Re:Choking phobia

Madalena,

Your message provides me with an opportunity to outline what happened with this case since my original posting. I appreciate your level of desperation, so I hope this gives you some understanding of what was found to be effective.

In general, I continued with the strategy outlined by Dr. Pretzer. Perhaps somewhat unusually, this client actually found drinking liquids at times to be more distressing than eating soft foods, although this varied across time. Our exposure heirarchy began simply with her sitting with a glass of water in front of her, until the anxiety related to this subsided. We then proceeded with very small steps such as holding the glass, then holding it to her mouth but not sipping, etc.

Another important variable in this case was the presence or absence of others when eating or drinking. Specifically, she felt safer when others were around, so we included this in the exposure program, combining the factor of liquid or food intake with the presence of others. It is important to note that it took many months for her to build up what she ate and drank, all still in the presence of others. She did very little alone throughout this time period. However, as she experienced increased success around others, we began the process of her proceeding alone. Again, in her view, this was a painstakingly slow process, starting with miniscule amounts of liquid or food.

In addition to this exposure work, she found it quite helpful to limit/eliminate the "safety behavior" of focussing so closely on taking in the substance and/or swallowing. She did anything she could to take her attention away from this (e.g., read, TV, think of her right foot, etc.).

As well, we always considered the role of "scary thoughts" in her anxiety, which certainly included a profound fear of stopping breathing and dying. We "unpacked" and challenged these using the various CT methods, and looked at the idiosyncratic meaning to her of dying.

At one point, she made a point of observing very young babies eating awkwardly (sputtering and spitting, as they do), which led her to conclude "even a baby can do it," for her a convincing piece of evidence countering her fear of her throat closing and her breathing being cut off. As well, simply spending so much time around a friend's baby at feeding time was a very useful exposure step.

In general, while the course of therapy in this case proceeded very slowly, and was up and down in nature, there was a general trend across time of normalization of her eating/drinking. In this case, an unrelated life situation led the client to discontinue our therapy before all of her goals were accomplished, although at the point of our final meetings, she had greatly expanded her repetoire. Perhaps most importantly, she evidenced a much greater ability to reassert the helpful strategies when she had a setback or "bad day," and was much less alarmed by these times.

I hope this provides you with a general understanding of the useful strategies in this case. A trained cognitive behavior therapist would be enormously helpful in providing the structure, collaboration, support, and patience required.

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