The Bergen 4-day treatment for specific phobia of vomiting: a case series

Behav Cogn Psychother. 2025 Feb 11:1-16. doi: 10.1017/S135246582400050X. Online ahead of print.

Abstract

Background: Specific phobia of vomiting (SPOV), also called emetophobia, is a debilitating condition that shares features with several other anxiety disorders and obsessive-compulsive disorder (OCD). Approximately half of sufferers from SPOV do not fully benefit from current treatment modalities.

Aims: Bergen 4-day treatment (B4DT) is a highly concentrated form of exposure and response prevention developed for OCD. This case series reports on the first participants undertaking the treatment for SPOV.

Method: Five female participants underwent the B4DT adapted to SPOV. The Specific Phobia of Vomiting Scale (SPOVI) and Emetophobia Questionnaire (EmetQ-13) were administered pre-treatment, post-treatment, and at 3- and 6-month follow-up. Participants were also shown a 27-minute video portraying vomit-related stimuli of increasing intensity at pre- and post-treatment. The time participants managed to watch the video and their subjective anxiety and nausea were assessed at regular intervals. Reliable and clinically significant change were calculated on SPOVI post-treatment and at 6-month follow-up.

Results: Four of the participants achieved clinically significant change and the fifth reliable improvement, and these results were maintained at 6-month follow-up. The participants watched the vomit-related stimuli video for an average of 10 minutes pre-treatment whereas all completed it post-treatment, experiencing considerably less anxiety. These results were maintained at 6-month follow-up.

Conclusion: The B4DT may be a robust and time-effective treatment format for SPOV with low attrition rates, but further research is needed to verify this.

Keywords: Bergen 4-day treatment; case series; cognitive behavioural therapy; concentrated exposure therapy; emetophobia; specific phobia of vomiting.