Tag: emetophobia treatment

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WHAT SHOULD YOU DO ABOUT THOSE Movie SCEnes?

You know the routine: close your eyes and plug your ears. Take one finger out of an ear, perhaps saying “LA LA LA LA” very loudly, and grope around for the remote, wildly doing anything to change the channel, mute the show, or whatever. If you can’t do that you ask your significant other to tell you when the scary bit is over. This fear of vomiting can ruin just about everything in life, even your entertainment.

Most people with emetophobia are “lucky” enough to have their partner already in control of the remote and they tell you when you can open your eyes and unplug your ears. They similarly enable you in movie theatres. Notice I put “lucky” in quotation marks but not “enable.” That’s because it is enabling, which is always a dirty word and an unhelpful concept in the big picture. So you may feel lucky in the moment, but this avoidance is making your phobia worse, which is probably the last thing your partner wants for you. I know that my husband was always trying to “help” (there are those quotation marks again) but he was also trying to avoid getting screamed at or me having a meltdown of some kind. 

I have to say that I love-love-love movies. Foreign films are ok but I’m not one to go to a film festival. I like American movies. I know and understand the formula, having taken a course once on scriptwriting. And it makes me happy that the hero or heroine always accomplishes their goal by the end, even if ten minutes before the end it looks like they won’t. I used to go to the movies by myself every Wednesday afternoon for 20 years when I was a minister. I worked pretty much 7 days a week so it was my self-care time. 

I also love television. I grew up in the 1960s where you got one channel in black and white and the whole family sat around the tiny little TV set on Saturdays for Hockey Night in Canada, or Sunday nights for the Ed Sullivan show. By the early 70s my brother and my dad were dead and my sister was married and moved out. So my mother worked hard to buy that colour TV. The first thing we watched was Disney’s “Wonderful World of Colour” and I still remember a warm, happy feeling watching the opening animation. 

Lovers of television and movies are often thought to be lazy bums. “Couch potatoes.” I am unapologetic. I love the genre – the 22 minute sitcom and the 44 minute drama. I’ve never been big into made-for-tv movies but I’m hopelessly addicted to Netflix, Crave and Prime right now. Binge-watching several seasons of an entire show can elicit squeals of delight from me.

I’m not sure when vomiting got to be a thing on TV and in movies. I know that in 1972 the movie The Exorcist came to the theatre in my home town. I was terrified of seeing even the commercials for it. Yes, it was the emetophobia, as I’d heard about the vomiting bit, but also the creepiness of the devil stuff freaked me right out. I did not see it and have not to this day. In 1983 Monty Python came out with The Meaning of Life and I heard about the vomiting scene in it from the psychologist who ran the first emetophobia group I was ever in. Now I have seen that movie since, and the vomiting is so fake it’s pretty ridiculous. 

Vomiting slowly crept into a lot of movies, and a lot of TV shows, both comedies and dramas. I remember going to see The Green Mile in about 2000 and while there’s no actual vomiting in it, the guy opens his mouth and this grey cloud of sort of like flies comes out – it’s supposed to be the evil or pain which he absorbs from others and then it flies out of his mouth and away from him. I remember sitting in the theatre kind of cursing that movie. And crying afterward, because it seemed like emetophobia was going to ruin everything in my life by that point. 

By the early 2000s we had a ton of reality TV so vomiting was one of the things that was, actually, real.

Here’s something I know now but didn’t know then: you can use the occurrence of vomiting in TV shows and movies to actually help your emetophobia, instead of avoiding it and making it worse. You just need a tiny bit of courage and no other skills. 

  1. Tell your significant other that you are going to try to actually watch and/or listen to vomiting scenes from now on.
  2. Decide which you think is easiest to do – look or listen. Let’s say it’s “look.”
  3. You probably know when the scene is coming because people with emetophobia have almost a sixth sense about these things. THAT’S the time to hit the pause button on your remote. Take a deep breath and click “play.”
  4. Plug your ears or mute the sound if you wish, but try to watch the scene. Your anxiety will rise. That’s ok – it won’t hurt you. Just allow your anxiety to be there and don’t try to make it go down. No safety behaviours! Your anxiety will go up, but not too high – it’s just a TV show after all and it can’t hurt you. 
  5. Rewind and watch it two more times. Be proud of yourself.
  6. Carry on and finish the show.

Next time, if you’re brave enough, try listening but with your eyes closed. Then the next time, put the two together and watch it all. Keep doing this. Like, forever. Your emetophobia will be knocked back a bit, and that’s a good thing.

PS – ANNA’S TOP 3 GOAT LIST – IN ORDER

Movies: 1. Schindler’s List 2. Star Wars IV 3. O Brother Where Art Thou

TV Shows (Dramas): 1. Downton Abbey 2. Breaking Bad 3. The Sopranos

TV Shows (Comedy): 1. Big Bang Theory 2. Seinfeld 3. Friends

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an emetophobia thanksgiving

Today is Thanksgiving Day in America. As I’m Canadian I can only reflect back to our Thanksgiving which was in early October. It’s not as big of a holiday here. Family don’t fly home for it – we save that for Christmas, and we don’t have a history involving pilgrims or our First Nations people. It’s scheduled at the time of the traditional harvest. But interestingly, we have the same food! The turkey, the pumpkin pie, the green bean casserole, even sweet potato puree with those little marshmallows toasted around it. And of course, we also give thanks. At our house we do the go-around-the-table-stating-what-you’re-thankful-for thing. With three children, three of their spouses and seven grandkids it takes a bit longer now. Every once in a while someone says something not so typical and we go “oh…ahhh.”

Today I’m thinking of my beautiful clients, present and past. I thank God that because of them I have meaning in my life, and a great passion, and with my husband’s illness and Covid and him being retirement age, I have an income which pays our bills. I am also able to live out my calling, which, corny as it sounds, is “to help people.” I will never forget the feeling of having emetophobia when I was young, and not only could I not get help for myself but how helpless it felt that there just wasn’t anyone who could help anybody with it. In 1983 I was privileged to be part of Dr. Claire Phillipps’ original emetophobia study and group treatment program. She published her findings around 1985, one of the first in the world to publish about emetophobia (we didn’t even know the word “emetophobia” at the time). When I started working as a therapist in 2010, treating exclusively emetophobia on Skype (another word nobody knew at the time), I could find only about ten research articles on the phobia, and just one other psychotherapist who was treating it – Dr. David Veale in London, UK. He is a psychiatrist and has now become an emetophobia researcher force to be reckoned with. Many of the studies published today (still only about 60) have his name in the group at the top. I thank God for him. Perhaps if he is a religious man, he might thank God for me as he points people and therapists to this website all the time.

Enough about me, though. How about the people still suffering with emetophobia? We’re told not to gather this year, no thanks to Covid-19, and if your family decided to honour that guideline, then perhaps as an emetophobic you’re pretty happy. All those people, especially the germy little kids, amIrite? And the food! Heavy, greasy gravy, sweet desserts never mind the sheer volume of it. I’m sure there are people with emetophobia reading this who are nodding their heads and heaving a sigh of relief (dare I say, thanksgiving?) that it’s not happening.

Yes, it’s 2020, the year of the global helldemic. Sickness, death, isolation, job loss, George Floyd (and so many others), conspiracy theories, economic disaster, civil unrest in the streets, Trump losing/winning/stealing/being robbed of the election. But there’s the vaccine! Unless you’re suspicious of vaccines, that is indeed something to be thankful for. Kamala Harris – someone who represents something, that about half the country is thankful for. As someone with emetophobia, can you even think on these things, or does the phobia grip the very life out of you, day after day after day?

The poet and all-around amazing human being, Maya Angelou, once said “[in a time of crisis] first, thank God.” I remember hearing her say it on Oprah early in 1996. I nodded and smiled and thought it was so wise and wonderful. At our church we met in small groups every week and we decided to start each group time with this phrase “First, thank God…” Then I got cancer. It was diagnosed on a Thursday and I was leading a small group that night. I didn’t think of it until I was driving there. I could not think of a single thing at the time to be thankful for. I had young children; I was only 37.

At the group I cried as I stumbled through the opening. A young woman, new to the faith, timidly offered up “I’m thankful you live in Canada.” Yes, of course. We have some of the best cancer treatment in the world here, and it’s all free. This opened a pandora’s box of thanksgivings. My family. My children. My job. My faith. Today I can certainly offer up thanksgiving that I’m still alive and healthy 24 years later.

If you are so inclined, what can you thank God for today? Allow me to make it a bit more challenging: apart from your partner, your children, your family, your health care, your job (house, car). What are you thankful for apart from these things? Think on it long and hard. After all, you’ve got lots of time that would normally be spent arguing with your drunk uncle who’s either 1) a Trump supporter, or 2) a flaming liberal snowflake.

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. Christie1 Comment

Chemotherapy

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.

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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.