Emetophobia and Chemotherapy

I took some liberties with the Halloween videos available on Canva this week – lol!

Pretty much since the birth of the internet I’ve been finding and talking to people with emetophobia. My first computer experience with internet was 1996, and by 1998 I discovered, after 39 years, that my phobia had a name and that there were other people like me! By the year 2000 I was a moderator of “emetophobia.org” – a discussion forum that quite quickly went to 10,000 members. There was no such thing as Facebook groups at that time. This website had so much traffic that you could go there any time of the day or night and find someone with whom you could talk. Thank goodness for time zones!

The great thing about a discussion forum (which still exists, by the way) is that topics can be organized into sections, and you can view the topics to see if you’d like to partake of that conversation. Now, Facebook groups have pretty much taken over the emetophobic community. Our latest podcast was about the pros and cons of social media support groups.

Despite changes in how emetophobics talk with one another online, there is always this question, “What would you do if you got cancer? How could you deal with chemotherapy?” Usually the responses are something to the tune of “I’d rather die.” Sound about right? It’s not.

I found the breast lump when I was just 37. My youngest of three children was only 11 years old. My world came crashing down, for a number of reasons only one of which was being freaked out about having to have chemotherapy. I had had some treatment, but I was still terrified of vomiting. I had always told myself that I would rather die than vomit, and thus I would rather die than take chemotherapy. I was serious about this. But let me tell you something: when death looks you right in the face, with a ghoulish sneer and an open door to utter darkness, you’ll take the chemo.

The reason we say we’d rather die than vomit is that our amygdala at the back of our brains is responsible for our survival and whenever it gets triggered it shouts out just one message: “Danger! You’re going to die!” With a phobia, for some reason the wiring in our brain isn’t just right and when we experience the phobic stimulus (nausea or someone else vomiting) our amygdala gets triggered. So we avoid vomiting at all costs, the way we avoid certain death. We believe that vomiting and death are pretty much equal and because we’re not faced with death we fear vomiting more. Avoiding death is pretty simple when you’re young and healthy.

But then actual death comes along. And suddenly they’re not equal anymore, and somewhere in our messed-up brains something clicks as if to say, “ok so vomiting isn’t really as bad as death and I sure don’t want to die.”

I went through surgery, chemo and radiation. The chemo was nowhere near as bad as they make it out to be on TV or in the movies. I only had to have chemo one time (four treatments, three weeks apart). I did get very tired and felt like hell for 2-3 days. They gave me a powerful anti-emetic – Ondansetron (Zofran) – at the time it was $30 a pill but I would have sold my cat, my dog and my TV set for it if I had to. I did not vomit. And this was in 1996 – they have much better, more efficient chemo now and a whole host of anti-emetics in addition to Ondansetron. They can give you a cocktail of about four or five of them at once if need be.

I never had a trace of cancer again. Since 1996 I’ve conquered my emetophobia, seen three children graduate university, watched my daughter dance on stage in Germany as a professional ballerina, held 7 grandchildren in my arms and loved each one like they were my own, celebrated 39 years with my husband, bought a beautiful house, been to Paris, had two wonderful and successful careers in which I helped a lot of people, published two books with a third on the way, and probably a thousand other things I never would have done if I’d said I’d rather die than have chemo. Trust me, life is so much better than death.

Avoiding norovirus: tips, Facts and myths

Trigger Warning: This blog may be very triggering to people with emetophobia, as vomiting is discussed in plain-speak. My hope is that it will reassure some emetophobic people so they can live a more normal life.

Norovirus is the scientific term for what has commonly been called “stomach flu,” “stomach bug,” “winter vomiting virus” and a few other terms. It’s short for “Norwalk-like viruses,” but it is neither a flu nor a bug. Norovirus causes several hours of nausea, vomiting and diarrhea. One may also have body aches, fatigue and a fever for up to 24 hours. All in all, it’s not very nice to have and nobody likes it. However in the grand scheme of things it’s harmless and over with quickly. The only thing you have to watch out for is that a child doesn’t get dehydrated, which can happen quickly and can be fatal if not attended to. Kids need to just have a few ice chips or a teaspoon of water and wait to see if they can keep it down. If not, keep trying and watch for signs of dehydration – they may need to go to a hospital for IV fluids. Adults can also get dehydrated. Sip water very very slowly and hold off on any water until you haven’t had vomiting for a couple of hours.

How contagious is Norovirus? Well, compared to Covid-19 which is airborne and you can catch by just breathing near a contagious person, it doesn’t seem so bad. Norovirus particles (virions) must be ingested (swallowed) in order to get you sick. This means that normally they enter through the mouth but sometimes the nose, and are sniffed back and swallowed. It is unlikely to ever get Norovirus through your eyes although it is theoretically possible (but your finger would have to be filthy). Sometimes Norovirus swirls through the air either when someone vomits in a room, or you flush a toilet without the lid being down. (I know, gross, eh?) You can pick up Norovirus particles on your hands when they settle on counters or doorknobs or a person with literally poop or vomit on their hand touches a knob or counter and then you touch it later and put your hand in your mouth. The particles stay active for about 9 days on surfaces that have not been cleaned, but just to be safe it’s good to think of surfaces as possibly contaminated for 14 days. Norovirus is present in saliva, but scientists don’t think it’s enough to make someone else sick through kissing or sharing utensils/cups – unless the sick person has just vomited and not washed out their mouth. You cannot catch Norovirus by having sex, or through the bloodstream, or on a toilet seat, or by sitting on an airplane and definitely not by breathing the air near a sick person. Unfortunately one of the ways people catch Norovirus is through food that has been handled by a sick worker (who hasn’t washed their hands) and the food is not cooked fully.

Norovirus is killed at 65C or 150F. This is a little hotter than food is normally kept in a restaurant (60C is all that’s required) and for water, too hot to put your hand in. However it is nowhere near boiling (100C or 212F). Check the manual of your washing machine and dryer to see how hot they get on their hot cycles. If it isn’t high enough, you’ll have to add bleach to the wash to kill off the Norovirus on your laundry. Diluted bleach is cheap and easy to find, and perfect for cleaning up if someone in your house is sick. Google how much bleach you need for porous surfaces, non-porous, laundry, etc. There’s lots of great info out there but don’t go crazy by using straight bleach or way too much bleach. You can literally make people sick doing that. Carpets must be cleaned with a steam-cleaner as you can’t bleach them. Keep contaminated sheets, clothing and underwear of sick people separate from other laundry for 2 weeks.

Washing hands with plain soap and water is the best way to get rid of Norovirus on your hands. You don’t need to scrub or go crazy – just 20 seconds washing all the areas of hands and wrists, then rinse off. Hand sanitizers are not as effective as plain soap and water. Some hand sanitizers don’t kill Norovirus (eg. alcohol-based). If you find one that has benzalkonium chloride, that will work but you have to leave it on for a minute or two. Again, Google will tell you if your hand sanitizer works for Norovirus.

One of the more common ways to catch Norovirus is through food, unfortunately. In fact, 70% of “food poisoning” is actually Norovirus and there was nothing wrong with the food. If you’re worried about your restaurant food, order takeout and microwave it to above 65C (use a food thermometer so you don’t go crazy and burn the food). Skip the salads.

Wearing a mask is a great way to prevent not only Covid-19 but Norovirus as well. They work because they keep your hands away from your mouth and nose. You can’t breathe Norovirus in, remember, but that mask will remind you not to touch your mouth or nose unless you’ve washed your hands. This method works great for kids as well.

The incubation period for Norovirus is 24-48 hours. Depending on how much viral load you’ve ingested, you will get sick either sooner or later. Some folks have even become ill before 24 hours. Norovirus has a “sudden onset” of symptoms. This means that you could feel increasing nausea for about an hour, maybe two, during which time you may have diarrhea that is like water (simply having soft stool is not indicative of Norovirus). Sudden onset does not mean that you’re fine one minute and vomiting the next. You’ll have plenty time to figure it out, get home from work, etc.

People are contagious from the time they begin to get sick until about 2 weeks after. They’re only contagious after because the Norovirus is shed in their stool. So if you trust someone to wash their hands after using the bathroom, then they’re not contagious at all. You can visit someone’s house if they’ve just gotten over Norovirus. Just don’t put your hands in your mouth or nose until you get home and wash them. Kids aren’t great at wiping bums or washing hands, so kids do carry a lot of Norovirus around and it spreads in schools. Many people in nursing homes are in diapers, and staff don’t use full PPE when changing diapers so they can easily spread the virus to others in the nursing home. Perhaps now that PPE is required for Covid, we will see less spread of Norovirus in nursing homes. That would be great.

It’s also great that people are wearing masks AND washing hands a lot more, and a lot more thoroughly. Scientists are also working on a Norovirus vaccine, which has proven tricky because the virus mutates during the year and so far would require 1 or 2 boosters every season. I know people with emetophobia would jump at that, but most people wouldn’t and vaccines like everything else have to be economical and practical.

You cannot catch Norovirus from your cat, nor can you give it to your cat. Dogs can carry it only if they’ve come into contact with the vomit or feces of an infected person. Oysters may contain Norovirus and if you eat them raw, you’re rolling the dice. You cannot get Norovirus from tap water.

For more tips, myths, information and cleaning solutions, check the websites below.


  1. References
  2. Burrell, Christopher J et al. Caliciviruses, in Fenner and White’s Medical Virology (Fifth Edition), 2017
  3. Cates, J.E., Vinjé, J., Parashar, U., Hall, A.J., 2020. Recent advances in human norovirus
  4. research and implications for candidate vaccines. Expert Rev. Vaccines 0, 1–10.

Centers for Disease Control and Prevention

de Graaf, M., van Beek, J., Koopmans, M.P.G., 2016. Human norovirus transmission and
evolution in a changing world. Nat. Rev. Microbiol. 14, 421–433.

Estes, M.K., Ettayebi, K., Tenge, V.R., Murakami, K., Karandikar, U., Lin, S.-C., Ayyar,
B.V., Cortes-Penfield, N.W., Haga, K., Neill, F.H., Opekun, A.R., Broughman, J.R.,
Zeng, X.-L., Blutt, S.E., Crawford, S.E., Ramani, S., Graham, D.Y., Atmar, R.L., 2019.
Human Norovirus cultivation in nontransformed stem cell-derived human intestinal
enteroid cultures: success and challenges. Viruses 11, 638.

Foodborne Disease Burden Epidemiology Reference Group. 2015. WHO estimates of the global burden of foodborne diseases. World Health Organization – World Health Organization, Geneva, Switzerland, 2019

  1. Garza, Jose M., Cohen, Mitchell, B. Infectious Diarrhea, in Pediatric Gastrointestinal and Liver Disease (Fourth Edition), 2011

Green, K. Y., Noroviruses and Sapovirus, in Encyclopedia of Virology (Third Edition), 2008

Yates, Marylynn, Norovirus, in Microbiology of Waterborne Diseases (Second Edition), 2014

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.

What is CBT? Does it help Emetophobia?

“CBT” stands for “Cognitive-Behavioural Therapy.” This therapy is quite well-known because it’s known as “evidence-based” meaning there is good evidence that it works. It is well-researched as a treatment for both depression and anxiety, including anxiety disorders, phobias and Obsessive-Compulsive Disorder (“OCD”).

Evidence of the effectiveness of CBT is discovered by way of a proper research study. Typically, researchers find a group of people with the same disorder – let’s say spider phobia. They test the whole group to get a numerical score as to how severe their phobia is. They then divide the group randomly into two and treat half the group with CBT while the other half sits on a waitlist. After the first group has been treated, both groups will be tested again. Study after study has found that the CBT group gets significantly better, while the waitlist group generally does not. The researchers will then treat the waitlist group out of courtesy to them for being involved in the study. To date over 1,000 research studies have been done on CBT.

CBT is made up of two originally separate theories and types of therapy. You guessed it – cognitive, and behavioural. Cognitive therapy was first theorized by Dr. Aaron Beck who at this writing is still alive at the age of 99 years. He was lecturing until about five years ago. Dr. Beck is also known as the father of CBT.

Dr. Aaron Beck

The basis of cognitive theory is that a person’s thoughts about a situation or topic relate more to their anxious or depressed reaction than the situation or topic itself. In other words, you are afraid of something because of your thoughts about it, not because it is inherently dangerous. Most emetophobic people I work with believe, for example, that vomiting is a huge, horrible, catastrophic event akin to a bloody murder scene. In reality (the reality of everyone who does not have emetophobia), vomiting is a normal, natural event that happens rarely which nobody likes but everyone feels better afterward.

Simply pointing out reality to a phobic person does not help them, as each of you reading this knows all too well. The logical, rational part of our brains knows the truth, but the part of our brains that is responsible for our survival does not know. For some reason, and the reasons are varied, vomiting or the thought of it triggers this survival instinct and we feel like we are dying even though we know full-well we are not.

Enter Behavioural therapy. Behaviour is often a word associated with children, but in this context,  it sort of means actions  or what you do. Early behaviourists include Ivan Pavlov (remember his dogs?) and Dr. B.F. Skinner. Behaviourism says that you will keep doing things that reward you or make you feel good, and you will not do things that punish you or make you feel bad/uncomfortable. With emetophobia you may avoid yogurt past its expiry date because if you eat it you will feel anxious. When you’re nauseous, one behaviour might be to suck on mints because they make you feel better and therefore less anxious. Avoiding what’s bad and doing what feels good may be fine for a neurotypical person, but for a phobic whose brain wiring is a bit criss-crossed it has the opposite effect. Every time you avoid the yogurt you feel better, so it reinforces that you should always do that. When you suck mints and then don’t vomit, you feel better, more relieved and calmer. This reinforces that you should do this every time you feel sick. Unfortunately, these avoidance and safety behaviours make your phobia get reinforced and it continues to get much much worse.

From Getselfhelp.co.uk

CBT for emetophobia means that your therapist will help you to slowly turn your behaviours around to the other direction. They will begin with something easy, such as looking at the word “vomit” on a page, then just allowing your anxiety to raise slightly and then lower to the baseline level, training your brain that this non-avoidance can also make you feel good, relieved and calm. Then you’ll slowly go up the ladder to look at things and do things you wouldn’t normally do. The whole time, your therapist will be with you and watching you to ensure you don’t get overwhelmed. They will also be helping you examine your thoughts along the way to ensure that you will, by the end of treatment, be able to say with confidence “Vomiting isn’t dangerous or harmful. It’s ok if it happens because I can cope with it.”

Lori Riddle-Walker, a colleague of mine who sadly died of cancer after completing her research study, was the first person[1] to study the efficacy of CBT on emetophobic patients. The preliminary findings were that it did indeed help people with a fear of vomiting get significantly better.


[1] The study was done in conjunction with Dr. David Veale who is the world’s leading researcher on emetophobia in the English-speaking world.

Emetophobia and Control

One of the things that I absolutely hated being called, ever, was a “control freak.” For one thing, if I were such a thing (and I don’t think I am) why does it have to have the word “freak” in the expression? Who likes to be called a freak? If someone is insistent on being in control, that does not necessarily make them a freak, a weirdo, an oddball or, as my mother used to say in 1950 “a queer duck.” People who are very disciplined, or very careful, or very responsible, or even very manipulative, authoritarian, or natural leaders are not all known as freaks. So ya. I hate that expression.

I think it is because I hate the expression “control freak” that I have done a lot of thinking over the years about emetophobia and control. The infamous Dr. Phil believes that all phobias, and most other anxiety disorders are about control. Don’t get me wrong, I kind of like Dr. Phil. He sure sees things clearly, which can be helpful, even though I don’t think anyone would want him for their therapist and he pretty much agrees with that. I don’t, however, think he’s right about everything and I definitely don’t think he’s right about this.

Many of my emetophobic clients talk to me about control. They don’t like the fact that vomiting seems to be out of their control. And furthermore, it’s a bodily function that’s out of their control. I point out to them that most bodily functions are out of their control: breathing, heart beating, blood circulation and oxygenation, digestion, urination and defecation. Sure you can hold your urine, your feces or your breath for a time but not forever. At some point, your body would take over and you would not be able to control it.

You can also control vomiting to a certain extent as well. I remember reading an article many years ago by Dr. David Veale, the world’s leading researcher on emetophobia (or as he likes to refer to it, “SPOV” or Specific Phobia of Vomiting.) He believed at the time that there was absolutely nothing that you could do to stop you from vomiting, so there was no point in any safety behaviours such as hand sanitizers, avoiding sick people, taking mints, ginger or over-the-counter (OTC) medications. After doing part of a research study some years later he discovered that people with emetophobia do indeed vomit less than the general population. So we do have some control over it, although if you get sick enough or poisoned enough you will vomit, no matter what you try to do to prevent it.

People who are often labelled as control freaks, in my opinion, are just people who want things under control. They don’t want the whole situation to be chaotic, out-of-control, crazy. Sometimes situations do get that way, and so people who have natural leadership qualities tend to take charge to get things under control. Many people labelled control freaks are quite happy to sit back if someone else who is a responsible leader is the one getting things under control. If they jump in and take charge regardless, I believe that they’re just scared. If you’re all on a raft heading down the river to Niagara Falls and the leader is not coaching everyone to row to shore, then you’re going to freak out and take over the lead.

The thing is, sometimes you just think you’re headed for Niagara Falls and you’re terrified so you take over when you don’t need to. We phobics can be like that sometimes. But don’t let anyone tell you that you’re a freak.

Emetophobia and the fear of sound

Emetophobia is not just the fear of vomiting. It is also the fear of anything to do with vomiting. The sight, the smell, the sound, the contagions. Most of my clients are more afraid of being sick themselves than they are of seeing or hearing other people. But yet, whenever someone in their own house is sick, they’re usually terrified that the family member has somehow contracted Norovirus and that they’re contagious.

I believe my phobia began sometime before I can really remember, but it was made a thousand times worse between the ages of eight and nine when my dad was sick with colon cancer. He was vomiting often, and it sounded like death. Sadly, he did die when I was nine so that probably reinforced the phobia for me. To this day no one has sounded as horrible or as unique as my dad when he was sick. I thought in later years that perhaps I was imagining it, or at least embellishing the memory. Until one day when I was in my forties I heard my aunt (dad’s sister) talking to another sister about how awful my dad sounded when he was sick. She recounted visiting him in the hospital once after he’d had surgery as a young man. In those days anesthetic was ether, and it made people terribly sick. The funny part about the story is that she went to the nurse’s station to ask his room number, but then heard him vomiting at the end of the hall in his room and knew right away by the sound that it was him.

As time went on, I married and had three children. My husband did not vomit for 32 years, even though he’s not the least bit afraid of it. I could not have chosen a more appropriate mate. But then there were the kids. When we had a young family we were pretty cash-poor, so there was no way I could go to a hotel room. After my successful emetophobia treatment we were a bit better off, but I no longer needed the hotel! Back when the kids were young if I heard anything that remotely resembled them being sick in the night I would race down to our basement rec room, curl up on a most uncomfortable couch and plug my ears tightly with my fingers. And cry. There was lots of crying back then. My kids would cry for me, and I would cry for myself and my husband was probably crying that he had to deal with it all. Those kids are 44, 37 and 35 now and I have seven grandchildren. They’re all very well-adjusted, educated and productive members of society with no phobias of their own and I have a great relationship with each of them. I share that not to brag, but to reassure you that if you’re doing what I did your kids can still turn out ok.

I’ve had clients who book a hotel room, who sleep in their cars, who go to their mother’s, who camp out downstairs or in the attic. One client insisted that their “mortgage helper” suite be left empty so she could move into it every time someone in the family was ill.

The treatment for emetophobia involves, among other things, desensitization to the sounds of vomiting. Most people with emetophobia are afraid of being sick themselves, while some are just triggered by the sight or sound. Either way, nobody likes to hear it. I used to have three or four sounds that I found on the internet which I went to great length to find, and used those in my emetophobia treatment program. But then I found this great website that has 88 sounds of vomiting, and it’s free for anyone to use! Here’s the link if you’re interested: https://www.soundsnap.com/tags/vomit You can begin by having your volume very very low, and then slowly increase it. Try all 88! The great thing is that it will desensitize you to the sound if you work on it, so you can be in a hospital ward with the curtain drawn, be a couple rows behind someone on a bus or plane, or be in your own house minding your own business and listen to someone vomit. It’s all the same. Good luck!