two years

Today's the anniversary of my "breakdown." Actually, I guess it really started the night before with the first of the panic attacks, but this was the date where I was in the hospital all day, so I consider this to be The Infamous Day.

I never thought I would feel like myself again, but I do. I can now say I feel like my anxiety is under control, at least as much as it can be while still having a phobia. It's just exhilarating to know that. Two years ago I was such a mess, and I had never imagined that things could get that bad. And then I couldn't imagine that they would ever get this good again either.

In celebration of this, I'm posting the timeline of my improvement. This is pretty much how the last two years went:

September 10, 2010: I was in the hospital most of the day discussing my non-stop panic attacks with various people. Then they gave me Ativan, and I went home and took that immediately, and then one or two other times in the next few days.

September 11-19: I went to the doctor three times. The first time I was given Lexapro, which made me feel sick, so I only took it once. The second time I got my thyroid tested (problems with it can cause anxiety issues), and nothing was wrong with it. The third time I was given Cymbalta, and I only took that once too. It didn't make me feel sick, but it did have minor side effects that bothered me (like restless legs).

I missed a lot of work. I couldn't eat or drink much. Everything I ate made me feel nauseous; I was taking a lot of Zofran during this time. I couldn't sleep and basically spent every night in the living room, dozing with the TV on.

I started seeing a therapist and doing breathing exercises, and I listened to a guided meditation CD every day and tried to meditate as much as possible. It was not something I had done much in the past, but it helped immensely anyway. Just made me feel temporarily calmer.

September 26: I started working through The Anxiety & Phobia Workbook. I know I've talked about it a lot, but I'll say it again. It's an amazing book. It helped me so much.

October 5: I joined a gym and started exercising more to see if that would help. It does help, but I still have a hard time sticking with the habit, even now.

October 8: By this point I was doing word searches almost constantly, especially when I woke up in the middle of the night (which was almost every night). They really helped me calm down when I was anxious.

October 16: I wouldn't let myself watch anything (on TV or in movies), read anything, think about anything upsetting or anxiety-producing. I felt frustrated by having to hide from negativity, but now I think it was the right thing to do. It helped me get better faster, and obviously I no longer have to do it. But I still don't watch horror movies. I used to watch them all the time and now don't let myself, because they have too much of an effect on me.

October 20: I had gotten a little notebook and was writing out affirmations in it every day. I would pick one from The Anxiety & Phobia Workbook and write it out five to ten times in a row, pausing in between to reflect on what it was saying and really try to believe it. I did this at least once a day, but more if I was really anxious. It was another activity that calmed me down.

December 4: I started noticing that PMS always made my anxiety issues much worse. I began reminding myself of this every month around that time so that I wouldn't take my thoughts and feelings so seriously.

February 3, 2011: I started doing yoga. I don't do it much anymore, but it was helpful and calming at the time. 

April 30: I printed out some of my favorite affirmations and would tape one to the wall above my desk so that I'd be reminded of it frequently throughout the day. Every so often, I'd switch to a new one. 

May 9: I was still seeing that my anxiety got significantly worse and hard to deal with during PMS, so I started taking 100mg of B6 daily (on top of a multivitamin) to help with that. It seemed to work wonders (after a couple months I think). I still take it. 

July 23 - 26: I started having bad panic attacks again. It felt like a repeat of the initial "breakdown" only to a much lesser degree. But again, it was extremely difficult to eat or drink for a few days, and I felt horrible all the time. I'm not sure what caused this relapse, but I got it under control much faster than I had the first time, mostly through forcing myself to eat as much as possible, which kept me somewhat stable. This gave me hope that I was moving in the right direction. 

August 29: I started taking a class at a college nearby. This forced me out of the house on a regular basis, forced me to interact with the world again, which was something I really needed. I had gotten pretty homebound. 

September 10: I tried hypnosis for the first (and only) time. I felt slightly better for a few days after it, but I have no idea if it was the hypnosis that caused this. Or the placebo effect. Or coincidence. 

November 22: I took a trip to see my family for Thanksgiving. This was very stressful and didn't go as well as I had hoped. Again, I had problems eating, drinking, and sleeping. I felt sick almost constantly. But I did manage to get through it without any medication (psychiatric or anti-emetic). I used affirmations that I had written out on index cards and the EmWave2 I had just gotten.

February 19, 2012: I did an online emetophobia study which started around this time. It involved a lot of CBT and exposure work that was helpful.

May 1: I stopped going to therapy, because I felt pretty confident that I knew what to do when I was anxious. Most of the time I could calm myself down by countering my negative thoughts and focusing on more positive ones.

That's about it. I've been doing really well this year. Basically, the Thanksgiving trip was the last "crisis" period I had, and I am sure that if I took that trip again this November, it would go a lot better.

Speaking of trips, I am taking a small one later this month. I won't even be leaving the state, but I will be staying in a hotel in another city. I'm excited. For the first time in a long time, I feel excited about a trip. I'm not dreading it! I think it's going to go really well and be loads of fun.

coping techniques from A to Z

About a week ago, I decided it'd be fun to see if I could come up with an A-Z list of techniques for coping with (or recovering from) emetophobia, and I've been working on that for the past few days. I ended up writing a lot more than I thought I would, so this is going to be a long post. But hopefully it will be a helpful reference for anyone who feels like they are stuck and in need of a new tactic. Here goes! 

Affirmations: Practicing positive self-talk is one of the things that has helped me the most with this phobia and anxiety in general. I have a list of positive statements (affirmations) that I say to myself when I am feeling anxious. It took months of repeatedly writing and saying them before they started having a noticeable effect. Now they lower my anxiety pretty quickly. I especially like the one “This feeling isn’t dangerous – it will pass.” Start saying this to yourself every time you feel “sick” or anxious, and really try to believe it.

Breathing: It still amazes me that something as simple as taking a few deep breaths can make you feel so much calmer. It’s so simple that I usually don’t even think to try it when I am feeling anxious. My mind rushes ahead to more complicated solutions. But just taking a few minutes to take some deep breaths (from your stomach/diaphragm) can sometimes solve the issue, nothing else needed. There are many deep breathing exercises that you can practice daily, and over time the habit will become ingrained, so that whenever you become anxious, you will remember to breathe slowly and deeply.

Cognitive-behavioral therapy: I’ve read that this form of therapy is the most effective for treating anxiety. The cognitive part of it is noticing your negative self-talk and countering it with positive and rational statements. The behavioral part is looking at your actions/behaviors when you’re feeling anxious and working to change those unhealthy behavioral patterns. That’s the simplified version, but there is a lot to it, and it is something that takes a lot of hard work and commitment to change.

Distraction: Sometimes when I am really anxious, I know I just have to ride it out. While I’m waiting for the anxiety to fade away (as it always will), I do something to distract myself from the sensations as much as possible. During a period where I was having high anxiety in the middle of the night every night, I had several word search and crossword puzzle books lying around. These forced me to think and use my hands, so I found them calming. I have also watched TV, drawn pictures, written letters or emails to people, etc. Any fun laid-back activity.

Exercise: I am horrible at motivating myself to exercise, but many people can attest to the amazing effect it has on anxiety. It uses up the excess adrenaline you have because of your anxiety issues. It also raises your endorphin levels, so it makes you happier overall. I have heard some emetophobics say that one good work-out will bring down their anxiety for the whole day, even allowing them to be able to calmly handle situations that they know would normally cause them to panic. All from exercising just once, so imagine the long-term benefits of a regular exercise routine. It also, of course, keeps you in good physical health.

Food: Keep eating it. Emetophobics are tempted to avoid eating so that they have nothing in their stomachs to “make them sick.” I know it’s not what anyone wants to hear, but you can throw up even when you haven’t eaten. Plus not eating is an unhealthy act in itself. Your blood sugar will drop, which will make you feel bad physically and mentally: dizzy/woozy, headaches, stomach pain. Sometimes it just gives me an overall “weird” feeling that makes me even more anxious. When it gets out of control and you’re starving yourself, you’re hurting your immune system and making yourself more susceptible to illness. So it is not actually keeping you safe. Also, try to branch out from your “safe foods” and get to the point where you are eating a healthy, balanced diet. Like exercise, that’s something that will make you feel better overall.

Goals: Try to take your emetophobia and anxiety out of the picture and think about what you want out of life. Figuring this out will help you know what goals you need to set and what specific parts of your phobia you most need to challenge or overcome. Maybe you want to have a child. You need to work on becoming comfortable around sick children, so maybe you set a goal of helping a friend or relative when their child gets sick, and then take tiny steps until you achieve that goal. If you don’t want children, then it isn’t as important that you push yourself in that area. Maybe you want to travel to foreign countries instead. Your goals would be to reduce your anxiety on public transportation and to experiment with eating foods outside of your comfort zone. Having some ultimate purpose/gain behind your goals helps you from getting caught up in the idea that this phobia affects every part of your life. That may be true, but you don’t have to fight all of the manifestations at once.

Humor: A sense of humor is a great weapon against anxiety. First, when your anxiety is really high, you can use humor as a distraction – a funny movie, TV show, or website. Second, you can laugh at yourself and your anxiety. I’m sure we’ve all had that moment where we realize how silly or ridiculous our thoughts or actions are. It’s not about judging/mocking yourself, just putting things in perspective and realizing anxiety doesn’t have to be taken seriously all the time. Anxiety Cat is a good website for laughing at anxiety.

Information: Learn the basics of anxiety. It’s much harder to fight something when you don’t understand it. For example, knowing how anxiety can affect the way you feel physically will greatly reduce the number of times you convince yourself you must be getting sick. There are many websites that explain anxiety and different anxiety disorders in detail, but in my opinion the best thing to do is buy and read The Anxiety & Phobia Workbook by Edmund J. Bourne. It is pretty much “the bible” of the anxious. Two other good books are Overcoming Health Anxiety by Rob Willson and David Veale and Cognitive Behavioural Therapy Workbook for Dummies by Rhena Branch and Rob Willson.

Join the world: It’s easy for a person with anxiety to become isolated. Fear can lead to you staying home all the time or avoiding all socialization. Or something less extreme, like a comfortable routine that passes for normal but still feels restrictive and unpleasant to you. I would encourage anyone feeling this way to take the risk of stepping outside the comfort zone – look for opportunities to leave your house and be around people. Take these opportunities as frequently as you can – if you don’t keep practicing and forcing yourself out, your anxiety at the thought of doing so will only increase. Even if you’re at the point where your anxiety has you stuck at home most of the time, keep in touch with your family and friends as much as possible, so you don’t lose your support system.

Keep taking steps: Part of recovering from a phobia is exposing yourself to what you fear. I think most emetophobics dread hearing talk of exposure therapy and are even afraid to go to therapy at all, because they think their therapist might force them to vomit in order to cure them. Exposure therapy involves making a list of different situations that cause you anxiety and then exposing yourself to them, from the one that makes you least anxious to the one that makes you most anxious. For most phobias, this is simple and straight-forward, because you would fear an external thing, like a spider, and it’s easier to control your exposure to spiders and take gradual steps to face your fear. It’s trickier with emetophobia, because what you fear is an internal process that can’t always be controlled, and it’s not even healthy to repeatedly force yourself to vomit until you’re desensitized to it. But that doesn’t mean you can’t still make an exposure hierarchy. Even though you’ll have to leave off that final step, you can include many other things like “handle and cook raw meat,” “leave the house without carrying anti-emetics with me,” “go out to eat at a restaurant alone,” “go out to a restaurant with a friend,” etc. Whatever you avoid because of your anxiety.

Limit caffeine/alcohol/nicotine/drugs: I want to say eliminate them entirely, but I know that some may consider that extreme, and most people wouldn’t want to do that. But none of these are going to be good for your anxiety, obviously. Some are even used as a crutch to escape anxiety issues, which can lead to dependence/addiction and all the problems that come with that. I have heard smokers say that smoking calms them and stops their panic attacks. That is probably true. But it’s so bad for your physical health, and there are other anxiety-reducing techniques that don’t involve poisoning yourself and lowering your immune system. Plus smoking is a quick-fix that you will need to use again and again, whereas other tactics can have the long-term benefit of overall decreasing anxiety.

Meditation: Like deep breathing exercises, this is something that you can practice each day, and over time it will make you less anxious in general. There are lots of different ways to meditate. Basically, you sit in a quiet, comfortable place and try to quiet your mind and clear it of worries. You won’t be able to get rid of all your thoughts, but the idea is to stop judging them and to just notice/observe a thought as it comes into your head and then let it go.

Notice negative self-talk: I mentioned this before as part of CBT. Sometimes it’s hard to even be aware of all the negative things you are telling yourself, because it’s so automatic. It can be helpful to keep a log of times/situations where you feel anxious and then write down any thoughts you can remember having during or leading up to that situation. After a while, you will start to see patterns. You will start to see the most common things you tell yourself and how they affect you by making you feel more anxious and leading you to anxious behavior (like avoidance).

Online self-help or support: There are some websites, like MoodGYM and E-couch that teach you anxiety-fighting techniques and give you assignments and exercises to help you practice. There are also several blogs that focus on emetophobia or anxiety in general, and there are forums (support groups) you can join. International Emetophobia Society is the main one for emetophobia. There is also an emetophobia community on livejournal. I don’t know of any others, but I’m sure there are many more out there.

Psychiatric medication: Taking medication is something that has helped many people, even though I’ve decided not to go that route. It’s something that is hard for emetophobics to do, since they fear nausea/vomiting as a side effect. I have tried to take two different medications but stopped both after the first dose, because I didn’t like the way they made me feel. But neither of them made me get sick – plus my doctor told me that those side effects go away after a while if you can push through the initial discomfort.

Quit Questioning: Sometimes we start asking questions and can’t stop, and the answers we get rarely make us feel better. Seeking reassurance reinforces the idea that you can’t handle the situation and the anxiety on your own. Receiving reassurance reinforces the idea that there is something to fear. If you hear someone is sick, don’t ask them what they have, what their symptoms have been, if they feel nauseous, when it started, etc. If you feel sick, don’t ask someone else if they think you are sick or are going to vomit. Don’t ask how the chicken was cooked. Don’t ask your spouse/child if they have washed their hands. It is only hurting your chances of feeling better, and on top of that, it’s annoying to the people around you. (I am terrible at following this advice by the way. I am always trying to cut down on my questions, and if I can avoid asking 10% of what pops into my head throughout the day, it’s a good day for me.)

Relaxation recordings: When my anxiety started to get really bad, I began listening to a guided meditation CD once or twice a day for at least 20 minutes. I strongly recommend this if you are new to (or struggle with) relaxation techniques like meditation, deep breathing exercises, visualization. The CD that I listened to was helpful in the moment at calming me down and also helped me practice different techniques. There was even a progressive muscle relaxation track. I can't find a link for purchasing that one (I got it from a local store), but here is another one I have that is also really good - Sound Beginning: Guided Meditations for Inspired Living.

Stay focused on the present: When you are anxious, you become trapped in worries about the future that usually include the phrase “what if” – what if I am sick, what if my food wasn’t cooked well enough, what if that milk had expired, what if I vomit, etc. Mindfulness is a technique that teaches you to get your mind out of the future and back to the present moment where it should be. In the present moment, what are you doing? Are you eating a sandwich? Then focus only on that sandwich, on the act of eating the sandwich, on the act of chewing, on the taste of each bite. Are you vacuuming? Think only about the fact that you are vacuuming and try not to let your mind wander to anything else, like what you’re going to do once you’re done vacuuming. If you are talking to someone, concentrate on what they are saying to you instead of getting lost in your anxious thoughts. Focus on what you are currently seeing, hearing, smelling, tasting, or touching. It takes a lot of practice. The Miracle of Mindfulness by Thich Nhat Hanh is a great book for learning more.

Therapy: Going to therapy/counseling can be extremely helpful if you can find a therapist that is the right “fit” for you and that provides the specific type of therapy you want (talk therapy, cognitive-behavioral therapy, dialectical behavioral therapy, etc.). They won’t have a miracle cure – you will still have to do the actual work of coping or recovering yourself. But they can help you come up with coping strategies and/or recovery plans and implement them. Then as you’re working on your issues, you have someone to help you with obstacles, give you feedback, and hold you accountable.

Untangle the feelings in your stomach: Emetophobics are generally unable to tell the difference between feelings in their stomachs. Hunger, indigestion, fullness, heartburn, bloating, and even menstrual cramps will all be seen as “nausea” even though they are nothing like nausea. Emetophobics are constantly focused on their stomachs and the slightest sensation they feel will be interpreted as a sign of danger. Most people (and this definitely seems to be the case for emetophobics) also feel a lot of emotions “in their stomachs” like anxiety, sadness, anger, guilt. This means stress and anxiety can easily lead to an upset stomach, which for an emetophobic leads to more stress and anxiety. It’s important to try to correctly identify the feelings in your stomach. The easiest way to do this is to take nausea off the table. Tell yourself that you aren’t feeling nausea (even if you really think you are), and then figure out what else it could be, since you “know” it’s not nausea. Look for clues. Has it been hours since you’ve eaten? Probably hunger. Did you have a hard day at work? Might be stress. The idea is to develop a sense for different feelings, not to obsess more over your stomach – if you can’t figure it out, that doesn’t mean it’s definitely nausea. You may not always be as certain as you’d like, but you should become better at deciphering stomach feelings with practice.

Vitamins: This is along the same lines as what I said for “Food” about eating a healthy, balanced diet. Taking a multivitamin makes me feel better physically, which leads to less anxiety. I also started taking a B-6 vitamin (100mg) every day that has helped my anxiety during PMS by reducing many of the symptoms that I used to have.

Watch your anti-emetic consumption: There are some people that say taking anti-emetics (or anti-nausea) medication all the time is not unhealthy for you. I don’t believe that at all. I can’t say I’m definitely right. I’m not a doctor. But I don’t see how constantly taking things that are meant to suppress or alter the actions of your stomach could be harmless. They are probably all having other effects on your body, like the way Zofran will cause constipation. Plus, physical health aside, it’s not mentally healthy to depend on them. Emetophobics feel sick frequently, and for most of them, most of the time, it’s caused by anxiety. There is no need to take medicine to make yourself safe, because you already are. Telling yourself that until you can believe it will make you feel much stronger and safer in the long run.

Xerox: Pay attention to what non-emetophobic people do in certain situations and “Xerox” (or copy) their normal behavior. (I know, I’m stretching here. I don’t know what the English language has against “x” and “z” words.) An example of this for me: I have a problem with eating fruits and vegetables. They are not pre-packaged standardized food items that are all the same. So many times I have been about to eat an apple, and then I notice a tiny spot on it, get scared, and throw it away. Enter my vegan friend who eats more fruit than anyone I have ever met. He never notices the spots and discolorations that I see, and he doesn’t ever get sick from eating any of these “flawed” fruits/vegetables. It has made me much braver about eating them myself.

Yoga: I still don’t have yoga cemented as a habit in my life, but I really want to. It’s a combination of relaxation and exercise, two amazingly helpful things for someone with anxiety (and everyone else, really). It also usually includes deep breathing and helps with mindfulness. It helps you get in touch with your body and how it feels. There are a ton of yoga DVDs out there, and I have one of these that I use. There are bound to be yoga classes in your area too (at a gym or a health center maybe) if that sounds more appealing.

Zonk out: Better known as “get some sleep.” Lack of sleep can make you feel horrible, so try to get at least seven or eight hours a night. In high school, I was pretty oblivious to the effects of my constant sleep deprivation. The less sleep I got, the more likely I was to feel “sick” and get really anxious about it. It also generally made me sad and grumpy.

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.