Tag: emetophobia

Christie-RussLeave a comment

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

Christie-Russ

Is this chicken cooked?

NOPE.

I belong to almost all of Facebook’s emetophobia groups, and by far this is the most common question. Sometimes it’s chicken, and sometimes it’s other types of meat. There are also questions about how long something was out of the fridge, freezer, or how something should be cooked. These are legitimate concerns. A lot of what emetophobics worry about isn’t, and I seldom if ever address it. But undercooked chicken can definitely make you sick. It can happen within 1-2 hours, or as long as 24 hours. Other meats, like sausage, can make you ill, when undercooked, up to several days later.

Chicken is particularly tricky as it must be cooked thoroughly, but not allowed to dry out (74C for chicken parts; Beef only has to be seared on the outside, as various diseases such as e.coli are only on the outside of the beef, not the inside. But chicken can have salmonella all the way through the meat. Anything that’s been chopped up such as hamburger or sausage MUST be cooked to the proper internal temperature. There’s a trend in the United States to eat hamburgers “medium rare” which is all fine and dandy so long as the meat hasn’t been contaminated in the slaughterhouse or butcher shop. I travelled to Paris some years ago where the steak is served tar tar (raw) which sounds scary because you sure as heck don’t want to buy a steak in the United States and serve it raw. But in France, beef that is sold for tar tar has been carefully slaughtered and butchered so as not to contaminate it. In order to assure this, you have to slaughter cattle one at a time. In America (and Europe for regular beef) cattle are slaughtered on an assembly line that resembles the making of an automobile. If you were ever to visit such a place, you’d be a vegetarian for life. Well, ok. I have and I did and I was, but I was only vegetarian for about 8 years until the slaughterhouse faded from my memory.

Pork is its own thing – at one time it had to be cooked to 71C/160F. You’re unlikely to get salmonella or e.coli. from pork, but there used to be certain parasite larvae within the meat that will attach to your intestines after which the parasites will migrate to skeletal muscle, but sometimes to heart, lungs or brain. Pig farming has come a long way, however. Yes, pigs are kept in small enclosures like most chickens and dairy cows. But unlike the latter, pigs are housed on concrete slats washed down several times a day. Humans must sanitize and wear clean overalls to even enter the “barns.” So they’re not digging up and eating dirt, rats or garbage anymore. The chance of parasites is virtually nil. If you keep your own pig in your own pigpen and feed him leftovers, then when you cook him, cook him to 71C/160F. If you buy your pork at the grocery store, it is now safe to cook it to anywhere between 63C/145F and the previous 71C/160F. The same parasite once found in pork IS present in wild game such as bear, wild boar, horse, dogs and several more.

The thing to keep in mind is that you can’t tell if any meat (or anything else) is cooked properly without a food thermometer such as the one through the link on Amazon, above. They’re inexpensive and easy to use. You want to make sure you get a digital one. The other thing you need is a proper chart to tell you what temperature each type of food should be cooked to. There’s nothing worse than eating dry or rubbery chicken because you’ve cooked the living hell out of it just to make sure. It’s so simple – just insert the thermometer and ensure your meat hits the minimum temp.

If someone else cooked your meat, at home and not at a restaurant, you may need to be more careful. I’ve been to many a barbecue in my day where hamburgers were served raw in the middle. If possible, go for a steak (always ok if seared on a barbeque) or a hot dog. Never give a child a homemade hamburger without cutting it in half and ensuring the centre has no pink at all. This is one time when you can tell if it’s cooked by looking at it. Perhaps better to tell your host you’re vegetarian and bring your own veggie burger patty to the barbeque. That’s what I started doing after a while. My husband always threw all caution to the wind, would eat the garbage if I fried it up, only started handwashing during Covid, and never vomited for 32 years (that was after drinking a few wee drams of Cape Breton whiskey 8 years ago. He’s now labeled the box “for cleaning bicycle chains”).

Restaurant food is far safer. Perhaps I’m speaking as a Canadian who owned a restaurant at one time. It was actually a bakery, but we served breakfast and lunch sandwiches and soups. We also made our own pastry cream and other cake fillings. The health inspector was strict and brutal. We needed to take a “FoodSafe” course first, to even get a license. Then she showed up at any time (usually the worst, busiest time) to do surprise inspections. We always got a “low risk” inspection review and rating, which was the best you could get. I was grateful for my history of emetophobia as I’d committed most of the food-safe facts to memory long before! I am not familiar with the health regulations in the United States although a little internet exploring and I came up with this January 12, 2021 blog which seems to imply that the regulations are exactly the same, but restauranteurs are not necessarily required to take a FoodSafe equivalent course. These regulations may have changed by the time you’re reading this.

This chart is not so much for safety as optimal freshness and taste.
For safety you can add a day easily in the fridge, and double the time in the freezer.

Christie-Russ

Let’s talk poop

You didn’t think I’d actually choose a poop picture for this blog, did you? Gaze on this lovely waterfall picture for sixty seconds and breathe slowly. It really helps sometimes.

I’m writing this today because I see so many people on the emetophobia support groups on Facebook really freaking out about poop. Mainly loose poop, which they often call “diarrhea.” The reason they get so anxious is because of course diarrhea and vomiting often go together. If you have norovirus (“stomach bug” or “stomach flu” – even though it’s not actually a “bug” or a “flu”) then you will normally get both. The virus multiplies so quickly and so much that it overwhelms your small intestine and then your stomach. As well, you stop digestion of food. So while technically norovirus is an intestinal virus, you often vomit a few times because the virus triggers a vomit mechanism in your brain to make sure you get as much of the virus out of your stomach and intestines as you can, while your immune system kills off the rest.

That being said, there is another, much more common reason for having loose or very loose poop: anxiety. I know that you’re probably very tired of well-meaning friends and relatives telling you that “it’s JUST anxiety” or “it’s all in your head” because these two things are often said with a tone of not-very-niceness to them. Like they’re fed up of you freaking out and complaining. I can well imagine my poor mother when I was a kid. I don’t know how many times in one day she’d have to explain to me what was actually wrong when I needled her with questions about poop or weird feelings in my digestive system (gas, bloating, acid, heartburn, upset stomach, butterflies, bowels just working properly, grumbling stomach, eating-too-little, eating-too-much, eating-too-many-sweets, eating-too-much-junk-food, not eating at all….).

The honest-to-God truth is, anxiety makes you have loose stool IMMEDIATELY. Like you know how someone is telling a funny story about someone jumping out at them and scaring them and they say “I almost shit myself!” Or I did. (I heard that story from one of my son’s friends once and I laughed so hard the tears ran down my legs.) Well, these aren’t just folklore – the stories are true. If you get a huge fright your bowels can loosen in an instant and then you really have to go.

Loose stool, and other digestive problems that often accompany anxiety, can happen because your brain and your gut are actually connected. And this works both ways. Your brain controls your gut, and your gut also has an effect on your brain. When you have emetophobia or some other anxiety disorders, this can cause what we call a “feedback loop.” So you get an anxious thought (which you may not even be aware of ) and your bowels loosen. The loose bowels make you anxious, so they loosen even more. And so on. Here’s an abstract from a 2013 scientific study:

Within the first few days of life, humans are colonized by commensal intestinal microbiota. Here, we review recent findings showing that microbiota are important innormal healthy brain function. We also discuss the relation between stress and microbiota, and how alterations in microbiota influence stress-related behaviors. New studies show that bacteria, including commensal, probiotic, and pathogenic bacteria, in the gastrointestinal (GI) tract can activate neural pathways and central nervous system (CNS) signaling systems. Ongoing and future animal and clinical studies aimed at understanding the microbiota–gut–brain axis may provide novel approaches for prevention and treatment of mental illness, including anxiety and depression.1

Dr Praveen Gupta, Director & HOD, Neurology, Fortis Memorial Research Institute (FMRI), Gurugram says: “The brain is responsible for sending signals to different parts of the body and hence, plays an important role in keeping all the systems of our body running smoothly. Now, the digestive system is no different. So, when you’re feeling anxious, your neuroendocrine system experiences changes, and this in turn causes changes in the enzymes of your digestive systems. This affects the mobility of the intestine. In fact, a lot of people who have anxiety also suffer from irritable bowel syndrome (IBS).”

Dr Gupta also says that once you’ve taken care of the root cause of your anxiety and feel more at peace mentally, your digestive system will also go back to functioning normally. That is until the next pang of anxiety hits you. All in all, your bowel movements and anxiety are interrelated
If you are experiencing anxiety, in all likelihood you can also end up suffering from digestion-related troubles such as acidity, stomach cramps, and in some cases, even constipation.2

What does all this mean for the person with emetophobia? It means, stop panicking about loose poop. It actually comes from panicking. So just let it happen, and carry on. Try to do some relaxation and breathing exercises to slow down the brain-gut reaction you’re having. You may not be able to, and that’s ok. If you actually contracted norovirus, the diarrhea would be quite severe, almost like you’ve just turned on a tap and water is pouring out. And it would be constant, even every half-hour or so. (So sorry for the TMI – I’m just trying to help.)

I hope at least some of you can find relief from your emetophobia through this blog!

  1. Jane A. Foster and Karen-Anne McVey Neufeld (2013). Gut–brain axis: how the microbiome influences anxiety and depression. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
  2. From Healthshots (Feb 6, 2021) https://www.healthshots.com/mind/mental-health/wondering-why-your-anxiety-makes-you-poop-take-a-deep-breath-and-read-this/

Christie-RussLeave a comment

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.

Christie-Russ

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.

Christie-RussLeave a comment

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!