self-healing rituals

Most people have heard of the placebo effect. A person is given a fake cure for some ailment, but it actually does make them feel better, because they believe it will work. Usually the person receiving the placebo doesn't know it's a placebo. They think they are getting real medicine (or surgery).

But some studies have shown that placebos can work even on people who know they are taking a placebo. This article from NPR gives more information. The theory as to why this works is that taking the medicine or having the surgery creates a "self-healing ritual" - which is just another way of saying that you're taking action to fix the problem. Your mind is aware of that, and then both your mind and body "expect" that this action will have good results. So it does.

A.J. Jacobs talks about this effect in his book Drop Dead Healthy:

"You could view placebos as depressing, I suppose. So much of medicine is a sham. Your brain is a three-card monte dealer running cons on the rest of your body. But I don't see it that way. I find placebos uplifting and exhilarating. It means that taking action - no matter what that action is - might help you feel better. The key is just to get your aching butt off the couch."

I'm not saying placebos are all you ever need to be healthy. When it comes to more serious illnesses, actual medicine would be necessary (although optimism - believing you will get better - is always a good thing). But for something like emetophobia, or any other kind of health anxiety, or even problems like IBS or chronic pain syndrome (that have been shown to improve using psychological treatment), I think self-healing rituals are extremely important.

I remember that when I started having those horrible panic attacks two years ago, I felt anxious almost constantly. It was like my brain was full of it, like I was always on the verge of hysteria - except when:

• I went to the hospital. On the drive there, in the waiting room, explaining how I felt to various doctors. I felt calmer this entire time - still not normal, but much better. I trusted that they would make me feel better. (It's been said that even seeing the usual attire of a doctor creates a placebo effect.)
• I went to the doctor to discuss trying psychiatric medication.
• I went to the pharmacy to pick up the medication. This one I remember the most. Even now, whenever I drive by that particular pharmacy, I feel my spirits lift a little, remembering how it was a beacon of hope for me at that moment. Even though I hated the medication and didn't continue taking it, I was so relieved at that time to have it as an option. I can see why many people believe medication is a quick fix. I told myself over and over that this wasn't true, but your desperation overshadows what you know.

Once all this was behind me, I realized there would be no quick fix, and I would need to keep working very hard on my own. I kept creating my own self-healing rituals: meditating every day for a certain amount of time, writing out affirmations over and over in a little notebook, and (my favorite, in terms of making me feel more hopeful) flipping through The Anxiety & Phobia Workbook and reminding myself that there were more things to try if what I was doing didn't work - that there was even the possibility that combining certain approaches would work best, which meant there were almost unlimited options.

So I am in total agreement with A.J. Jacobs when he says that taking any action can help - and that this concept is extremely uplifting. Anxiety can feel like it is paralyzing you, but taking steps, even small steps, to conquer it can be a powerful "weapon" in itself.

movie scenes

I didn't write about it at the time, but a few months ago, I finally decided to sit down and force myself to watch some movie vomit scenes I usually avoid. I had seen most of them, but I tend to hide even from those I've already seen by covering my face or leaving the room, just because they make me uncomfortable. But two scenes I saw for the first time, the scene from Drop Dead Gorgeous and the scene from Bridesmaids. I had heard about how graphic these scenes were from other people before seeing the movies, so I made sure to always leave during them.

The Bridesmaids one in particular has already become a frequent mention on emetophobia forums. I've seen a bunch of threads talking about how awful it is, other people disagreeing and saying it's funny, debates starting about whether vomit should ever be shown on TV or in movies.

Of course it should. I may sit around at home and complain about it and get really angry and say it's completely unnecessary. But so is everything else in shows/movies. I'm choosing to watch, and I know what I'm getting myself into. There's no way of knowing what will pop up. I also don't particularly like excessive gore. And I hate how movies about babies almost always include some disgusting poop-related scene. Oh well. Other people like those things and think they add to the drama and/or comedy. Vomit is a somewhat extreme act that can be used for either purpose. Of course they're going to keep taking advantage of that. It's up to me to desensitize myself as much as possible.

I was pretty surprised at how nervous I was. I watched the scenes without any volume at first. Which I would highly recommend, because that made them totally manageable. Once I had seen everything that happened without having heard any of it, I watched them again with a little volume, and then a few more times with normal volume. They were definitely unpleasant. I can't say I ever enjoyed them (even the Bridesmaids one - I didn't think it was that funny), but it was easy to get to the point where I could tolerate them.

With new movies/shows, I won't be prepared. I won't know when the scene is, and I may not have heard the basics of what happens. And a lot of times they like to surprise you when it comes to vomit, to have it come out of nowhere. But I feel like this desensitization exercise has a broader effect than you would think. I haven't been flinching as much when I encounter new TV/movie vomit.

It also helps (with vomit, gore, any gross thing in movies) to remind yourself every time that it's fake. Of course you already know that, but actually thinking about how they did it takes away much of the ickiness. I don't know what they use to make movie vomit, but I'm guessing it's usually some mixture of food. This website talks about how they use a vomit machine to project tomato soup in one movie.

Plus with Drop Dead Gorgeous, Denise Richards is in it, and knowing that she has emetophobia makes me feel oddly comforted about the scene in that movie. I guess it's knowing that someone is involved who understands how I feel (although I don't think she is actually in the vomit scene). Who knows? This may be true of other actors/actresses as well, and they just haven't come forward about it yet. 

"it's different this time"

This is usually how one of my emetophobic anxiety attacks plays out.

I notice something happening in my stomach. This leads me to think/say "I don't feel well."

I try to pinpoint the cause. In fact, I want to know the exact cause, which then leads to frustration, because that's almost always impossible. If I ate three different things an hour ago, I might spend way too much time and brainpower arguing with myself about which of the three things would be the most likely to make my stomach hurt.

I start assessing how bad the unpleasant feeling is. This is where things can quickly spin out of control. It doesn't really matter how bad the feeling is - what matters is how anxious I am. If I'm not careful, if I don't do something to try to calm down, I will soon arrive at the conclusion that this feeling is somehow different than any stomach-related feeling I have ever had before in my life. It's more severe, or it's in a different part of the stomach, or it feels like there's more _____ this time (churning, bubbling, flipping, whatever).

"It's different this time" - four words that I should never say, but I say them far too frequently. Other variations: "this feels different" or "what if this is something different?"

Sometimes it's not even the feeling itself that leads me to this "conclusion." Sometimes it's that I feel I was exposed to some illness a couple days ago, so this feeling MUST be related to that and therefore, it's different, where "different" really means "the moment I'm finally going to get sick."

From looking around at emetophobia blogs and forums, I can tell this thought is not unique to me. It seems like most, if not all, emetophobics get hung up on this idea of stomach pain being "different this time."

Maybe it's not only emetophobics, but all people with anxiety. One of the main cognitive distortions an anxious person will struggle with is catastrophizing, and if you are telling yourself "it's different this time" you are catastrophizing. Instantly you have changed something that is benign/harmless to something huge and scary. You have taken something you can handle, something you are familiar with (stomach pain for emetophobics, a panic attack for those with panic disorder, etc.) and made yourself believe it is unfamiliar and unmanageable.

You're basically saying "though every other time has been fine, this time I am clearly in great danger." Even if you don't fully believe that, that's the message you are reinforcing with your words, and it will only lead to more anxiety.

It seems like emetophobics have a kind of amnesia when it comes to their stomachs. With all the times in my life I have felt "sick," and all the times I have thought or said that what I was feeling was different than anything I had felt before, it's impossible that I could be right all those times. There isn't an unlimited number of unpleasant stomach sensations. If I am able to calm down some and then reassess, it's rare that I still believe it is a brand new feeling.

I think this irrational thought is one of the most harmful for me, so I have been putting a lot of effort into correcting myself whenever I catch myself thinking or saying it.

It is not different this time.
The truth is, I have been through this many, many times before.
I have had this same feeling at some point in the past and lived through it.
I know I can handle this. I'm practically an expert.
This feeling will pass.