigate the psychometric properties of the SPOVI in a large student sample (n = 1626), specifically focusing on its factor structure, measurement invariance across gender, and convergent/divergent validity. Confirmatory factor analysis results provide support for a one-factor model of the SPOVI, in contrast to the previously proposed two-factor model. Internal consistency of the SPOVI was good (α = 0.89) and measurement invariance across gender invariance was supported. The SPOVI also demonstrated good psychometric properties with respect to convergent and divergent validity. The present study's demonstration of the reliability and validity of the SPOVI suggests that the instrument may be a valuable tool for assessing emetophobia symptoms based on its one-factor structure.
Chapter
Specific phobias are characterized by immediate, intense, and irrational fear when confronted with a particular object or situation [Diagnostic and Statistical Manual-5 (DSM-5) American Psychiatric Association (APA), 2013]. When confronting the feared stimulus, the individual experiences an automatic physiological reaction that may include increased heart rate, sweating, and fainting in some cases (Fyer, 1998). As a result of this aversive reaction, an individual with specific phobia actively avoids situations that may involve the feared stimulus (DSM-5, APA, 2013). Avoidance behaviors can vary in severity and intrusiveness, ranging from taking a different work commute to refusing lifesaving medical treatment, e.g., claustrophobia leading to an inability to have a CT scan. Such behaviors are usually linked to escape from the stimulus, but if contact is unpreventable, avoidance behaviors such as diverting eye contact (Tolin, Lohr, Lee, & Sawchuk, 1999), distraction (Craske, Street, Jayaraman, & Barlow, 1991), or safety signals (Telch, 1994) may also serve to decrease fear. Generally, an individual with specific phobia experiences intense fear when confronting a specific object or situation and often exhibits avoidance behaviors to prevent or cope with this fear.
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While disgust is a clinically and theoretically relevant construct for selective eating, limited research has examined how different aspects of disgust relate to selective eating severity in adults. Thus, the present study sought to 1) compare disgust propensity (how easily people are disgusted) and disgust sensitivity (how unpleasant disgust is) across a spectrum of selective eaters, 2) explore the specificity of the associations between disgust sensitivity/propensity and selective eating across selective eating and related phenotypes, and 3) explore whether the relationship between selective eating and disgust is food-specific. Participants were 554 adults recruited on Amazon's Mechanical Turk who completed cross-sectional surveys on study constructs. The sample was recruited to over-represent individuals with high levels of selective eating. Results support that disgust propensity, but not sensitivity, was elevated in the impaired selective eating group compared to non-impaired selective eaters and non-selective eaters. Only the selective eating phenotype was independently associated with both disgust sensitivity and propensity. Correlation results supported that the associations between selective eating and disgust were specific to the disgust elicited by food (i.e., animal protein, fruits, vegetables). Overall, results support that disgust propensity and disgust sensitivity play a role in selective eating. Results imply that disgust sensitivity associated with selective eating appears limited to the food domain and may be more specific to disgust eliciting food itself, rather than signs of food contamination or spoilage.
Article
Specific phobia of vomiting (SPOV) can be a severe and debilitating anxiety disorder and affects women in the childbearing years. The perinatal period and early parenthood is a time of increased risk for the onset or exacerbation of anxiety problems, which can have an impact on both the woman and the developing child. There are particular issues pertinent to the physical experience of pregnancy and tasks of early caregiving that women with SPOV may find difficult or distressing to confront, but these are not well documented. Cognitive behavioural therapy (CBT) focused on exposure to vomit cues and processing distressing early memories of vomiting is an effective treatment for SPOV. This paper describes the successful CBT treatment of two young mothers with SPOV, outlining the challenges faced by parents at this time and the need to take this into account in treatment, using illustrative case material. Key learning aims (1) To understand how specific phobia of vomiting (SPOV) affects women in early parenthood. (2) To know how to target and update traumatic early memories of vomiting with imagery rescripting. (3) To know how to design and carry out effective behavioural experiments for perinatal SPOV. (4) To understand how to take mother, baby, and the mother–infant relationship into account in SPOV treatment.
Article
Background and objectives: Specific Phobia of Vomiting (SPOV) may be difficult to treat, and to date only one RCT has been published. Specific Phobias can be successfully treated using time intensive treatment formats. Imagery rescripting (ImRs) has also been shown to be a successful component for treating various anxiety disorders. The present study aims to evaluate the effectiveness of time intensive CBT and ImRs at reducing symptoms in SPOV. Methods: A multiple baseline ABCADE single case experimental design (SCED) was used to monitor symptoms across time in eight participants. The Specific Phobia of Vomiting Inventory (SPOVI) was administered to measure SPOV symptoms at each clinical session. Visual analysis of graphed data was used to compare data across treatment phases. Reliable and clinically significant change was also calculated on the SPOVI at 6-month follow up. Results: Findings suggest that time intensive CBT is associated with improvements across symptoms of SPOV. There was limited support for ImRs in the current study; however, informal discussion of aversive memories of vomiting, and formulation of the problem may be helpful in its own right in treatment of SPOV. Seven out of eight participants (87.5%) achieved reliable improvement and five (62.5%) achieved clinically significant change on the SPOVI at 6-month follow up. Time intensive treatment was associated with high client satisfaction ratings. Limitations: Limitations include lack of measurement of therapist adherence to protocol, and a short period of daily symptom monitoring in between ImRs and intensive treatment phases. Conclusions: Time intensive CBT including an ImRs component may be an effective and acceptable treatment in reducing SPOV symptomatology. Further research using larger sample sizes in a RCT is needed.
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Specific phobia is highly prevalent worldwide. Although the body of intervention studies is expanding, there is a lack of reviews that summarise recent progress and discuss the challenges and direction of research in this area. Hence, this rapid review seeks to systematically evaluate the available evidence in the last five years in the treatment of specific phobias in adults. Studies published between January 2014 to December 2019 were identified through searches on the electronic databases of Medline and PsychINFO. In total, 33 studies were included. Evidence indicates that psychotherapy, and in particular cognitive behaviour therapy, when implemented independently or as an adjunctive, is a superior intervention with large effect sizes. Technology-assisted therapies seem to have a beneficial effect on alleviating fears and are described to be more tolerable than in vivo exposure therapy. Pharmacological agents are investigated solely as adjuncts to exposure therapy, but the effects are inconsistent; propranolol and glucocorticoid may be promising. A handful of cognitive-based therapies designed to alter fear arousal and activation pathways of phobias have presented preliminary, positive outcomes. Challenges remain with the inherent heterogeneity of specific phobia as a disorder and the accompanying variability in outcome measures and intervention approaches to warrant a clear conclusion on efficacy.
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Humour in education for counselling and psychotherapy is essential, particularly interventions that are pertinent to deep emotions and experiences such as trauma. Exposure Therapy has been actively employed for various symptoms and contexts including traumatic experiences, phobias and anxiety. Teaching this therapy often involves tragic events, therefore students may be distracted by the details of these events. Some students may feel that certain issues should not be talked in the classroom, which can hinder their learning experience. We have taught Exposure Therapy with humour, which enables students to focus on the intervention, and more importantly, without damaging their curiosity and spontaneous learning mindset. This book chapter reports two cases where we have utilised humour relating to a popular British TV series 'Doctor Who', and discusses the importance of humour in teaching this intervention.
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Emetophobia (specific phobia of vomiting) emerges as one of the most neglected clinical conditions in clinical practice and academic literature. In this article, a phenomenological, epidemiologic and clinical picture of emetophobia is presented and the cognitive behavioral model is discussed as a therapeutic approach for its treatment [JCBPR 2017; 6(1.000): 39-48]
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The specific phobia of vomiting (also known as emetophobia) is an under-researched area. We present a case report of cognitive therapy treatment for vomit phobia in order to demonstrate the successful implementation of the cognitive techniques proposed by the cognitive models of vomit phobia. The client was a Japanese female living in the UK whose vomit phobia remained after treatment for panic disorder and comorbid depression. The case formulation suggested that the manner in which her fear escalated was similar to the cognitive model of panic disorder. The therapy involved case formulation, attention training, opinion survey and behavioural experiments. These techniques allowed the client to stop her safety-seeking behaviours and adjust her beliefs about vomiting.
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Whether it’s dogs, spiders, blood, heights or some other fear, specific phobias are one of the most prevalent mental health problems, affecting as many as one in eight people. In recent years, cognitive-behavioral therapy (CBT) has emerged as particularly effective in treating young people and adults with specific phobias. And of these methods, one-session treatment stands out as a long-lasting, cost-effective intervention of choice. Intensive One-Session Treatment of Specific Phobias not only provides a summary of the evidence base, it also serves as a practical reference and training guide. This concise volume examines the phenomenology, epidemiology, and etiology of phobias, laying the groundwork for subsequent discussion of assessment strategies, empirically sound one-session treatment methods, and special topics. In addition, expert contributors address challenges common to exposure therapy, offer age-appropriate guidelines for treating young clients, and describe innovative computer-assisted techniques. Organized to be read individually or in sequence, chapters delve into key areas, including: Evidence-based assessment and treatment of specific phobias in children, adolescents, and adults.One-session treatment theory and practice with children, adolescents, and adults.Handling difficult cases of specific phobias in youth.Interventions for specific phobias in special populations.Training and assessing therapists in one-session treatment.Ethical issues in considering exposure. Intensive One-Session Treatment of Specific Phobias is an essential resource for researchers, clinicians, and graduate students in child, school, clinical, and counseling psychology; social work; and general and special education.
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This article summarizes the current knowledge and treatment for a specific phobia of vomiting (SPOV). It is relatively uncommon compared to other specific phobias but may have been misdiagnosed in catchment-area surveys. The differential diagnosis of SPOV includes obsessive–compulsive disorder, hypochondriacal disorder and anorexia nervosa. I discuss the following: a model that is linked to past aversive experiences of vomiting; conducting a clinical assessment; making a formulation; psycho-education, engagement and therapy. The strategies employed depend on the formulation but are likely to include: exposure in vivo to cues of vomiting, exposure in imagination and role-plays of vomiting, imagery re-scripting, behavioural experiments; and dropping of safety-seeking behaviours.
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Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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Data from 33 randomized treatment studies were subjected to a meta-analysis to address questions surrounding the efficacy of psychological approaches in the treatment of specific phobia. As expected, exposure-based treatment produced large effects sizes relative to no treatment. They also outperformed placebo conditions and alternative active psychotherapeutic approaches. Treatments involving in vivo contact with the phobic target also outperformed alternative modes of exposure (e.g., imaginal exposure, virtual reality, etc.) at post-treatment but not at follow-up. Placebo treatments were significantly more effective than no treatment suggesting that specific phobia sufferers are moderately responsive to placebo interventions. Multi-session treatments marginally outperformed single-session treatments on domain-specific questionnaire measures of phobic dysfunction, and moderator analyses revealed that more sessions predicted more favorable outcomes. Contrary to expectation, effect sizes for the major comparisons of interest were not moderated by type of specific phobia. These findings provide the first quantitative summary evidence supporting the superiority of exposure-based treatments over alternative treatment approaches for those presenting with specific phobia. Recommendations for future research are also discussed.
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Aims: To explore whether the phenomenology and co-morbidity of a specific phobia of vomiting (SPOV) (also known as "emetophobia") might best fit within the group of obsessive compulsive and related disorders. Method: Case review of individuals who were assessed for a SPOV (n=83). Results: Sixty-two per-cent of cases reported being markedly or very severely preoccupied by the fear that they might vomit. A majority of people with a SPOV reported either often or always conducting repetitive behaviors such as compulsive washing; reassurance seeking; self-reassurance, counting or superstitious behaviors to prevent vomiting; checking others for signs of illness or checking sell-by dates. Cases that had more frequent hand washing were associated with higher scores on standardized questionnaires for a SPOV and a later age of onset. The diagnosis of OCD formed the highest degree of comorbidity. Conclusions: The results have implications for future research into the nosology and treatment of a SPOV. Clinicians should assess for repetitive behaviors in a SPOV and include them in a formulation and treatment plan. Future research should conduct prospective studies to determine which aspects of the phenomenology of a SPOV might best fit under OC and related disorders.
Article
Background Emetophobia is a neglected area within clinical research. Only case studies have been performed examining treatment effectiveness. The present study aimed to examine the preliminary acceptability and effectiveness of a cognitive behavioural group therapy developed specifically for the treatment of emetophobia.Method The present study design was a one-group pretest, post-test, follow-up design with a double pretest. Twenty-three patients, in three treatment groups, participated in the study. Four assessment time points were conducted (1) five weeks prior to treatment, (2) before the first treatment session, (3) after the final session and (4) 3 months after the final session. Participants completed the emetophobia questionnaire, Beck Anxiety Inventory, and Montgomery–Åsberg Depression Rating Scale—self assessment at all assessments.ResultsAfter treatment, patients showed a significantly lower degree of emetophobic symptoms. About half of the patients were clinically significantly improved or recovered after treatment, and two thirds were improved or recovered at follow-up. Participation at sessions was high, and patients were satisfied with treatment.Conclusions The results from this study, the largest trial yet for emetophobia, indicate that cognitive behavioural therapy may be an efficacious treatment for emetophobia. The study design involves several limitations, and further studies should include independent control groups, randomisation, and longer follow-up assessments.
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Two patients suffering from long-standing psychogenic nausea were treated by paradoxical intention and exposure in vivo within an A–BC–B–BC single case experimental design. Each received six treatment sessions. At the six month follow-up, both patients had improved substantially. Contrary to what was expected, paradoxical intention produced adverse outcome; both patients because nauseous and even vomited a few times while practicing the technique. Exposure in vivo gave better results.(Received March 1984)
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The successful treatment of a client with a handicapping fear of other people vomiting is described. This involved exposure to “vomiting”, using a simulation procedure. It is suggested that the appropriate stimulus in such cases may be someone vomiting rather than vomit itself.
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OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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Background: Vomiting is an almost universal phenomenon, but little is known about the aetiology of a specific phobia of vomiting (SPOV). The associations with vomiting during childhood and autobiographical memories may have relevance for our understanding of the development of SPOV and its treatment. Method: Two groups: (a) a group with SPOV (n = 94) and (b) a control group (n = 90) completed a self-report questionnaire assessing their lifetime memories of both their own vomiting and others vomiting. Results: People with SPOV recalled the memories of their own and others vomiting experiences from an earlier age and rated them as significantly more distressing than the control group. There was no difference between the groups in the number of memories of their own vomiting recalled before the age at which vomiting became a problem. However, the SPOV group recalled more memories of others vomiting before the onset of the problem. After the age at which the phobia became a problem they recalled less memories of their own vomiting and more memories of others vomiting than the control group. They recalled significantly more memories of vomiting associated with inter-personal events, health or emotional or unrelated life events. Conclusions: Avoidance and hyper-vigilance for others vomiting after the onset of the phobia may have slightly reduced the risk of vomiting. There is some evidence for associative learning in SPOV with aversive consequences of vomiting and an unrelated life event. It suggests a model of autobiographical memories of vomiting that have lost a time perspective and context, which are being reactivated with cues for vomiting. The limitations of the study are those of memory biases in both groups.
Article
Through electronic mail, we surveyed members of an internet support group for emetophobia (fear of vomiting). Respondents were 50 women and 6 men with a mean age of 31 years. Results suggest that, for this sample, emetophobia is a disorder of early onset and chronic course, with highly persistent and intrusive symptoms. Emetophobia is implicated in social, home-marital, and occupational impairment and it causes significant constriction of leisure activities. Nearly half of women avoided or delayed becoming pregnant. About three quarters of respondents have eating rituals or significantly limit the foods they eat. Respondents describe other problems such as depression, panic attacks, social anxiety, compulsions, and frequent history of childhood separation anxiety. Depression and Anxiety 14:149–152, 2001. © 2001 Wiley-Liss, Inc.
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Emetophobia, or the fear of vomiting, is among the least studied phobias. The literature on the etiology, symptomatology, and treatment of this problem is just beginning to develop. Research to date suggests that for many people with emetophobia, anxiety is triggered by both external and internal factors, but to date only one English-language report describes an intervention that directly targets both external and internal triggers. This paper presents a case in which a cognitive-behavioral treatment (including education about the origin and implications of physical symptoms of anxiety, graduated exposure to feared situations, interoceptive exposure, and cognitive restructuring) was used successfully in the treatment of emetophobia.
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A patient with a long-standing vomiting phobia was treated by flooding under a hypnotic trance. A follow-up 1 yr after treatment showed that she had remained free of her phobia.
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The aim of this study was to explore the eating behaviour in people with a specific phobia of vomiting (SPOV), and whether those identified as restricting their food had a greater degree of psychopathology and impairment than those who do not restrict their food. We recruited 94 participants with SPOV. They were divided into those who reported restricting their food (SPOV-R) (n = 32) because of fear of vomiting and those who did not restrict their food (SPOV-NR) (n = 62). People with SPOV frequently have abnormal eating behaviours to reduce the perceived risk of vomiting. Only 3.7% had a body mass index (BMI) of less than 17.5, and 8.5% had a BMI of less than 18.5. The SPOV-R group had significantly higher frequency of psychopathology and abnormal eating behaviours than the SPOV-NR group. Abnormal eating behaviour, BMI, and the degree of food restriction are important factors in the assessment of SPOV.
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AND OBJECTIVES: Specific phobia of vomiting (SPOV) is a chronic, pervasive and debilitating disorder which is clinically regarded as difficult to treat. Research into its development, maintenance and treatment has been limited. This study explored the prevalence and characteristics of intrusive mental imagery in people with SPOV. It investigated the relationship between presence of imagery and severity of phobia. Thirty-six participants meeting DSM-IV criteria for SPOV were recruited from online support groups and outpatient clinics. A semi-structured quantitative interview was administered. Twenty-nine (81%) participants reported multi-sensory intrusive imagery of adult (52%) and childhood memories (31%) and worst case scenarios ("flashforwards") of vomiting (17%). Extent of imagery was significantly related to severity of phobia. Participants primarily fearing others vomiting had less severe phobic symptoms. No control group was used and a heterogeneous sample of clinical and community participants was recruited. Correlational data comparing extent of imagery with severity of SPOV symptoms were derived from as yet unvalidated measures. Intrusive mental imagery is a clinically important feature of SPOV and may contribute to its maintenance. Causality needs to be demonstrated.
Article
Unlabelled: Specific phobia of vomiting (also known as emetophobia) is a relatively understudied phobia with respect to its aetiology, clinical features and treatment. In this stage, research is mostly based on people with self-reported fear of vomiting. This paper presents a survey on the clinical features of fear of vomiting of individuals. Self-reported vomit-fearful subjects from the Dutch community and from an Internet support group are included. Both vomit-fearful groups were characterized by high reports of fear, the presence of panic symptoms, and by extensive avoidance and safety behaviours. They also reported other psychiatric complaints, which were measured with a structured screening instrument. Vomiting complaints started mostly in late puberty. A significant proportion of the vomit-fearful participants had a treatment history. The prevalence rate of fear of vomiting in the community sample was established at 8.8% (female : male ratio = 4:1). Overall, results show that fear of vomiting is a common phenomenon, which can seriously impair daily functioning. Finally, clinical questions to be addressed in future research are formulated. Key practitioner message: Specific phobia of vomiting (also known as emetophobia) is among the least studied phobias. Most clinical data come from research with self-described fear of vomiting. This paper presents data on the clinical features, prevalence and additional psychiatric complaints of fear of vomiting in two vomit-fearful samples and one control sample with no fear of vomiting. Estimates of prevalence of fear of vomiting in a Dutch community sample were established at 1.8% for men and 7% for women. Evidence suggests that fear of vomiting is a chronic and disabling condition that may cause significant impairment in daily functioning.
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This report details the treatment of a vomiting phobia in a young woman. By utilizing her need to defeat the therapist and her orientation towards growth, the client was motivated to perform the phobic action.
Article
Four adolescent girls were referred for psychiatric assessment because of suspected anorexia nervosa. Although all of them had lost at least 15% of their body weight, investigation showed that they did not meet the criteria for anorexia nervosa. In all cases, refusal to eat resulted from fear of vomiting following a viral illness and not from a desire to lose weight. Their family configurations and personal histories showed many similarities, including constricted range of affect and a notable lack of anger. With counseling and, in one case, psychotropic medication, the patients recovered promptly.
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A distinction is proposed between anxiety (frequency of symptom occurrence) and anxiety sensitivity (beliefs that anxiety experiences have negative implications). In Study 1, a newly-constructed Anxiety Sensitivity Index (ASI) was shown to have sound psychometric properties for each of two samples of college students. The important finding was that people who tend to endorse one negative implication for anxiety also tend to endorse other negative implications. In Study 2, the ASI was found to be especially associated with agoraphobia and generally associated with anxiety disorders. In Study 3, the ASI explained variance on the Fear Survey Schedule—II that was not explained by either the Taylor Manifest Anxiety Scale or a reliable Anxiety Frequency Checklist. In predicting the development of fears, and possibly other anxiety disorders, it may be more important to know what the person thinks will happen as a result of becoming anxious than how often the person actually experiences anxiety. Implications are discussed for competing views of the ‘fear of fear’.
Article
A small group of patients with a fear of vomiting were treated using an exposure method that allowed investigation of the processes underlying the elimination of their phobias. The within-session decrements were suggestive of habituation, while the between-session changes were marked by return of fear, which appeared to be related to stimulus-provoked depression. Feelings of fear and of nausea were not well correlated.
Article
A case study is presented of a 10-year-old boy who obsessively feared he would vomit. The material is formulated within a psychodynamic as well as a strategic model, and treatment approaches are suggested for each. The treatment consisted of a five-session, strategic, problem-focused approach over three months with a two-year follow-up. The rationale and effective ingredients of the intervention are discussed.
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The frequent occurrence of desynchrony between psychiatric symptoms and disability makes it necessary to measure disability/ functional impairment in addition to psychiatric symptoms when tracking treatment outcome. Existing disability measures in psychiatry are comprehensive but lengthy. There is a need for short, simple, cost-effective, sensitive measures of disability and functional impairment in psychiatric disorders. We developed a discretized analog disability scale (DISS) which uses visual-spatial, numeric and verbal descriptive anchors to assess disability across three domains: work, social life and family life. The DISS has proved to be very sensitive to change in drug treatment studies in psychiatry. The usefulness of the DISS in assessing disability in terms of work, social and family relationships is discussed.
Article
Fear of vomiting (emetophobia) is a poorly understood anxiety disorder, with little research published into its conceptualization or treatment. The current article uses established cognitive and behavioral models of other anxiety disorders as a basis from which to propose a detailed model of emetophobia. The model proposes that emetophobia results from a constellation of factors including a general anxiety-vulnerability factor, a tendency to somatize anxiety as gastrointestinal distress, a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms, hypervigilance to gastrointestinal cues, beliefs about the unacceptability of vomiting, negatively reinforced avoidance behavior, and selective confirmation biases. A formulation-based treatment package for emetophobia is outlined, including arousal management skills, distraction/attention training, exposure and cognitive restructuring.
Article
This study determined the prevalence, age of onset, comorbidity, and impairment associated with specific phobia subtypes in the community. Data were drawn from the Dresden Mental Health Study (N=2064), a representative community-based sample of young women in Dresden, Germany. The lifetime prevalence of any specific phobia was 12.8%, with subtypes ranging in prevalence between 0.2% (vomiting, infections) and 5.0% (animals). There were significant differences in the mean age of onset of specific phobias. Significant differences in comorbidity patterns also emerged between subtypes. No significant differences were found in level of impairment associated with the subtypes. The findings suggest that specific phobias are common among young women and that they differ in prevalence, associated comorbidity, and mean age of onset. These data suggest significant differences in the phenomenology and clinical significance of specific phobia subtypes.
Article
There is a lack of current detailed national data on the prevalence, correlates, disability and co-morbidity of DSM-IV specific phobia (SP), the prevalence of specific objects and situations feared, and associations between impairment, treatment and co-morbidity and the number of specific situations and objects feared, among adults in the USA. The data were derived from a large (43093) representative sample of the adult population in the USA. Prevalences of 12-month and lifetime DSM-IV SP were 7.1% and 9.4% respectively. Being female, young, and low income increased risk, while being Asian or Hispanic decreased risk (p<0.05). The mean age at onset of SP was 9.7 years, the mean duration of episode was 20.1 years and only 8.0% reported treatment specifically for SP. Most specific phobias involved multiple fears, and an increasing number of fears, regardless of content, was associated with greater disability and impairment, treatment seeking and co-morbidity with other Axis I and II disorders. SP is a highly prevalent, disabling and co-morbid disorder in the US adult population. The early onset of SP and the disorders most strongly associated with it highlights the need for longitudinal studies beginning in early childhood. Results suggest the existence of a generalized subtype of SP much like social phobia, which, once revealed, may lead to a classification of SP that is more etiologically and therapeutically meaningful.
Article
The present investigation examined the factor structure, internal consistency, and construct validity of the 16-item Anxiety Sensitivity Index (ASI; Reiss Peterson, Gursky, & McNally 1986) in a young adult sample (n = 420) from the Netherlands. Confirmatory factor analysis was used to comparatively evaluate two-factor, three-factor, and four-factor models of the anxiety sensitivity construct. Support was found for a hierarchical structure of anxiety sensitivity, with one global higher-order factor and four lower-order factors. Internal consistency for the global and lower-order factors of the 16-item ASI was adequate. Convergent and discriminant associations between the 16-item ASI and general mood and panic-specific variables were consistent with anxiety sensitivity theory. In addition, incremental validity of the anxiety sensitivity construct was established, relative to negative affectivity, for unexpected panic attacks and agoraphobic avoidance.
Article
Although imagery rescripting has long been part of cognitive behaviour therapy (CBT), recent years have seen a growing interest in the use of imagery rescripting interventions in CBT, especially with patients who struggle with distressing, intrusive imagery. This growth in the clinical applications of imagery has led to the creation of the current special issue of collected papers on imagery rescripting, which is designed to: (a) present research and clinical applications of imagery rescripting techniques to problematic mental imagery, (b) consider problematic imagery across a wide range of psychological disorders that might be a target for imagery rescripting (including novel areas such as mental contamination, bulimia and suicidality), (c) explore a variety of imagery rescripting techniques in the treatment of PTSD, as well as depression, social phobia, and snake phobia, and (d) stimulate interest for future treatment innovation in the use of imagery rescripting techniques to address other clinical disorders. The aim of this editorial is to summarise the collected papers presented and the links between them. A working definition of two types of imagery rescripting is provided, along with a heuristic framework for conceptualising the range of imagery techniques in cognitive therapy.
Intensive one-session treatment of specific phobias
  • Iii Davis
  • T E Ollendick
  • T H Öst
Davis III, T. E., Ollendick, T. H., & Öst, L. G. (2012). Intensive one-session treatment of specific phobias. New York: Springer Science.
Emetophobia: Preliminary results of an internet survey
  • M B First
  • R L Spitzer
  • M Gibbon
  • J B W J D Williams
  • A J Fyer
  • A Paterniti
  • D F Klein
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Lipsitz, J. D., Fyer, A. J., Paterniti, A., & Klein, D. F. (2001). Emetophobia: Preliminary results of an internet survey. Depression and Anxiety, 14(2), 149-152. doi:10.1002/da.1058
Anxiety sensitivity, anxiety frequency and the prediction of fearfulness
  • S Reiss
  • R A Peterson
  • D M Gursky
  • R J Mcnally
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther, 24(1), 1-8. doi:10.1016/0005-7967(86)90143-9