Emetophobia is the specific fear of vomiting. It usually begins in childhood or adolescence, and it is often overlooked. The most familiar form of cognitive behavioural therapy (CBT) for this fear aims to expose patients to vomiting, which many people find daunting to consider.
Simons and Vloet described a different route. They developed a metacognitive concept and treatment approach to emetophobia and illustrated it in a small case series. Metacognition refers to the beliefs a person holds about their own thinking, and metacognitive therapy (MCT) works at that level.
Three adolescent girls with emetophobia were treated with MCT. Measures of anxiety, worry, depression and metacognitions were taken before and after treatment. All three patients recovered during the course of 8 to 11 sessions, and the measurements of anxiety, worry, depression and metacognitions dropped markedly.
These are encouraging results, and the authors conclude that MCT presents a valuable treatment option for emetophobia in adolescents. The size of the study matters, though. Three participants cannot tell us how well the approach works for other young people, and larger studies would be needed to find out.
If a fear of vomiting is limiting your life or your child's, effective help exists. A conversation with your GP or a psychologist is a good place to start.
What the study did
Emetophobia is the specific fear of vomiting. It usually starts in childhood and adolescence, and the authors describe it as an overlooked disorder. Cognitive behavioural therapy (CBT) for emetophobia aims to expose patients to vomiting. Simons and Vloet set out to illustrate a newly developed metacognitive concept and treatment approach to the disorder, using a small case series.
Metacognition means thinking about one's own thinking. It includes the beliefs a person holds about their worry and their thoughts. Metacognitive therapy (MCT) targets those beliefs rather than relying on exposure to the feared event. The authors treated three adolescent girls with emetophobia using MCT. Each was assessed in the same way, which allows the before and after scores to be compared. They documented measures of anxiety, worry, depression and metacognitions before and after the treatment.
What it found
All three patients recovered during the course of 8 to 11 sessions. The measurements of anxiety, worry, depression and metacognitions dropped markedly. The authors conclude that MCT presents a valuable treatment option for emetophobia in adolescents.
The fall in metacognition scores sits alongside the falls in anxiety, worry and depression. This fits with the idea behind the approach, which is that the way a person relates to their own thoughts is part of what keeps the fear going. The abstract does not say more than this about how the treatment was delivered, so the details are best taken from the full paper.
The limits
This is a small case series. It has three people in it, and it needs to be read as such. A case series describes what happened to a handful of patients who were treated. It does not include a comparison group, and it cannot show how often the same result would occur in other adolescents. All three participants were adolescent girls, so the findings say nothing about boys, younger children or adults. The abstract also does not say whether the improvements lasted after treatment ended. No follow-up is reported.
For these reasons, the paper is best viewed as an early and promising description of a new approach, and a reason to run larger and more rigorous studies. It does not show that metacognitive therapy is better than CBT with exposure, and the authors do not claim that it does.
Why it matters
Emetophobia can narrow a person's life considerably, and the paper highlights that it is a disorder that has received little attention. Exposure to vomiting is a difficult prospect, and some people hesitate to seek treatment because of it. It is therefore useful to know that other approaches are being developed and tested. Having more than one evidence-informed option gives clinicians and families more to discuss. It also matters for young people who are frightened of the very thing exposure asks of them. A treatment that works through beliefs about thinking could, if it holds up in larger studies, suit some of those young people better. At this stage that remains a possibility rather than a finding, and the authors present their work as an illustration of the approach, not as proof of it.
If a fear of vomiting is affecting your life or your child's, please consider speaking with your GP or a psychologist. This fear is treatable. Asking for help is a good first step, and a GP can refer you on if needed.