Can Imagination Be An Emetophobia Treatment?

What if just imagining the threat of vomiting gave you the same fearful feelings as actually doing it? Well, first of all, that sounds pretty scary. We go through enough anxiety from the fear of vomiting without adding to it by imagining it! So it’s not something anyone would do in their spare time. However, in the safe setting of a therapy appointment for emetophobia treatment, perhaps it could be quite useful.

Think about it for a moment. If you have a fear of, let’s say, puppies (yes, it’s a real thing), then all I need to do is put a puppy in a crate at the end of the hallway. For gradual exposure, you just need to inch closer and closer to the crate until you can finally touch the crate, unlock the door, reach your hand in a for a moment, etc. Ah….how divine would it be to have a phobia of puppies, eh? Because once you’ve received treatment and you’re over your phobia what do you get? A PUPPY! A WARM, FURRY, LICKY, CUDDLY, JUMPY, TAIL-WAGGY, ADORABLE PUPPY!!!

What do WE get? *sigh*  We get to throw up. Whoop dee doo.

Anyway, back to the main point. We can’t put ourselves vomiting at the end of the hall in a crate and slowly approach it. So we therapists have to get very creative. Some therapists think that an acceptable emetophobia treatment would be to just make yourself vomit. They used to sell something called syrup of ipecac in drug stores. You were meant to buy it and have it in your cupboard at home in case your kid swallowed some sort of poison so you could give it to them and induce vomiting. They don’t recommend this now, as many things that a kid could swallow would harm them more if they vomited. They don’t even sell it at all here in Canada – it’s not even on Amazon. Anyway, it’s a terrible idea to drink ipecac or use any other method to vomit on purpose. Some therapists want you to stick your finger down your throat like the bulimics do. Terrible idea. It’s like having a gigantic rabid Pitbull at the end of the hallway, and not in a crate. Therapists aren’t very creative if they can’t think of any other way to treat emetophobia than to make their clients sick. All healthcare providers should remember the jist of the Hippocratic Oath: first, do no harm

So what are we left with, then? Well, there are pictures and sounds and videos and those help, but there is also the idea that you can work with clients in their imaginations and/or memories. And the good news is that there is a good amount of science behind it. The latest study (December, 2018), relating to anxiety disorders, just came out of the University of Colorado Boulder and Icahn School of Medicine researchers.[1] These folks got 68 people to hear a sound an experience a mildly unpleasant shock. They then divided everyone into three groups. The first group heard the sound, but didn’t receive the shock. The second group imagined the sound, but didn’t receive the shock, and the third group imagined sounds of birds and rain falling. 

The results were pretty amazing. In the first group who heard the sound with no shock, eventually they desensitized to the sound. Enough times without the shock and the sound didn’t bother them anymore. The amazing part is the second group who just imagined the sound – they also were initially “fearful” but then the more they imagined the sound, the less afraid they were of it. And their brains showed the same parts “lighting up” on the fMRI.

This has great consequences for phobia therapy. Imagination can be a powerful tool. It can be used in a few ways:

  1. The client can imagine vomiting, rather than having to experience it.
  2. The client can imagine a calm, peaceful place as part of an overall strategy to calm the body. Apparently imagining the beach and being there are the same thing to many parts/systems in your brain!
  3. Clients can imagine something they fear, and further imagine coping with it well, rather than avoiding, using safety behaviours or refusing to take part in the exposure. Sports psychology uses this theory all the time: imagine making the shot, the goal, the swing. Work it out in imagination first, then execute it.

Meanwhile, I’m going to go imagine I’m eating a peanut-butter-cup Blizzard from Dairy Queen so I don’t gain any more Covid pounds!

[1] Reddan et al., 2018, Neuron 100, 994-1005.