CYEAT: Chapter 9

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CYEAT: Chapter 2

Chapter 2 focuses on cognition and how the way you think affects your mood, your anxiety, your outlook on life (similar to chapter 1’s belief systems affecting your perception). It also goes into visualization, which I always find interesting.

The author talks about Coué's Law of Reversed Effort, which says (I'm paraphrasing) that when you want one thing to happen, but you are imagining or worrying about a different outcome, what you imagine will have a stronger effect than what you want. You can make it more likely something will happen by imagining/visualizing it.

Of course, that’s not always going to be true. If you want to have a safe flight and are worrying the plane will crash, you won’t make it crash. If you are worrying you will vomit, it’s very unlikely you will make yourself vomit. But you can make yourself feel “nauseous” and convinced you’re going to vomit by worrying you’re going to vomit, or even by worrying you’re going to feel nauseous.

Another example the author gives is losing a sports game because you’re imagining how awful it would be to lose, which then makes you anxious and causes you to lose your focus. Basically, your thoughts, your belief systems, your imagination, all of it, can influence your feelings and anxiety level, and that can have an effect on your behavior too.

To counteract this, it’s best to 1) tell yourself positive things and 2) visualize what you want to happen instead of what you fear might happen. Seems pretty common sense, right? Putting happy thoughts/images in your head can only have good results.

It’s difficult to do though. I spent months after my breakdown drilling affirmations into my head. I’ve gotten to the point where I can pull them out during an anxiety attack (and they are really helpful), but in general, I’m still usually thinking negative thoughts and putting myself down. It’s such a strong habit. And I hardly even know how to form a picture of what I want to happen when I’m so used to visualizing the worst outcome for every situation. The book recommends practicing these positive visualizations on a regular basis, sitting down for 5-10 minutes at a time and really fleshing out the visuals. I’m definitely going to start doing that.

emetophobia and high school

I hate having emetophobia, obviously. It impacts every area of my life and generally makes everything a little more difficult. But I’ve been thinking lately about what it was like to have this phobia during high school, and I have to say that was probably one of the biggest challenges I’ve ever faced – getting through every single day of those four years while having to deal with this fear. I’m so glad to have that behind me and have the utmost respect for anyone still in that situation, because it is incredibly difficult.

You are pretty much trapped in one building for the entire day, going straight from one class to another. You have all the usual stress of schoolwork, interacting with your classmates (some of them nice, some of them psychotic), interacting with teachers and counselors and administrators and security guards and bus drivers (some of them nice, some of them psychotic), and then when you add anxiety issues and panic attacks to all of that, things start to get incredibly messed up.

I definitely made the situation worse, because I didn’t take care of myself physically in any way. I thought it was fine to get four to six hours of sleep a night. I usually skipped breakfast and sometimes lunch too. Many days I just ate one giant meal after I got home from school and that was it. Plus my diet consisted mostly of things like frozen pizza and soda (yes, tons and tons of caffeine), which I guess is pretty normal for adolescents, but definitely not healthy. I wasn’t even really aware at the time of how unhealthy all this was, but I’m certain it’s the reason I had horrible stomach aches so frequently.

I’ve been remembering some of the ways I used to cope with these stomach aches and the anxiety that came along with them. For the most part, my coping skills back then were pretty unhealthy and I would not recommend them, but I’m going to list everything.

***
1) Probably my main coping mechanism was to dig my nails into my skin (usually the backs of my thumbs or other fingers) as a distraction from my stomach hurting. Not the worst form of self-harm, but it did sometimes leave marks that were embarrassing.

2) I skipped school a lot more than I should have because of feeling “sick” when I woke up in the morning.

3) Along the same lines, I went to the nurse’s office an abnormal amount of times and sometimes went home early from school. This fluctuated. I went through periods where I was in the nurse’s office almost every day, and other times it would be more like once a month.

4) I guess you could say skipping breakfast/lunch was a coping skill I used, although a really bad and counterproductive one. I was even afraid to drink anything at times and would end up dehydrating myself.

5) I would leave class to go to the bathroom just to calm myself down. Getting myself out of the classroom where I felt trapped would usually make me feel a lot better, and then I could convince myself that whatever was happening was mostly in my head. But obviously I could only do this one time per class, so I had to try to save it for when I really needed it. Sometimes I would break down early and then regret it later in the class.

6) In my notes for class, I would draw lines, each one representing a minute, for however many minutes were left in the class. I would watch the clock and keep telling myself “I can get through this next minute. I can get through this next minute” and then scribble through each minute line as the minutes passed.

7) I had a bunch of questions I asked myself to try to determine if I was actually ill, like "if I was home right now, would I still be feeling this way?"

8) I heavily relied on my friends. I was open with almost all of them about my phobia. Most of them understood, even if some didn’t grasp the full extent of the problem. My closest friends knew almost everything about it and were an amazing support system. It was so great to be able to talk to them and have them reassure me. They had mental health issues of their own, and we actually had a simple hand code to communicate with each other about how we were feeling (for when we were around a lot of other people, or when we were in class but sitting across the room from each other). Holding up a hand meant “are you okay?” or “what’s going on?” Then two fingers meant the person was sad, three fingers meant the person was fine, four fingers meant the person was anxious. One finger was the response that only I used. It meant “I feel sick” and everything implied along with that.

After a while we started using these numbers in our notes/emails and when speaking to each other too. I can remember many times answering the question “what’s wrong?” with “I feel one” or “oneness.” Even though “oneness” is basically a philosophy of unity/harmony to everyone else in the world, it will always make me think of feeling anxiety-related sickness.

Anyway, having that code and knowing that I usually had someone around who would understand how I was feeling was a big comfort to me.

***

I would say numbers 5-8 are the only good responses, and #5 is iffy since it’s better to wait out your anxiety than flee the situation you’re in.

I so wish I had been aware of all the anxiety-reducing techniques I know now during those years. I know just making the changes to my diet and sleep schedule would have had such a huge impact on how I felt, and using affirmations, mindfulness, and breathing techniques would have helped with the rest.

But I would recommend telling friends if at all possible. Unless your friends are jerks and you know they would only use the information to make fun of you or torment you (in which case it might be a good idea to get some new friends), having them know takes so much pressure off. Before I started telling people, it felt like this huge weight/burden and this shameful secret I had to keep, and that tended to make the anxiety attacks even worse, feeling like I was not just trapped in the situation and in the feeling of anxiety but also trapped inside my mind, alone, with the secret of what was happening to me.

I still find that in any situation where I feel anxious, if I can say it out loud to the person I’m with, it helps diffuse a lot of the anxiety. And most people are understanding about it, many more than I would have imagined back when I tried to hide it.

In general, I was embarrassed by the way I acted a lot of the time in high school. I’m still embarrassed thinking back on some of these things. So I just want to say that if anyone reading this is in high school and feels this way, cut yourself some slack. Emetophobia and high school don’t mix well. You’re basically a superhero for every day you deal with both. Whatever you can do to get through it (aside from hurting yourself/others), it won’t be that big a deal in the long run. And college (where you have a little more freedom to design your schedule and can include breaks between your classes) is not nearly as terrible.

when in doubt, say yes

There hasn't been much change with my phobia lately. I still feel "sick" at least once a day, usually when I know I have to go somewhere soon or I'm already out somewhere. Or when it's early morning and I've woken up for some reason and want to get back to sleep.

For the most part, I don't feel a lot of anxiety, and I've also gotten way better at ignoring the fake sick feelings and moving on. But it feels like I've hit a plateau and can't get to the next level. I never want to do anything but sit around at home. I have to be talked into going anywhere. I'm even anxious at the thought of going on a walk around the neighborhood, because what if I start feeling ill and I'm several blocks away from home?

I have to keep reminding myself that this isn't new at all. I have been reluctant to leave the house almost my entire life. My friends in middle and high school usually had to talk me into going to the movies with them. I would always worry about it, especially if there were going to be people there who didn't know me that well and didn't know about my anxiety issues. What would they think if I started panicking? In other words, it's an ingrained habit to want to say no, one that may take a long time to change.

I guess I'm lucky in that I've always been aware that if I didn't keep forcing myself to do these things, day after day, year after year, it would quickly lead to very bad consequences (as in being unable to even walk out my front door). I've always told myself things like "you have to do this. You didn't do the last three things. Now do this one because none of them are ever going to be safe enough."

I do feel like I've gotten worse with regards to my tendency to want to be home. I lost the momentum I had in school, having a larger circle of friends, people who always wanted to hang out, events to go to, classes to attend. I started working from home, and now it sometimes feels like I don't even know how to be in public anymore.

But I also think I've gotten better in the past couple years at forcing myself to go out when the opportunity arises. It's definitely been my mantra this year - "when in doubt, say yes." If I'm unsure about doing something, if I'm thinking things like "I'm anxious about the idea of going to hang out with people" or "what if I get sick on this car ride?" or "what if this other bad thing happens?" then I take that as a clear sign that I have to go. That it would be bad for my mental health if I didn't. I don't want to let any of those thoughts dictate what I do, especially when it means I'm going to end up sitting at home watching TV some more. Even though I feel like that is what I'd rather do, and forcing myself to go somewhere else feels like self-punishment, I usually end up having a good time and am happy I went.

It's hard to work up the courage, and I've been forcing myself to think things like "so what if I go on this walk and end up getting sick three blocks away from home?" and trying to convince myself that I believe what I'm telling myself. I know I don't actually feel nonchalant about the possibility of that happening, but it works well enough for me to take the small risk of walking out the door. It works well enough for me to focus on the fact that I don't feel sick at that moment, and if I feel sick a few minutes later, after I've already left, oh well. I'll deal with those moments when I get to them.

It works for other situations too. Like sleeping. Sometimes I will be afraid to go to sleep because I don't feel well. It used to be that I would take that as a sign that I should stay up and wait until the "sick" feeling passed and I could be sure it was safe to sleep. Now I will go to bed anyway, and I tell myself that this doesn't necessarily mean I have to go to sleep. I'm not going to sleep, I'm just going to go lie in bed and see what happens. But once I'm lying in bed, in the dark, tired, I can't stop myself from drifting off even if I'm still half-worrying in the back of my mind.

And eating. I used to refuse to eat if I didn't feel well, even after I realized that lack of eating (low blood sugar) can also make you feel sick. Now I'm training myself to go get food when I don't feel well and haven't eaten in a while. It could be low blood sugar. Maybe not, but I'll eat at least a few bites of something and see what happens. Usually it starts to make me feel better and I eat the whole thing.

So basically, whatever my phobia is telling me I shouldn't do, I am doing. I think it's working out pretty well. I went on a weekend trip recently to a place that was a 3-hour drive away. I went to game night at a friend's house. I've been taking walks regularly. I've been saying yes to whatever comes up. I still wish I could get to the point where I actually wanted to say yes, but I may be far away from that point, and in the meantime, I'm happy to report that most of my yes-es are turning out to be fun enjoyable experiences.    

forums

I haven't had another panic attack since that one at the grocery store last month, but my anxiety levels have still been all over the place. Some days have been perfectly fine, others not so good. I have been meditating and doing deep-breathing exercises more. I have been looking through my affirmation flashcards. Hopefully this is helping me even out, but I haven't noticed a significant change yet. That might be because I am still not doing these relaxation exercises consistently enough. I should be doing them every night, but right now it's more like twice a week.

Another change I made that I do think is really helping me is that I stopped going to emetophobia forums. Up until maybe a year or two ago, I never went to these forums. I mean, I can remember popping into them a handful of times during my teen years, but they bored me. I really had no interest in putting more effort into handling my phobia then. I felt like I did well enough. But when things got worse, I started visiting them, thinking they might be helpful.

It's been just the opposite for me. I feel like they have made me worse. And they were somewhat addicting too. I couldn't stop logging in for a while, reading everything, leaving comments with advice occasionally. I tried to avoid threads that looked like they might contain information I didn't want to have in my head. For example, I try not to read anything anyone posts anywhere ever about norovirus. I don't care if it's facts about it, helpful tips on avoiding it, how it's spread, good news about it, whatever. I know I have the potential to get so unbelievably obsessive about it. The information gets stuck in my head, and I find myself changing my behavior.

But it wasn't always easy to tell what might be in a thread, and I still kept coming across this negative information. I remember one night I had just eaten Pizza Hut for dinner. Then I logged into one of the forums, and the very first thing I saw was a thread titled something like "Pizza Hut food poisoning" or something like that. So I didn't even have to click on that one for it to make me anxious!

That is what annoys me so much about groups of people with emetophobia getting together. Inevitably, 90% of what is discussed will be things like that. People asking which foods or restaurants are best to avoid. People posting in a panic asking for someone to give them a safe/benign reason why they feel sick. I wish there was more discussion of how to deal with the anxiety/phobia itself. But I notice that when people bring up this point on the forums, they usually end up getting attacked by people who are "anti-recovery" I guess, that stress they would rather it be a "support" group than a "recovery" group. I find it odd. I think the best support is encouraging someone to recover. If someone had encouraged me to work on recovery when I was younger, I'm sure I would have ignored them, so yes, I agree that no one can/will recover before they're ready. But at the same time, during those years that I was technically "anti-recovery" I wasn't "pro-support" or at least not that kind of support that seems like a merry-go-round of scaring each other. I don't see how that helps anyone.

I have become very afraid of eating out at restaurants during the winter, and I know that is a direct consequence of hanging out on these forums and seeing other people constantly post about being worried about this. It's something I never thought about before. I have eaten out at restaurants year round my entire life, and I have never gotten sick from doing so. My method of eating out whenever I wanted to did no damage, and there was no need for anything to change. But I have changed and am now extremely reluctant to eat out anywhere until it's spring/summer again.

I feel frustrated with myself for letting myself be influenced like this. It seems I can't read the fears of other emetophobics on a regular basis without being affected by them. So I have stopped going to these forums, and now I'm hoping that as time passes these extra thoughts/fears I've acquired will drift out of my head again.

It's a little disappointing, because, first of all, it is exhilarating to be in contact with so many people who understand the way you think. And also, every so often, I would come across something that was uplifting or helpful. But it was so rare, and it's just not worth digging through all that negativity for those few positive gems. 

I think I'm much better off sticking with blogs. I've always found they tend to be more recovery-focused and positive, since they are more about sharing information than getting support. I've never seen a blogger post while having a panic attack and expect someone to immediately show up to talk them through it (maybe because bloggers know they're addressing a smaller audience). I really like that. I'm looking for less agitation in my life and more understanding of the fact that anxiety is really something you have to handle on your own. Not that I don't sometimes rely on my wife to calm me down, but I like to see those times as times where I have failed myself. Any time I can fix a situation on my own, I know I've just done something that is so much better for me in the long run.         

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.

self-healing rituals

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

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

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

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

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

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

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

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

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

"it's different this time"

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

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

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

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

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

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

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

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

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

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

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

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

accomplishments

I finally did it. I made a doctor's appointment for a check-up. It's at the end of August, and I'm already really worried about it. I can't even put my finger on why exactly, but I guess it's a fear that I'll find out I have some horrible health problem. Or that I have one, but it won't be identified, because I will forget to bring something up or describe something incorrectly. I feel like I should make some long list of all my concerns to take with me, so I don't forget anything. But that would probably be annoying, huh?

I also have been trying to take better care of myself physically - exercising and eating healthy. I wouldn't say I'm doing either enough, but I'm keeping it in mind as a constant goal, and I have been doing better than usual. Last Friday I took the day off work and dedicated the day to relaxation. I didn't speak all day (just thought it'd be nice to have an atmosphere of absolute quiet). I tried to eat all my meals mindfully. I took a long walk around town (it was a gorgeous sunny day) and then did about 45 minutes of yoga. I worked on some writing projects and then later that evening, I listened to my meditation CD. It was the perfect vacation day.

Then over the weekend, I went to see the new Pixar movie Brave. There were of course children in the theater, and as a general rule, I try to stay away from them. They scare me quite a bit, because I see them as being constantly sick. Seriously, it seems like my (almost 2 year old) nephew is sick with something different every single week, sometimes things I have never heard of. But I was able to handle the movie without feeling much extra anxiety. I tensed up slightly every time one of the children walked by me and kind of leaned away from them. That was about it. The movie was incredible, by the way. It was the best kids' movie I've seen in a long time.

After the movie, I went out to eat at a restaurant I've only been to once before. I was really hungry and ate a lot, including dessert. I only had a little anxiety, and it was in the car after leaving, when I realized how full I felt. But it (the anxiety) passed quickly.

I'm so happy with all of this. I feel like I'm doing really well, other than freaking out about the doctor's appointment. It's not for a while, which could either mean I have plenty of time to calm down about it or that I have plenty of time to get more and more anxious. Of course, that's up to me and what I choose to think, so... time for affirmations! 

defeating the health anxiety (again)

Last week I noticed a dull pain/ache in my stomach/abdomen area. My first response to something like that is always to try to ignore it. But it persisted for a couple days, and then I started getting really worried about it. I broke all my rules. I did an online search for my symptoms (not at first - I think I held out for at least two or three days, which admittedly is kind of pitiful). I found websites that made me think it was cancer. One of the websites even had a note advising that it was much more likely it was another smaller problem and that only 5% of cases would be cancer, but of course I kept thinking "I could be part of that 5%!"

I then spent a few more days thinking about all this information and my possible impending death, which made me into a semi-mess crying frequently over minor things. I kept mentioning the pain to my wife, and she kept making efforts to downplay it (since I was making no effort to do so myself), but I kept arguing with her about it.

I've read many articles about people who developed some serious health problem. I don't know why. I don't seek them out, but they seem to be everywhere, trying to scare people into taking better care of themselves or going to the doctor more often. I think the only effect they actually have is making anxious people more anxious. It's like those commercials for aspirin where there is a guy saying something like "I'm in great physical shape and run marathons all the time. Imagine my surprise when I had a heart attack completely out of the blue." You could be next! Buy aspirin!

Anyway, in a lot of these articles they will have a quote from the sick person talking about how they were fortunate enough to catch the problem early because they just "felt like something was wrong" and went to the doctor. No specific symptoms. They make it sound like it is just a vague sensation of something feeling different in your body. I think I even saw one article that said the sick person had dreamed about something being wrong with part of their body, which influenced them to go to the doctor, where they discovered it was true!

Do things like this actually happen, or is it just people being dramatic or trying to look like they have a special sense for detecting illness? I don't know. But, me being who I am, I got the idea in my head that it was of the utmost importance that I notice any changes in my body and take them seriously. SUPER seriously.

Well, that was a mistake. Maybe it is good advice, if you don't have anxiety. But it doesn't work for someone like me, because I am almost constantly noticing things about my body that seem "off" in some way or that I can't recall ever feeling before.

So basically, whether the advice is good or not, I need to let it go. I'm not going to be one of those "special-sense" people (if they even exist) - it's definitely not in the cards for me. All I'm going to end up doing is freaking myself out over and over and over again.

I finally managed to get past the autopilot anxiety and convince myself that worrying about the pain was in no way helpful. Worrying wasn't going to make me go to the doctor. If the pain was still there after a few weeks, I would, but not before then. I would only be making myself miserable until that point.

("I'm learning to let go of worrying. I can replace worrying with constructive action.")

So I forced myself to stop dwelling on it and distracted myself as much as possible. And a day or so after that, no more pain. Which means that not only was it not the 5% cancer, it wasn't even the 95% more benign problem. 100% nothing. Probably indigestion of some sort, made worse by my constant stress and attention to it.

It still shocks me that with all I know, I can go so wrong. Catastrophizing is a bitch.

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

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.