Treating Emetophobia in Kids and Teens
The fear of vomiting, known as emetophobia, is a common form of anxiety in kids and teens. Emetophobia can cause significant disruption to a child’s life, including school refusal, food avoidance, and difficulty being around peers. For some kids, the fear of throwing up can make it hard to leave the house at all.
Although the symptoms of emetophobia can be debilitating, the good news is that help is available. One of the most effective forms of emetophobia treatment for kids is called ERP. ERP focuses on helping kids face their fears in a gradual, supported way, and is very successful in treating emetophobia in people of all ages, including kids and teens.
Wondering if your child has emetophobia? Check out our post on recognizing emetophobia in kids and teens. [Include hyperlink to blog post 1]
What is ERP for emetophobia?
ERP stands for Exposure and Response Prevention and is a kind of Cognitive Behavioral Therapy used to address certain types of anxiety, including emetophobia. Like all CBT, ERP is focused on teaching clients concrete skills they can use to manage their symptoms and regain control over their lives. ERP targets a child’s anxiety about vomiting through the use of exposures, or challenges. Exposures help a child learn to face their fears by gradually practicing stressful things they may have been avoiding. Exposure therapy for emetophobia may involve looking at cartoons, images, or movies with vomiting, being near people who are sick, returning to places the child has been avoiding, and reintroducing food, clothes, or activities that the child associates with throwing up. ERP also involves a component called “response prevention,” which refers to helping kids reduce the rituals and anxious responses that they have come to rely on. The reason for this is that these behaviors, also known as safety behaviors, can reduce the child’s confidence in their own ability to handle their anxiety. Through the course of ERP, the child learns how to manage their anxiety, builds their confidence, and starts getting back to living their life outside of the rules created by their emetophobia.
How does ERP work for kids and teens?
For a child with emetophobia, the idea of starting therapy may seem scary. ERP clinicians who work with kids have lots of experience breaking down the process in a way that feels manageable and understandable. Here’s what treatment might look like:
Education about symptoms - Treatment begins by teaching kids how to understand their fear of vomiting. Kids can be taught to think of their anxiety as a “false alarm” that sometimes goes off when nothing is wrong. Many people’s “alarms” include physical symptoms, including stomachaches. For a child afraid of getting sick, learning to identify these stomachaches as false anxiety alarms, and not a sign that they are about to throw up, can be very helpful.
Learning about avoidance and developing a fear ladder - It's normal to avoid something that feels scary or stressful, and sometimes this does make us feel better for a little while. But for kids with emetophobia, avoiding situations related to vomit just tends to spiral into more and more avoidance. Their therapist will help them learn the importance of facing their fears so they can build up their confidence and their ability to handle these situations. They will also work together to create a fear ladder or hierarchy of ways to practice slowly, one step at a time.
Gradual practice - Once a fear ladder is developed, it's time to start practicing! Exposures, which we generally call “challenges” or “bravery missions” with kids, are the most important part of ERP. An initial target is selected from low down on the hierarchy that the child feels that they can handle. The therapist supports the child in managing their anxiety, and will often practice in session together to help the child build their confidence. Throughout treatment, as the child is ready, they will progress up the fear ladder to face more challenging situations.
Reducing safety behaviors - Most kids with emetophobia come to rely on anxious rituals or safety behaviors to manage their anxiety. This can involve carrying special snacks to reduce nausea, checking to make sure others aren’t sick, scanning their own body for signs of illness, asking their parents if they will throw up, and more. These behaviors may make the child feel better for a short while, but just like avoidance, they actually increase the child’s anxiety by creating a belief that they cannot handle the situation without elaborate support. In ERP, the child will work with their therapist to reduce these safety behaviors and learn that they can handle their feelings on their own.
Reinforcement of successes - Exposure therapy is hard work, and it’s important to recognize that effort as kids progress through ERP. For many kids and teens, simple praise and acknowledgement is the affirmation they need. For others, a reward system may be helpful to increase motivation and to celebrate the child’s efforts in facing their fear of vomiting.
Parent involvement - ERP for kids often involves some work with parents as well. This is especially true for younger children, but can also be a component of therapy for teenagers. Parents can help the therapist understand the child’s symptoms, assist the child in completing their challenges at home, and help reward and celebrate their progress. In some cases, parents will meet individually with their child’s therapist to learn more about strategies they can use to support their child and encourage brave behaviors.
It can feel hard to know how to help a child with emetophobia. But ERP is a well-established treatment that is very effective, and has helped many kids and teens learn how to manage their fear of vomiting. With the support of an ERP therapist, you and your child can learn the strategies you need to regain control of your lives and gain freedom from their anxiety.
Ready to start your child’s recovery?
CABT's Emetophobia Institute and expert therapists specialize in ERP therapy for patients of all ages. Many of our clinicians are child psychologists with extensive experience treating emetophobia in kids. Book a free 15-minute intake call today.
