Abstract

BA case report of a woman treated with a multi-faceted cognitive-behavioral exposure therapy (CBET) for multiple chemical sensitivity (MCS) is presented. The patient reported substantial improvements in the severity of her somatic symptoms, catastrophic thinking about symptoms, and functioning. Improvements were maintained six months after treatment ended. It hypothesized that CBET reduces symptoms by reducing central sympathetic activation, maladaptive thinking and avoidant behavior. Long-term efficacy of CBET for MCS should be examined in large clinical trials.

Multiple chemical sensitivity (MCS), also referred to as idiopathic environmental intolerance, is a poorly understood and often intractable condition. MCS is characterized by a wide range of recurrent distressing and often debilitating somatic symptoms, such as fatigue, dizziness, headaches, breathing difficulties, heart palpitations, mucous membrane irritation, and nausea [1]. The symptoms follow and are presumed to be elicited by exposure to various low levels of chemicals, such as pesticides, cleaning products, perfumes, renovation materials including new carpet and paint, and diesel exhaust [2].

There is no consensus on the underlying cause of or treatment of choice for MCS. Although many patients with MCS report salutary effects of chemical avoidance and living in chemical-free environments [3], such approaches have not been supported in controlled clinical research. Treatments encouraging chemical avoidance can result in life-changing outcomes and extraordinary costs, with patients leaving their jobs, homes, and activities for secluded chemical-free environments [3]. Laboratory studies with patients reporting MCS suggest the importance of patients’ learning histories and expectations in their somatic reactions to chemicals [4] and provide a rationale for cognitive and behavioral interventions for MCS. Nevertheless, no treatment has been demonstrated in controlled clinical trials to be efficacious for MCS [4]. In this paper, we describe a case study in which a manualized, 8-session, individual CEBT was administered for MCS. This treatment was adapted from our previous work on cognitive-behavioral treatment for somatization [5,6].