dream-sick

I decided to keep a dream journal this year, just for fun, because I love dreams and attempting to analyze them. I also kept a tally of how many times I dreamed about a particular person or thing. So, for example, I dreamed about my mom 97 times this year, I dreamed about being at work 52 times, etc. That I can remember, anyway. The other night I got curious about emetophobia-related dreams and reviewed every dream I had about vomit. I dreamed about it 29 times (it ranked 33 in my list of 143 people/things).

When I've seen other emetophobics talk about their vomit dreams on forums/blogs, usually they say the dreams cause them a lot of distress, that they are nightmares even. I wonder if this is the "norm" for emetophobics or if those people are just the only ones who talk about their dreams because of the fact that they are in distress over them. It's not the case for me. I think I dream about vomit pretty frequently, but I don't usually feel upset about it, either in the dream or after I wake up. I wouldn't consider any of the dreams I had this year to be nightmares. These are the categories I could divide them into:

-- seeing vomit or mentions of vomit on a sign, in a book, online, or while watching TV (9)
-- hearing someone is sick, has vomited, or might vomit but don't actually see/hear them do it (6) 
-- someone I recognize vomits - people I know or "dream friends" (5)
-- a stranger vomits (4)
-- my cat vomits (3)
-- I vomit (2)

I will feel anxiety in the dream, but it's like a muted "dream anxiety" that is really more shown by my behavior in the dream than actually felt. I will cry, hide, run away, obsess about it, avoid anything I think may be contaminated, etc. All the standard behaviors from reality. But the anxiety doesn't wake me up or cause me to feel upset after waking up and remembering it. It's maybe more like a general rehearsal, since I so rarely encounter vomit in reality.

Also, in dreams where I get sick myself (and they are so rare that even having two this year seems excessive to me), I usually don't feel sick. Sometimes I am doing it intentionally (for example, in one I was engaged in a vomit competition with someone), and it's easy and laid-back. It always feels like liquid spontaneously appears in my mouth without actually coming from my stomach.

This really has nothing to do with coping with emetophobia. I'm just sharing out of nerdy curiosity. I'd be really interested to hear what themes or patterns other emetophobics have encountered in their dreams.

holiday parties

Merry Christmas / happy holidays!

I know the holiday season can be stressful for emetophobes, since there will usually be a party to attend. Which usually means large groups of people, a crazy amount of food/alcohol, and possible sickness thrown into the mix. I don't live near any of my family (and saw them at Thanksgiving), so thankfully, I don't have to deal with any family holiday gatherings this year. I did have to go to one party a couple weeks ago, but it turned out to be a pretty low-key event. Anyway, I just wanted to share some thoughts:

-- I don't drink ever, so that's simple enough. I just tell people that, and I've never had anyone put up much of a fight about it. If I was someone who occasionally drank, but I didn't want to at the holiday party, I imagine I'd just say I had to drive later that night, even if it wasn't true.

-- There was a lot of food at the party I went to, but any time anyone asked me why I wasn't eating, I said I already had. I've used this technique many times at social occasions. Usually there are enough people so that no one is keeping constant track of you. I have had people respond to my lie with "well, have more!" but I just say I'm full. I don't really understand why there are people that are desperate to make sure everyone they know is fed - whatever the reason, it clearly means a lot to them, so it's easier to tell them what they want to hear - that you are thoroughly and happily fed.

-- I wouldn't worry extra because you heard (for example) your sister-in-law wasn't feeling well earlier in the day, or your cousin's best friend's dad had a stomach virus two days ago, or anything else like that. Because you could just as easily not have heard about it. At the party I went to, I hadn't heard about anyone being sick or exposed to someone sick, but that doesn't mean there weren't potentially sick people there. There were a bunch of people who had children, so I'm almost certain there was a connection to a stomach virus somewhere in that room. You're not in any more danger for having heard about it, and you're taking no more of a risk than when you go out anywhere else, like to the grocery store. Just take the same precautions you always do (washing your hands, not sharing food/drink, etc.).

Try to enjoy yourself as much as possible! Laughter, relaxation, and socializing are all good for your overall health.

anxiety about cat

I love my cat, but I have a hard time dealing with him when he vomits (pretty rare) or has a hairball (less rare). I wouldn't say it causes an anxiety attack, but it's extremely upsetting, especially to listen to while it's happening. And of course, I know I'm supposed to grab him when he first starts hacking and stick him in the bathroom, so he doesn't end up getting sick on our living room carpet, but I can never do it. I have to get as far away from him as possible.

Because of this, I quickly took note of two things. The first, that he would always meow in a low and mournful way right before getting sick. The second, that if he didn't finish his meal (we feed him twice a day, and he is a fanatic about eating it all right at that moment), that usually meant he would be getting sick within the next half hour.

Both of these neurotic observations have done nothing to help me. There is no way to scientifically measure how low his meow is, and I have gotten anxious about a thousand times over what I thought was a low sick meow and locked him up in the bathroom for no reason. And now, for the past week or two, he has developed a new habit of not finishing his "breakfast" meal. I don't know why. Maybe he still hasn't gotten over the stress of being boarded while we were on vacation. But he will leave some, go wander around, and then come back and finish it a little bit later. Other than that, he seems totally fine. It's too bad he has to live with the crazy emetophobe who checks his bowl after every meal, because again, I keep shutting him in the bathroom unnecessarily.

It's frustrating. I hate how easy it is to come up with these little irrational rules related to your fears. As if anything can be identified and controlled so easily. I just need to let this go and realize there is nothing I can do to avoid being exposed occasionally to cat vomit/hairballs. I wanted a cat, it comes with the territory. So does incredible cuteness, to look on the bright side.

One of these days I'm going to write an actual post again. I've just been all swept up in other things lately, like poetry and Judaism and Gloria Steinem, and ignoring anxiety as much as possible. Which is both good and bad. It's nice to be able to "set it aside" temporarily, but I know if I do that for too long, I'll be right back where I started. But I'm sure I'll get back on track with the start of the new year. 

new year's resolutions

I know I'm overshooting here (and yet still falling short of what I actually want to be doing), but these are my health-related goals for the new year:

1) Eat four servings of fruit / vegetables a day.

2) Do yoga twice a week.

3) Exercise three days a week.

4) Get check-up / physical.

5) Limit taking temperature to once a month.

6) Limit taking anti-nausea meds or anti-emetics to once a week (except for Tums).

7) Limit asking my wife if I am sick to once a day.

8) Meditate or work with affirmations or deep breathing once a week.

9) Do actual written CBT work once a week.

10) Do something outside the house that makes me anxious at least twice a month.

caffeine free

One of the first decisions I made after my "breakdown" last year was to give up caffeine. Most books / websites talking about anxiety disorders will advise against it. Pretty common sense - we're stimulated enough, why add to that? I know chocolate has some, and I still eat that, so I'm not super strict about it. But I stopped drinking (caffeinated) coffee and Mt. Dew, both of which I love love love. Mt. Dew especially has always been the only soda I enjoy and one of my favorite drinks in general. The loss of the coffee didn't pose much of a problem, since you can find decaf everywhere you go. Apparently there is also a caffeine free version of Mt. Dew, but I never see it being sold anywhere. At some point I may order it online. I probably should wait a little bit longer so that I can be absolutely certain I've forgotten the amazing taste of the original.

It has always been pretty easy for me to give up things. I don't have much trouble subtracting the bad. It's when I need to add something (like doing yoga, which I've been neglecting yet again) that I find myself unable to succeed (so far). But still, the fact that it's been a year and I still crave Mt. Dew makes me proud of myself for not caving. I'm considering it a success.

Speaking of goals, I've already started coming up with New Year's resolutions. This is probably obvious from this blog, but I'm a little obsessed with self-improvement, so I always get really excited around the New Year and have these grand ideas of changing myself into a completely different person. I overshoot every time, so I'm trying to at least make each goal realistic this year, but the list will still be long I'm sure.

wisdom teeth

Not much has been happening. My anxiety has been extremely manageable since we got back home from the trip. I'm amazed - I definitely wasn't expecting things to go this well. But since they are, and I have nothing new to report, I'm going to post an old story. I got my wisdom teeth removed about two years ago. It was an experience I was dreading, because I felt sure it would put me in danger of throwing up. But it actually turned out completely fine, and I consider it one of my greatest successes ever. I'm so glad I didn't chicken out, because now I know I don't have to worry about them ever again.

So it started out with a consultation with the dentist who was going to perform the surgery. That part was awful. He was definitely not skilled in dealing with anxiety issues. I had envisioned that the consultation would be in a quiet back room with a closed door, but it was in a little examining room right next to the front desk, and he left the door open the whole time. And he talked incredibly loudly. I was of course trying to get all my points across the same way I had rehearsed them earlier, but after I mentioned the phobia, he started talking (shouting) about the possibility of me getting sick and how I was afraid of getting sick, and I was very aware of the fact that the people at the front desk could hear every word. I guess dentists don't expect you to be self-conscious.

He didn't have any comforting information either. He said that even prescribing me a strong anti-emetic might not keep me from getting sick, because 1) most people get sick immediately after the procedure before they've had a chance to take it and 2) people won't usually take it until they start feeling nauseous. Plus if they are going to sedate you, any kind of sedation makes you nauseous, so he said they already add anti-emetic to the drip and that none of it is any guarantee. Then he said 5% of people or 1 in 20 will throw up, and usually it is from the pain medication. He recommended sedation for me, based on my X-rays, and he said he thought everything would be uncomplicated for me. But obviously he didn't see the vomiting thing as a big deal, no matter how much I tried to make him see it that way. He prescribed me two anti-emetics, a regular one and then a more expensive one that he said was super strong. This was my first experience with prescribed anti-emetics. I later found out the super strong one was Zofran. Of course I planned to use that one, because I wanted the strongest one possible.

I was pretty freaked out when I walked out of there, but it still seemed like I could possibly avoid getting sick. I decided I would take the anti-emetic before the procedure, I would not be sedated, and I would not take any prescribed pain medication.

The morning of the procedure, I took the Zofran before even leaving the house. It dissolved on my tongue easily and tasted okay but had kind of a bad after-taste. I didn't notice any bad side effects from it either. I also had three 45-minute Kathy Griffin comedy routines on my iPod so I would have something really hilarious to distract me during the surgery.

The first thing they did was put two giant Q-tips in my mouth with a bad-tasting goo on them to start numbing my mouth. Pre-numbing to get me ready for the long needle that really numbs you. Then the doctor gave me about eight shots with the long needle. I only felt an uncomfortable pinching sensation. After that, they told me good job, I had gotten through the worst part of it. I did not believe them. But it was true. I felt no more pain after that.

I was left alone for a while, and my mouth, lips, chin and even the sides of my face up to my ears got extremely numb. Then the doctor came back, and he and an assistant went right into the procedure. It all started so fast I hadn't had time to start my iPod, so I was fumbling with it while they continued shoving tools in my mouth. I finally got it playing, and as soon as I did, I shut my eyes really tight because I knew it would be bad to see anything that was going on. They started drilling, and the drill was so loud I couldn't hear the iPod anyway. I was just catching snatches in-between, and I couldn't really concentrate on it, because I was focused on the pressure and the sounds and wondering exactly what they were doing to me and marveling at the idea that they were hurting me extremely badly, but I could not feel a thing. They were having a pleasant conversation the entire time. I wasn't really paying attention, but they were laughing and talking like they were just sitting down having coffee.

I only had two wisdom teeth, both on the bottom. They started with the right side, and after probably three to five minutes at the most, they stuck a wad of gauze in there and switched to the other side. I wondered if they were done but couldn't really believe it could be so. They spent the same amount of time on the left side, and then they stuck a wad of gauze there too and said I was finished. I "said" (mumbled) "really?" and they said yes, and the doctor said that I definitely wasn't a patient that needed to be sedated, and that most people needed to because they couldn't handle the stress of it. I was shocked by all this, shocked that it was over, shocked that I was pretty comfortable the whole time, shocked that they were making it sound like I was one of their least anxious patients.

That was it. Then the assistant gave me a speech about how to take care of my mouth and what I should eat that day (cold, soft foods). I had a bunch of questions I wanted to ask her, but I couldn't speak. I don't remember what they were, but I guess they weren't that important, because it all turned out okay. Later on, when the anesthesia wore off, my mouth felt extremely sore, but it was not the terrible pain I had heard described by other people. I think I took some Aleve for the pain, nothing else.

The end. I know the experience will be different for each person, but I wanted to share my happy ending. Everyone I had ever talked to about it had made it sound like a nightmare of excruciating pain and unavoidable sickness. Maybe I got lucky, or maybe people just love to exaggerate this type of story in a bizarre "whose life sucks more" competition. I couldn't say for sure. With all the horror stories, it was only my fear of facing worse problems in the future from not getting the teeth removed that pushed me into it, but I'm really so glad I got it over with.

my "safe foods"

I'm back from vacation. The rest of it was pretty much the same - seeing people and having fun, but all while feeling "sick" and/or anxious. Experiencing anxiety that high almost constantly for an entire week is unusual for me, and it's strange to reflect on it now. Every day I was at some point convinced I was going to throw up, but I didn't. So much of the trip spent worrying about something that never happened. Then I start thinking about how much of my life in general I've spent worrying about it. And it hasn't happened in 16 years. It blows my mind.

The drive home was especially bad. I forced myself to eat and drink much more than I had on the drive there. Which was a good thing. I didn't have to deal with the high anxiety that comes from being dehydrated and light-headed, where everything starts feeling surreal. Plus I'm sure it helped me readjust to eating once I got home. But in the moment, it sucked. I felt "nauseous" for most of the drive.

It's been four days since we got home, and I already feel completely back to normal physically, which is huge for me. I was half-expecting that I still wouldn't be able to eat an adequate amount for the first week or so. I'm still feeling anxiety when I eat, but even that seems to be going away much faster than I thought it would.

I wanted to write about the foods I usually eat when I am having really high anxiety and feel unable to eat. Not that I'm saying they make up a balanced diet. I'm the last person to give nutrition advice - I'm pretty terrible at eating healthy. It's just a list of foods that feel safe to me, because they are easy on the stomach:

1) An egg and cheese sandwich. I heavily rely on these during my bad periods. They're delicious. There are so many different options for the bread part: bagel, croissant, English muffin, toast, biscuit, waffles. If I am feeling really "sick" I usually just go for a plain bagel and sometimes even leave off the cheese. But bread and egg, easy on the stomach, plus (so important when you're not eating well) you're getting protein in there.

2) Luna bars. I ate a ton of these on the trip, especially when I had to eat in the car. I don't eat anything without washing my hands first, which is not really convenient on a long drive. But granola bars or nutrition bars you can hold in the wrapper without touching. With Luna bars, you're getting protein again and also vitamins. The only downside is they're not high-calorie. They're pretty small, which is partly why they always seem manageable to me. Mini-meals.

3) Cereal, toast, pasta. I love all of these simple carbs when I feel anxious. Cheerios has always been one of my super-safe foods. It used to be pretty much my only safe food. I remember one trip I went on where I only ate Cheerios the entire time. So unhealthy, plus everyone around me thought I was insane. Now I try to avoid eating only foods that fall into this category, since they are usually lacking in the protein area.

4) Bananas. I don't love the way they taste, but they're healthy and convenient / portable like nutrition bars. They're in their own little "wrapper" so you don't have to touch them. Plus they're dense / filling, and you can find ripe ones pretty much wherever you go.

vacation update

I'm still on vacation. I have had Internet access but up until now have been either too busy or too overwhelmed to even think about what to write here. I'd love to make this entry have a coherent message, but I'm guessing it's going to be more of a blow-by-blow recounting of events. I haven't gotten the best sleep this week.

The first two days were the traveling days. We drove for six or seven hours each day. We got lost twice, once around NYC, once around Philadelphia. I managed my anxiety pretty well while in the car, except for the fact that I hardly ate or drank, because I felt "nauseous" a lot of the time. It was the first nights in the two different hotels that really threw me. It took hours of reassurance from my wife (that I wasn't going to throw up, go crazy, die, or always be this way) before I felt okay enough to get any sleep.

As is usually the case, two days of bad sleep and inadequate eating/drinking led to me feeling horrible. When I woke up Tuesday morning, I felt slightly less anxious but couldn't get up and walk around without feeling nauseous and dizzy. I decided I needed to cancel all my plans for that day and just spent the day in the hotel room forcing myself to eat and drink as much as possible. It was upsetting / frustrating, but necessary. Sometimes the hardest thing about all this is having to accept that I can't do whatever I want whenever I want. I get jealous of other people who can keep pushing themselves without taking a break, who could have packed a million activities and social interactions into a vacation this long. Sometimes I have to work within my limits, and for now, sometimes that includes missing out on things I was really looking forward to. But I'm sure that won't be the case forever.

I did visit my family briefly that night, because I thought I might get a guilt trip if I didn't make it to their house within 24 hours of arriving in the city. That went well, no anxiety attack there, so I knew I was heading back in the direction of normal.

The next day, finally, was like actually being on vacation instead of in hell. I felt almost 100% better physically. First thing in the morning, I went back over to my parents' house, because now my older sister was there with my 15-month-old nephew. I got to meet him for the first time. He wasn't sick at all. I still worried he might throw up on me whenever he coughed, but he didn't. I spent a couple hours with him, and we played with all his toys together. He is adorable, and I love him so much. Spending that time with him really cheered me up.

I also went to the company I work for and saw all the coworkers I haven't seen in two years, which was awesome. I love them all too and have missed actually being around them. My anxiety got really high again though. I think it was partially because I'm not used to being around so many people who know me and are all looking at me, and partially because I knew some of them had been sick recently. I ended up spending a few minutes hiding in the bathroom until I didn't feel so nauseous and shaky. I didn't even really care though. I was so happy to be there that I couldn't muster up the usual annoyance I feel at myself. Seeing them plus seeing my nephew made me feel certain that this trip was a good idea, that it was all worth it, even though it has been challenging. Besides, I'm almost positive I'm not going to get sick. I took Emergen-C for a few days before we left, I take a regular multivitamin every day, and I'm generally very physically healthy and have a great immune system.

The afternoon was a lot of fun too. I hung out in the hotel room with my wife and an old friend of ours from high school. I went to see my grandmother, who is the sweetest woman in the world. I don't think I know anyone who knows how to love people as unconditionally as she does. In the evening, I went back to my parents' again to hang out for a while. Despite doing all these different things, I managed to eat well the entire day!

Today I'm "embracing" my limits again. Both my family and my wife's family are having Thanksgiving meals / gatherings, but I decided not to go to either. I really wanted to go to the one with my wife's family, because I haven't gotten to see my sister-in-law or mother-in-law very much while here. But both gatherings are in another city, and I know a long drive, lots of people, and pressure to eat is likely going to result in me feeling "nauseous" for hours. I know I could handle it, but I really don't feel like forcing myself to get through something else. So I'm hanging out in the hotel for most of the day and seeing my family one more time tonight after they get back from their party. We're leaving early tomorrow morning, and possibly these last two days of driving will be just as bad as the first two days, so I'm sure it's a good idea to have a "chill day" before that.

This trip has really driven home the fact that there is a lot more work I need to do in order to get to the point where I can function the way I want to. I'm definitely going to be recommitting to recovery hardcore when we get home. Less thinking about and resenting my anxiety all the time and more actually doing the things that will help.

Oh, but the good news is that I didn't take any anti-nausea, anti-emetic, or anti-anxiety medicine on this trip. I either talked to my wife or used word searches and crosswords, my emWave, and affirmations to calm down. I'm really proud of that, and of how well I managed to eat overall despite feeling "sick" for hours every day. I suppose I can go as far as to say that this trip has been a good representation of the "emetophobia shmemetophobia" mentality. Not everything went perfectly, but I bounced back like a badass.

happy thanksgiving!

We're leaving early tomorrow morning on our trip. I'm trying to be excited, but I'm more on the nervous end of the spectrum. I do think we are extremely well prepared. In addition to the regular luggage, we packed two extra bags:

-- an "anti-anxiety" bag. It has my thermometer, anti-nausea medicine, a couple of my anxiety workbooks, word searches / crossword puzzles, and relaxation CDs. I also have 10 affirmations on notecards and my emWave in my purse.

-- a food bag. I didn't want to have to rely on whatever was around, restaurant-wise, both while driving and also when we get to the hotel. So we packed things to eat - some peanut butter sandwiches, chips, pretzels, and Luna bars.

We've got tons of music to listen to in the car. We've spaced out the trip so it's not too busy and overwhelming. I've just been trying to distract myself from my worries about it. If I'm having a hard time doing that, I try to think about it as a series of manageable steps rather than the whole trip at once. The first step is to get through six hours of driving tomorrow. That's it. I can handle that, and once I have, then I can think about the next part.

a visit to the pharmacy

I went to the pharmacy tonight to buy some "just in case" items for the trip. My prescribed anti-emetics are long expired. I have nothing to tell a doctor to convince them to prescribe me more. So I figured I would just get something over the counter in case I get some sickness while on the trip. I ended up buying Emetrol (anti-nausea), some Emergen-C (to strengthen my immune system over the next week), and seven individually wrapped toothbrushes.

I should feel better now, but I don't. I don't usually do things like this. I don't have an emetophobia kit, I don't carry medication around with me all the time, I don't even bother with immune system boosters. Because taking any of those precautions always makes me feel like this, like crap. I have way more doubts and anxiety thoughts now than before I went into the pharmacy. Shopping for an anti-emetic leads to visualizing myself in a situation where I would need it. I'm happiest when I try not to think about any of it as much as possible.

I hold myself to very high standards, and I'm embarrassed, and I guess a little ashamed, that I bought these items. It feels weak. It's a big deal to me to be mentally healthy as well as physically healthy, and letting myself indulge in these safety behaviors always makes me start worrying about the mental health side. I want to be in control of my life. I don't want to be limited. That bottle of Emetrol I bought for no good reason is just a symbol to me of a downward spiral to a point where I won't be able to live in any meaningful way.

I'm probably being too hard on myself. It's only one trip, and it's the most stressful thing I've done in over a year. I can have an emetophobia kit just this once, and it's completely irrational to think that having these things will jinx me in some way.

When we get back home though, I am done with all of this. I'm throwing it out. I don't even want it in our apartment. Thinking about that makes me feel better. I'm not going to allow this to take over my life any more than it already has. This will probably take the form of New Year's resolutions. No more anti-emetics around, no more thermometer. I don't know. I'll make a firmer list later on. 

emWave2

I have the greatest wife in the world. She bought me an emWave2 for Christmas! She gave it to me this morning. She wanted to give it to me early so that I could practice with it and then use it on our upcoming trip.

I've been thinking about getting one of these for months, but I kept hesitating and putting it off, because it's pretty expensive. I haven't actually charged it or gone through the instruction booklet yet to see everything it can do, but my therapist has one and showed me the basics a few months ago. Basically, it's a biofeedback device that measures your heart rate and breathing rate, allowing you to better see what is going on inside you. Then you can practice achieving relaxation through various methods and see which methods work best for you, work the fastest, etc. You can also download what's on the device to your computer and then look at your information over time, review your progress.

I'm sure I'll write more about it later. I don't think I am going to have much time to play with it today though. Since it's our last weekend before leaving, there are a ton of chores and errands to do. I'm going to be spending the whole day cleaning.

swallowing pills

I know a lot of emetophobes have trouble swallowing pills. I had this problem for most of my life. In high school, I used to dissolve Aleve or Midol in a glass of water and then drink it. There are no words to explain how disgusting this tastes. You will just have to try it and see for yourself. Or on second thought, don't ever do this.

Now I have a method that works most of the time. Very similar to the method people use to trick their pet into eating a pill. I chew up a bite of food that I know I can swallow all at once, then put the pill in my mouth and maneuver it into the middle of that bite. As long as I can't feel it there at all, I can then swallow the bite of food and the pill along with it. Thus, it works best with foods that are more solid and don't dissolve in your mouth, nothing like pudding or applesauce. For a long time, I had the most success with cereal, but now I can use practically anything. The only time I have trouble is when I'm so tense with anxiety that my throat feels closed up. Then it's hard to swallow in general.

I still prefer liquid medicines or chewable pills, and luckily, you can usually find them. But sometimes they're not available, and at those times, it's nice to not have to choose between pain and painkiller-flavored drinks. Ick.

general health anxiety

It's been an intense week. It seems pretty clear that as this VA trip gets closer, I am going to be dealing with every anxiety thought in my big fat collection. I was in near panic mode two nights in a row, thinking I had cancer or some other life-threatening disease, because of an irritated throat and all my muscles being incredibly sore. Actual causes? I'm thinking the throat thing is (...still...) our heater (hoping this will possibly maybe sink in sometime soon), and the muscle soreness was from lack of sleep and anxiety. I'm feeling fine now and don't know how I managed to leap from those incredibly benign symptoms to "I'm probably dying."

I think I'm going to start doing some serious CBT work again to keep myself from getting stuck in this negativity. A while ago I bought and read Overcoming Health Anxiety by Rob Willson and David Veale. There are a ton of CBT exercises in it to combat health anxiety, but I haven't done any of them yet. I just read the book straight through first. Now I am revisiting it, so I figured I would share my general thoughts about the book here.

I specifically bought it, because I heard there was a chapter devoted to emetophobia (a whole chapter!). But that chapter was a huge disappointment to me. It was late in the book, and emetophobia was basically laid out as an example of a type of health anxiety. So the book up until that point had already covered health anxiety in general and had provided several different techniques to help cope with or overcome it. At the end of the emetophobia chapter, they listed ways to cope with or overcome emetophobia, but they were the same techniques given in the earlier chapters (just reworded to show how they related to emetophobia). There was nothing new. There isn't anything wrong with that really, but it bothered me, because the rest of the chapter was only a description of our usual neurotic thoughts and behaviors. So at the end of the chapter, I was left feeling more anxious than I was before reading it.

The authors even included a list of conditions or situations that can cause vomiting that emetophobes don't usually worry about, as a way of pointing out how irrational we are by selecting certain risks to focus on and ignoring others. In what scenario did they imagine that information would be helpful? For some emetophobes, their current goal is only to become the safest / healthiest emetophobe they can possibly be, no matter what abnormal behaviors that goal leads to. This would be almost a challenge to them! For those that are trying to cut down on abnormal behaviors, they are just left with more information in their heads to try to ignore.

I consider myself to be in the second group, which is why I'm never going to post an entry here talking about 1) what foods have been reported to cause the most food poisoning, 2) which anti-emetic is the best to take before going on a long car ride, 3) "full-proof" ways to make sure you never get a stomach virus, etc. I don't consider any of that helpful and try to avoid reading anything of that nature on other emetophobia blogs or forums. It's my hope that this blog will not make other emetophobes worse.

But back to the book. That chapter aside, most of it was really amazing, and I would recommend it, because any of the CBT exercises can be used with emetophobia. One of the exercises is to write down the symptom (or physical sensation) that you are worrying about, write down your "catastrophic misinterpretation" of the symptom, and then write down all possible alternative explanations for the symptom. My experience a few days ago probably would have been better if I had used this exercise to remind myself how many possible alternative explanations there are for muscle soreness.

When I read these self-help books, I sometimes don't take the time to actually work through the exercises, by writing down responses or repeating ideas to myself on a regular basis. I have tended to think that just reading through them is good enough - especially because most of it is very logical or common sense. The rational part of my brain tells me "that's obvious and easy, and I'll remember it." It's funny, because a bunch of the books even include a warning NOT to think this way and stress how important it is to do the work. When the anxiety disorder takes over, there is no logic or common sense anymore. Reading through all those exercises did not stop me from feeling terrified that I had cancer. It doesn't stop me from worrying that I am going to throw up. I need new thoughts to compete with the negative thoughts I've been rehearsing my entire life, and they won't be there if I don't practice them and drill them into my brain. Sometimes it's as dull and tedious as studying for school, but it's worth it.

dry hands

The cold weather just started, and already my hands are all dry/rough and red from washing them so much. This is an issue I run into every winter. Eventually they get so bad that the skin cracks and bleeds. I try to keep putting lotion on them, but since I'm bound to wash it off within a half hour during the day, it basically only helps to put it on right before I go to bed. Plus most lotions seem inadequate in the face of the damage emetophobes inflict on their hands. The one I have found that helps the most (if I remember to put it on every single night) is Vaseline Intensive Rescue. If anyone else has found anything that works well, I'd love to hear about it.

practice trip

We took another practice road trip this past weekend. We went to the same restaurant, and this time, I got something that I considered to be "unsafe" to eat while out in public. After eating, we drove around the area. We were looking for a particular store, but we never found it. We just kept driving around and got kind of lost in a semi-busy area. Driving in an unfamiliar area and traffic and being lost are all things that make me stressed out, but I didn't start feeling really "sick" because of it, which is exciting to me. I think I am ready for the VA trip. I actually feel like I can handle it. There were many times during the past year when I felt like I might be stuck here forever because of my anxiety, so I am looking forward to getting far away. 

winter

We had our first snowfall this past week, and it snowed again last night. There is still some left on the ground this morning. It's beautiful, but it signals the start of winter to me, or as emetophobics refer to it, the season of illness. So it's leaving me with a general feeling of dread.

I haven't been sick at all in the past two years, not even a cold. Which is not normal. I used to get a cold per year like most people, and I'm guessing the reason for my healthy streak is that I started working from home two years ago, so I'm no longer in an environment like a school or office where illness spreads around like crazy. You'd think it would be reassuring, but I just keep worrying - will I get sick this year, and will it hit me harder than usual since it's been a while? I am taking that class now, so I'm back in contact with the notoriously unhealthy college crowd. Plus I've been trying to force myself to go out places as much as possible. Which is of course a good thing, a great thing. It's sad that I keep having to remind myself that it's not worth trading all life experiences to avoid a mild illness once in a while.

I've been reading other emetophobia blogs out there, and some of these people have so much more contact with vomit than I can imagine having. This woman Robin in particular amazes me. It seems like she has to deal with vomit frequently because of her kids, and she also has gotten sick herself due to morning sickness and a stomach virus in the past few years. She has survived and even kept a positive attitude throughout all of it. It makes me start to think brave thoughts like 'wow, does this even matter? I'm sure I would survive it too. Why am I so worried about this all the time? I should just never think about it again.'

But then an hour or so goes by, and I feel something "weird" in my body, and everything brave or rational goes out the window. I keep getting a scratchy throat (from our heater, I'm assuming), and even though I know it can't be from illness, I still worry that it is. I try to ignore it, but it actually causes my appetite to go away. Then I have to force myself to eat, and when I do, I feel anxious the whole time. If I try really hard to focus only on my stomach, I will realize that I feel absolutely nothing there. But emotionally, I feel like I am moments away from throwing up. It's bizarre.

emetophobia survey

Friday night of a hectic week. Sounds like a good time for a survey, followed by a lot of lying around and not working for two days. I've seen this posted a few places - not sure where it came from originally.

1. Does your family know of your Emetophobia? I don't think so. To make a long story short, we have serious communication issues in my family.

2. Do your friends know of your Emetophobia? Yeah, probably all of them do. I'm pretty open about it.

3. Would you tell a stranger that you have Emetophobia? I guess it depends. I think the only strangers I have told are doctors / dentists so that 1) they would prescribe me anti-emetics 2) they wouldn't prescribe me anything with nausea or vomiting as a main side effect. It doesn't usually come up in normal conversation for me.

4. If you are currently in a relationship, how long did you wait to tell your partner? We were friends for a while before we started dating, so she already knew all about it.

5. Are you scared to have kids? Of course. But underneath all the fear, I don't think I want kids anyway, so I'm not too concerned about it. My life is pretty stress-free compared to the average person's life, and I have a hard time handling that tiny amount of stress. I can't imagine adding the stress of raising children to that. 

6. If you are a mom who suffers from Emetophobia, how do you deal with the struggles of your kids being sick? N/A, but I'm sure I wouldn't deal with it well at all. I feel panicked even when our cat throws up and usually run to hide in the next room.
 
7. What age did you discover that you had a problem? I was around 11 and found a website describing emetophobia. I can't remember if I was actively looking for an explanation. I had recently had some problems with missing a lot of school because of "feeling sick," so maybe.
 
8. What type of methods have you tried to reach recovery? I've never really believed I could get rid of the phobia completely, but to cope better, I have tried just about everything. Exposure therapy, talk therapy, CBT, ACT, affirmations, all the basic relaxation techniques (meditation, progressive muscle relaxation, deep breathing, visualization), yoga, mindfulness, and hypnosis. Most of this I still do, because I find it all helpful. The only thing I haven't given a fair chance is long-term medication. The side effects scare me too much, so both times I tried it, I stopped after the first dose. 
 
9. When was the last time you have thrown up and why? I was nine years old, and I'm pretty sure it was just a basic stomach virus.
 
10. When was the last time you saw someone else throw up? I'm not sure I remember. I've done a really good job of avoiding seeing it, even if all I could do was shut my eyes or turn my back on it. I feel like my last "direct experience" with it was December 2007 when I went into a stall in a communal bathroom in my college dorm building and then heard the girl in the stall right next to me start throwing up. I ran out right away.

11. What type of foods do you avoid? I don't think I avoid any food all the time, it's more situational. I avoid cooking any raw meat myself, because I don't trust myself to do it right, plus I don't want to deal with that kind of "contamination" stress. I hate trying anything new, so usually I make my wife try it first, and if she doesn't get violently ill from it (she never does), I might have some. I'm afraid of restaurants I've never been to before, so I try to stick with chains. Same for groceries - I have my safe "brands" and hate buying a different brand or the generic brand. When I know I have to go out somewhere, or when I am already in public, I try to go for simple / bland foods only like sandwiches or pasta. Oh, and I always avoid alcohol. The only alcohol I've had in my life was a tiny sip of champagne when I was really young (New Year's Eve).

more on road trips

The test run drive went really well. I didn't even need to get out my written affirmations. It was a quiet, non-stressful drive. Most of the time we were surrounded by farmland. On the way there, I could feel the anxiety start in my stomach at times, and I just tried to bring my attention back to the external world - the music playing, the scenery. I read somewhere (no clue where, my brain is way overloaded with self-help books and websites) about playing a game with yourself to calm down where you look for something that starts with the letter "A", then the letter "B", etc. So I used that to distract myself too.

Sometimes when I start to "feel sick" I view it as a kind of black and white transition where I've left the realm of calmness / happiness, and that's it - now there's no going back. But on this drive I happened to be able to tap into logic (for once) and realize that only a few seconds had passed between feeling absolutely fine and feeling "off" in some way. Obviously I still was absolutely fine and was able to return to feeling that way with a little effort.

I felt a little "sick" after eating in the restaurant too, but it didn't last long, maybe about five to ten minutes of the drive back home. All in all, I'm super pleased with how it went, although I do keep thinking about how tame a challenge it was compared to the much longer trip coming up. My main areas of concern are:

-- the drive itself. We'll be on the road longer, there will definitely be more traffic and crazy drivers. Plus having to eat during the drive.

-- staying in a hotel. The last time I actually threw up, I was in a hotel, on vacation with my family. I know some emetophobes have bad associations with certain foods because they were sick after eating them. That didn't happen to me, but I guess I associate hotels in general (well, they do all look alike and smell alike) with the experience and feel slightly unsafe in them.

-- I'll be meeting my nephew for the first time. He's a little over a year old. I might have to hold him. Part of me really wants to. I've loved him since the day he was born and the first pictures went up on facebook. But part of me worries he will spit up on me. Or get sick on me? At what age does it stop being called spit-up? I have no clue, but really it makes no difference to me.

-- eating in general on the trip, eating away from home, eating around other people. I need more practice with this.

We are planning to have a couple more of these "test run" trips, if we have time to fit them in. The goal for the next one is to go eat somewhere and then go out shopping instead of coming straight back home.

road trip

In a month, we're going to be taking a trip to Virginia to visit family. We'll be driving, and the drive down there takes about 12-14 hours. I'm starting to get really nervous about it. The last time we took a road trip, it was to a city about three hours away. I had a horrible anxiety attack during the drive, and the stress of it not only ruined the trip, but it stayed with me for months even after getting back home.

As a test run, we are taking another smaller trip this weekend to upstate Vermont. This drive will only be one and a half to two hours, nowhere near the length of the VA drive, so maybe it isn't the most challenging test run possible, but that's probably a good thing. I think what I really need is some confidence-boosting, and hopefully this is small and easy enough that it will be a complete success. Plus we're going to be eating breakfast once we get there, in a diner that I've never been to before, so that will make the whole experience a little scarier. My goals are to eat a small snack before we leave, eat a normal-sized breakfast at the diner, and keep my anxiety down as much as possible.

It's already starting to get cold here, and we have had to turn our heat on a few times in the past week. Not being used to it, I got a mild sore throat for a couple days, and ever since then, I have been on edge about every tiny little thing happening in my body and have convinced myself several times that I am coming down with some illness. I'm seriously frustrated with myself. I don't think I have been working hard enough at fighting these irrational thoughts. I've been neglecting affirmations. I'm going to take a list of them with me on this car trip so that they will be easily accessible if/when I get anxious.

"I don't need these thoughts. I can choose to think differently."

CBT websites

I'm lucky enough to have access to regular therapy, but I know that's not the case for everyone. Even with it, most of the work you do is on your own. I usually prefer working through self-help workbooks, but I have also spent a lot of time on these two websites MoodGYM and E-couch. They both walk you through cognitive behavioral therapy skills and have a bunch of exercises you can do to practice. They're free, as opposed to the workbooks, and you don't have to worry about running out of space when you write your answers (or having to make twenty copies of a certain worksheet).

There is also this Beacon website where you can browse through other online self-help programs.   

yoga / anxiety cat

I reached my yoga goal - three times this week. Now if I can just keep going, establish that as a routine, I'd be so happy. There are a bunch of other things I should be doing to improve my health (sleeping more, balancing my diet, etc.), but it never works out for me when I try to tackle them all at the same time, so I am focusing on just one for now. When I'm all set with the yoga, then I'll move on to something else.

I only started doing yoga about a year ago, so I still consider myself a novice (especially since I have not been able to consistently stick with it yet). It took me a while to find a DVD I liked. At first, I was using one that was way too easy, and I felt like I wasn't doing anything. Then I switched to another and had the opposite problem - it was super advanced. I couldn't even keep up with that one. Eventually I started using this YogaAway one, and it works perfectly for me, for now anyway. I love it because 1) it repeats each position/stretch several times, giving you ample opportunity to get the feel of it and make sure you are doing it correctly, and 2) the voice-over tells you exactly when to breathe in and when to breathe out the entire way through (and in a way that isn't awkward). I have a hard time maintaining deep breathing on my own, so I find that really helpful.

My anxiety has been higher than usual this past week, and aside from yoga, I've been trying to ride it out with funny movies and websites. I found this Anxiety Cat tumblr today and laughed over it for a long time. I can relate to almost every one of the entries.

projection

Another thing I wanted to talk about from that book (No Boundary: Eastern and Western Approaches to Personal Growth by Ken Wilber).

Part of the book talked about the psychological concept of projection and how everything we feel is just a projection of a deeper subconscious feeling. Like if we feel obligated to do something, it's because we actually want to do it - otherwise, we wouldn't care at all and would feel no obligation. For anxiety, the deeper subconscious feeling is excitement. I started thinking this over and wondering if some part of me could feel excited about vomiting. Which is impossible to imagine. But if I substitute "fear of losing control" for "fear of vomiting" I can easily imagine having a subconscious feeling of excitement about losing control. I even consciously fantasize sometimes about being a different person, one that isn't reserved and uptight all the time. Of course, that's assuming "fear of losing control" has anything to do with this phobia. I feel that it does, but I don't know for sure what the main underlying "cause" is.

But the concept also seems to fit with the social anxiety I have. If someone doesn't care at all about social interaction, about being around other people, then chances are they won't have social anxiety (or they'll have it, but it will have no effect on their life). It's only going to bother someone who deep down is excited about being around people, talking to people, having other people look at them, etc. And thinking about it that way makes me feel more willing to face the anxiety. For example, at some point during the class I'm taking, I'm supposed to give a presentation, and I've been thinking about it and dreading it ever since I heard about it. But put the nice projection spin on it, and I know that deep down, I'm actually dying to give that presentation. So why try to think up ways to get out of it? 

centaur / mind-body

I've been trying to figure out what my little blog picture should be, what image could be associated with emetophobia. I'm reading this book No Boundary: Eastern and Western Approaches to Personal Growth by Ken Wilber, and a couple nights ago I got to this part of the book that was talking about the centaur as a representation of a unified mind-and-body:

"A centaur is a legendary animal, half human and half horse, and so it well represents a perfect union and harmony of mental and physical. A centaur is not a horse rider in control of her horse, but a rider who is one with her horse. Not a psyche divorced from and in control of a soma, but a self-controlling, self-governing, psychosomatic unity."

I love this. This is the emetophobic issue. We see our bodies as "the enemy" that we have to fight and master. It's the source of what we fear, so we want to escape it, but it's not something that can be escaped. It's us.

I want to get rid of this mind-body split, and in order to do that, I really need to commit to doing more things that will relax my body. In other words, not just sitting around and reading all the time, as fun as that is. I'm going to start doing yoga again. There was a brief period of time many months ago where I was doing yoga on a regular basis, and I know it was helping me. I really can feel how doing the stretches and then releasing the tension makes my body feel better and also seems to allow me to tune in to different parts of my body in a way that is pretty foreign to me. I don't know why it is so hard for me to stick with the habit. I would love to eventually get to the point where I do it every day, but I think for now, my goal is going to be three times a week. Starting this week. Here's hoping that posting this will keep me accountable. 

online study

I think I may be the last person in the online emetophobic community to come across this, but just in case that's not true:

www.emetstudy.org

It's an online treatment program / study. I signed up for it, and I'm really excited.

body visualization

I just finished reading Molecules of Emotion by Candace B. Pert, Ph.D. She's a scientist, and the book focuses mostly on her research involving peptides and receptors in the body. There was definitely much more scientific/medical jargon than I was prepared for, as I was kind of expecting a basic psychological self-help book. But I love science, and she breaks it down to the point where I could follow what she was saying most of the time, so I didn't really mind pushing through those parts. Especially because she interspersed the science with autobiographical narrative.

In the second half of the book, she started to pull it all together and talk more about health and emotions. Basically, through her research she has developed a holistic body-mind outlook: emotions are in the body and not just the mind; the mind can influence the body, and the body can influence the mind (a two-way communication); all systems tie together (immune, endocrine, nervous, etc.) and communicate with each other. I think most of these ideas would not be surprising to anyone these days. The book was written over a decade ago, so it was probably a more revolutionary message back then. But it was still interesting to read about the actual science behind it. At the very end, she tied spirituality into it too, another subject that fascinates me, so the book ended up containing almost every topic I adore: science, history, personal narrative, sexism / feminism, psychology, health, and religion / spirituality.

My original intention in reading it was to find something that might help me with my anxiety though, and on that front, there wasn't much that I didn't already know or hadn't already tried. She did inspire me with her many little anecdotes about using visualization to actually bring about changes in the body. For example, she talked about visualizing her pituitary gland releasing endorphins and how as a result of doing this, she could actually feel the endorphins being released and traveling all over her body, lifting her mood. I am a super skeptical person, and my thoughts immediately went to "maybe she just imagined this happening." But does that even make sense, saying she only "imagined" an increase in happiness? She still felt happier either way, which is the whole point. Goal achieved.

A similar story talked about a man who broke his elbow and then spent twenty minutes each day visualizing blood flowing to the site of the injury, which apparently resulted in the injury healing much faster than would normally be the case.

Since reading that, I've been experimenting a little with this kind of body visualization, focusing on my stomach / digestive area and imagining the resources of my body - blood, peptides, molecules, energy, whatever - all going to that one spot. The book describes the entire body and everything working within it as an "information network" so that I can imagine my stomach as an area that needs more research, since I usually find myself out of touch with it. Often I will find myself in the bizarre situation of knowing that I should be hungry (as a healthy person who last ate several hours ago) but not actually being able to feel that hunger. It's like my stomach is not accessible to me. I will get headaches or feelings of fatigue that alert me to my hunger without ever having passed through the stage where I felt it in my stomach.

The other morning before going out to breakfast, I tried this. I am not a morning person, and when I am tired, what's happening in my stomach is even more indecipherable to me. Then anxiety can take over and interpret the "strange" / unidentifiable feeling as fullness, or worse, nausea. But having just woken up, I know logically I must be hungry, since I haven't eaten for about twelve hours. I tried the visualization exercise, and it seemed to work after only ten to twenty minutes. I wouldn't say I was ravenous, but I began to feel like I could eat without there being any danger. I began to get a sense that the "strange" feeling was one of emptiness.

Which I find promising. In general, I am and always have been focused on the mind over the body. I loved school, and I love reading and writing and exploring ideas. I tend to see my body as an annoyance or (more frequently) as something to fear, and I really want to change this perspective. I want to learn to be aware of it in a more detached / mindful way, and I'm hoping one day I'll get to the point where enjoying my body, taking pleasure in it, is the rule rather than the exception.

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.