Facing a fear of vomiting: step ideas
Step ideas to choose from with your therapist for facing a fear of vomiting, from words and pictures to foods, places and people you avoid. Based on Riddle-Walker et al. (2016) and Craske et al. (2014): a list of graded practice ideas for fear of vomiting, with safety behaviours to drop and steps to carry to the exposure hierarchy.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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Facing a fear of vomiting: step ideas
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How facing the fear helps
When something frightens you, it makes sense to avoid it or to do things that make you feel safer. But avoiding anything linked to sickness, or only facing it with your safety behaviours, stops you finding out what really happens. The fear never gets tested.
Each step on this sheet is a chance to test what you fear. Before a step, you and your therapist write down what you expect to happen. Afterwards, you write down what did happen. Your anxiety does not have to go down before you start or before you stop: what matters is finding out. Feeling anxious during a step is expected.
Practise each step more than once, and vary it: a different time, place or length. This helps what you learn carry over to everyday life.
Only practise steps you have agreed with your therapist, and leave out anything that would put your health or safety at real risk.
Words, pictures and sounds
These steps start with reminders of sickness rather than feeling sick yourself. What feels hard is different for everyone, so tick what fits you.
Feeling a little queasy
These steps bring on mild, everyday stomach feelings like the ones you fear, so you can find out what happens. Being sick is not part of this practice. Talk to your therapist before you try any step that brings on a queasy feeling.
Only try exercises you have agreed with your therapist. Check with your GP first if you have a heart or breathing condition or epilepsy, or are pregnant. Stop if you feel unwell in a way that is different from your usual panic feelings.
Eating and food
These steps bring back foods and ways of eating you have cut out because of the fear. What feels hard is different for everyone, so tick what fits you.
If you are making yourself sick, using laxatives or eating very little, tell your therapist and your GP. If you faint, have chest pain or a racing or uneven heartbeat, get urgent medical help.
People and places
These steps take you back to people and places you avoid because they remind you of sickness. What feels hard is different for everyone, so tick what fits you.
Safety behaviours to drop
Safety behaviours are things you do to feel safer. They can stop you finding out what really happens, so dropping them is part of each test. Tick the ones you use.
Choose which safety behaviours to drop with your therapist. Keep precautions that protect your real health or safety. Do not stop or change any prescribed medication on your own; talk to your prescriber first.
Steps to add to my ladder
With your therapist, write down the steps you would like to try and what you fear will happen in each. Then rate how anxious you expect to feel, from 0 (no anxiety) to 100 (the most anxious you can imagine).
You and your therapist will add these steps to your graded exposure hierarchy, where you rank them and plan your practice.
| # | Step I could try | What I fear will happen | Expected anxiety (0 to 100) | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 |
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When to use ‘Facing a fear of vomiting: step ideas’
‘Facing a fear of vomiting: step ideas’ is an interactive cognitive behavioural therapy (CBT) worksheet. As a core CBT skill it is used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 15 minutes. It moves through six short steps:
- How facing the fear helps: When something frightens you, it makes sense to avoid it or to do things that make you feel safer. But avoiding anything linked to…
- Words, pictures and sounds: These steps start with reminders of sickness rather than feeling sick yourself. What feels hard is different for everyone, so tick what…
- Feeling a little queasy: These steps bring on mild, everyday stomach feelings like the ones you fear, so you can find out what happens. Being sick is not part of…
- Eating and food: These steps bring back foods and ways of eating you have cut out because of the fear. What feels hard is different for everyone, so tick…
- People and places: These steps take you back to people and places you avoid because they remind you of sickness. What feels hard is different for everyone, so…
- Safety behaviours to drop: Safety behaviours are things you do to feel safer. They can stop you finding out what really happens, so dropping them is part of each…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Facing a fear of vomiting: step ideas’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. doi:10.1016/j.brat.2014.04.006
- Riddle-Walker, L., Veale, D., Chapman, C., Ogle, F., Rosko, D., Najmi, S., Walker, L.M., Maceachern, P., & Hicks, T. (2016). Cognitive behaviour therapy for specific phobia of vomiting (emetophobia): A pilot randomized controlled trial. Journal of Anxiety Disorders, 43, 14-22. doi:10.1016/j.janxdis.2016.07.005
- Keyes, A., Gilpin, H.R., & Veale, D. (2018). Phenomenology, epidemiology, co-morbidity and treatment of a specific phobia of vomiting: A systematic review of an understudied disorder. Clinical Psychology Review, 60, 15-31. doi:10.1016/j.cpr.2017.12.002
- Keyes, A., Deale, A., Foster, C., & Veale, D. (2020). Time intensive cognitive behavioural therapy for a specific phobia of vomiting: A single case experimental design. Journal of Behavior Therapy and Experimental Psychiatry, 66, 101523. doi:10.1016/j.jbtep.2019.101523
- Meule, A. (2026). Emetophobia appears to be the most common specific phobia that requires treatment. BJPsych Open, 12(1), e34. doi:10.1192/bjo.2025.10947
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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