If you feel that you or a close relative are affected by emetophobia and would like help or more information, then there are psychological treatments available.
The treatment with the most evidence for effectiveness is called Cognitive Behavioural Therapy (CBT) and you will need a referral for further assessment.
This may lead to outpatient treatment or, if very serious residential or in-patient treatment. The treatment offered should be CBT that is specific for emetophobia. There is no evidence that hypnotherapy or treatments based upon rationality work.
What is CBT?
Cognitive behavioural therapy (CBT) is based on the idea that the way we feel about a situation is directly linked to how we think about it. For example, we are likely to feel anxious about something if we think it is going to be scary or something bad is going to happen.
In the case of emetophobia, fear is usually in response to beliefs that vomiting is going to be uncontrollable, or extremely awful or frightening. CBT is a structured programme, which focuses on the way you think and act. Some work may need to be done on memories of vomiting in the past. After this, it is best treated by “graded exposure” or learning to face up to the situations or activities you are avoiding and to drop all the excessive safety behaviours, which you believe reduces the likelihood of vomiting.
Facing your fear will get easier and easier to face up to your fear and your anxiety will reduce. CBT differs to other treatment approaches in that it is an active therapy that requires change to your behaviours as opposed to just ‘talking’ about the problem.
Will treatment involve exposure to vomiting?
The evidence shows that the most effective way to overcome your emetophobia, and live a life that is meaningful is to engage in exposure to feared and avoided activities. This enables you to learn about how the world works in reality, as opposed to what fear tells you will happen. It also gives you the opportunity to learn to tolerate feelings of anxiety and uncertainty in relation to vomiting.
However, the process of treatment will never require exposure to actual vomiting, as we know this is not practical or helpful. You may be encouraged to engage in exposure to fake vomit, or to role-playing situations involving nausea or fake vomit, but a therapist should never ask you to vomit in real life.
If this happens, then it might be helpful to raise this with your therapist and discuss their rationale for suggesting this. If you are unable to reach a helpful consensus, then it might be that a different therapist is better suited to your needs and goals for recovery.
Does CBT work?
There has not been much good quality research into the effectiveness of psychological treatments for emetophobia to date. The gold standard research for testing treatment effectiveness is called a Randomised Controlled Trial, and there is only published for emetophobia so far.
The evidence base shows that CBT is effective at reducing symptoms of emetophobia, and that it appears to be well tolerated by people with the condition. CBT offered in either a group or time intensive format appear to be equally as effective as weekly individual sessions.
In practice, CBT works for many sufferers if they are prepared to do the homework and to challenge their fears. The most likely outcome is that the phobia of vomiting will become a fear of vomiting, that is it is not significantly distressing or interfering in your life.
What we need to build is a community of people with emetophobia and their families so we can research into better treatments that can translate into better services for the future.
What about medication?
Anti-nausea medication is often prescribed. It is unhelpful in the long term as it reinforces the idea that you can prevent yourself from vomiting. Sometimes a type of anti-depressant called an SSRI (for example, sertraline, citalopram, or fluoxetine) may be prescribed that can help reduce anxiety or treat other problems such as depression and OCD. There are no controlled trials on medication in emetophobia.
Self help for emetophobia
A new self-help book called Free Yourself from Emetophobia: A CBT Self-Help Guide for a Fear of Vomiting by Alexandra Keyes and David Veale will be available from September 2021. The book uses evidence-based CBT techniques to support people to overcome their fears and avoidance behaviours in a guided and supportive way.
For some people, a self-help guide might be enough support to reach your goals and improve your quality of life. For others, it might be a helpful resource as an introduction to CBT, or to read and use in conjunction with or whilst awaiting treatment with a professional.
How can I access treatment for emetophobia?
In the UK, the best way to discuss your treatment options is to visit your General Practitioner (GP). They will be able to tell you what treatments are available in your local area, and how to make a referral. Some services accept self-referrals, via website or email. Other services will require your GP to refer you. Most services available on the NHS will involve a waiting time.
There are options to access treatment privately, either by self-funding or payment through an insurance provider. If you wish to explore options for private therapy, then you can visit the BABCP website to check for accredited CBT therapists in your area. It is important to check that a therapist is sufficiently qualified in CBT, and ideally has experience in treating emetophobia. You can do this by looking at the therapist’s profile on the BABCP website, or speaking to them before arranging an assessment.