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Psychol Health Med. 2010 Dec;15(6):625-31. doi: 10.1080/13548506.2010.498893.

Breaking the cycle: cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome.

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Psychosomatic Unit, Department of Child Psychiatry, Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqwa.


The present article presents a case of cognitive behavioral therapy (CBT) along with heart rate variability (HRV) biofeedback training for the treatment of a medication unresponsive 13-year-old boy with cyclic vomiting syndrome (CVS). CVS is characterized by recurring stereotypic episodes of vomiting, interspersed with asymptomatic periods. Triggers for vomiting include anticipatory anxiety related to school examinations, family conflicts, and birthday parties as well as infectious diseases, and certain foods. Current treatment design addressed two pivotal etiological factors: autonomic dysregulation and anticipatory anxiety. Treatment outcome suggests that vomiting episodes may be successfully prevented by aiding the patient to identify and manage precipitant psychological stressors, to regulate HRV patterns, and gain a renewed sense of bodily control and self-efficacy. Further research is suggested using a controlled study with pre- and post-behavioral and stress measures to evaluate the effectiveness of CBT and biofeedback training compared to pharmacotherapy and placebo.

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