B.R.I.T. – A Way to calm anxiety

According to the experts – scientists who study anxiety and treatments – the best way to deal with an anxiety or panic attack is to do nothing. Just let it be. Don’t run away from what triggered it, don’t use a safety behaviour so you’re not sick, don’t even think about it, which means don’t battle it in your mind and try to stop it. If you can do that, then the anxiety will come to a peak and then slowly dissipate on its own, all within 15-20 minutes. EASY FOR THEM TO SAY, EH?

There – you got my little bit of Canadian for today! The formula, according to said experts is:

Notice it

Acknowledge it

Don’t engage with it

“Just notice it” my therapist used to say. It made me so mad. How the H-E-double-hockey-sticks could I NOT notice it? (I’m on a Canadian roll now, eh? Go Canucks!) But seriously, I used to go from 0-10 in 1/5000th of a second. I wondered if anyone who came up with these ideas had ever actually had a panic attack. It troubled me deeply as I sought to help others with their emetophobia because I assumed that everyone was like I used to be.

As the years and the clients clicked by I started to notice a pattern with them. They were not like me. In fact, I have met or talked online to very few people who reacted as I did to the triggers. I basically felt well and healthy every day of my life. I never felt nauseous, icky or “off.” So I’d be going along minding my own business when one of my three kids would come up to me and say, “Mom, my tummy hurts.” ZAPPO! 10/10. I had no time to “notice it” or “acknowledge it” – that was just crazy talk. Ironically, once I was successfully treated for the phobia and wasn’t afraid of vomiting anymore, I started to notice that I got anxious about other things. It’s like before – if everyone was feeling good – I didn’t care what else happened to me or anyone else in the world. No one was going to vomit, so everything was great! Once I got over the emetophobia I realized that I was still an anxious person, because I was born that way (and so were you). NOW, when the grandkids go to the playground I’m the one thinking OMG HE’S ONLY 2 AND HE’S AT THE TOP OF THE SLIDE!!!! My point? It’s not 10/10 – it’s maybe 4 or 5, and then the more I watch him the more it creeps up and up and up. I just let it be, and eventually it goes away on its own.

Many of my clients are like that with emetophobia. They wake up feeling “off,” so they’re a little nervous – maybe 3/10. Then they eat breakfast and start to feel icky – 4-5/10. Then as the day wears on icky turns to worried which makes the icky worse and the numbers creep up. Now, I understand that your experience may also be different than that, but the point is that if your anxiety moves up slowly, then the experts are correct: do absolutely nothing about it.

Today’s little acronym is “B.R.I.T.” (How do you like that, peeps in the UK? eh? eh?) BRIT is not for the slow climb – just notice, acknowledge, and don’t engage those. BRIT is for the times when it goes HIGH QUICKLY. Or when you just can’t “do nothing” about your anxiety, and so it continues to rise. BRIT are the ACTIONS (Remember last week’s “A” in the STAR plan?) needed to calm down. They’re all tools you carry with you every single day. You don’t need a safety kit in your purse. You just need BRIT. So let’s go through them one by one.

Breathe

Your breath is your salvation! Learn to breathe slowly and evenly, deep into your abdomen. Let the out-breath be longer than the in-breath. Try “7-11 breaths” – breathe in for 7 counts, out for 11. Check out my YouTube Video on how to breathe properly to help bring anxiety down: https://youtu.be/PPkUWoloQog

Relax

“Relax” means to relax, soften and drop the large muscle groups in your body starting from your forehead and eyes, and extending down to your toes. In order to do this effectively you have to practice it. I give all my clients a sheet of paper with the numbers 1-90 on it so they can check off the number of times they listened to a 20-minute recording teaching progressive muscle relaxation. Just putting on a recording when you’re anxious will not help you very much. You need to learn the technique much like learning a piano concerto or an entire hip hop routine. You can’t just tell someone to do either of these – they have to learn the notes/steps and practice until it’s just “body memory.” It’s the same thing with this. Your body has to know where to go. Here’s a link to one of my progressive muscle relaxation recordings. There are many more on YouTube: https://youtu.be/XfF5Srxtj9M

Shout out to PianistMiri who improvised on harp with me to make these! https://www.youtube.com/user/pianistmiri She does WICKED piano covers of popular songs!

Imagine

Studies have been done on the brain where a person was shown an object such as a cabbage in an fMRI machine. The next day the person was put in the MRI machine again and told to remember the object from the day before. The cool thing is that the brain lit up exactly the same way. Like, exactly. So of course the “logic” part of the brain knew the cabbage wasn’t there – that the subject was just imagining it on the second day. But the rest of the brain did not know. Psychologists got hold of this and used it for anxiety recovery. Imagine you are in the most peaceful, tranquil, calm and beautiful place in the universe. Really imagine it. Your brain won’t know you aren’t actually there.

Using the “imagine” tool may be helpful when sitting on in an airplane, but not as helpful if you’re at the front of the room giving a presentation. It’s ok – you have three other tools.

Think

Sometimes when we’re busy emoting (aka freaking out) we fail to THINK. Thinking can calm the troubled mind and body. Use positive, calm and rational thoughts. I used to write mine down on a business card and carry it with me all the time when I was working on my emetophobia. I volunteered at the hospital, and one day I walked into a patient’s room and she was very nauseous, holding one of those cardboard bowl things under her chin. I could not take the card out and read it, but I reached into my pocket with my hand and just felt it. That really helped. Here are some positive thoughts (“positive cognitions”) that have helped me, and many of my clients. In fact, my clients came up with most of them:

  • You’re not in any danger
  • It feels dangerous but it isn’t
  • Usually the worst doesn’t happen
  • If it really happens, your anxiety will go down.
  • Vomiting isn’t dangerous or harmful. It can’t hurt me, so I don’t need to be afraid of it
  • There’s no point being afraid all of the time for something that happens so little of the time/rarely
  • It doesn’t matter if I vomit
  • Even if I get sick, I will be ok.
  • I’m perfectly safe
  • It doesn’t matter
  • I can cope with vomiting

Sex and emetophobia

It wasn’t until a client once asked me if it were ok to talk about sex that I started to think about sex and emetophobia. I reassured them that they can talk to me about absolutely anything. One might think that we 60-something grandmas don’t know much about the subject except for the missionary position in a long flannel nightie, but let me revamp our image for you: we went to college in the 70s. THE SEVENTIES. All the girls were on birth control pills, and there wasn’t any disease you could catch from a partner except gonorrhoea, which if you were so unfortunate, could be cleared up with one dose of penicillin. The good old days before herpes and HIV. Imagine it.

My first counselling gig was at the University of Waterloo “Peer Counselling Centre” in 1976. With some good, solid training, we volunteered a few hours a week talking to our peers about sex, birth control, abortion, being gay, being born in the wrong gender. Yes, 44 YEARS later we’re still talking about that.

But I digress. Emetophobics actually have a few things to worry about when it comes to sex, especially with some of the latest activities that many couples enjoy. What’s worse is that they’re often afraid to share these fears with their sexual partner.

I’ll try to be crystal clear, so you may want to read this blog in private.

Oral sex

Oral sex can present a problem to either male or female emetophobes. For the (straight) female or gay male the possibility of gagging on either the penis or the ejaculate can be terrifying. Men can become equally terrified of their partner gagging and even vomiting during oral sex. There are some emetophobic queer women who are quite reluctant to perform oral sex on another woman.

anal sex

Considering that Norovirus particles are contained in fecal matter, anal sex can be daunting whether one is the giver or the receiver. The problem is that the penis (or sex toy) is removed, theoretically contaminated. And then what do you/they do with it? We all know it’s not getting near your mouth anytime this century. But does he know that?

anilingus

Yep. I had to look that one up. Thanks to a comedy routine by Chris Rock, I heard it was called “tossing his salad.” Apparently there are a plethora of other terms. Suffice it to say that your average emetophobic would not be caught dead doing this one, which involves your tongue and your partner’s anus.

anal-digital stimulation

What’s he going to do with that hand now?

the solution

This may seem ridiculously simple, but you have to talk to your partner about the kind of things you like to do, and what you feel uncomfortable with. If you’re afraid to do just about everything, and your partner really wants to be adventurous then perhaps they aren’t the right partner for you. But if you’re already married to them, then there needs to be some give and take. Explain what frightens you. It’s easy enough for him not to push his penis too far into your mouth, and to let you know when he’s about to ejaculate. If they want anal sex, you might have to negotiate a shower afterward before doing anything else. You get the idea. Talk. If you can’t talk to someone with whom you’ve taken off all your clothes, then who can you talk to?

The other, perhaps more obvious solution, is to get treatment for your emetophobia. It really is treatable, and you don’t need to be afraid of the many things in life that non-emetophobics enjoy forever.

Best of luck, and remember that you can discuss anything with your therapist if need be.

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!

coronavirus and emetophobia

Edit: August 7, 2020. Wear a mask over your nose and mouth. Don’t touch it except to put it on and take it off. If you have to go out, try to keep 2 metres away from other people, even if they’re wearing masks. Don’t congregate in groups larger than 10, and be sure to know everyone in the group or have some contact info for them. Get tested if you show any symptoms at all.

Edit: March 12, 2020. “Cancel Everything” – don’t go out unnecessarily to places where there are a lot of people. Avoid travel. Protect the elderly. End edit.

When Coronavirus was first publicized in January, many of the Facebook pages and chat sites for emetophobia carried the same message: “I’m not afraid of it, because none of the symptoms is vomiting.” In other words, if you’re only afraid of vomiting and not of dying then you’re good. If truth be known, emetophobic people are also afraid of dying – they just don’t realize it. Vomiting=dying in some part of the emetophobic brain. Other forms of dying we feel pretty much immune to, even though there is risk involved. Phobics are naturally unwilling to take any amount of risk as it relates to the thing they fear, even though they’re quite willing to get into an automobile every day.

I was hoping that the conversation might be a bit more realistic, which it has now become: we germ phobics have something to teach the rest of the world – good hygiene! Wash your hands well, and don’t touch your face, meaning the “T-zone” of eyes, nose, mouth. Those are the mucus membranes just waiting for the virus to find its entry point.

With norovirus, touching one’s nose is less likely to infect you, and touching the eyes even less, as norovirus must be “swallowed,” meaning vomit or fecal matter has to make its way to your stomach and intestines. Ew. Coronavirus, on the other hand, just needs to make its way, via your mucus membranes, to your lungs. Gah!

Wearing a mask may help you to remember not to touch your mouth or nose, but as masks are in high demand just now it’s better to leave those for folks who are actually sick. That way, their sneezes and coughs can’t infect anyone else. Gloves are pretty useless because, just like hands, they touch everything and are quickly covered in germs.

Click here to link to a great Washington Post article that talks about the psychology of why refraining to touch our faces is so difficult.

Six Degrees of Separation

There’s a running joke in Hollywood that there are only ever six degrees of separation from any actor to Kevin Bacon. If you’re a real movie buff you can play the game with your friends and try to figure it out.

The Kevin Bacon game works pretty much with any actor, as it’s based on the idea that there are only six degrees of separation from any one person to another on the planet. It got me to thinking…

I find that a lot of my emetophobia clients who have a fear of vomiting worry extensively (some much more than others) about the degrees of separation of Norovirus (aka “stomach flu” or “stomach bug”)[1]. What I mean by this is they’re afraid that someone with Norovirus touched this, then that, then what if I touch this, then, that – is “that” contaminated with Norovirus? Here’s an example of what I mean:

  1. Bob has Norovirus
  2. Bob doesn’t wash his hands after using the bathroom. There are Norovirus particles on his hands
  3. Bob opens the door
  4. Bob picks up his keys
  5. Bob opens his car door
  6. Bob drives to the grocery store
  7. Bob gets a grocery cart
  8. Bob grabs a box of granola bars, reads the label, then puts it back.
  9. A few moments later I grab the granola bars and put them in my cart. I buy them and they get put in a bag
  10. I touch the bag handles
  11. I touch my purse handles and keys
  12. I eat a burger without washing my hands
  13. I will get Norovirus.

I now believe that I must wash my hands, my purse handles, and wipe everything item of my groceries or I will catch Norovirus.

Here’s the thing: you won’t. Norovirus is very contagious, true, but what we have here are TWELVE degrees of separation from the Norovirus particles and you. That’s way too many for the virus to still be active. Here’s what can happen at the grocery store:

  1. A kid has Norovirus
  2. The kid doesn’t wash his hands after using the bathroom.
  3. He touches nothing until the grocery cart handle.
  4. You use the cart next and touch the handle.
  5. You put your fingers in your mouth or eat a burger.
  6. You get Norovirus

That’s six, right? So yes – you could get Norovirus this way. But NOT IF THERE ARE ANY MORE THAN SIX. Because I’m actually talking about one item touched by the kid, touched by you (the grocery cart), and I’m also talking about invisible Norovirus particles, not visible poo. Ew. Sorry for that. This is why there are wipes in grocery stores now, for your cart handles.

Here are the items you don’t want to touch, then put your hand in your mouth:

  1. Anything in someone else’s bathroom, or yours if someone in your house has Norovirus: toilet flusher, taps, soap dispenser, paper towel dispenser, countertops, cups, toothbrushes, toiletries or makeup, door handles.
  2. Doorknobs
  3. Other people’s phones (your phone is fine)
  4. Light switches (especially in bathrooms)
  5. Elevator buttons
  6. Gas pumps
  7. Other people’s hands

 For all you emetophobia folks out there, let’s review how you might catch Norovirus:

  1. Someone with Norovirus throws up within ten feet of you. That’s about the radius that the aerosolized particles can travel, although it’s more like seven feet to the side. (Now you know why it’s so contagious in schools.)
  2. Diarrhea in a toilet can become aerosolized when the toilet is flushed. It can land on toothbrushes across a room.
  3. Someone in the food production business doesn’t wash hands and touches your salad or hamburger bun.
  4. You touch something from the list, above, don’t wash your hands, then put your hands in your mouth. You could theoretically catch it from putting your finger in your nose, but it’s highly unlikely, and even more unlikely you’d catch it from touching your eye. Zero chance from touching your face.

There is more information on the Norovirus page of my website including myths about how it is caught. The truth is, most Norovirus is spread by children. They suck at handwashing. Apparently so do caregivers in nursing homes.

The good news is that it’s really easy to get the virus off your hands – you just wash them with plain soap and water. Emetophobia folks will tell you about all the things that kill Norovirus, but if you wash your hands before putting them in your mouth you really don’t need to worry.


[1] Noroviruses are neither a “flu” nor a “bug” – those are just sayings.

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!