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.

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.

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.

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.

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.