CYEAT: Chapter 8

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

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

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

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

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

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

CYEAT: Chapter 1

Ah, belief systems! The first chapter explores how your beliefs about the world influence the way you perceive the world, and how your perceptions then reinforce those beliefs.

For example, if you believe knocking on wood will bring you good luck, you're going to notice every single time you knock on wood and then something good happens. This will reinforce your belief. You're less likely to notice/remember the times you knock on wood and something bad happens.

Or (for a more negative emetophobia-related example) if you assume you're going to feel "sick" any time you go out somewhere, you will tend to notice the times you go out and don't feel well while overlooking the times you go out and feel fine. This is definitely one of my beliefs. I will complain to my wife that this always happens, that I can't ever go anywhere without feeling "sick" from anxiety, and she will remind me this isn't true and point out specific examples. She can see the whole picture, whereas I only see the bad because I'm invested in my belief - probably because 1) I get extremely frustrated and want to be able to express it in an extreme way ("this always happens" instead of "I hate that this ever happens") and 2) knowing there is potential to experience anxiety makes me want to stay home and if I can believe going out will always result in a struggle, it's that much easier to talk myself out of doing things.

Today was one of those good days that defies this belief. I went to see the new movie Into the Woods, which is pretty long (about 2 hours), and I didn't feel "sick" once.

At the end of the chapter there were a couple exercises about identifying what beliefs you have that may be limiting you (nothing about how to change them yet) and also a quiz, which excited me because I love taking quizzes. But at the end of the quiz there was no scoring or commentary. The author just said to set it aside and the book would come back to it later. Intriguing.

Nothing ground-breaking yet. I already know I have many flawed and harmful beliefs. But of course, it never hurts to remind yourself of these things. Even knowing I have these beliefs, I still don't always realize when I am reinforcing them and behaving as if they are true.

obsessive thoughts

I can't decide if I'm doing a particularly good job lately of living by the "emetophobia shmemetophobia" motto. I guess in some ways. But I've been noticing many areas where I need serious improvement.

I volunteered to help out at an event at my old college this weekend. I was at a registration table for some of Friday and most of Saturday, which meant having to socialize with a lot of people (and reflect on how terrible my social skills are, but that's a whole other issue).

It was early afternoon on Friday when I first got there, and one of the very first things that happened - I mean, probably within fifteen minutes of me showing up - was that a janitor walked by and stopped to inform me that I should be glad I hadn't been around this morning, because someone had thrown up in that room. She of course didn't know about my phobia and was just following that weird custom of gossiping about any vomit one has seen or heard about recently. I don't quite understand why people love to do this - maybe they feel compelled to because of their own disgust over the situation. I've encountered it many times in my life, but this was probably the first time in several years. It gave me déjà vu, because it's always so similar with the person lowering their voice and giving you this sly and almost gleeful smile. I've got something good, it's really really good, it's going to make me super popular with everyone, because it's about vomit! It's stuff like this that makes me want to stay home and never interact with anyone again.

She didn't give too much detail except to say it was "gross" and that it had all been cleaned up, but after she left I could not stop thinking about it. Wondering where it had been. Was I sitting right on top of it. Wondering, of course, if it had been from sickness or drunkenness or something else. I couldn't let it go, and it tainted the whole weekend for me.

My one success is that I still ate, and I ate pretty normal amounts. I'm proud of myself for that, because having heard this story, I didn't particularly want to anymore. I also only had one brief period (about five to ten seconds) of feeling on the verge of panic because of imaginary "sick" feelings. The rest of the time I felt fine.

But I couldn't bring myself to eat in the campus dining hall (the closest available food) and walked to a restaurant in town instead. The dining hall is buffet style, and I kept thinking the most likely way to catch any sickness going around would be to share food with all the students.

What really bums me out about this is that when I was a student there, I ate in that dining hall almost every single day and usually didn't worry about it that much. Now it seems like a terrible and dangerous idea. I've been thinking about this and realizing that my germophobic tendencies have gotten much worse since college. I guess that makes sense, because these days I am usually at home, which means I feel like I'm rarely in contact with other people's germs. That's not true at all. I still go out places, and even if I didn't, my wife does, and other people come to visit here occasionally. I'm not at all isolated, I just have the illusion of being isolated. It makes me feel safer, and then on the other hand it makes me much more anxious about certain situations and places that I used to be able to handle.

Logically I know that someone has probably thrown up in every single room on that campus, and that it was even happening when I was living there. I lived there for four years and encountered plenty of illnesses. I caught a lot of colds but managed to avoid the stomach bugs. Possibly that was just luck. Either way, it makes much more sense that I would have gotten sick then, while living there, than now, when I was just working there for the weekend. But it didn't feel that way to me. I felt like I left the safety of my apartment and walked into a hotbed of various illnesses.

On both days, the first thing I did when I got home was put my clothes in the hamper and jump in the shower. Then I thought about how that behavior has been gradually developing over the past few years, where I feel the need to get rid of all contact with the outside world when I come home from certain places that I feel were particularly dirty or germ-filled. In some of the books on OCD I've read, they talked about how people with extreme germ-focused OCD will have "outside clothes" and then have to change into their inside/home clothes as soon as they get home. This reminds me of that, and while the thought of me getting to that point seems ridiculous right now, I probably shouldn't dismiss the possibility. Which is unsettling.

All that extra anxiety just because I happened to hear about an instance of vomit that happened that day, even though it's likely happening all the time without me hearing about it. It's so difficult to get something like that out of your head once it's in there. It makes me think about how I watched the original short for the horror movie Mama on Youtube a few weeks ago and ever since then, I can't stop myself from imagining her standing behind me at night when I turn off the lights to go to bed. I normally don't let myself watch anything in the horror genre anymore. It was a tiny act of defiance (against my own limitations) that was clearly oh so stupid.

Sometimes I stop right before I flip the light switch and wait until I can think of something that is not scary that will hold my attention long enough for me to get to the bed. Sometimes that works. I wish that technique was as effective in the emetophobia situations, but there is no destination point (like the bed) where it feels like the obsessive thoughts can be let go, so instead I just have to keep reminding myself to replace them with positive thoughts, over and over and over.  

"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.