Exposure response management in sensu in a specific phobia of swallowing and choking with pavor nocturnus

Exposure Response Management in Sensu in a Specific Phobia of Swallowing and Choking with Pavor Nocturnus A single-case study of exposure treatment in a patient with fear of swallowing the wrong way and choking is presented. Exposure in vivo with response prevention is difficult to realize with patients with this type of phobia. Therefore, and as exposure in-vivo in the presence of her therapist ( M. D.) was not particularly fear-evoking for our patient, we suggested an in sensu approach which was accepted by the patient once a trustful therapeutic relationship had been established. Under high emotional arousal in several treatment sessions the patient remembered various traumatic experiences in her childhood which were related to her throat and to breathing. These traumatic memories were treated with anxiety management techniques, leading to an improvement of symptoms. This encouraged the patient to apply exposure in vivo in real-life situations on her own. Feelings of helplessness were gradually replaced by growing coping abilities and self-confidence. She also changed her interactional behavior in her family and professional life. This process was supported by homework assignments and cognitive interventions. After about 35 sessions, treatment goals seemed to be achieved. However, the sudden death ( from suffocation) of her father-in-law induced a heavy relapse. This could be successfully treated within another 15 sessions. At the end of this treatment phase, the patient reported for the first time regular nightly states of agitation. Three nights with laboratory observation confirmed a pavor nocturnus. We hypothesized a connection between the phobia and fear memories ( of the early traumatic experiences) in the limbic system, and offered additional treatment. The patient felt no need for that. Six months after treatment, she experienced a partial relapse when she had to face surgery with intubation narcosis. This relapse could be overcome with another 5 treatments sessions. At 1 and 2-year follow-up the phobia remained completely vanished, the pavor nocturnus occurred only very rarely, and changes in activities of daily living proved to be stable. The implications of the study are discussed.