Tag: emetophobia therapy

Anna S. Christie

I’m Afraid to Get Better

I’ve had many clients over the years gingerly tell me that at least part of them is afraid to get over the emetophobia. I know their reasoning before I even ask. “You’re afraid that if you get better, you won’t be so careful, and you’ll end up getting sick.” 

“Yes.”

Most of them understand that this doesn’t make sense, but many do not. Either way, they’ve been embarrassed to tell me. I blame a lot of it on other therapists who have been judgmental of them in the past when they’ve come in for emetophobia treatment. In fact, many therapists who don’t understand emetophobia or how to treat it have told their clients that they just don’t want to get better. They usually conclude this when they can’t think of what to do with these clients that to help them. 

Sometimes the refrain is picked up by parents who are also at their wits’ end about what to do with an emetophobic child who doesn’t want to eat, drink, go to school or go to therapy. They conclude that the child/teenager doesn’t want to get better or is afraid to get better so they’re not “trying.” 

I do get it. I remember at least thinking that I might be afraid to get better when I had emetophobia. Yet I desperately wanted to get better. I knew it wasn’t logical – after all, if you get better that means you’re not afraid anymore, so whether you’re “careful” or not, it really doesn’t matter if you get sick because you’re not afraid of it anyway. That may have been too confusing a sentence. Sorry! Think of it this way: a person has a severe phobia of puppies. Especially those fluffy, bouncy, slobbery Golden Retriever puppies. Ya, these guys:

Yes, there are many people terrified of them. They have panic attacks just like you, and they do everything they can to avoid going anywhere where they might see one, and they never watch Disney movies and close their eyes during most TV commercials. If one of these phobics accidentally stumbled on this page they’d be crying right now from seeing that picture. Don’t even say in your head that you think it’s ridiculous!!!! These things aren’t logical, as you well know. 

Okay, so now imagine that someone who has a phobia of puppies comes to me for treatment. On intake, they whisper gingerly that they’re afraid to get over the phobia because if they do, they might end up not caring any more and then they’ll just go get a puppy some day. 

Did that make you scratch your head? But it’s the same thing, right? EVERYONE with a phobia is afraid to get better in case they stop being “careful” to avoid what they fear. What if someone gets over their spider phobia and just throws caution to the wind and starts gardening? What if someone with a clown phobia gets better and just starts going to kids’ birthday parties? You’re getting the idea, right? And yes, I know that if you’d rather be afraid of puppies or clowns or even spiders for that matter right about now.

So first of all, the obvious: if you don’t have emetophobia you won’t care if you get sick, or risk getting sick because you won’t be afraid of vomiting anyway. But secondly, and I speak from experience here, you’re not going to just let all hell break loose and start licking the bottom of your shoes or your fingers after shaking hands with sick people or whatever. I’m no longer afraid of vomiting but I sure as heck don’t like it. I might risk eating something that seems wonderful if I’m not sure about it or who cooked it, but I don’t want Norovirus – I had it ten years ago and it wasn’t very nice: the worst part for me was the fever, chills, exhaustion and body aches. So even though I don’t fear vomiting any more, I still wash my hands before I eat and I don’t put my fingers in my mouth or nose unless I’ve just washed my hands thoroughly for 20 seconds and not left my living room.

Get better, ok? Don’t be afraid of it! Getting better is awesome.

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Safety Behaviours

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!

Anna S. Christie

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!

Anna S. Christie1 Comment

Exposure Therapy

I’ve been “talking” with emetophobia folks online since 2000. Over these twenty years I’ve seen more people misinformed about what exposure therapy is than I’ve seen people who’ve tried it. It’s probably better to start off with what exposure therapy is not.

Exposure therapy is not just randomly running into a situation that exposes you to someone vomiting, or you, yourself feeling very ill. Yes, if you go to a birthday party and a kid is suddenly sick in front of you then I suppose you have been exposed to what you fear most. But the “therapy” part is missing. Therapy comes from the root word for “healing” and just randomly being exposed to vomiting and having the bejeezus scared out of you does nothing for your healing. In fact, it may make your phobia worse by re-traumatizing you.

For exposure to be therapeutic, it has to be structured. If you go to a CBT (Cognitive Behavioural Therapy) therapist they will normally build a hierarchy with you. Since this is difficult for most emetophobics to do, I have a good hierarchy that works for pretty much everyone right here on my website under “Resources” – “Exposure.” The current literature on anxiety and exposure therapy says that a list is as good as a hierarchy anyway. So you make a list of everything that frightens you. Or go to my website exposure section. Then you would normally begin with the least frightening thing, and progress slowly to the most frightening (which is normally watching explicit videos, hearing sounds or mixing up something that looks and smells like vomit).

Seriously. Don’t freak out. The final, most difficult steps ALWAYS seem impossible when you’re just starting out. But that’s the beauty of exposure therapy – it begins with something SO EASY and you go SO GRADUALLY that by the time you get to the difficult stuff, you hardly notice. Think of it like this: you’ve fallen down a hole, are terrified and you can’t get out. Then you notice there are a set of steps to climb up to get out. If you go one step at a time it’s easy to get up and out, but if you just look at the top step and think “I can’t possibly get up there” then you may not even try to take that first step. You’ll just sit at the bottom in the hole and cry. I did that for about thirty years.

The first steps in my online hierarchy are as simple as looking at the word “vomit.” There. You just did it. You may not have liked it, but you’re ok right now, ya? Then we look at some other words. If those are too difficult then we might just begin by imagining a scene where you’d be a little afraid.

In addition to the exposure resources I have online, I get all my clients to make a list of everything they avoid and all the safety behaviours they have. An example of an avoidance behaviour is perhaps not making medical appointments. An example of a safety behaviour is feeling nauseous and taking ginger or mints.

I usually wait until we’ve looked at all the words and drawings and cartoons and pictures and then have my clients begin to approach things they previously avoided, and/or stop using a safety behaviour. I assign this work as homework and check in each week. Then at the next session we begin looking at videos, which also start with simple things like a baby spitting up.

It’s not enough to just look through all my exposure resources to prove that you “can.” Anyone can white-knuckle it through the list and then feel great relief that the exercise is over. Your phobia will not improve. In fact, it will make your phobia worse to do that because the part of your brain that’s giving you all the trouble will say, “Wow, it sure feels good NOT to looking at that stuff now. To continue feeling good, I’ll avoid it forever.”

At each stage of the exposure, you must look at an item, record your fear level 0-10, and then either try to tolerate the fear level (if it is below 7) while still looking at the picture or use previously-learned skills to bring the number down below 7 where it can be tolerated. So you keep looking at the item until you are no longer afraid.

Sometimes if clients are recording rather low numbers for a few pictures in a row, I ask them to purposely raise their anxiety level. This ensures that the client is not “white-knuckling” their way through the pictures.

So….is it scary? The answer is yes, a little. But normally my clients’ anxiety levels only go up to about 5, maximum. That’s how I like to work with people. It’s a little scary, but it can be tolerated. Before long, they come to realize that all anxiety can be tolerated with a little practice.

Anna S. Christie

The Dreaded Colonoscopy

Often I work with clients who have gastro-intestinal issues. Their doctors almost always recommend a colonoscopy. It’s a simple procedure done under heavy sedation (you’re usually totally asleep, but not under general anesthetic). Most emetophobics aren’t too worried about the procedure; they’re just terribly worried about the prep the day before. Since it’s important that your whole colon is clean as a whistle, you’re usually told to eat no fibre for a day or two, then have only clear fluids the next day, and then drink some form of powerful laxative to clean out your colon. Yes, it’s a day of diarrhea, but it beats paying for one of those “colon cleanses” at a spa, since it’s the same thing and generally paid for by your insurance or medical system. And of course it’s waaaaaay better than getting colon cancer! I myself have had several of these procedures and I don’t mind them at all anymore. Then again I don’t have emetophobia anymore so maybe that doesn’t count.

So why is it “dreaded?” Well, emetophobics worry that drinking the laxative will make them sick. Even though I’ve never talked to a single emetophobic who ever got sick from it. Some folks who have very weak stomachs and are NOT afraid of vomiting report getting sick from it. These people are not you guys! Emetophobics can control vomiting at the worst of times, and this is not the worst of times.

One of my clients, Jessica, has gone through several colonoscopies when she was very phobic, and she was kind enough to write a short post about it. So here it is:

“Three years ago I had whittled down to 100 pounds after being nauseous and having an upset stomach for seven months (an emetophobic’s worst nightmare). I finally got an appointment with a GI doctor who suspected Crohn’s Disease from my symptoms. When he mentioned the colonoscopy procedure to confirm, my chest tightened and heart stopped. How was I ever going to drink all the liquid to prep for it? What if it made me sick? I had only ever heard how terrible prepping for one was.

I made a decision. I immediately went into fight mode, toughened up, and decided to just do it. I surprised myself when it was way easier than I imagined. I was instructed to drink 64 ounces (2 litres) of Gatorade mixed with the prep medicine. To make it easier, I drank the prep/Gatorade mix with a straw over ice. I stayed calm, stayed distracted, and reminded myself it was a temporary discomfort for a healthier me. I watched a tv show and played Yahtzee with my family.

The next morning I went to the hospital, and completed the colonoscopy under general anesthetic. I woke up next to my husband and nurse. My doctor made sure I stayed comfortable in the recovery room as well. They offered me anti nausea medicine for when I was coming out of the anesthesia and warm blankets for my feet. Once I was home, it was like nothing had ever happened. I’ve had two colonoscopies in the last three years and when it comes time for my next one, I will be excited for the best nap I’ve ever had.

Nothing is as ever bad as our heads tell us it is.”

Anna’s notes: 1) Most colonoscopies are not performed under general anesthetic anymore, but rather “conscious sedation.” There’s no nausea afterward. 2) The prep mixtures are getting way better with every passing year. For my last one, I only had to drink a small bottle (less than a cup) of lemon-flavoured liquid the night before and another one the morning of. 3) Jessica met with me for about 14 sessions and is doing great! Thank you, Jessica, for submitting this for me!

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Being Thankful

As an emetophobic, it can be hard to truly appreciate the holidays. You often have to travel by car or plane, stay at someone else’s house, eat food cooked by someone else, and put up with all the family members including little ones who can be germy to say the least.

Our Canadian Thanksgiving has passed now, but I am aware that most of my clients are from the USA, and their Thanksgiving is looming. Not being thankful, in fact not enjoying oneself, can bring with it guilt and shame. Everyone else is having a good time sharing food and wine, stories and games. You might be curled up in a chair away from people staring at your phone, not wanting to eat. “Waiting.”

Many ask me if I have any “tips” for getting through the holidays. I do not. Recovering from a serious anxiety disorder such as emetophobia is not about tips or five steps to a cure, or a quick fix. It is a slow, methodical process; a road that is straight uphill. Let me share this with you, however: you can do it. You can get through the holidays; you can cope with whatever happens. You know darn well you’re going to wash your hands and not put them or anything you’ve touched in your mouth anyway. So the chances of YOU getting sick are pretty much non-existent. If other people are sick that would be upsetting, but nothing bad will happen to you. You may be afraid, but you’ll be ok. Try to remember this – write it on a little card, perhaps, and take it with you for the weekend. Refer to it whenever you feel your anxiety start to rise.

What about being thankful? Everyone else will talk about being thankful for food (probably not you) and for family (even those germy kids?) and for other various aspects of privilege. You may feel that while you’re suffering so much, you don’t feel very thankful for your life at all. When I was a kid, I made the same wish blowing out the candles on every birthday cake: I wish I didn’t have this phobia! I figured the wishing didn’t work. But here I am at 61, nearly twenty years completely free of it. So maybe it worked after all. It just wasn’t instant.

Here are a few thanksgivings to ponder:

  1. I am thankful that I live in America (or any other country that celebrates Thanksgiving). There is treatment for emetophobia here.
  2. I am thankful that I live in the information age, so I can find out lots about emetophobia right at my fingertips.
  3. I am thankful that I live in the age of Social Media, so I don’t feel alone with this and it’s pretty easy to have someone to “talk to.”
  4. I am thankful that people are studying emetophobia and conducting research all the time, so it may be easier to get treatment very soon.
  5. I am thankful that people are working diligently on developing a Norovirus vaccine!