1 CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited

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Vomit Phobia?

Breathing, a resource?

Discover

exercises

that can

steady the

nerves

2 CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited

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Contents

Vomit Phobia?

What is it and how can it affect meDavid & Rob Page 3

Breathing can it helpfactcorner Page 4

Exercisesfactcorner Page 5

2011 CBT in the City Ltd Registered company in UK:6709268.

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3 CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited

vomit phobiawhat is it?By Dr David Veale and Rob Willson

A phobia of vomiting is a condition where an individual fears vomiting or others vomiting (but commonly both). You may often feel sick but vomit phobics are not actually sick any more than someone without a phobia of vomiting. It may become a preoccupation and the only thing you think about. It may be linked to a fear that you will lose control, become very ill, faint or that others will find you repulsive. As a result you try too hard to avoid a wide range of situations or activities that you might believe might increase of risk vomiting. These include being near drunks; going on a fairground ride; being near people who are ill; travelling by boat; going on holidays abroad; travelling by aeroplane; drinking alcohol; going into crowded places or using public transport; or eating certain foods. Some people with vomit phobia have avoided general anaesthetic for surgery. Many women with phobia of vomiting have avoided getting pregnant or terminated a pregnancy. Women with babies might experience a great deal of distress about their child vomiting.

You might excessively check the sell-by date of foods in a shop or eat only small amounts of food. You might be excessive hygienic; check the health of yourself & others; use superstitious behaviours; seek reassurance about whether others are ill or could be sick; or excessively clean the kitchen area. If you think you are going to vomit, then might look for an escape route; try to keep tight control of your behaviour, take anti-nausea medication or suck a sweet. All these are called “safety seeking behaviours” and maintain your fear as you never find out whether you need to use them or not and increase your fear.

When does a concern with vomiting become a phobia?Many people are fearful of vomiting to a certain extent,

but to be diagnosed with phobia of vomiting it must be very distressing and have an important effect on your life. For example, it may interfere with an important relationship or your social life and cause significant handicap.

How common is a phobia of vomiting?It’s hard to say as there have been no large-scale surveys

conducted. Many people with a phobia of vomiting are often too ashamed to talk about their problem or feel very misunderstood. The best estimate is about 0.1 to 0.2% of the population. This is different to a fear of vomiting which is more common.

What causes a phobia of vomiting?There is virtually no research into the cause of vomit

phobia. Causes are thought to be psychological and biological. There might be a genetic influence in vomit phobia. It usually develops in childhood, sometimes after a bad experience of vomiting. Once a phobia develops it is maintained by the way avoid anything linked to vomiting. It is much more likely to occur in women.

Is a phobia of vomiting linked to other condition?You may feel demoralised or clinically depressed. Some

sufferers restrict their food believing that a range of food may

cause vomiting. You may then become very underweight and be misdiagnosed with anorexia nervosa.

How is the condition likely to progress?No long term follow studies have been done. Many people

with phobia of vomiting have a chronic condition. If left untreated, then the condition is likely to persist.

What treatments are available?If you feel that you or a close relative are affected by

phobia of vomiting and would like help or more information, contacting your GP is often the easiest way to get help and further treatment. He or she may refer you to cognitive behaviour therapy for further assessment. This may lead to outpatient treatment or, if more serious in-patient treatment.

Details of obtaining national specialist treatment (1) privately at The Priory Hospital North London or (2)  NHS appointment at the Bethlem Royal.

If you’re worried about talking to your GP, consider writing down your concerns and questions. You can:

take a friend or family member with you to act as an advocate

see another doctor in the practice; orjoin a new GP practice.NHS Direct can offer you advice on moving to a new

practice. You can visit the website at www.nhsdirect.nhs.uk or phone them on 0845 4647.

There has been very little research or controlled trials on the treatment of a phobia of vomiting. The most likely treatments offered are cognitive behaviour therapy (CBT) and medication.

What is CBT?Cognitive behaviour therapy (CBT) is based on a

structured programme of self-help, 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 tend to reduce.

What about medication?Anti-nausea medication is usually unhelpful in the long

term as it reinforces the idea that you can control yourself from vomiting. Sometimes a type of anti-depressant called an SSRI may be prescribed that can reduce anxiety or treat other problems such as depression. There is no evidence from controlled trials that medication is of any benefit in vomit phobia.

Does treatment work?Treatment works for many sufferers if they are prepared to

do the homework and to test out some of their worries. Some sufferers may feel well for a time then go back to old behaviours, while others remain chronically ill.

Self-help may be useful as the first stage of treatment or alongside other treatments. There are a number of websites for individuals with a vomit phobia such as Gut Reaction, and EmetOnline.

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CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited

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CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited

Diaphragmatic breathing, abdominal breathing, belly breathing or deep breathing is the act of breathing done by expanding one's belly and thereby allowing the diaphragm to move down creating more room for the lungs to expand, rather than only through chest wall expansion/ movement of the rib cage.

Due to the lung expansion being lower (inferior) on the body as opposed to higher up (superior), it is referred to as 'deep' and the higher lung expansion of rib cage breathing is referred to as 'shallow'. The actual volume of air taken into the lungs with either means varies. Attaining maximal lung expansion may require both diaphragmatic contraction as well as rib cage expansion, as the amount of room created by the abdominal depression or rib stretching may not create an adequate enough vacuum space on their own.

The term 'diaphragmatic' is sometimes misinterpreted to imply that the thoracic diaphragm is not used in shallow breathing. This is a misunderstanding as it is used in either case. In belly breathing, the lower ribs are stabilized and the central tendon of the diaphragm is mobilized so that a contraction of the diaphragm pulls the tendon down. In rib cage breathing, the central tendon is stabilized and the lower ribs are mobilized so that a contraction lifts the lower ribs.

This deep breathing is marked by expansion of the abdomen rather than the chest when breathing.

It is generally considered a healthier and fuller way to ingest oxygen, and is often used as a therapy for hyperventilation, anxiety disorders and stuttering.

Some yoga and meditation traditions draw a clear distinction between diaphragmatic breathing and abdominal breathing or belly breathing. The more specific technique of diaphragmatic breathing is said to be more beneficial.

Although the diaphragm is the primary breathing muscle, it is believed that many people have little sensory awareness of it, almost no idea how to engage it more fully, and even how it works. Some breath therapists and breathing teachers believe that because of the increasing stress of modern life and the resulting over-stimulation of the sympathetic nervous system, as well as of the idealised hard, flat belly, many people carry excessive tension in the belly, chest, and back, which makes it difficult for the diaphragm to move freely through its full range of motion.

It is generally considered a healthier and fuller way to ingest oxygen, and is often used as a therapy for hyperventilation, anxiety disorders and stuttering.

can breathing techniques help?a resource that is localBy fact corner

Contact 0207 4671508 and find out more about CBT in the City

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CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited

A common diaphragmatic breathing exercise is as follows:Sit or lie comfortably, with loose garments.Put one hand on your chest and one on your stomach.Slowly inhale through your nose or through pursed lips (to slow down the intake of breath).As you inhale, push your belly/ stomach out and feel your stomach expand with your hand.Slowly exhale through pursed lips to regulate the release of air while squeezing your belly/ tummy.Rest and repeat.Another diaphragmatic breathing exercise for raising oxygen levels in the blood and energy in the body is to take several negative breaths, immediately followed by an equal number of positive breaths. During negative breaths, one

inhales, immediately exhales and then holds one's breath for a short time. The emphasis is on keeping one's lungs empty. Negative breaths reduce the amount of oxygen in one's blood. During positive breaths, one inhales, holds one's breath, and then exhales. The emphasis is in keeping one's lungs full of air. Positive breaths increase the oxygen in one's blood. Although not always taught, continuing to breathe into the chest at the same time can provide an ever more "fulfilling" exercise. The goal is to have the entire torso move in and out when breathing, as if one is surrounded by an expanding and contracting inner tube.

breathing exercisesanytime, any place, anywhereby fact corner

“A common diaphragmatic breathing exercise is as follows:Sit or lie comfortably, with loose garments.Put one hand on your chest and one on your stomach.Slowly inhale through your nose or through pursed lips (to slow down the intake of breath).As you inhale, push your belly/ stomach out and feel your stomach expand with your hand.Slowly exhale through pursed lips to regulate the release of air while squeezing your belly/ tummy.”

fact corner

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