Understanding & treating a specific fear of vomiting
Webinar (90 minutes)
Abstract
Background: A Specific Phobia of Vomiting (SPOV) or emetophobia commonly develops in childhood with a mean duration of about 10 years before getting treatment. It occurs almost exclusively in women. It is one of the most common specific phobias that present to clinicians. People with a SPOV tend to be more handicapped than people with other specific phobias (for example they may avoid a desired pregnancy or being significantly underweight from restriction of food). There is one RCT of CBT compared to a wait list (Riddle-Walker et al, 2016) and one single case experimental design of time intensive CBT. Newer developments are focussed on use of virtual reality.
Learning Objectives:
By the end of the skills class, participants will
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Understand the phenomenology of a Specific Phobia of Vomiting (SPOV) and its relationship with OCD, social phobia, health anxiety and eating disorders.
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Be knowledgeable about the association of SPOV with past aversive memories of vomiting.
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Be knowledgeable about a cognitive behavioral model and have a functional understanding of the cognitive processes and behaviours that maintain a SPOV.
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Be able to use appropriate outcome measures.
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Use appropriate exposure including dropping of safety seeking behaviours and consider what expectations are being tested by exposure.
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Use appropriate imagery re-scripting for any past aversive experiences of vomiting.
Training Modalities: Didactic, discussion and practise of formulation – participants are encouraged to bring a case to discuss.
Workshop leader
Professor David Veale is a Consultant Psychiatrist at the South London and Maudsley Trust and the Nightingale Hospital London. He is a Visiting Professor in Cognitive Behaviour Therapies at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. He is an Honorary Fellow of the BABCP, a Fellow of the British Psychological Society and Fellow of the Royal College of Psychiatrists. www.veale.co.uk. He has authored or co-authored 10 peer-reviewed publications in a SPOV.
References
Keyes, A, Gilpin, H, Veale, D, (2018). Phenomenology, Epidemiology, Co-morbidity and Treatment of a Specific Phobia of Vomiting: A Systematic Review of an Understudied Disorder. Clinical Psychology Review 60:15-31
Riddle-Waker, L, Veale, D, et al (2016) Cognitive behaviour therapy for a specific phobia of vomiting (emetophobia): a pilot randomised controlled trial. Journal Anxiety Disorders, 43, 14-22.
Veale, D (2009) Treating a Specific Phobia of Vomiting. The Cognitive Behaviour Therapist, 2, 272–288.
Treating contamination fears in OCD
One day on demand workshop (6 hours) £80
Contamination is one of the most common fears in OCD. About 1/3rd of people with OCD will have co-morbid depression. A common process in contamination is that of ‘contagion’ or transfer. It can include mental contamination where the source is usually inside the body or all-over dirtiness or polluting thoughts about sex, violence, or blasphemy. Contamination is associated with avoidance behaviour, compulsive washing, checking and mental rituals. The motivation to prevent contamination may be to prevent harm, losing control or to avoid feelings of disgust.
Newer developments In CBT include the role of inhibitory learning in exposure and how this overlap with behavioural experiments and understanding of the problem by testing Theory A / Theory B. Exposure in contamination includes transfer of the “contaminants” and spoiling of compulsions such as washing. Special consideration in therapy is required for intrusive sexual and violent images. Newer treatment interventions include imagery rescripting for aversive memories and concurrent treatment for depression (for example improving sleep, diet, exercise, social activity and reducing shame).
Learning objectives
By the end of the workshop participants will
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Understand the phenomenology of obsessional contamination (physical and mental) with special reference to the law of contagion and transfer
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Understand the phenomenology of unacceptable thoughts and images and the processes that maintain them
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Be knowledgeable about the emotion of disgust and derivatives such as self-disgust (shame), guilt, and contempt in contamination
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Use appropriate assessment scales and conduct a functional analysis of cognitive processes and behaviours to develop a formulation
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Conduct a real risk assessment for polluting thoughts
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Understand the role of inhibitory learning in exposure and the overlap with behavioural experiments
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Conduct exposure and response prevention, behavioural experiments, drop safety seeking behaviours and do “anti-OCD” tasks.
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Conduct imagery re-scripting for aversive memories
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Treat co-morbid depression
References
Rachman, S. (2006) The Fear of Contamination: Assessment and treatment. Oxford University Press
Veale, D, Willson, R, (2006) Overcoming Obsessive Compulsive Disorder. Robinson
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Professor David Veale
Professor David Veale is a Consultant Psychiatrist at the South London and Maudsley NHS Foundation Trust and the Nightingale Hospital, London and a Visiting Professor in Cognitive Behavioural Psychotherapies at the Institute of Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London. He is past President of The British Association of Behavioural and Cognitive Psychotherapies. He is co-director at the Centre for Anxiety Disorders and Trauma at the Maudsley and the Anxiety Disorders Residential Unit at the Bethlem. His website is www.veale.co.uk. He has published about 100 peer-reviewed articles and four self-help books.
David specialises in obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), health anxiety and a specific phobia of vomiting (emetophobia). He is also interested in the rapid treatment of depression using Wake and Light Therapy. and nutritional psychiatry.
Education/Academic qualification
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Doctor of Medicine, University of London 1995
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Master of Philosophy, Royal Free School of Medicine 1989
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Bachelor of Medicine and Bachelor of Surgery, Royal Free School of Medicine 1982
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Bachelor of Science in Psychology, Bedford College, University of London 1979
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Professional Qualifications
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Fellow, British Psychological Society , FBPsS Dec 2015 -
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Fellow of the Royal College of Psychiatrists, FRCPsych 2003 -
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Member of the Royal College of Psychiatrists, MRCPsych 1987 -
Books by David Veale
This is a selection of books written by Professor Veale that might be of interest if you would like to join his workshop or find out more about his work,
The OCD 'Bully'
People with OCD often consider their OCD to be like a bully or a demon that has to be obeyed. During the process of cognitive behaviour therapy, they may be encouraged to “externalise” their bully and to act against it by doing the opposite to what the bully demands. Clinicians at the Institute of Psychiatry decided to make a humanoid version of an OCD bully or monster. On the outside of the bully are various manifestations of OCD – for example a clock that represents the wasted time of compulsions; a toilet seat that is full of “germs”; knives for fears of being violent; words such as “Paedophile” and numbers such as “666”. The bully has several eyes to depict the vigilance for threat. A door in its chest opens to reveal a heart of stone. At the base is a broken mirror.
The Bully was featured in the British Medical Journal (BMJ 2010; 341: c2596).
It was unveiled by Professor Jack Rachman on 9th March 2010. Professor Rachman is a leading authority on OCD and used to work on the unit in the 1980s. It is now on permanent loan to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital from David Veale, who commissioned the piece from his friend Steve Caplin.
