food anxiety

While I was eating dinner tonight, I became convinced that "something was wrong" with my body, and everything in me told me to stop eating, because there was a good chance I would throw up soon. I ate anyway, trying to focus all my attention on the fact that I didn't have one bit of evidence to show that anything was wrong aside from my uneasy feeling. It's been a while (a week or two) since I've had this experience, and it's strange how easy it is to forget how to handle it. At first, I didn't do anything, just letting the thought "something is wrong something is wrong something is wrong" run through my head over and over again, which is a thought I frequently have at the start of emetophobic anxiety. It's nice and vague but still terrifying. The word "wrong" stands out to me when it would probably be better to zero in on the word "something" to remind myself that the "something" is only anxiety. Eating dinner did not cause anything bad to happen, as usual. The existence of anxiety in general baffles me sometimes. I'm a rational person, but it takes over and puts thoughts in my head that make no sense. How is it possible that it can do that?

I'm going out to breakfast early tomorrow morning before work. I've been thinking about this all day and how all I want is to be able to go and eat eggs and pancakes and enjoy them. Situations like this seem so conditional in my mind - I'll be able to enjoy my breakfast only if I get enough sleep tonight, only if the restaurant isn't crowded, etc. I stood in my kitchen for at least a full minute earlier, trying to decide if I would be more likely to feel okay tomorrow if I had a small snack before going to bed. Snack or no snack, snack or no snack. It feels like I have to make the right decision, and then suddenly I remember that no normal person would care, because they would be able to enjoy their breakfast whether they had a snack or not. This decision in no way actually affects that outcome. It felt really amazing to think about that. There is potential to have so much more freedom in my choices and to not have to analyze everything all the time. There is an annoying wall between what's going on in my mind and that kind of freedom, but sometimes I can break through it temporarily.

now what?

I'm still doing really well when it comes to anxiety issues. I don't know why. Maybe it's the self-help books. Maybe it's the class I've been taking. Maybe hypnosis really is a miracle-worker.

Not that everything is perfect. I've still been feeling "sick" at times, and I've been unnecessarily taking my temperature a lot. But all of it just doesn't feel as bad as usual. It feels like the emetophobia of my college years, when I had things under control at least 80% of the time.

I'm not sure what to do with this period of calmness, because I keep thinking it's the perfect time to challenge myself - but how? Sometimes I think I've boxed myself in so much over the course of my entire life that I can't even see what's outside the box anymore.

self-help books

I have been having a really good week anxiety-wise. I haven't been feeling "sick" much at all, not even when I go to class. I've had the opportunity to actually think about topics other than anxiety and recovery and relaxation, which is a nice change. What's strange about this is that I have to keep reminding myself it's not the right course of action. I should be practicing my recovery and relaxation techniques in both good and bad times. I don't know, I'm still feeling a little rebellious about it all right now, wanting to just throw myself back into the person I used to be, the one who never thought about any of this.

In other words, I haven't been putting much effort into lowering my anxiety this week. The one thing I have been doing is reading / working through this self-help workbook my therapist recommended: Get Out of Your Mind and Into Your Life by Steven C. Hayes. I am about halfway through but haven't been blown away by it yet. I can see how it would be helpful if you didn't know anything about mindfulness and acceptance, but I have already read extensively about both, and this book (so far) is only covering the basics. Plus it seems like most of the writing "exercises" are only there to prove some point that is being made by the author, and for the most part, they are obvious points that didn't need to be proven in the first place.

I like the Cognitive Behavioural Therapy Workbook for Dummies so much better. I think I've written about it before. It covers so many different CBT techniques, and you actually feel like you are accomplishing something with its exercises. I think I am going to go back to that book once I am done with this one, because there are still some chapters I haven't worked through.

The 'Get Out of Your Mind...' book implies that other anxiety-fighting techniques, like CBT, don't work and that clearly you already know they don't work, or else you wouldn't have felt the need to buy their book. This is another reason why the book is bugging me. First of all, what works for one person may not work for another and vice versa - everyone is so different. Second, it is usually the case that knowing several different techniques is what is most helpful. I feel like CBT has helped me so much, but I don't see that as meaning that mindfulness and acceptance won't also help me. Even though CBT and acceptance are pretty much complete opposites, one of them could be more helpful in a certain type of situation. Or just the process of going back and forth between them could be helpful. Choosing among all the different techniques. Using a different one for every anxiety situation that arises. I believe variety is essential.

PMS / vitamins / exercise

I'm heading into that PMS time of the month, so I thought I would write a little about that.

I used to be pretty unaware of how much PMS affects my anxiety, but over the past year, I've come to see how my anxiety always spikes at this time. I'll be doing really well, and suddenly it will feel like I've lost control over my emotions again. Last night I didn't feel well after eating dinner, and I became convinced that I was going to throw up, even though I really think this episode of "not feeling well" was no worse than usual. After I calmed down, I was kind of shocked that my anxiety had escalated so quickly. All signs pointing to "oh yeah, PMS." It's back, wreaking its havoc.

But even though it's still a tough time for me, it's not as bad as it was several months ago when I first started noticing the pattern.

For one thing, that in itself - being aware of it - has been a huge help. Now I am prepared for it every month, and when my anxiety starts to get worse inexplicably, or when I start feeling really upset/depressed or frustrated about my anxiety, I know that is most likely the cause. That knowledge helps me stay calm, because I can remind myself that it's temporary. I've started training myself to avoid thinking about certain topics, high-anxiety topics, during PMS. For example, my wife and I are planning a vacation for Thanksgiving. I am excited, but the thought of it also stresses me out a lot. During PMS, if I think about this trip, I usually feel none of the excitement and about ten times more overwhelmed than I do at other times. I start to worry and worry about every little facet of it, and it only ends up making me feel like it's going to be a disaster. So now, if I start to think about it during PMS, I just tell myself "you don't need to think about that right now" and move on to something else.

I also started taking a 100mg B6 vitamin every day in addition to the standard multivitamin I was already taking. This extra B6 has helped so much. I would say it's almost miraculous. Not only does it reduce my general PMS symptoms (including the intensity of my emotions, it seems), but it has made my menstrual cramps less painful. Cramps have always triggered emetophobic anxiety for me, and the more pain I felt, the more anxiety I felt. So that is a huge relief.

Yoga and/or exercise are also supposed to be amazing for helping with PMS. I have seen a little evidence personally, because I was doing yoga almost every day for a couple weeks, and that month I felt a lot better than normal during my period. I would love to be able to say more about this, but I have yet to maintain a regular yoga or exercise schedule. This is something I have been wanting to do for months, and I have made several attempts, but they always die out. Apparently the only exercise I truly enjoy is playing tennis, and for some reason, there are no free open-to-the-public courts in our area.

Anyway, even though I am not currently exercising, I firmly believe in its power to make things significantly better. For anxiety in general, not just PMS-related anxiety. I'm still hoping I'll someday motivate myself to start exercising again and to actually stick with it so that I can enjoy the (many) benefits of it.

hypnosis

I tried hypnosis for the first time yesterday.

I didn't really know what to expect. I was sure it wouldn't be like stage hypnosis or the way they show it in the movies where you relive your childhood and then don't remember anything that happened afterward, but other than that, I was at a loss. I wondered how aware I would be during it and if my state of mind would really be altered. I did some research online the night before and found no help there. There are so many different descriptions of the process and its supposed effects, so I guess it varies from office to office all over the country.

My own experience was very similar to guided meditation, except for an additional segment where the hypnotherapist gave affirmations / suggestions guiding me to feel the way I want to feel.

At the beginning of the session, we had a brief conversation about what I wanted the hypnosis to accomplish, because he said it works better when you have a specific outcome in mind. I think this is mostly about reframing your goal, turning it into something you want to happen (like "I want to exercise more") versus something you don't want to happen ("I don't want to be so lazy").

My goal was a pretty vague one of wanting to feel less anxiety, especially the emetophobic kind. But then I started talking about how all my anxiety issues seem to boil down to a fear of not having control. I want to control my body. I want to control the way I am thought about or perceived by other people. I want to control everything about my life in general - to make sure all my decisions have been and will continue to be the perfect ones, to become so self-aware and evolved that I will be able to know with certainty that I will never make a mistake and possibly go down a "wrong path" that will waste time. So my goal was reframed into "I want to feel more in control," and with that settled, the actual hypnosis began.

He started with a body scan meditation where I was asked to imagine a relaxing color slowly filling my entire body, starting from the toes and moving up. Then he asked me to imagine a remote control with an "Up" button on it that controlled my level of relaxation, so that each time I pushed the button, I would feel more relaxed. In the final relaxation exercise, he said he was going to count down and asked me to visualize each number as he said it and then imagine the number fading away. When he reached zero, that was the point of complete relaxation.

I never reached a state of complete relaxation, since I find it hard to ever be completely relaxed, especially outside my home. But I was more relaxed than I had imagined I would be at the beginning. I have been listening to guided meditation CDs regularly for a while now, and through practice, I've gotten to the point where it's easy for me to lose myself in them. I almost felt like I was at home, just listening to a recording.

After those three exercises, the hypnosis script began. He told me before he started that I should try to tune out what he was saying, if possible. I'm guessing this is because the suggestions are meant for your subconscious. Guided meditation CDs and meditation exercises in general tell you to focus on the words of the speaker, or focus on your breathing, an affirmation, or a mantra, to try to clear your mind of all other thoughts and distractions. This is something I find extremely difficult to do. Having to tune out words, on the other hand, was not a problem. I caught parts of what he was saying, enough to piece together the general message he was giving me, but I didn't hear all of it. I was reciting lyrics and poems to myself or letting my thoughts wander to certain memories that easily hold my attention.

He said that I was in control and that I would feel more in control from that point on. He also talked about bodily sensations, how they were mostly harmless, and how they should be viewed as a message from my body (for example, the feeling of hunger being a message to eat something). That's all I remember.

I haven't noticed a significant decrease in my anxiety, but it has only been a day. I'll write about it again in a week or so and give an update. In any case, I just wanted to share the experience and say that if nothing else, hypnosis is relaxing in the moment and doesn't lead to vulnerability, lack of awareness, or embarrassing / uncontrollable behavior. It's worth a try, if you're thinking about it.

celebrating progress

I am usually hard on myself. I think all the time about things I do that I shouldn't be doing, things I avoid that I shouldn't be avoiding, etc. I try to pin down every single way that I am failing to function as a "normal" person due to anxiety so that I can fix it all. I'm not doing that today.

One year ago today, I was in the hospital for almost the entire day because of panic attacks. I knew that was what was happening; I've had anxiety my whole life, so I was familiar with the symptoms. But this was different than anything I had experienced, panic attacks that were hitting me from out of nowhere - while I was sitting safely at home - and lasting for hours. I really thought I had reached the point where I was going to lose my sanity. I couldn't stop thinking about those brief biographies that are written about authors like Poe or Plath or Hemingway, the kind that paint them as people who were doomed all along to a life of insanity, and it was just a matter of waiting for that final blow, the last nervous breakdown or institutionalization.

The panic attacks didn't start from an emetophobic place, but of course they ended up there. Before I even went to the hospital, I had gotten to the point where I wasn't eating much, because I was so overwhelmed. Then that turned into (what felt like) an inability to eat anything, which lasted for about two weeks. I did eat during this time, but only because of my wife. She would bring me something and insist that I eat it. I never once felt aware of being hungry, and everything I put in my mouth, including water, made me feel so "nauseous" that I was terrified of swallowing. I remember her bringing me a small bowl of dry Cheerios one morning, and after one or two bites I started sobbing, because it felt impossible to eat the entire bowl. I was scared I would never want to eat again and couldn't imagine a lifetime of forcing myself to do it every day.

I know the anxiety set this off, and taking Ativan one day, attempting Lexapro another day, and then trying Cymbalta on another, all on a practically empty stomach, can't have helped the situation. Especially when it was my first time ever taking psychiatric medication (I didn't end up sticking with any of them). But I think what caused it to last for so long was my own inaction. I was clinging to my long-held belief that 'not eating is the best defense against feeling bad,' even though I felt absolutely horrible, and it was clear that not eating was perpetuating that.

But since I'm celebrating progress here, I'm not going to talk about how I should have handled that better and could have gotten myself accustomed to food again much faster. I'm going to talk about how I did handle it better the second time around, because about two months ago, this happened to me again. I had a few panic attacks, and once again, I felt like I couldn't eat.

I'm really glad this second bad period happened. At first, it shook me up and made me feel that in spite of all my hard work, I hadn't gotten anywhere in the past ten months. But it became obvious, from the way things played out, that I had changed. There was no hospital trip. Instead of missing about five days of work, I only missed two. I still had some Ativan, but I didn't end up taking any. I increased my focus on affirmations and practiced breathing / visualization exercises. Most importantly, I made it one of my top goals to eat as much as possible. I still wasn't consuming anywhere near the amount I should have been, but I was at least having enough every day so that I didn't get into that emetophobic cycle where it just gets worse and worse: hunger = nausea = don't eat = more intense hunger = more intense nausea = still don't eat, etc.

I was back to eating normally within a week, and it never got so bad that I was crying over a meal. I was able to drink water the whole time. Plus whenever I did eat, I actually thought about what would be the best choice, given that I was somewhat malnourished and might not be able to eat a sufficient amount. I tried to choose what had protein and actual substance, versus a year ago when I only went for "safe" carbs like crackers, toast, cereal.

So looking back over this entire year now, I feel like I've come so far. It's strange even to remember being in the hospital and how I was desperate for them to send me home with some drug, because I figured it was all over for me, and that was the only way I might possibly be able to live a normal life again. It's incredible to know that when these bad anxiety periods happen, I don't have to just fall into that state of helplessness and passivity. I have some control and can do things to reduce both the level of anxiety and the length of time I feel that way. I've been trying to convince myself of this for the past year, and I am finally at the point where I believe it most of the time. Now I just have to figure out how I can prevent these bad periods from happening in the first place.

class

I went to my first class the other night. I sat through the entire thing, and I guess because of that I can call it a success, but I still feel disappointed in myself. I don't feel like I handled my anxiety well. I felt "nauseous" through the first half of the class, and since I was in a more stressful situation than I normally am, the "nausea" felt more intense. It was so overwhelming that I kept forgetting to attempt to use the affirmations and mindfulness techniques, and when I did, I didn't find them as helpful.

I fell back to using old "tricks" that I came up with years ago. Planning out the fastest way I could escape the situation if necessary. Asking myself "if I was home right now, would I feel this way?" or "if I was home right now, would feeling this way be bothering me as much?" It's not like these techniques are horrible, but they're not recovery-focused - they only help in the current moment.

Even using those methods didn't make my stomach feel better, but they did allow me to keep convincing myself to stay. Eventually I calmed down just from time passing, and I was then able to concentrate on and enjoy some of the class. I am happy that I went and that I got through it, because obviously I'll need to force myself through these first unpleasant experiences in order to get to the point where they become pleasant.

I plan on being more prepared for the next class though. I am going to eliminate any other stressful things I have planned for that day, because I think this one big event is all I can handle for now. I am going to engage in some form of deep relaxation beforehand, maybe listen to a guided meditation CD. My wife also suggested coming up with some class-specific affirmations, and maybe I will write them down somewhere so that I don't have to worry about forgetting them because of being anxious.

restaurants / new goal

My wife and I went to a restaurant for lunch today, which didn't go quite as well as dinner the other night. I had a lot of anxiety ("nausea") in the time between finishing my meal and leaving the restaurant. Of course, the moment we walked out the door, I felt better, an experience I'm all too familiar with. It's always kind of infuriating, because part of me is thinking "this isn't anxiety, it really is something else this time" but that never turns out to be true. Being wrong is not the infuriating part. I'm happy to find out that the horrible thing I thought was happening to me is not real. What's infuriating is knowing that once again, I let anxiety bring down my enjoyment of an experience.

I used the same techniques I've been using: affirmations, deep breathing, mindfulness. In a public place it's not always possible to be completely focused on telling yourself "I am breathing in, I am breathing out" or something like that. Mindfulness in a situation like this involves focusing on your environment (instead of on your thoughts/feelings/internal state). It helps to think of the five senses (although smell and taste might be too much for an anxiety attack that is presenting itself as "nausea"). I focused on the music playing on the overhead speakers, the tennis match on the TV above the bar, the conversation I was having with my wife, the cold/wet feeling of the glass of water sitting in front of me.

In discussing my anxiety with my wife, she made me realize that I have a habit of trying to finish my meal as close to the time of us leaving as possible. Of course, this never really works out, because no waiter/waitress is going to bring the check while you still have food in front of you. But still, this is exactly the type of behavior that I am trying to eradicate from my life. I'm making a new goal to stop doing this, to eat at the pace that is normal for me and finish whenever I finish. If I have to sit in the restaurant for half an hour after I'm done, oh well. Nothing bad will happen. Emetophobia shmemetophobia! 

restaurants / thinking through anxiety

Since my second class was canceled, I wanted to come up with a suitable replacement challenge. A few nights ago, I was out with my wife, and we decided spur-of-the-moment to walk to a nearby restaurant for dinner. I generally don't handle restaurants well, and when we go to one, it's usually planned out at least a day in advance. It felt wrong and dangerous to go to one right then, without the planning, and since I know logically that no planning is necessary, I agreed that we should go and that I should handle it.

It was an extremely successful meal. I felt some anxiety when we first got there, because I had a strange feeling in my stomach, but I was almost positive it was a combination of hunger and my anxiety about going to the restaurant. It went away once I got my food and started eating. Most of the time, I feel the least anxiety while actually eating, because I am focused on the delicious food. The time between when I finish eating and when we leave is the problem. The check has to come, and then it has to get paid, and then the receipt has to come back, and I spend this time worrying about how full I am and the feelings of digestion in my stomach. Lately when we go to restaurants, I focus on making myself as calm as possible during this period, by saying affirmations to myself or doing breathing exercises. I think I am getting much better at sitting with the feelings and knowing that it's just my body doing the normal work it always has to do.

I tend to focus on the fact that "this uncomfortable feeling is happening to me again" rather than the fact that it has never resulted in anything bad happening in the past. I noticed this a few months ago in therapy when I was talking about events that were coming up that I was anxious about. I told my therapist that I thought I would feel sick during them and worry that I was going to throw up, and in the back of my head I was thinking "but why does that matter? You are saying you are afraid of fear, which is pointless. Don't you get it? That is all that will happen. You might feel anxious, and that's it. As it has every other time in the past, it will fade away without anything horrible happening. Then it will be gone as if it never existed, because it's barely anything, just an out of control emotion." It was such a strange epiphany, the first time I'd ever really gotten that concept in my entire life. It didn't fix everything, but it was exciting to me anyway, and it's something I've always tried to keep in mind since then.

Around the same time, I discovered another similar hole in my logic. Often when I "feel sick" in a public place, I don't think about the feeling itself. I think mostly about where I am or what I am doing and judge whether it's okay to feel the way I feel based on that. Like if I am out at the grocery store, I will be thinking without even realizing it something like "I could throw up because I am at the grocery store" instead of "I'm not going to throw up, I've had this feeling before, and being at a grocery store in no way increases the odds of anything bad happening."

Sleep is like this. I feel convinced (especially when I wake up in the middle of the night and am still half-asleep) that being asleep in itself will lead to me throwing up, because I am not awake to guard against it. I know it's best to calm down, no matter what, but I find it hard to move on to the next step after that, which would be to return to sleep. Even when I start feeling better, I tell myself to wait a few more minutes and make sure it sticks.

To help with this, I posted a set of affirmations next to my bed so that I see them if I wake up in the middle of the night: "This feeling isn't dangerous - it will pass." "I've survived this before and I'll survive this time too." "This isn't an emergency. It's okay to think slowly about what I need to do." "These are just thoughts - not reality." I'm so used to them by now that sometimes I'll just stare at them, too tired to really take in what they mean word by word, but knowing that they have a general meaning of 'I'm not going to throw up, I can go back to sleep.'

It's just comforting to have them there, not only as a means to reduce my anxiety in that moment, but as a reminder of the changes I've been making to my life in general. Positive self-talk is no longer foreign to me. My outlook on everything is changing, and it's exciting to think about where I am heading.

mindfulness

It turns out the teacher for the class I'm taking is currently out of the country and unable to get a flight back because of the nasty hurricane weather that's been traveling up the coast. She didn't show up for our first class, and I got an email letting me know that the second class is canceled too. So much for my goals for the week!

But on some level, I'm grateful it turned out this way. I felt like this class was a huge step for me, and this turned it into a smaller baby step. I did not technically attend a class, but I sat in a room with about twenty other students I didn't know for the twenty minutes before we all decided to give up on the teacher and leave. That alone was a frightening situation for me, and I "felt sick" for probably the first fifteen of those twenty minutes.

I said my four-part affirmation to myself, and it did help somewhat. But in a sense it felt like the anxiety was flooding my brain and making it hard to even focus on the words, so I switched over to a mindfulness / breathing exercise from another book I read recently, The Miracle of Mindfulness by Thich Nhat Hanh. I took deep breaths, and each time I inhaled, I would say to myself "I am breathing in" and each time I exhaled, I would say to myself "I am breathing out." Or "I am breathing in a long breath" and "I am breathing out a long breath."

I guess because the words are combined with the concentrated act of controlling my breathing, they work in a way the affirmations don't, where I'm able to replace the "flood of anxiety" feeling in my head with just the breaths and the descriptions that go with them. At this point, it's hard to sustain, because I haven't been practicing mindfulness for very long. But having seen the way affirmations became more and more helpful the longer I worked with them, I'm optimistic that mindfulness techniques will end up being incredibly useful also.

Mindfulness teaches you to be only in the present moment, not in the future or the past. This may seem like a stupid idea to an emetophobic who is feeling nauseous - why would you want to remain in that present moment rather than thinking of something else?

-Because the more you practice being in the present moment, the more relaxed you will be, in general, overall. It's easy to handle what is happening right now in the present moment, not so easy to handle the vast expanse of possibilities in the future.

-Because when you are in a situation that causes a lot of anxiety, you may think that you won't be able to remain in that situation for the length of time you need to, but you can be pretty sure that you can get through the next minute or five minutes, at least. Kind of like AA's "one day at a time." Staying in the present moment in this way, you can get through whatever scary situation you are facing. And then, having survived it once, you'll know you can do so again.

-Because as an emetophobic, when you're leaving the present moment, it's usually not to go to some happy place in your mind where you don't feel sick. You're leaving the present moment to go into a fake or feared future ("I must be getting sick" "what if I am getting sick, and what if this causes me to throw up?"), and this is obviously not helpful.