(PS3-D86) Virtual Implementation of Evidence-based Cognitive-behavioral Interventions for Youth with Emetophobia During the COVID-19 Pandemic: A Clinical Case Study

Emetophobia, the specific phobia of vomiting, is one of the most understudied and least understood anxiety disorders (Boschen, 2007), yet it impacts approximately 1.7 to 7% of adults (Hunter & Anthony, 2009). Even less is known about emetophobia in children and only a few case studies in the literature have utilized cognitive behavioral therapy (CBT) to treat emetophobia in children—clinical cases on children with emetophobia have primarily used exposure therapy in traditional face-to-face clinical settings (Dosanjh et al., 2017; Graziano et al., 2010). Research has not yet focused on the treatment of children with emetophobia via telehealth. The purpose of this case study is to demonstrate the clinical assessment of a 10-year-old female with emetophobia and the implementation of CBT using the Coping Cat manual delivered via telehealth during the COVID-19 pandemic. The Coping Cat manual (Coping Cat) (Kendell & Hedtke, 2006), which incorporates skill building and exposure interventions, was used for this patient due to its positive treatment outcomes in youth diagnosed with anxiety disorders and secondary specific phobia (e.g., Kendall et al., 1997).

At baseline, the child met criteria for specific phobia, emetophobia as indicated by a diagnostic interview with the child’s parents and administration of self-report measures (e.g., the Screening for Child Related Anxiety Disorders and the Emetophobia Questionnaire). Assessments were completed monthly to monitor symptomatology. The child experienced weekly episodes of severe anxiety and avoidance surrounding vomit that had persisted throughout four years. Her symptoms caused functional impairment at home and at school.

Treatment sessions took place via Zoom and creatively engaged the child in treatment. Session structure followed Coping Cat while incorporating exposure exercises from the existing treatment literature on emetophobia (e.g., graded hierarchy of pictures, sounds, and videos of vomiting). Skill building included identifying and understanding reactions to anxiety, identifying and challenging anxious self-talk, learning effective coping strategies, and providing self-reinforcement. The Coping Cat workbook was presented on a shared screen which the client and therapist were both able to draw and write on. Exposure interventions involved using the Zoom share screen function to view content and collaboratively planning how to navigate her anxiety by writing on a shared virtual whiteboard. She also created her own subjective units of distress scale by drawing on the shared screen. Parental involvement was occasionally required to prepare exposure interventions ranked higher on the child’s fear hierarchy (e.g., parental preparation of a fake vomit recipe).

Improvement in the child’s symptoms was seen within 30 sessions. Post-treatment, she no longer met DSM-5 criteria for specific phobia and experienced significant symptom reduction. This case study illustrates the positive effects of virtual CBT including exposure interventions for children with emetophobia and the innovation of therapy through digital technology for children. Specific results will be presented along with recommendations for conducting virtual treatment with children with emetophobia.