Specific phobia of vomiting (SPOV) is a persistent, excessive fear of vomiting that is more prevalent in females, often begins in childhood and typically lasts 25 years before treatment is sought. It is a relatively neglected area of research, with most evidence consisting of single case studies. There are implications for the perinatal period, in particular the experience of pregnancy which for many involves symptoms of nausea and vomiting. However, there is a paucity of research on the experience of SPOV during pregnancy and currently no published treatment research. This study aimed to extend the existing literature by applying Veale’s (2009) protocol for SPOV to a pregnant client in her twenties. The intervention consisted of 12 one-hour face-to-face sessions and was effective in significantly reducing anxiety (GAD-7 reduced from 7 to 0), depression (PHQ-9 reduced from 6 to 1), impaired functioning (WSAS reduced from 20 to 4) and vomiting phobia (SPOVI reduced from 40 to 0).

Key learning aims

1. (1) To understand the impact of SPOV during pregnancy.

2. (2) To understand how to adapt Veale’s (2009) SPOV treatment protocol for a pregnant client.

3. (3) To learn how to carry out behavioural experiments and imagery rescripting related to SPOV during pregnancy.

This paper describes a single case study of a female asylum seeker presenting at a specialist clinic for women with female genital mutilation (FGM). The patient presented with post-traumatic stress disorder (PTSD) to multiple events due to her 45-year history of sexual and physical abuse. She also had intense feelings of being contaminated due to the sexual abuse. Within the cognitive model, a cognitive restructuring and imagery modification protocol was used to treat the patient’s feelings of being contaminated. After that, imagery rescripting was used to address the patient’s many PTSD re-experiencing symptoms. Clinicians can often feel overwhelmed when working with patients who present with multiple, traumatic events spanning many years; it is hoped that this case study helps clinicians to feel more confident about working with this client group and with women with FGM.

Key learning aims

1. (1) To be able to assess and treat survivors of multiple sexual assaults over many years using imagery rescripting.

2. (2) To learn how to use cognitive restructuring and imagery modification to treat feelings of being contaminated.

3. (3) For therapists to gain confidence with working with women who have experienced female genital mutilation.