Emetophobia (Vomiting phobia)

Client
Private patient

This patient was a 30-year-old female with a severe phobia of vomiting, particularly if someone was sick in front of her. This was a long-standing phobia which had developed in childhood and had gradually impacted more and more on her daily life. When we met X, there were several elements of the phobia that were affecting her and her Family. 

X worked within the healthcare sector and had to change jobs so that there was no possibility of her encountering vomit during her working day (moving away from a clinical role). She was hypervigilant when outside the house in case someone looked pale or ill or as if they were going to vomit. There were scenarios where this hypervigilance and anxiety were more pronounced. For example, when eating out in a restaurant with family she had safe foods she could eat to minimise the risk of herself being sick and she preferred eating out before evening time. 

In the evening she felt there was more chance of people drinking alcohol and being sick. She also could not travel by public transport in the evening as again there was more chance of people having drunk alcohol and therefore more chance of them being sick. This had a big impact on her ability to socialise with friends and family. She would become extremely anxious if there was a sickness bug at her child’s school in case her child was affected. If there was vomiting involved, she could not take care of her daughter and her partner would step in – this situation X found distressing. The worst situation would be to be trapped somewhere when someone was being sick. Therefore, being on public transport (buses, trains, underground) or particularly flying were huge trigger points for X. Her partner’s family lived a plane ride away so not being able to fly was a big problem, as well as curtailing family travel for holidays. 

X described the phobia as having become a daily worry for her – worry that she would come in contact with someone sick at some point in her day and would hear, see or smell someone vomiting. The anxiety would be triggered if she heard someone coughing loudly or retching. In the past X has tried hypnotherapy and traditional CBT to try to overcome the phobia. 

When X came to the VR, we developed several scenarios along her hierarchy of feared situations. From easiest to most challenging these were: 

• A customer vomiting in a restaurant 
• A child vomiting in a bedroom 
• A drunk man on a metro vomiting 
• A plane flight with turbulence and a passenger vomiting 

Over her four sessions in the VR, she gradually worked through her four scenarios. Her therapist worked with her at all stages to help her to practice managing her anxiety and to talk through her thoughts in the different scenarios. Her partner was able to watch the treatment taking place in an adjacent room. By the end of the fourth session, X was able to sit comfortably in the VR with an avatar being repeatedly sick on an airplane. She left the fourth session feeling confident that she could manage the sound and sight of someone being sick. 

We checked in with X at 8 weeks post the last VR session. She described the treatment as having ‘changed her life’. She now felt she could travel freely on public transport and while not completely anxiety-free she was confident to manage these situations using the techniques, she had learned in the VR. She has been out to eat socially in the evening with both friends and family with minimal anxiety. She has been on a night out in a busy town environment in the evening which she could not have managed before. 

The family have booked two flights for two family holidays in the next few months. X feels confident she can manage these two flights and it will be the first family holiday with grandparents they have had in many years. Her family too are confident she can manage these environments which she could not do in the past.