Re:Choking phobia

You don't say anything about how this problem developed or about the client's thoughts, fears, and beliefs regarding swallowing. This information would be quite useful in responding to your query.

Most commonly, something (an event, thought, or image) results in the client fearing that he or she will choke and die. They respond to this fear by paying close attention to their sensations as they chew and swallow and "being careful". Unfortunately, when one pays close attention while chewing and swallowing, swallowing no longer feels "natural" or "right." This often leaves the person with more of a sense that "something isn't right" with their swallowing and increasingly convinced that they must "be careful" in order to avoid choking. This results in continued close attention to their swallowing and in avoidance behavior such as chewing very carefully, avoiding foods which seem particularly likely to result in choking, etc. Over time, the anxiety intensifies and the avoidance becomes more and more of a problem.

We generally have good results with a treatment approach which consists of: 1) obtaining a good history and developing a good understanding of the client's fears and beliefs, 2) helping the client look critically at the experiences which lead them to believe that they are in danger of choking to death, 3) sharing the understanding of their symptom which was described in the previous paragraph, 4) helping them realize that swallowing is scary but not dangerous, 5) explaining the importance of "facing your fears" (i.e. in-vivo exposure) for anxiety reduction, and 6) gradual in-vivo exposure.

I work collaboratively with the client in developing an exposure heirarchy but we usually start by first reducing and then eliminating the precautions the client is taking (including their paying close attention to how they chew and swallow) and then by gradually expanding the range of foods they eat until we get back to a normal diet without any noticeably avoidance or precautions. With this client, a good starting point might be to have her drink small amounts of liquid and tolerate the anxiety and discomfort. I'd then work towards having her drink small amounts frequently and having her relinquish her towel and swallow her saliva rather than spitting into the towel. We'd then progress from "easy" liquids like water and juice to more substantial liquids like milkshakes and nutritional supplements and then move on to solid foods.

This approach takes some persistence but my experience is that it usually works well.

It will be important to watch for signs of dehydration and to get medical attention for her if necessary.

Replies:

Re:Choking phobia, by Paul Robinson, 01/16/01 Re:Choking phobia, by Madalena Lobo, 03/07/03 Re:Choking phobia, by Dr. Paul J. Robinson, 03/25/03

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