Anticipatory nausea and vomiting: A review of psychological interventions

  • Edwin Boudreaux


Although a cure for cancer continues to elude scientists, modern chemotherapy treatments can typically reduce or reverse the rate of disease progression and can often lead to restored health. However, chemotherapy can also produce severe, sometimes intolerable, side effects. A particularly distressing and aversive side effect that develops in 25 to 32% of all chemotherapy patients is anticipatory nausea and vomiting (ANV). Fortunately, research investigating the prevalence, etiology, predictors, and treatment of ANV has flourished since the early 1980s, and there has been significant progress in understanding this phenomenon. Although antiemetic medications appear to be ineffective in controlling ANV, several psychological interventions, including progressive muscle relaxation training, systematic desensitization, hypnosis, attentional distraction, and stimulus control have produced promising results. The present paper is a review of these interventions.

Key Words

cancer chemotherapy anticipatory nausea and vomiting psychological treatment 


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  1. American Cancer Society (1993).Cancer Facts and Figures: 1993, American Cancer Society, New York.Google Scholar
  2. Andresen, G. V., Birch, L. L., and Johnson, P. A. (1990). The scapegoat effect on food aversions after chemotherapy.Cancer 66: 1649–1653.Google Scholar
  3. Andrykowski, M. A. (1986). Definitional issues in the study of anticipatory nausea in cancer chemotherapy.J. Behav. Med. 9: 33–41.Google Scholar
  4. Andrykowski, M. A. (1987). Do infusion-related tastes and odors facilitate the development of anticipatory nausea? A failure to support hypothesis.Health Psychol. 6: 329–341.Google Scholar
  5. Andrykowski, M. A. (1988). Defining anticipatory nausea and vomiting: Differences among cancer chemotherapy patients who report pretreatment nausea.J. Behav. Med. 11: 59–69.Google Scholar
  6. Andrykowski, M. A. (1990). The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: A review and synthesis.Psychosom. Med. 52: 458–475.Google Scholar
  7. Andrykowski, M. A., and Redd, W. H. (1987). Longitudinal analysis of the development of anticipatory nausea.J. Consult. Clin. Psychol. 55: 36–41.Google Scholar
  8. Andrykowski, M. A., Redd, W. H., and Hatfield, A. K. (1985). Development of anticipatory nausea: A prospective analysis.J. Consult. Clin. Psychol. 53: 447–454.Google Scholar
  9. Bernstein, D. A., and Borkovec, T. D. (1973).Progressive Relaxation Training: A Manual for the Helping Professions, Research Press, Champaign, IL.Google Scholar
  10. Bilgrami, S., and Fallon, B. G. (1993). Chemotherapy-induced nausea and vomiting.Postgrad. Med. 94: 55–64.Google Scholar
  11. Black, P. M., and Morrow, G. R. (1991). Anticipatory nausea and emesis: Behavioural interventions. In Watson, M. (ed.),Cancer Patient Care: Psychosocial Treatment Methods, Cambridge University Press, New York, pp. 45–73.Google Scholar
  12. Bovbjerg, D. H., Redd, W. H., Jacobsen, P. B., Manne, S. L., Taylor, K. L., and Surbone, A. (1992). An experimental analysis of classically conditioned nausea during cancer chemotherapy.Psychosom. Med. 54: 623–637.Google Scholar
  13. Broberg, D. J., and Bernstein, I. L. (1987). Candy as a scapegoat in the prevention of food aversions in children receiving chemotherapy.Cancer 60: 2344–2347.Google Scholar
  14. Burish, T. G., and Carey, M. P. (1986). Conditioned aversive responses in cancer chemotherapy patients: Theoretical and developmental analysis.J. Consult. Clin. Psychol. 5: 593–600.Google Scholar
  15. Burish, T. G., and Lyles, J. N. (1979). Effectiveness of relaxation training in reducing the aversiveness of chemotherapy in the treatment of cancer.J. Behav. Ther. Exp. Psychiat. 10: 357–361.Google Scholar
  16. Burish, T. G., and Lyles, J. N. (1981). Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy.J. Behav. Med. 4: 65–78.Google Scholar
  17. Burish, T. G., Shartner, C. D., and Lyles, J. N. (1981). Effectiveness of multiple-site EMG biofeedback and relaxation in reducing the aversiveness of cancer chemotherapy.Biofeed. Self-Regul. 6: 523–535.Google Scholar
  18. Burish, T. G., Carey, M. P., Krozely, M. G., and Greco, F. A. (1987). Conditioned side effects induced by cancer chemotherapy: Prevention through behavioral treatment.J. Consult. Clin. Psychol. 55: 42–48.Google Scholar
  19. Carey, M. P., and Burish, T. G. (1987). Providing relaxation training to cancer chemotherapy patients: A comparison of three delivery techniques.J. Consult. Clin. Psychol. 55: 732–737.Google Scholar
  20. Carey, M. P., and Burish, T. G. (1988). Etiology and treatment of the psychological side effects associated with cancer chemotherapy: A critical review and discussion.Psychol. Bull. 106: 307–325.Google Scholar
  21. Challis, G. B., and Stam, H. J. (1992). A longitudinal study of the development of anticipatory nausea and vomiting in cancer chemotherapy patients: The role of absorption and autonomic perception.Health Psychol. 11: 181–189.Google Scholar
  22. Chang, J. C. (1981). Nausea and vomiting in cancer patients: An expression of psychological mechanisms?Psychosomatics 22: 707–709.Google Scholar
  23. Chin, S. B., Kucuk, O., Peterson, R., and Ezdinli, E. Z. (1992). Variables contributing to anticipatory nausea and vomiting in cancer chemotherapy.Am. J. Clin. Oncol. 15: 262–267.Google Scholar
  24. Cohen, R. E., Blanchard, E. B., Ruckdeschel, J. C., and Smolen, C. (1986). Prevalence and correlates of post-treatment and anticipatory nausea and vomiting in cancer chemotherapy.J. Psychosom. Res. 30: 643–654.Google Scholar
  25. Cotanch, P. H. (1983). Relaxation training for control of nausea and vomiting in patients receiving chemotherapy.Cancer Nurs. 6: 277–283.Google Scholar
  26. Cotanch, P. H., and Strum, S. (1987). Progressive muscle relaxation as antiemetic therapy for cancer patients.Oncol. Nurs. Forum 14: 33–37.Google Scholar
  27. Cotanch, P. H., Hockenberry, M., and Herman, S. (1985). Self-hypnosis as antiemetic therapy in children receiving chemotherapy.Oncol. Nurs. Forum 12: 41–46.Google Scholar
  28. Dempster, C. R., Balson, P., and Whalen, B. T. (1976). Supportive hypnotherapy during the radical treatment of malignancies.Int. J. Clin. Exp. Hypnosis 24: 1–9.Google Scholar
  29. Ellenberg, L., Kellerman, J., Dash, J., Higgins, G., and Zeltzer, L. (1980). Use of hypnosis for multiple symptoms in an adolescent girl with leukemia.J. Adolesc. Health Care 1: 132–136.Google Scholar
  30. Greene, P. G., and Seime, R. (1987). Stimulus control of anticipatory nausea in cancer chemotherapy.J. Behav. Ther. Exp. Psychiat. 18: 61–64.Google Scholar
  31. Hailey, B. J., and White, J. G. (1983). Systematic desensitization for anticipatory nausea associated with chemotherapy.Psychosomatics 24: 287–291.Google Scholar
  32. Harris, J. G. (1978). Vomiting and cancer treatment.Cancer 28: 196–201.Google Scholar
  33. Hoagland, A. C., Morrow, G. R., Bennett, J. M., and Carnrike, C. L. (1983). Oncologist' view of cancer patient noncompliance.Am. J. Clin. Oncol. 6: 239–244.Google Scholar
  34. Hoffman, J. L. (1983). Hypnotic desensitization for the management of anticipatory emesis in chemotherapy.Am. J. Clin. Hypnosis 25: 173–176.Google Scholar
  35. Jacobsen, P. B., and Redd, W. H. (1988). The development and management of chemotherapy-related anticipatory nausea and vomiting.Cancer Invest. 6: 329–336.Google Scholar
  36. Kolko, D. J., and Rickard-Figueroa, J. L. (1985). Effects of video games in the adverse corollaries of chemotherapy in pediatric oncology patients: A single-case analysis.J. Consult. Clin. Psychol. 53: 223–225.Google Scholar
  37. Kvale, G., Hygdahl, K., Asbjornsen, A., Rosengren, B., Lote, K., and Nordby, H. (1991). Anticipatory nausea and vomiting in cancer patients.J. Consult. Clin. Psychol. 59: 894–898.Google Scholar
  38. LaBaw, W., Holton, C., Tewell, K., and Eccles, D. (1975). The use of self-hypnosis by children with cancer.Am. J. Clin. Hypnosis 17: 233–238.Google Scholar
  39. LeBaron, S., and Zeltzer, L. K. (1984). Behavioral intervention for reducing chemotherapy-related nausea and vomiting in adolescents with cancer.J. Adolesc. Health Care 5: 178–182.Google Scholar
  40. Lerman, C., Rimer, B., Blumberg, B., Cristinzio, S., Engstrom, P. F., and MacElwee, N. (1990). Effects of coping style and relaxation on cancer chemotherapy side effects and emotional responses.Cancer Nurs. 13: 308–315.Google Scholar
  41. Leventhal, H., Easterling, D. V., Nerenz, D. R., and Love, R. R. (1988). The role of motion sickness in predicting anticipatory nausea.J. Behav. Med. 11: 117–130.Google Scholar
  42. Love, R. R., Nerenz, D. R., and Leventhal, H. (1982). Anticipatory nausea with cancer chemotherapy: Development through two mechanisms.Proc. Annu. Meet. Am. Soc. Clin. Oncol. 2: 242 (abstr.).Google Scholar
  43. Lyles, J. N., Burish, T. G., Krozely, M. G., and Oldham, R. K. (1982). Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy.J. Consult. Clin. Psychol. 50: 509–524.Google Scholar
  44. Margolis, C. G. (1983). Hypnotic imagery with cancer patients.Am. J. Clin. Hypnosis 25: 128–134.Google Scholar
  45. Morrow, G. R. (1982). Prevalence and correlates of anticipatory nausea and vomiting in chemotherapy patients.J. Natl. Cancer Inst. 68: 585–588.Google Scholar
  46. Morrow, G. R. (1984). Clinical characteristics associated with the development of anticipatory nausea and vomiting in cancer patients undergoing chemotherapy treatment.J. Clin. Oncol. 10: 1170–1176.Google Scholar
  47. Morrow, G. R. (1985). The effect of susceptibility to motion sickness on the side-effects of cancer chemotherapy.Cancer 55: 2766–2770.Google Scholar
  48. Morrow, G. R. (1986). Effect of the cognitive hierarchy in the systematic desensitization treatment of anticipatory nausea in cancer patients: A component comparison with relaxation only, counseling, and no treatment.Cognit. Ther. Res. 10: 421–446.Google Scholar
  49. Morrow, G. R. (1992). Behavioral factors influencing the development and expression of chemotherapy induced side effects.Br. J. Cancer 66: 54–59.Google Scholar
  50. Morrow, G. R., and Dobkin, P. L. (1988). Anticipatory nausea and vomiting in cancer patients under-going chemotherapy treatment: Prevalence, etiology, and behavioral interventions.Clin. Psychol. Rev. 8: 517–556.Google Scholar
  51. Morrow, G. R., and Morrell, C. (1982). Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy.N. Engl. J. Med. 307: 1476–1480.Google Scholar
  52. Morrow, G. R., Arseneau, J. C., Asbury, R. F., Bennett, J. M., and Boros, L. (1981). Anticipatory nausea and vomiting in chemotherapy patients.N. Engl. J. Med. 306: 431–432.Google Scholar
  53. Morrow, G. R., Lindke, J., and Black, P. M. (1991). Predicting development of anticipatory nausea in cancer patients: Prospective examination of eight clinical characteristics.J. Pain Symptom Manage. 6: 215–223.Google Scholar
  54. Morrow, G. R., Asbury, R., Hammon, S., Dobkin, P., Caruso, L., and Pandya, K. (1992). Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists.Health Psychol. 11: 250–256.Google Scholar
  55. Olafsdottir, M., Sjoden, P., and Westling, B. (1986). Prevalence and prediction of chemotherapy related anxiety, nausea and vomiting in cancer patients.Behav. Res. Ther. 24: 59–66.Google Scholar
  56. Olness, K. (1981). Imagery (self-hypnosis) as adjunct therapy in childhood cancer: Clinical experience with 25 patients.Am. J. Pediat. Hematol./Oncol. 3: 313–321.Google Scholar
  57. Pickett, M. (1991). Determinants of anticipatory nausea and anticipatory vomiting in adults receiving cancer chemotherapy.Cancer Nurs. 14: 334–343.Google Scholar
  58. Redd, W. H. (1986). Use of behavioral methods to control the aversive effects of chemotherapy.J. Psychosoc. Oncol. 3: 17–22.Google Scholar
  59. Redd, W. H., and Andrykowski, M. A. (1982). Behavioral intervention in cancer treatment: Controlling aversion reactions to chemotherapy.J. Consult. Clin. Psychol. 50: 1018–1029.Google Scholar
  60. Redd, W. H., Andresen, G. U., and Minagawa, R. Y. (1982). Hypnotic control of anticipatory emesis in cancer patients receiving chemotherapy.J. Consult. Clin. Psychol. 50: 14–19.Google Scholar
  61. Redd, W. H., Jacobsen, P. B., Die-Trill, M., Dermatis, H., McEvoy, M., and Holland, J. C. (1987). Cognitive/attentional distraction in the control of conditioned nausea in pediatric cancer patients receiving chemotherapy.J. Consult. Clin. Psychol. 55: 391–395.Google Scholar
  62. Redd, W. H., Dadds, M. R., Futterman, A. D., Taylor, K. L., and Bovbjerg, D. H. (1993). Nausea induced by mental images of chemotherapy.Cancer 72: 629–636.Google Scholar
  63. Scott, D. W., Donahue, D. C., Mastrovito, R. C., and Hakes, T. B. (1983). The antiemetic effect of clinical relaxation: Report of an exploratory pilot study.J. Psychosoc. Oncol. 1: 71–84.Google Scholar
  64. Syrjala, K. L., Cummings, C., and Donaldson, G. W. (1992). Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: A controlled clinical trial.Pain 48: 137–146.Google Scholar
  65. Van Komen, R. W., and Redd, W. H. (1985). Personality factors associated with anticipatory nausea/vomiting in patients receiving cancer chemotherapy.Health Psychol. 4: 189–202Google Scholar
  66. Walker, L. G., Dawson, A. A., Pollet, S. M., Ratcliffe, M. A., and Hamilton, L. (1988). Hypnotherapy for chemotherapy side effects.Br. J. Exp. Clin. Hypnosis 5: 78–82.Google Scholar
  67. Watson, M., and Marvell, C. (1992). Anticipatory nausea and vomiting among cancer patients: A review.Psychol. Health 6: 97–106.Google Scholar
  68. Watson, M., McCarron, J., and Law, M. (1992). Anticipatory nausea and emesis, and psychological morbidity: Assessment of prevalence among out-patients on mild to moderate chemotherapy regimens.Br. J. Cancer 66: 862–866.Google Scholar
  69. Weddington, W. W., Blindt, K. A., and McCraken, S. G. (1983). Relaxation training for anticipatory nausea associated with chemotherapy.Psychosomatics 24: 281–283.Google Scholar
  70. Wolpe, J. (1973).The Practice of Behavior Therapy, 2nd ed., Pergamon, New York.Google Scholar
  71. Zeltzer, L., Kellerman, J., Ellenberg, L., and Dash, J. (1983). Hypnosis for reduction of vomiting associated with chemotherapy and disease in adolescents with cancer.J. Adolesc. Health Care 4: 77–84.Google Scholar
  72. Zeltzer, L., LeBaron, S., and Zeltzer, P. M. (1984). The effectiveness of behavioral intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy.J. Clin. Oncol. 2: 683–690.Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Edwin Boudreaux
    • 1
  1. 1.Louisiana State UniversityBaton Rouge

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