Do Safety Behaviours Work?
Along with avoidance of the feared stimulus (nausea, someone else saying they feel or were sick, seeing something associated with vomiting), a safety behaviour is something that you actively do to avoid vomiting at all costs. Some examples of typical safety behaviours are:
- Sucking on mints
- Taking ginger (candies, tablets, tea)
- Drinking ginger ale or another fizzy drink
- Sipping water
- Chewing gum
- Sniffing peppermint or eucalyptus essential oils
- Taking an OTC stomach medication such as Gravol (Dramamine), Pepto Bismal, Divol, Tums,
- Taking a prescription anti-emetic such as Ondansetron (Zophran)
- Taking a prescribed “Rescue Medication” tranquilizer such as Xanax, Ativan
- Taking prescribed stomach medications such as Omeprazole
- Carrying a plastic bag in your purse or pocket at all times
- Carrying a “safety kit” with any of the above items with you at all times
- Wearing a face mask before Covid-19
- Washing hands, changing clothes, showering
- Opening doors or pressing buttons with your sleeve
- Checking “best by” dates on food
- Drinking alcohol, smoking marijuana, taking illegal drugs
- Asking someone for reassurance, when you know what they’ll say every time
- Practicing large muscle relaxation and/or slow breathing not to calm down, but so you won’t vomit
- Needing to be with or talk to a “support” person when anxious/nauseous.
How many of these can you relate to? Are they helpful or do they work? Well, what if I told you that they most certainly don’t work and that you should really try to slowly give every one of them up? I imagine that might make you very anxious. Without working with a therapist, it might be difficult to give these up on your own. It is the same with avoidance behaviours – stopping them is really difficult without some sort of professional help. Nevertheless, there are determined people out there who are reading this right now who can do it if they try!
So, do safety behaviours work? The answer is yes and no. Yes, they make you feel better in the moment. They calm you down. Some of them most certainly prevent vomiting although the odds of you vomiting without them are pretty slim anyway. But no, they don’t work to lessen your anxiety and in fact most of them will make your anxiety worse over time. So the more you use these behaviours the worse your phobia will get. Let’s look at why that is.
Engaging a safety behaviour presupposes the wrong thing: that the problem is vomiting. I’m sure it will surprise many of you to hear that vomiting is not the problem. Vomiting is normal, natural and neutral. It isn’t dangerous or harmful. It can’t hurt you, so there’s no need to avoid it or fear it. (I know that’s not what you actually think right now; I’m just pointing out the logic.) The problem is anxiety. Your anxiety around vomiting is what’s not normal. It’s way out of whack for what vomiting is – just a yukky, unpleasant thing that nobody likes. There are many of these things in the world: diarrhea, Pap tests, proctology exams, colonoscopies, doing your income tax, picking up dog poop, flossing your teeth. None of these is dangerous or harmful, but if the universe could eliminate any one of them we’d all be happy about it.
Anxiety/fear/terror should be reserved for dangerous things like alligators, grizzly bears, home invasions and nests of gigantic furry venomous spiders. It doesn’t have any place in the normal yet yukky things of life. Your emetophobic brain has somehow mixed up vomiting with all the other deadly things you need to be terrified of. So you avoid it at all costs and then come up with these safety behaviours to keep you “safe.” The thing is, you ARE safe, whether you vomit or not! But I know it doesn’t feel that way.
The road to recovery is long and hard with emetophobia. One important part of the journey, however, is slowly giving up your safety behaviours so your brain comes to realize that you’re just as safe without them as with them. You also need to slowly stop avoiding the things you’ve been avoiding. Either with a therapist or on your own, you also need to slowly change your thoughts from the catastrophic “OMG vomiting is horrible/terrible/awful/the worst thing ever” to something more normal such as what your non-emetophobic friends think about it (ask them, write down what they say, memorize it, replace your catastrophic thoughts with these thoughts every time you think them.) It will take time, but eventually it will work.
Once you come to realize that anxiety is your real problem, you can focus your energy on working on that, instead of on preventing vomiting. This will make your phobia better, which is really what you want.
There is a ton of information on this website that will help both you and your therapist get your anxiety under control!