thoughts on being overcautious

I'm back. I have something very important to share. Here it is!

Nobody wants to have bad things happen to them, especially if those bad things involve harm to their body.

Which you know, of course. That's obvious. But there are related implications that I find very reassuring and that really didn't occur to me for years. Once I realized what this truly meant, it became much easier to calm myself down in a variety of triggering situations.

You want to avoid catastrophes, and so does everyone else. So does our society in general. This is why so much of our world is designed to be easy to use for, let's say, those who don't have a lot of common sense or don't think things through. This is why you'll encounter warnings like don't drink this chemical, don't let your child play with this plastic bag, don't stop the chainsaw with your hands, etc.

Not only do we get these warning labels for almost any imaginable danger, we also have more common warnings drilled into our head by the people around us, pretty much from childhood. Don't go swimming during a storm. Don't get in a stranger's car. Everyone learns the general scenarios that could lead to danger, and, depending on their personality, respond with varying levels of caution.

Which brings me to you, unfortunate person with severe anxiety. I am guessing you're extra cautious when confronted with any of those scenarios or warning labels. I am guessing you also have a wide range of scenarios you have decided are dangerous all on your own, without anyone else telling you so (or agreeing with you) and are constantly doing your best to avoid those scenarios or take (most likely unnecessary) steps to make yourself safer.

But remember, nobody wants to have bad things happen to them. Especially if those bad things involve harm to their body. And with regards to whatever you fear, ask yourself: if there was an actual danger of this behavior or situation causing harm to my body, wouldn't I have heard about it before? Wouldn't I have heard or read something, somewhere, about it potentially causing harm?

If eating parts of the apple too close to the stem could cause me to get sick, wouldn't I have heard about that?

If this dental procedure I'm about to go through was likely to make me vomit, wouldn't I have been told that was a possibility?

If watery sour cream or watery yogurt was a sign that it was likely to be bad in some way and give me food poisoning, wouldn't that be one of those things that I was warned about all my life?

Those are just a few of my own personal examples.

I don't know how to stop these little worrying thoughts from popping into my head, as they still do, regularly. But I have found this line of thinking to be an effective countermeasure, a way that I'm often able to dismiss the worry.

If anything has a good chance of making you get sick, it's incredibly unlikely you wouldn't 1) already know about it or 2) be warned beforehand.

CYEAT: Chapter 12

Throughout this book, the author keeps dropping hints of a special technique he developed that you’re going to learn later to help reduce anxiety and change your negative thoughts. Well, in this chapter, that special technique is finally revealed, and I’m not all that surprised it was a bit of a let-down.

It’s not even that it’s not a good technique. It is just very similar to the anxiety-reducing advice you would get anywhere else, kind of a melding together of a few different common techniques (noticing and countering negative thoughts, positive visualization, self-esteem building).

The technique, I’m sure, could be helpful. It’s the trademarking and the weirdly intense hype that lead me into the mindset of ‘that’s it?’ Before finally telling you the technique, the author builds it up for several pages. I honestly feel like I am watching an infomercial at times. This will make your life substantially easier! Quick and simple! Anyone can learn it! You don’t need to believe it, just do it! Stop living a life that isn’t really the life you want! This may seem like other techniques you have used, but it is actually very unique!

It is a pretty short chapter, especially if you disregard the lengthy sales pitch. The exercise at the end is to keep a log of every time you can use this technique to combat an anxious or negative thought over the next week. If I’m wrong about the amazingness of this technique and it works much better in practice than it sounds, I’ll report back here.

One part of the technique is focused on detailed visualization of a positive outcome, and that is something I’ve been thinking about a lot lately. Because I am great at envisioning everything that could go wrong, but I don’t put nearly enough effort into imagining something could go well. Or even adequately. And it has usually been the case that things don’t go quite as badly as I thought they would.

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 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 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.

list of self-help books

I'm pretty sure I've talked about all of these books before in other posts, but I thought it might be helpful to have them all listed in one place.

If you're not able to get any of these, please check out this post where I linked to some great free websites that help guide you through anxiety-fighting techniques.

1) The Anxiety & Phobia Workbook - Edmund J. Bourne

If you can only buy one book from this list, this should be the one you get. In my opinion, it is the best book on anxiety out there. It covers so many different skills, techniques, and exercises. It has information on all the different anxiety disorders, anxiety-related research, types of medication, good nutrition and exercise habits, etc.

The only downfall is that if you're in the middle of an anxiety crisis, the amount of information it contains can be a little overwhelming. If you are feeling overwhelmed, I wouldn't sit down and read through the entire book all at once. It is more manageable one chapter at a time. Each one gives you so much to think about that it is probably better to take breaks anyway, just to let it all sink in.

2) Cognitive Behavioural Therapy Workbook for Dummies - Rhena Branch and Rob Willson

This book was very helpful for me. I was new to trying any kind of CBT work, and it lays out the methods in simple, easy to understand ways. It has tons of exercises to work through (charts to fill out, questions to answer) to understand the faulty/irrational ways you think/act and to help you correct those thoughts and behaviors. It also includes chapters on using CBT to help with depression, low self-esteem, maintaining relationships. I skipped most of that and only worked through the anxiety-focused chapters.

3) Get Out of Your Mind & Into Your Life - Steven C. Hayes and Spencer Smith

I've been meaning to take a second look at this one. I really didn't care for it when I started working through it the first time. It focuses on acceptance and commitment therapy (ACT), and I am a much bigger fan of CBT than ACT. ACT teaches that rather than trying to control your thoughts, you should just accept them and learn to live your life with the anxiety (or other unpleasant emotional pain), still doing everything you want to despite the problems you have.

For one thing, I feel it is possible to control your thoughts and change your behaviors. It's extremely difficult, but I have seen it happen in small ways with myself. For another thing, when it comes to emetophobia, I get confused as to how you can just accept it the way it is and push yourself to live your life. But I don't think I got far enough in the book to be able to say I fully understand their method.

4) Living with Emetophobia: Coping with Extreme Fear of Vomiting - Nicolette Heaton-Harris

I wrote a detailed post about this book after I read it. To summarize, I feel it is a helpful book if you are looking for validation of your issue, a detailed description of your problem and everything you have to deal with, or if you want someone else to understand and you are looking for a book to explain emetophobia to them. The book is about the author's experience of living with emetophobia, and if you have emetophobia too, it's likely you'll relate to most of it. It's also likely that there are some anxiety thoughts that the author has but you don't have, and the book could be triggering in that sense. You could end up acquiring new anxiety thoughts/behaviors, so I would be careful when reading this one, if you decide to.

5) The Miracle of Mindfulness - Thich Nhat Hanh

This book is an in-depth look at meditation and mindfulness, two techniques that can be helpful in fighting anxiety. There is also a lot of Buddhism in the book. I'm not a very religious or spiritual person. But you can skim past those parts. I would say probably the best part of the book is near the end, the section called "Exercises in Mindfulness". There is also a section after that called "Selection of Buddhist Sutras" - both of these sections can give you ideas to help with meditation or mindfulness.

6) Overcoming Health Anxiety - Rob Willson and David Veale

This book is similar to the CBT workbook for dummies. It walks you through CBT techniques and exercises, only in this book it specifically applies them to health anxiety. I have a lot of general health anxiety on top of emetophobia, so I found it really helpful.

The book also contains a chapter dedicated to emetophobia. I didn't think that chapter was as helpful as the rest of the book. I would say the same thing about it as the Living with Emetophobia book described above - it is a good description of emetophobia, but it could be triggering and give you more things to worry about that you hadn't been worrying about before. It had that effect on me, but luckily, by now I think I've forgotten all the new worries it gave me. If I was reading the book over now, I would just skip that chapter. The exercises in the rest of the book can be applied to emetophobia as well as any other health anxiety.

7) Freedom from Obsessive-Compulsive Disorder - Jonathan Grayson

I don't have OCD, but during the time period where my anxiety was the worst, I started having a bunch of horrible intrusive thoughts/obsessions that bothered me even more than my emetophobia. I bought this to try to figure out how to deal with those, and it is an amazing book. I would actually recommend it to anyone with an anxiety problem, even if it's not OCD.

The premise of the book is that for people with OCD (and I would say any anxiety disorder), their main problem is that they are unable to accept uncertainty in life. This is so true for me, and it's something I've thought about frequently ever since reading this. So if I was worrying I was sick, instead of telling myself that it is extremely unlikely that I will get sick and in CBT-fashion using logic to try to prove that, I would tell myself "you might get sick, and you should deal with that possibility because the alternative of not being able to deal with it is ruining your life." I suppose it might be similar to ACT (acceptance of anxiety versus fighting it), but the way the author related it all to the fear of uncertainty made so much more sense to me. The book also focuses on exposure and response prevention, or exposing yourself to your fears and then preventing yourself from engaging in irrational behaviors as a result.

Just a warning, a large chunk of the book deals with specific OCD problems, like checking, counting, etc., and if you don't have those issues, there is probably no need for you to read any of that. I felt the rest of it was worth getting through those (for me) unnecessary sections.                

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.

"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.

dentist anxiety

I had to go to the dentist today to get some filling work done. They gave me a tiny partial filling in one tooth, and they also removed a filling I got when I was a child (one of those old mercury ones) and replaced it with the upgraded version.

I'm surprised at how anxious I was. This procedure was nothing compared to the wisdom teeth extraction, but for some reason I had lower anxiety during that one. Maybe just because I had lower anxiety in general back then.

I wish I was more comfortable talking to people (like dentists, doctors) about my phobia. I always think to myself that maybe I should give some brief explanation before they do whatever they're going to do, but I usually chicken out. They see I'm anxious, but they assume it's because of the pain, so that's what they reassure me about. I don't worry about the pain that much. I worry about all the objects and substances being shoved in my mouth, especially the substances. I worry about my mouth being numb. I also don't like being horizontal while they're doing all this, and I really hate it when they adjust the chair to the point where my head is lower than the rest of my body. It's awful to feel like you're upside down when you're anxious.

There were all these nasty tastes in my mouth after a while, and I could feel myself getting very scared. I was starting to feel "sick" and could feel my heart pounding in my stomach. Sometimes (here being a good example) I'm almost grateful for my social anxiety, because I fear that without it I would be much more likely to escape situations, to sit up right in the middle of my filling and say "okay, I'm done here." But I don't want to embarrass myself, so I search around desperately for things to tell myself to make myself stay, like:

• They do this procedure all the time. They can't possibly expect that whatever they are putting in my mouth would cause nausea/vomiting. If they did, they would have something ready in case of that happening. They would have warned me.
• My heart is pounding. This is clearly anxiety. Don't forget to keep breathing, slowly and calmly.
• Even if I did vomit, it's not as though this is a normal public place, like a mall. It's like a doctor's office. I wouldn't have to feel as humiliated about it here.

If I can visualize my mouth as disconnected from the rest of my body, it's easier. All the numbness and drilling and other stuff is going on there, not anywhere else. I can use my nose for breathing. I don't have to swallow. I just pretend it's not a part of me, or at least not a part that I need for the moment.

The procedure only took about fifteen minutes. When I sat up at the end, I discovered I was really shaky, so walking out to the car felt weird. Also, once I started driving, I started feeling even more "sick" and had to pull into a parking lot and sit for ten minutes to calm down. I had a bottle of water and probably would have felt better if I had rinsed out my mouth, but there's the downside of the social anxiety. I couldn't talk myself into doing that where other people could possibly see me. So I just took sips of the water instead, which helped a lot. Every time I swallowed a little water, the sick feeling went away temporarily, so I started driving again and kept taking sips all the way home. By the time I got there, I was feeling better.

I know I should be proud of myself for getting through it. I won't have to worry about it anymore, and it's nice to know I no longer have mercury in my mouth. But man. Right now I just feel wiped out. Anxiety is exhausting.

tricks

I have been doing so well lately. I've been going out to restaurants and eating with little anxiety. I've been going other places without experiencing much anxiety. I've been eating at home even when I don't feel well, forcing myself to stick to a normal eating schedule.

I even decided to terminate therapy, because I feel like I have gotten to the point where I can handle situations on my own. Since then, I've had a few "oh god what have I done" moments of panic, but I just remind myself that I can go back if I ever need to, which brings me back to the realization that I'm doing okay without it. In fact, I think I could have stopped going a while ago, but I guess I had this fear that if I didn't show up on a regular basis and announce that I hadn't had a breakdown that month, I would jinx myself, and it would happen again. Like a fear that I was being too confident and would possibly miss signs that a professional wouldn't.

So far, so good.

I should be pushing myself more than I am, but I'm still happy with the way things are at the moment. I'm trying not to stress about any of it. In a rural area, there aren't exactly tons of ways to push yourself out of the house. I'm planning on going to a movie and lunch this weekend.

Life may not be super exciting, but I did start having an exciting new thought. I'm going to put it in the category of "positive mind tricks." By the time I hit middle school, I had come up with a bunch of thoughts I used to argue myself out of anxiety in public. They were really helpful, but I started thinking in the past couple years that maybe they weren't healthy. I don't care as much right now, because right now I'm more in the mentality of "living my life" than "step-by-step recovering." So I'm still using them. The main ones I have relied on are:

-- If I was home right now, would I still be feeling this way? When I was younger, I pretty much only felt "sick" if I was out in public, so most of the time, this question was all I needed.

-- If I was home right now, would feeling this way be bothering me as much? Kind of the same thing. It helped clue me in to what I was feeling specifically. If it was hunger, envisioning myself at home with the feeling would help me realize it was hunger.

-- Does the thought of leaving right now, immediately, make me feel any better? Why yes, it does. Look at that. Anxiety. Sometimes I would even test this by going outside or to the bathroom for a few minutes, and I would instantly feel much better, giving me the courage to go back.

-- Is anything else making me feel better? Sometimes I would notice that I was feeling "sick" and then something really funny or really scary would happen, shocking me out of it temporarily. Once the shock subsided, the "sick" feeling would come back, but the proof of being able to briefly feel better was still there.

-- How fast did this feeling come on? Usually leading me to the realization that ten, fifteen minutes ago, there hadn't been the slightest sign of anything being wrong. Actual sickness comes on more gradually.

There are probably more I'm not thinking of, but you get the idea.

I don't know where this new one came from. It just popped into my head maybe a couple months ago when I was sitting at home feeling "sick" and starting to get really anxious about it:

You would be damn lucky to only feel this bad right before vomiting.

I love it. I love how it's not a question. I love how it works at home. I love how it has gratitude built into it, something I'm trying to express more of. Though I've only thought about it during moments of anxiety and feeling mildly unwell, I have this idealistic hope that it would be comforting even if I was sick, even if I was about to throw up. Because nausea, even at its peak, is never going to be unbearable pain. At least that's what I gather from non-emetophobics. Unbearable pain by definition is a level of pain that would make you lose consciousness, but people don't lose consciousness because of nausea, even severe nausea.

Again, I know it's idealistic, and my new trick probably wouldn't hold up in the face of actual nausea and illness, but it is helping me quash a lot of budding anxiety attacks.

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

movie excursion

I went to see the new movie The Hunger Games yesterday. It was fantastic, by the way, and without having to include any vomit or excessive gore. Hurray for the PG13 rating!

It was two and a half hours long, and I felt "sick" for about the first half. But I didn't leave the theater, not even for a quick break from the anxiety. I'm wavering between optimist/pessimist viewpoints. Optimist: "I stayed the whole time despite how awful I felt! That's wonderful! Success!" Pessimist: "Okay, so my behavior was good, but why can't I control my anxiety more so that I don't feel this fake sickness 50% of the time I'm out somewhere?"

I've been told I have a bad habit of being way too hard on myself, so let's just choose Optimist and run with it. I did manage to calm myself down so that I felt okay for the second half, and there was a lot of mental work that went into that success (and the success of staying the entire time):

-- I wanted to leave several times to compose myself and didn't let myself.

-- When I feel "sick" I never want to swallow, because I'm afraid it will push me into throwing up. I kept forcing myself to swallow and then drank water to prove I was not going to get sick.

-- I wanted to get my wife to reassure me somehow, either by asking her if I was sick or by asking her to feel my forehead, but I didn't let myself.

-- I reminded myself of all the evidence pointing to anxiety, not sickness (I felt fine up until the movie started; I have had many experiences going to a movie and feeling the exact same way, and it has never resulted in me throwing up; there were some parts of the movie that were making me laugh, and it's pretty unlikely I would be so alert and able to enjoy the humor if I were actually sick).

-- I told myself that in the unlikely event of me actually getting sick, it would not be the end of the world. It would be embarrassing and unpleasant, but I would survive it.

-- I tried a visualization exercise where I focused on one of those little red floor lights that guide people along the aisle and imagined transferring all my anxiety and "sick" feelings into that light. I imagined the light could contain all of that unpleasantness, and then it would no longer be in me, and I would be free to enjoy the movie. It really seemed to help some.

Ta-da! A six-step guide to passing for a normal movie-goer!

But it will not always be so hard. Repeated exposure is the key. It seems I really have no choice but to go see The Hunger Games several more times. And I suppose I'd better treat myself to some more delicious restaurant meals as well. Whatever's good for recovery!