weird al understands me

You know what I find really amusing about having emetophobia? The fact that the lyrics to the song "Germs" by Weird Al so closely mirror actual thoughts I've had.

 

positive self-talk / exposure hierarchy

I'm still working through the different steps of the emetophobia online study. Last night I was trying to come up with my own personal exposure hierarchy, and I started going back through the Cognitive Behavioural Therapy Workbook for Dummies, because I worked through a lot of the exercises back in 2010-2011 and knew I would get ideas there for what I tend to avoid the most. I also found a bunch of loose papers I had been keeping in there with helpful affirmations. I haven't looked at any of this stuff for a long time now, because I've been feeling so much better, so it was weird to go back and see how much trouble I was having. Some of the things I was thinking back then seem so foreign to me now, which I love, because they were awful things. But I thought I would post some of the positive information/statements that I collected or created to help during that horrible time.

I remember I looked online for new affirmations sometimes, but I usually couldn't find anything that resonated with me like the affirmations from the workbooks did. I did find this website with anxiety coping statements and information about thought stoppage, and I printed it off and had it tucked in the front cover of the book.

Then I had a list of negative statements I was constantly thinking back then and a positive rebuttal I had come up with to counter each one:

1. 

I should be able to just get over my anxiety, knowing that's all that it is and that it's in my head. What is wrong with me? 

It's not that simple. There is no quick fix. It will take time and work to overcome my anxiety, and I am working really hard at it. I should be proud of myself for what I am able to accomplish at this point, and for my ability to stay motivated at working hard on these issues.

2. 

There is no reason for me to feel anxiety in this situation. I'm getting worse (or not getting better). I'm not the same person I used to be. 

I keep thinking that my anxiety should "make sense" and should only pop up at the times that it makes sense that it would based on the past. But an anxiety disorder isn't like that - by definition, the amount of anxiety you feel with an anxiety disorder is extreme and does not make sense. I may still be going through a rough time, but that doesn't mean I haven't improved a lot in the past year, and it doesn't mean I should lose hope that I can one day be a relatively anxiety-free person.

3. 

I have a very hard time knowing what I feel or want, and that isn't normal. 

Again, I have an anxiety disorder. This causes me to feel insecure and doubtful and indecisive at all times. It doesn't mean that I am an abnormal person that has no real feelings or desires. It doesn't mean that I will never figure out what I want. There is always time to change things, and it is within my control to change them.

4. 

I never really do anything. I don't have a real life. 

I actually do many things, sometimes so many that I complain about how I am too busy. It is in my nature to want to stay home, and some people are like that. But also, some of that tendency might be coming from my anxiety problems (which, aside from this severe period, I have had to some degree all my life) and maybe once I get better at dealing with my anxiety, I will feel more like going out and doing more social/outside activities.

5. 

I know better than to expect this event to go well. I'm definitely going to have anxiety there, so I should just accept the fact that I'm going to be miserable and get through it as best I can. 

I can't predict the future. There is no way of knowing for sure how much anxiety I will have in any situation. I may not even have any. Expecting the worst will only make me more anxious, which won't help. If I tell myself I can handle this situation and go into it with confidence, I am more likely not to feel anxiety and to have a good time overall.

6. 

This feeling is unbearable. I can't stand feeling like this way anymore. 

This feeling may be unpleasant, but it is not unbearable. I have survived it many times before and can survive it again. If I tell myself I can handle the feeling, it will most likely go away faster and will not be as horrible. 

Thoughts on worrying 

Worry does not help you prepare for problems. Planning and taking constructive action in response to worries can help you solve a problem or prepare for a less than ideal situation. But worrying in itself will not help you prepare for what might come up in life. 

There is no point in practicing being unhappy. Most of the time, things turn out well, and in preparing all the time for bad things by worrying, you are just increasing the amount of time you spend feeling miserable.

---

This is the exposure hierarchy I came up with in the end (in order from least scary to most scary). I can do all these things, but I try to avoid them as much as possible, because they make me either really uncomfortable/uneasy (for the first few) or really anxious.

-- Watching vomit scenes on a cartoon
-- Watching vomit scenes in shows/movies (not animated)
-- Going to a pharmacy
-- Eating dessert (or something unhealthy) at a restaurant
-- Buying/eating something from the grocery store that I think is "high-risk" (for food poisoning)
-- Eating at a restaurant and getting something new/unfamiliar from the menu
-- Using public restroom
-- Eating a big meal before leaving the house to go somewhere
-- Eating at a restaurant, then going somewhere else (not straight back home)
-- Eating far away from home (at least a 3 hour drive back)
-- Eating at a restaurant at a busy time when it's crowded
-- Staying at a hotel overnight
-- Staying at a hotel overnight and eating out somewhere that night

emetophobia treatment plan / exposure

I wanted to share this article, which outlines a treatment plan that was successful in curing a 12 year old girl's emetophobia.

Worrywise Kids In Session: Case Conference on Vomit Phobias and OCD

Some thoughts I have after reading it:

1) I'm pretty fascinated by the idea of a fake vomit mixture. I remember reading about the idea somewhere else a few years ago, and I thought about doing it, but I decided it would be gross and that the idea really didn't bring up that much anxiety for me. However, in this scenario they add in the elements of urgency (by running to the toilets with the mixture in their mouths) and messiness (getting some of it on the toilet seat). That makes me feel more anxious when I think about doing it, which is surprising to me.

2) Since this treatment plan is for a 12 year old, I wonder if a similar plan would be as successful for an adult. I've often wondered if I could have gotten past all this if I had just gotten therapy for it when I was really young. I'm guessing age 11 would have been the prime time for me to go into extensive phobia counseling. But maybe the only reason it's easier for a child is because they have more motivation and are more willing to take risks. She mentions at one point that other patients resist the exposure exercises more. I found myself resisting a LOT of them even though I was only thinking about them, not even being asked to do them.

I am resistant to the idea of hanging out in a nurse's (or doctor's) office with sick people, to the idea of having a normal conversation with someone who was just sick, and to the idea of going on nauseating rides like roller coasters. When I think about exposure, I think "sure, I have no problem with it, as long as I'm not doing something that legitimately makes it likely I will end up vomiting." Things like going out to restaurants, eating "high-risk" foods, and taking trips involve a certain degree of risk, obviously, but in the logical part of my mind I know it's a very small risk. Actually forcing myself to ride a roller coaster or have a conversation with a sick person seems like a very big risk.

Either I'm being irrational by thinking that it's a big risk, OR that's the idea, to take a big risk and not care. I'm not sure which it is, but I'm guessing probably the second one. I know part of exposure therapy involves going to extremes, doing things that not even a normal person would do. For example, in a book I read about OCD (Freedom from Obsessive-Compulsive Disorder, by Jonathan Grayson), part of an exposure hierarchy for someone afraid of germs was to touch the inside of a dumpster. Why? For one thing, although a normal person would not just go up to a dumpster and touch the inside (and would feel grossed out by the thought), they might take out the garbage before going out to eat without thinking about it, which is essentially the same thing. Also, going to extremes takes you even further in your recovery. Doing something as extreme as touching the inside of a dumpster makes you even more aware of how low-risk other (less extreme) activities are.

3) This particular therapist mentions that the main reason she did not have the 12 year old girl induce vomiting as part of the exposure hierarchy was because young girls have body image issues and are at risk for eating disorders. I'm assuming this means that if she was working with an adult, she would include this step.

I have mixed feelings about this. I think self-induced vomiting is dangerous. This is probably due to more irrationality on my part (my general health anxiety), since I think manipulating your body in any way, even by taking a painkiller, is dangerous. This is why I hate medication so much. Of course, I still take it, as sometimes it's necessary, but very rarely. I have read that taking the recommended dose of Ipecac (the most commonly used emetic) is not dangerous, but I'm not entirely convinced.

Then there's the "evidence" that vomiting (self-induced or not) doesn't cure emetophobia. I put "evidence" in quotes because I'm talking about stories I've read on various websites from people who have either gotten sick with a virus or have self-induced, usually through taking Ipecac. I can't really call this evidence, because I can't say for sure these stories are true, although I'm assuming they are. Most of the people who give these accounts claim that they don't feel that anxious directly following the act of vomiting, but that they are back to their usual phobic state within a day (or a few days).

On the other hand, there is the occasional account where the person says that the act of vomiting did cure them or at least made them feel considerably better. I've given this a lot of thought, wondering why it works for some when it doesn't for (it seems) most. Maybe the phobia is not as severe for these people. Maybe they have some fundamental difference in their personalities or brains that makes them good candidates for this type of treatment. What I tend to lean towards (out of hope, because it's something that I could actually control) is that it has to do with how these people react to the experience in the moment. Some people, after vomiting, are horrified and upset and scared. They are usually writing about how they "ruined their streak" or how their anti-emetics didn't work (or they didn't even have time to take them), how aware they suddenly are of how little control they have over vomiting.

Other people are excited and relieved. They write about how they felt better after vomiting, how proud they are of themselves for getting through it, how it wasn't as bad as they had always thought. I don't think this has to do with the experience itself (as in it was much worse for the people in the first, upset group). These people are making a choice to cast the experience in a positive light. It's not fun or pleasant, but they choose to downplay those parts and emphasize the triumph involved, and the fact that no terrible consequences came from vomiting.

I tend to be a negative/pessimistic person, so I would probably fall into the first group. This gave me the idea of writing a letter to myself, a letter that I would read immediately if/when I ever vomited, to remind myself that I should make every effort to see this experience as okay and even a good thing. I haven't actually written it yet. It's just something I've been mulling over.

4) The imaginal exposure parts bothered me a little, because sometimes it is actually the case that a kid gets teased for vomiting or that a parent reacts badly. I don't have any experience with the teasing, but I remember my parents always being more annoyed than concerned when I got sick (or my sisters did), because they didn't want their carpet (or the car, etc.) to get messed up. It makes me wonder what the point is of convincing yourself this is unlikely to happen, especially if you are still a child. Shouldn't the focus be more on accepting that other people might be inconsiderate/mean and that it's okay (they'll get over it)? Maybe that was part of the focus. I mean, it is a pretty short case study and obviously isn't including every detail.

5) Everything else aside, this little girl is my absolute hero.