CYEAT: Chapter 11

I found this chapter really interesting because it talks more about unhealthy belief systems and about various types of reinforcement you receive.

First, there is the reinforcement of your actual fears or symptoms. If you get really anxious about a situation, then it might not go as well as it could have. You might even have a panic attack or react in a way that is embarrassing to you. This would (wrongly) reinforce that you were right to be anxious all along.

Another way you can reinforce your fears is by constantly asking the people around you to reassure you. Asking if they think you are sick, if you will get sick based on this thing that happened to you, if it’s safe to go on a boat, if this medication you were prescribed causes nausea, if they have ever experienced this specific physical symptom, etc. Asking these questions reinforces the idea in your head that you need to ask the questions because there is a need to fear these things, because these things are dangerous. Also, since people are usually nice and want to make you feel better, they will offer this reassurance you want, probably forever, for as long as you keep asking. Their reassurances also reinforce the idea that you have something to fear, and that you can’t handle it or solve the problem on your own.

My wife and I have discussed this before, because I ask her for reassurance sometimes - still too frequently, I’m sure. But it used to be a lot worse, especially when my anxiety was really bad, and she started giving me different responses to my requests for reassurance. Instead of telling me ‘no, you’re not sick’ or ‘yes, everything will be fine’ she would say ‘what do you think?’ and make me come up with the answer myself. Or if I asked if she thought I was sick, she might say something like ‘I don’t know, we’ll see.’ I think it helped me because I realized I wasn’t going to get what I wanted from her, so I stopped asking the questions as much and just turned instead to relaxation techniques to stop myself from obsessing about these worries. Or I relied on my own logic, common sense, past experiences and realized I couldn’t be certain what would happen, but I could figure out what was likely to happen.

This kind of reinforcement is everywhere you look in online support groups for emetophobia, which is why I am so wary of them and have spent very little time hanging out on those sites. The author seems to agree with me on this; he says that when you are frequently interacting with other people who have the same worries you do, it normalizes those worries. It also keeps them fresh in your mind, easily accessible, like lyrics you hear over and over. So for example, next time you have to get in a car, you might automatically think of the eight posts you saw recently from people worrying about carsickness. Even though being in a car doesn’t usually worry you that much, now you feel more anxious about it.

Another kind of reinforcement is positive reinforcement for having the phobia. This would be anything you feel you gain from being emetophobic. For example, going back to online support groups, you might start feeling close to the other people with emetophobia you have “met” and consider many of them friends. This could be an especially positive gain if you are usually isolated because of your anxiety issues and don’t have many friends. You have gained a social network, and maybe you will start to think that if you get better and the phobia doesn’t affect your life as much, you will lose that.

Or it could be that you have had the phobia for so long, it feels like a big part of who you are. It’s one of the things that makes you you, and other people in your life (like your closest friends) know that. If someone in a movie gets sick, your friend might automatically look over and ask if you are okay, and that feels good, to be known that well.

Maybe in general, you love the attention you get for having anxiety. It feels nice when the people around you care about you and want to take care of you. The author points out this is especially true when you have low self-esteem. And having a lot of social anxiety or general anxiety doesn’t help either, because again, it’s isolating and that can lead to cravings for social contact.

I know that’s definitely a factor for me. I am a very quiet, reserved person. I don’t know what the biggest cause is (social anxiety, introversion, shyness, stoicism - I am pretty sure they all contribute), but I don’t talk much, especially in groups, and I’ve been that way for most of my life. I also don’t do much. I have tended to sit at home most of the time, by myself, where things feel safer and I feel more in control. So from my perspective, it has always seemed like most of the attention I get is for having problems - anxiety related problems, usually. I don’t know any other way, because it feels like I’m not going to be the person who is dramatic, or tells a captivating hilarious story, or does something risky that amazes everyone. And even those moments when I have done something amazing and people have given me attention, it gets overwhelming for me very quickly and I want it to stop. It feels easier to be sort of chronically pitied by reminding people of your anxiety and limitations every so often. I don’t know. It’s weird.

None of that means that the problems aren’t real. I have severe anxiety. It just so happens that I sometimes get something positive out of it (or at least something that appears to be positive from my warped perspective). The author is pointing it out because it’s good to keep it in mind, to be aware of any obstacles that might stand in the way of recovery. A small part of you wanting to stay anxious because you get attention from it (or because you have anxious friends, or you run a popular anxiety-related blog, or whatever) is another obstacle to reflect on in order to figure out how to move past it.

CYEAT: Chapter 10

I don’t have much to say on this chapter other than it seems weirdly out of place. It probably would have made a better Chapter 1 or even part of the Introduction.

It discusses what the terms “anxiety” and “stress” mean in detail and the differences between them. Basically this boils down to: anxiety relates more to mental worries (thoughts and emotions), stress relates more to your body’s physiological responses to a perceived threat. Either one can cause the other, and sometimes the words are used interchangeably. Anxiety can be about something in the present moment, or it can be “anticipatory anxiety” - worrying about something in the future (and building it up in your mind so that it does end up being scarier than if you hadn’t worried about it for weeks beforehand).

It’s all a giant feedback loop. If you worry about something and tell yourself it is (or will be) terrible, you become more anxious and stressed. As you become more anxious and stressed, you worry about it more. You may worry so much that you can’t sleep. Not sleeping causes even more stress build-up because your body is not as equipped to deal with it. Stress plus this lack of bodily care can lead to you getting physically sick, which leads to more anxiety and stress (especially for emetophobics). Etc.

If you can intervene in the cycle and try to minimize the effects, it will help in all the other areas too. Fighting your negative thoughts lowers your anxiety, makes it more likely you will get a good night’s sleep, meaning you will be more able to handle the next day’s stress and will stay healthier.

CYEAT: Chapter 9

I wrote a post a few years ago about how important it is to choose the right words for your self-talk. When I am telling myself "I feel sick" or "I feel nauseous" I am reinforcing the idea in my head that I am actually sick or nauseous, when really it's most likely anxiety. So it would be better to say "I don't feel well right now" (just because it doesn't have that word "sick" in it, which carries all the visuals and associations I have with the concept of sickness) or "I feel anxious."

That is basically what this chapter is about - the way the language we use affects our emotions, thoughts, behavior, and ability to handle situations well.

I have mixed feelings about this concept. For a while, I was uncomfortable with the idea of affirmations and positive thinking, because I couldn't help seeing it as self-brainwashing. But I was in such a bad place, I didn't much care. I still recited positive thoughts to myself constantly, obsessively, trying to get back to being a person who could also feel positive emotions on a regular basis. And they really helped me, and that was awesome, although still in the back of my mind I was worried about self-brainwashing, about turning myself into someone who was happier but somehow not authentically me.

Then something occurred to me. Two things, actually. One was the idea that I could just as easily say I was un-brainwashing myself, because I had already brainwashed myself throughout my life to think negatively. Which then led to the realization that it was useless to fear self-brainwashing, because we are all doing it all the time, every second of every day, and we have no control over the fact that it happens. It is just happening. We’re thinking our thoughts, and those thoughts are changing us. I’m still slightly uncomfortable with the idea of actively taking control of this process, making the conscious choice that I’m going to think a certain way so that I’ll feel a certain way. But I think that is just because of my external locus of control and the fact that I don’t want to make decisions in my life because I’m always worried I will make the wrong ones.

Which is also a useless fear, because I can't escape making decisions. Even if I think I am choosing not to decide, that's a decision. And I'm pretty sure my chronically deciding not to decide is having a more harmful effect on my life than anything else.

Back to the book - the author includes many examples of negative statements we might think ("I should be able to do this by now" or "I couldn't do that") and examples of how to counter these negative statements ("I'm getting better at this every day", "I can do anything that I put my mind to").

I can get on board with this. I do think it's best to pick apart your negative thoughts and try to make them as positive as possible.

My only issue is that I feel like this strategy belittles some people's problems, and the author doesn't say anything about this. For example, there is an example where the negative thought is "This cancer is killing me - I'm going to die" and the positive replacement (which was focusing not just on making it positive instead of negative, but also active instead of passive) is "I own this cancer, I'm going to fight this thing." Positive thinking does help in all situations and it's possible it could even help you get over cancer. But I don't like the idea of someone being really sick, dying even, and the people around them insisting it's because they are not thinking positively enough.

So I guess what I'm saying is I believe positive thinking is an enormous help in all situations, but it's not guaranteed to change reality. If you're thinking "I couldn't do that" about lifting a car, you can't just keep telling yourself you can do anything, you're strong enough to lift this car. I suppose in that sort of situation you can tell yourself other positive things, such as "I'm sure if I trained really hard physically, I would get much stronger, even if I was never strong enough to lift a car." Or "even though this cancer might kill me, I can still enjoy my life fully as long as I have it."

Another point the author makes is that we shouldn't be so quick to apply medical labels. For example, if you say you're depressed, it could be harder for you to get over that feeling than if you just said you were feeling sad at the moment. Calling our worries about vomiting a phobia could make it harder to get over it. Saying "I'm addicted to smoking" could make it harder to stop smoking than if you said "I smoke because I want to." A medical label gets us entrenched in the idea that it's huge and scary and more permanent, that it's a condition, it's the way we are, and either we can't change it or it would be extremely difficult to change it.

I'm still torn on this one. I can see the logic, and I think some people do use these sorts of labels too freely - such as saying they are depressed when they are really just having a bad day. I think that is something our society does in general, not just about illness/mental illness. Most of us tend to want to stand out, and we want all of our experiences to be big and important. So we might walk out of a movie theater saying "that was the worst movie I have ever seen in my entire life" when we know that's not true at all and we could think of 20 worse movies we have seen. Just because it sounds more fun and dramatic that way, better than just saying "that movie was not good."

But it sounds like the author is saying we should throw out all diagnoses, and I think that's an overreaction. Sometimes it feels really amazing to have a label for a problem you have had all your life, a problem that seems like this weird force acting on you that you can't understand until one day, you look around on the internet and find out it's called "emetophobia." And you read about it, and you say "this is me." I can still remember experiencing that moment (I was 11 years old), and in my memory it all seems magical, everything falling into place. Everything becoming understandable.

Yes, the downside to that might be that it reinforces it as a part of who you are. But honestly, before I found that word, it was already part of who I was. And I have seen other people with emetophobia leaving comments online along the lines of "Wow, I have had this problem for 40 years and now I finally know what it is, I am crying, I am so relieved, I always felt so weird and hid it from people" etc. Meaning they have lived most of their lives without that label, and it doesn't seem like it enabled them to get over the problem because they were downplaying it in their mind as just a quirk of theirs. Receiving that label can make you realize that it's an anxiety problem and that there are things you can do to get better.

So I pretty much don't agree with that particular part of the chapter. But I do think it's a good idea to refrain from labeling things inaccurately (referring to yourself as bipolar because of basic mood swings everyone has).

Basically, it all boils down to being careful with your language, analyzing it to determine if it is true, if it is too negative, what effect it could be having on you. I don't think there is a need to avoid saying you have a phobia at all costs. But if you are saying things on a regular basis that are having a negative effect on you (like "This phobia controls my whole life and I can't do anything about it") then it would be a really good idea to change that, because you will feel much happier and more in control of your life.

CYEAT: Chapter 8

This chapter looks at unhelpful thinking styles. I already knew most of them and have talked about some of them in other posts, but it is very useful information and I figure it’s always good to review and keep them fresh in my mind:

- Negative thinking (aka chronic pessimism)
- Obsessive thinking (you can’t stop brooding about things)
- Paranoid thinking (you think everything is about you - ties into social anxiety)
- Black and white thinking (extremist, not considering there could be a middle ground because you hate uncertainty and want things to be clear-cut)
- Catastrophic thinking (blowing up minor things into huge issues)
- Perfectionism (setting too high standards, being too hard on yourself)
- Hypervigilance (over-arousal, being too focused on what you consider to be dangerous signs in your body or surroundings)

Catastrophic thinking is one I know I’ve talked about before. The author claims all of these unhelpful thinking styles are common for people with emetophobia, and I would agree I have had trouble with all of them, but in my opinion catastrophizing is the one that seems to fit emetophobia most. It is usually the same thing we are blowing out of proportion every time - some harmless feeling in our bodies that we automatically think means we could be sick.

For me, that catastrophizing can then lead to all the other types: obsessing over the feeling and the worry that I am sick, being hypervigilant for signs of any changes to the feeling, being paranoid that if I did get sick everyone would notice and hate me, pushing myself to fight through the anxiety while maintaining my usual stoic appearance (perfectionism), and then, once the anxiety passes, thinking about how I can’t stand anxiety attacks and how much my life sucks because of anxiety (negative, black and white thinking).

The chapter includes tips on how to change these thinking styles, such as distracting yourself with some fun activity when you are obsessing, minimizing negative thoughts you have and focusing on what you can be grateful for instead, taking time to relax every day, and in general challenging your thinking Notice your negative thoughts, question whether they are true, revise them if they sound extreme (“That was the worst day ever. I will never be happy again” becomes “That was an unpleasant day, but I have no way of knowing what tomorrow will be like or how my feelings might change”).

It also discusses how we can gain things we feel we need from these unhelpful thinking styles. For example, if we continue to expect the worst, we know we won’t be disappointed or rejected, which is comforting in its own way. So I’m sure it’d be a good idea to think about why I might want or need to cling to certain bad thinking habits.