Prior to starting a course of Cognitive/Behavioural Therapy (CBT), you would probably undergo an assessment by the therapist and be asked to complete a number of questionnaires relating to Fear, Depression and General Health. These are standard psychological tools with standardised rating scales of 0-8 where 0 represents no anxiety, 2 represents mild anxiety, 4 - moderate anxiety, 6 - severe anxiety and 8 is maximum/acute panic. Having some advance awareness of the questions you are likely to be asked may give you some time to consider these areas and be prepared with answers - so that your first few sessions can get off to a flying start.
The Fear Questionnaire (FQ) asks about fear on a scale of 0-8 relating to :
The General Health Questionnaire (GHQ) asks 58 standardised questions but is often abbreviated to the following 20 measures of mental distress, with responses of 'more than usual', 'same as usual', 'less than usual' and 'not at all':
In the last 2 weeks have you . .
You may also be asked specific questions about your general state of health, according to the styles and interest of the therapist.
The above can take up all or most of the first two assessment sessions with the therapist.
In preparation for the first assessment sessions, it may be useful to think, in advance, about the following:
 | what you mean by 'panic' (if you also suffer from panic attacks) |
| the thoughts, fears and emotions during a panic attack |
| a full description of every symptom experienced during panic attacks |
| the severity of these symptoms |
| the duration of these physical and emotional symptoms |
| how often the symptoms occur and whether they vary in severity |
| when they occur - the time of day, when, where, with whom . . . |
| what, if anything, makes the symptoms better or worse |
| whether anything makes the symptoms better or less likely to occur |
The above approach assumes that the anxiety and panic attacks are purely psychological, although physical triggers might be identified here which could/should be medically investigated. Where the nausea is felt to have a physical trigger, the above model would appear to be less applicable - ie for emetophobes who suffer from nausea which is not thought-induced or situation-related or where there could be neuro-physiological factors involved (see link).
One approach to test whether symptoms are genuinely physical or purely psychological, or a combination of both, is to actually test for them during sessions in a 'controlled' environment - providing the therapist is confident s/he can deal with the outcome. (If you don't feel confident with the therapist - don't proceed). Patients who have been asked to deliberately hyperventilate during appointments (try to avoid driving within 30 minutes of doing so - for safety reasons), and at home (in a more natural, relaxed and representative environment) to compare the physiological sensations with those of a panic attack. One emetophobia patient had to deliberately induce retching during sessions which was most unpleasant but helped her realise it was a psychological response to anxiety and she was able to learn how to control her anxiety and prevent the retching occurring.
It has been suggested to some emetophobes that the only way they are likely to overcome the phobia would be to actually confront it. This would involve inducing vomiting via an emetic drug. In desperation, having tried every other form of known therapy available in the UK, one Gut Reaction member actually went through with this treatment approach. (Her story and experience can be read on :emetic-method )
A TYPICAL TREATMENT PROGRAMME FOLLOWS: cbt-treatment