Case formulation and behavioral treatment of chronic cough.

The present report describes the case formulation and successful treatment of a 13 year-old boy with a severe habitual cough persisting 2 months after hospitalization, despite negative physical findings. At initial assessment, he literally coughed at every breath and was on housebound instruction. The case formulation highlighted the etiological importance of classical conditioning to breathing in air and the subsequent development of a nervous habit. Treatment was conducted over six sessions and initially involved desensitization to increasing amounts of air flow. A second phase involved strengthening awareness and control over coughing at home using self-management and positive practice procedures. The case formulation, treatment procedures and changes in coughing behavior (2-year follow-up) are described.