Novel use of placebo tablets in the treatment of choking phobia

Abstract

Background: Choking phobia is a specific phobia characterised by fear and avoidance of swallowing. If related to the swallowing of medications, this phobia may have profound implications for the management of a disease state. Cognitive behavioural therapy is well recognised as an effective treatment for specific phobias, but there are few reports of its use for choking phobias. Case Report: We report the use of cognitive behavioural therapy to treat a 24-year-old woman with reflux nephropathy who was unable to comply with her treatment regimen due to a choking phobia. Oral placebo solid dosage forms were successfully utilised in graded exposure-based therapy. Discussion: No other case reports describe the use of placebo medications as a tool in a desensitisation protocol for choking phobia. Whilst the treatment itself was reasonably straightforward, there was difficulty in the procurement of placebo medications at reasonable cost. Although this case represents the extreme end of medication compliance, it highlights the advantage of multidisciplinary team involvement in problem solving. This resulted in better patient care and also in a more cost-effective and acceptable dosing regimen.