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A combined EMDR/CBT-based approach for the successful management of cyclical vomiting syndrome: a case study

Published online by Cambridge University Press:  15 April 2024

Kate Ashcroft*
Affiliation:
Lancashire and South Cumbria NHS Foundation Trust, UK

Abstract

Abstract

Cyclical vomiting syndrome (CVS) is an extremely debilitating condition that can have an adverse impact on physical health and can significantly disrupt social and occupational functioning. It is a poorly understood illness in terms of aetiology, and most research has focused on the pharmacological management of the condition. This article describes a case study of a combined cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR)-based intervention with an adult with past trauma who had a 20-year history of CVS accompanied by high cannabis use. Therapy led to improvements in physical health and social functioning, reduced use of cannabis, and a significant reduction in the frequency and severity of vomiting episodes and associated hospital admission. Implications for future research and management of the illness are discussed.

Key learning aims

  1. (1) To understand how the presence of co-morbid untreated trauma in individuals with CVS may result in unhelpful coping strategies that can worsen the course of the illness.

  2. (2) To explore how the addition of psychological therapy to routine care of gastrointestinal disorders such as CVS can improve treatment outcome.

  3. (3) To consider how offering an individualised and flexible approach to appointments may benefit individuals who find it more difficult to engage in psychological therapy.

Type
Case Study
Copyright
© Crown Copyright - Lancashire and South Cumbria Foundation Trust, 2024. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Hackmann, A., Bennett-Levy, J., & Holmes, E. A. (2011). Oxford Guide to Imagery in Cognitive Therapy. Oxford University Press, USA CrossRefGoogle Scholar
Palsson, O. S., & Balou, S. (2020). Hypnosis and cognitive behavioral therapies for the management of gastrointestinal disorders. Current Gastroenterology Reports, 22, 31. https://doi.org/10.1007/s11894-020-00769-z CrossRefGoogle ScholarPubMed

References

Abell, T. L., Adams, K. A., Boles, R. G. Bousvaros, A., Chong, S. K. F., Fleisher, D. R., Hasler, W. L., Hyman, P. E., Issenman, R. M., Li, B. U. K., Linder, S. L., Mayer, E. A., McCallum, R. W., Olden, K., Parkman, H. P., Rudolph, C. D., Tache, Y., Tarbell, S., & Vakil, N. (2008). Cyclic vomiting in adults. Neurogastroenterology and Motility, 20, 269284. https://doi.org/10.1111/j.1365-2982.2008.01113.x CrossRefGoogle ScholarPubMed
Allen, J. H., de Moore, G.M., Heddle, R., & Twartz, J. C. (2004). Hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut, 53, 15661570. https://doi.org/10.1136/gut.2003.036350 CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn).CrossRefGoogle Scholar
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893897. https://doi.org/10.1037//0022-006x.56.6.89 CrossRefGoogle ScholarPubMed
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II Manual. San Antonio: The Psychological Corporation.Google Scholar
Boschen, M. J. (2007). Reconceptualizing emetophobia: a cognitive-behavioral formulation and research agenda. Journal of Anxiety Disorders, 21, 407419. https://doi.org/10.1016/j.janxdis.2006.06.007 CrossRefGoogle ScholarPubMed
Chen, Y. J., Song, X., Winer, I., Smith, P., Bhandari, S., Almansa, C., Richmond, C., Venkatesan, T., & Levinthal, D. J. (2022). Health care resource use and associated costs of cyclical vomiting syndrome in the United States. Gastro Hep Advances, 1, 963973. https://doi.org/10.1016/j.gastha.2022.06.013 CrossRefGoogle Scholar
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461470. https://doi.org/10.1016/0005-7967(86)90011-2 CrossRefGoogle ScholarPubMed
Craske, M. G.,Wolitzky-Taylor, K. B., Labus, J., Wu, S., Frese, M., Mayer, E. A., & Naliboff, B. D. (2011). A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behaviour Research and Therapy, 49, 413421. https://doi.org/10.1016/j.brat.2011.04.001 CrossRefGoogle ScholarPubMed
Fleisher, D. R. (1997). Cyclic vomiting syndrome: a paroxismal disorder of brain-gut interaction. Journal of Pediatric Gastroenterology and Nutrition, 25, S13S15. https://doi.org/10.1097/00005176-199700002-00007 Google ScholarPubMed
Fleisher, D. R. (2008). Empiric Guidelines for Treatment of Cyclic Vomiting Syndrome. Cyclic Vomiting Syndrome Association. http://cvsaonline.org/wpcontent/uploads/2019/09/fleishers-empiric-guidelines.pdf (Accessed 27th February 2023.Google Scholar
Fleisher, D. R., Gornowicz, B., Adams, K., Burch, R., & Feldman, R. J. (2005). Cyclic vomiting syndrome in 41 adults: the illness, the patients and problems of management. BMC Medicine, 3. https://doi.org/10.1186/1741-7015-3-20 CrossRefGoogle Scholar
Fleisher, D. R., & Matar, M. (1993). The cyclic vomiting syndrome: a report of 71 cases and literature review. Journal of Pediatric Gastroenterology and Nutrition, 17, 361369. PMID: 8145089.CrossRefGoogle ScholarPubMed
Hejazi, R. A., Lavenbarg, T.H., Foran, B., & McCallum, R. W. (2010). Who are the nonresponders to standard treatment with tricyclic antidepressant agents for cyclic vomiting syndrome in adults? Alimentary Pharmacology and Therapeutics, 31, 295301.CrossRefGoogle ScholarPubMed
Hejazi, R. A.,Lavenbarg, T. H., Pasnoor, M., Dimachkie, M., Foran, P., Herbelin, L., & McCallum, R. W. (2011). Autonomic nerve function in adult patients with cyclic vomiting syndrome. Neurogasteroenterology and Motility, 23, 439443. https://doi.org/10.1111/j.1365-2982.2011.01679.x CrossRefGoogle ScholarPubMed
Hejazi, R. A., & McCallum, R. W. (2014). Cyclic vomiting syndrome: treatment options. Experimental Brain Research, 232, 25492552. https://doi.org/10.1007/s00221-014-3989-7 CrossRefGoogle ScholarPubMed
Levinthal, D. J. (2016). The cyclic vomiting syndrome threshold: a framework for understanding pathogenesis and predicting successful treatments. Clinical and Translational Gastroenterology, 7, e198. https://doi.org/10.1038/ctg.2016.55 CrossRefGoogle ScholarPubMed
Levinthal, D. J., Romutis, S., Rajalaban, A., Kumar, V. C. S., Feldman, R., Althouse, A. D., & Venkatesan, T. (2021). Greater intolerance to uncertainty predicts poorer quality of life in adults with cyclic vomiting syndrome. Neurogasteroenterology and Motility, 33, 12. https://doi.org/10.1111/nmo.14159 Google ScholarPubMed
McRonald, F. E., & Fleisher, D. R. (2005). Anticipatory nausea in cyclical vomiting. BMC Paediatrics, 24, 3. https://doi.org/10.1186/1471-2431-5-3 CrossRefGoogle Scholar
Moran, D. J., & O’Brien, R. (2005). Competence imagery: a case study treating emetophobia. Psychological Reports, 96, 635636. https://doi.org/10.2466/pr0.96.3.635-636 CrossRefGoogle ScholarPubMed
Namin, F., Patel, J., Lin, Z., Sarosiek, I., Foran, P., Esmaeli, P., & McCallum, R. (2007). Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy. Neurogastroenterology and Motility, 19, 196202. https://doi.org/10.1111/j.1365-2982.2006.00867.x.CrossRefGoogle ScholarPubMed
Pritchard, M. J., & O’Neill, S. (2010). Cyclical vomiting syndrome: diagnosis, causes and treatment. Nursing Standard, 24, 3541.CrossRefGoogle ScholarPubMed
Slutsker, B., Konichezky, A., & Gothelf, D. (2010). Breaking the cycle: cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome. Psychology Health and Medicine, 15, 625–31. Available at: https://doi.org/10.1080/13548506.2010.498893 CrossRefGoogle Scholar
Thurler, A. H., & Kuo, B. (2013). From heave to leave: understanding cyclic vomiting syndrome. Gastroenterology Nursing, 36, 407413. https://doi.org/10.1097/SGA.0000000000000013 CrossRefGoogle ScholarPubMed
Trabell, S., & Li, B. U. K. (2008). Psychiatric symptoms in children and adolescents with cyclic vomiting syndrome and their parents. Headache, 48, 259266. https://doi.org/10.1111/j.1526-4610.2007.00997.x CrossRefGoogle Scholar
Veale, D., & Lambrou, C. (2006). The psychopathology of vomit phobia. Behavioural and Cognitive Psychotherapy, 34, 139150. https://doi.org/10.1017/S1352465805002754 CrossRefGoogle Scholar
Venkatesan, T., Levinthal, D. J., Tarbell, S. E., Jaradeh, S. S., Hasler, W. L., Issenman, R. M., Adams, K. A., Sarosiek, I., Stave, C. D., Sharaf, R. N., Sultan, S., & Li, B. U. K. (2019). Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenerology and Motility Society and the Cyclic Vomiting Syndrome Association. Neurogastroenterology and Motility, 31 (Suppl 2), e13604. https://doi.org/10.1111/nmo.13606 CrossRefGoogle ScholarPubMed
Venkatesan, T., Prieto, T., Barboi, A., Li, B., Schroeder, A., Hogan, W., Ananthakrishnan, A., & Jaradeh, S. (2010). Autonomic nerve function in adults with cyclic vomiting syndrome: a prospective study. Neurogasteroenterology and Motility, 22, 13031307. https://doi.org/10.1111/j.1365-2982.2010.01577.x CrossRefGoogle ScholarPubMed
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) – Standard [Measurement Instrument].Google Scholar
World Health Organization (2019/2021). International Classification of Diseases, Eleventh Revision (ICD-11). https://icd.who.int/browse11 Google Scholar
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