logotherapy

I recently read Viktor Frankl's book Man's Search for Meaning, which is both a memoir about his experiences in concentration camps during the Holocaust and an explanation of his therapeutic method/theory called logotherapy.

It was an amazing book, as I knew it would be. I had wanted to read it for probably two years and kept putting it off because I was afraid. For the past two or three years I have been trying to avoid books, movies, news articles, etc. that I thought would make me have any kind of strong emotional reaction. My anxiety issues had gotten so bad that whenever I felt extreme sadness or fear or disgust I would feel "sick" or worry that the emotion would make me lose control or go crazy in some way.

Over the past few months I've been testing this boundary. I've watched a couple horror movies I had never seen before. I read a few books that were really sad or had disgusting parts. Nothing bad has happened. I enjoyed the movies and books and didn't freak out. Probably the ultimate test was going to see the movie August: Osage County last weekend. This one took me by surprise, as I actually thought it was going to be more light-hearted than it was. The previews showed a lot of Julia Roberts / Meryl Streep banter that reminded me of the interactions between Lorelai Gilmore and Emily Gilmore. But the movie was not like that at all. It was dark, dark, dark. From the very first scene, I became tense and felt kind of queasy and upset through the entire thing. I even thought about walking out at some points. But I stayed, and I felt like that was the final proof that I can handle pretty much any form of entertainment again.

Back to Man's Search for Meaning. I loved it and was extremely interested in the concept of logotherapy. I didn't know much about it. Basically it focuses on searching for the meaning in your life rather than trying to solve the problem of suffering (because there will always be suffering of some sort). From the wikipedia page:

"Frankl’s concept is based on the premise that the primary motivational force of an individual is to find a meaning in life. The following list of tenets represents basic principles of logotherapy:

• Life has meaning under all circumstances, even the most miserable ones.
• Our main motivation for living is our will to find meaning in life.
• We have freedom to find meaning in what we do, and what we experience, or at least in the stand we take when faced with a situation of unchangeable suffering."

The concept is appealing to me. I feel like what started to make me feel happier about my life was trying to ignore/minimize my anxiety and focus on the rest of my life instead ("Goals" from my list of coping techniques). Realizing that I would probably never get rid of this phobia (or anxiety in general) completely, and even if that was true, it didn't have to be my entire existence or identity.

It's as if a person wants to cook breakfast, but there is a giant box taking up most of the space in their kitchen. They are still able to make the meal. It's just a little more difficult because they have to work around the box, make sure not to trip over it and spill food, make sure not to stub their toe or bang their knee on it. I'm trying to think of anxiety as being like that annoying box. What's my objective? What do I want to do? Once I know that, I can figure out the exact ways that my anxiety will present itself as an obstacle. Then I can figure out (using various other coping techniques) how I can deal with that anxiety and do what I want to do anyway.

It's worth working around the box to get the delicious meal in the end. And even if the worst happens, like you trip over the box and spill all your ingredients, then you would just have to start over. Go to the store. Get new ingredients. Try again. Because you can't just not eat. And living your life and going after your goals, finding your purpose/meaning, should be as vital as eating.

One of my favorite quotes from the book:

"What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge of tension at any cost but the call of a potential meaning waiting to be fulfilled by him."

challenges

I've been seeing so many inspiring stories on emet blogs and forums recently, stories from people who are pushing themselves to confront their fear. It's exciting, and it's been encouraging me to look for ways I can do the same. I have definitely talked a lot on here about the benefits of challenging yourself, about how important it is to get out of your safe "bubble." Yet I am usually at home. Or if I'm not, then I'm in the safest possible non-home place, like an uncrowded grocery store. Not much point in knowing what to do if I never do it.

Half the time I don't even notice the little ways I'm avoiding. The first Hunger Games movie comes out this month. It comes out the day after my birthday, and I really want to see it. Perfect timing, right? But my first instinct was to say no, we can't go that weekend. It will be too crowded. Let's wait a week or two. A few days went by before I realized what had happened. Saying no, planning out "safe" ways to do things, is such a strong habit. That's my first challenge for this month. I'm going to see the movie that first weekend. Maybe it will be really crowded, maybe not. If it is, it's a chance for me to learn to deal with it. Large crowds can't always be avoided. I'm even hoping to someday live in a city again (I'm in a pretty rural area right now), so I know I'll have to be in contact with large groups of people then.

My other challenge is work-related. My boss asked me if I would visit another company sometime in the next month and observe how things run there. I've been asked to travel for my job a few times, and it's usually long-distance travel, sometimes even leaving-the-country travel. I always say no, or worse, I say yes and then slowly back out of it. This time, the place I've been asked to go is about a ten to fifteen minute drive from my house. As convenient and manageable as that is, I still had the urge to say no. And it was clearly just because of anxiety, because I even think it sounds like fun. So I said yes, and now I have to do it. I can't back out of something this easy. I don't know any of the specifics yet of what I'll actually be doing, so I'm trying to mentally prepare myself for several different scenarios. But in general, I'm worried about a social situation where I will be "trapped" and could possibly feel anxious or "sick." Which makes it the perfect challenge for me, since that's the worry that keeps me from doing just about everything.

In a sense, I'm dreading these things. But I also can't wait to find out how well I can handle them. Whatever happens, it will at least show me what I need to work on more. That's how I'm trying to see all these situations, as tiny experiments that will eventually lead to me being able to manage my anxiety at all times. The more I experiment, the more "data" I'll have.

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.

the comfort zone

Things have been going extremely well for me. I've been eating almost every meal without feeling really sick and/or anxious. I think I'm finally back to the point where my anxiety is pretty much non-existent as long as I am just hanging out at home. It's only an issue if I go out anywhere or if someone comes to visit us. That doesn't sound like much to celebrate, I guess, but I'm loving it. Pretty much all of last year (and some of 2010), for the first time in my life, I felt like there was nowhere that was safe. It was horrible, and I'm so happy to have a "refuge" again and to be feeling more in control of my anxiety.

On the other hand, I don't want to spend all my time at home, which is what I've been doing. Clearly it's time to get out more and see what happens, see if I can manage to feel anxiety-free other places. I think I am going to start trying restaurants again. Sometimes my experiences with them are fine, sometimes they are awful. I'm hoping with practice that the awful times lessen.

Unfortunately, there is some possible unidentified problem with my car right now, so I am sort of stranded until it gets checked out and fixed (or given a clean bill of health). Hopefully it gets resolved this week. Until then, I can't deny that I'm thoroughly enjoying my comfort zone. Right now I'm making my way through the Hunger Games trilogy.

happy new year

Happy New Year! I hope 2012 is a great year for everyone. I feel optimistic that it's going to be a better year for me. 2010 was a crazy hurricane / whirlwind of anxiety. 2011 had its intensely bad moments too, but it was better than 2010, so I seem to be heading in the right direction. Also, I am determined to get it together this year and actually do the work I need to do (like eating healthier, doing CBT, etc.). I had to go back to my long list of New Year's resolutions and revise it into a plan that I think is realistically achievable. This is something I've never done before. For some reason, letting go of the idea of "perfection all at once" tends to fill me with a squirmy reluctance to try anything at all. But that reluctant feeling wasn't as strong this year. More evidence of progress!

So the last book I ended up reading in 2011 was Living with Emetophobia by Nicolette Heaton-Harris. I bought it months ago, maybe around September, but I have been putting off reading it, because I had heard that it was mostly a long description of emetophobia, and I had a feeling it would only end up upsetting me or triggering me in some way. I figured it would not be helpful at all but might add more irrational thoughts or behaviors to my list. A few times, reflecting on that, I thought about never reading it. But since it is pretty much the only book on emetophobia out there, and I am writing about the same topic on a regular basis, I had to check it out.

All the reviews I heard were correct. The book mostly explained emetophobia in depth, all the different thoughts or behaviors an emetophobic person might have. I could relate to most of it. Some of it made no sense to me. (Am I the only emetophobe that doesn't feel compelled to look at someone who may be getting sick? When I see a car parked on the side of the road, I shut my eyes or look away and feel no urge to witness what I fear might be happening.) In addition to the explanations and personal stories, there were about four pages of advice on how to cope, including nothing more advanced than deep breathing, distracting yourself, and taking small risks whenever possible to try to expand your comfort zone.

But as bad as I felt it was objectively, I am hesitant to really criticize it, because it exists, at least. It's something that takes emetophobia out of just the Internet world, and I have to think it has had some positive impact in giving the problem more weight / attention. Also, if what an emetophobic is looking for is validation of their issue and the knowledge that they are not alone, the book does provide that.

Unfortunately, I'm way past that. Thanks to the Internet, I've known for years what the name of my issue was, and I've read stories from and talked to many people who are also dealing with it, and I'm betting that's the case for most of the emetophobes of my generation. It's not enough anymore. I'm not looking for someone to swap horror stories with. In fact, I generally feel like it might not be a good idea for me to ever meet another emetophobe in person. The idea of emetophobia support groups all over the country raises some doubts in my mind. Would we not just feed off each other? If half of us in the meeting felt nauseous from anxiety at being at the meeting, and the other half found out about it, wouldn't we all just be scared one of us might be legitimately sick? I don't know.

My real issue with the book is that I felt a little damaged and hopeless after reading it, and that feeling stayed with me all night. I rang in the New Year with a vague feeling of sadness at knowing that this phobia touches every part of my life and that there is no cure for it. I don't think the author meant to leave the reader with that impression, at all. But I feel like she spent 95% of the book talking about all the ways emetophobia manifests in a person's life and then ended the book with the message that it could be contained but not cured. It's hard not to focus on the bad parts of that instead of on the ray of hope that is "containment."

This morning, though, post-sleep, I felt better and able to see it all in a more positive light. Containment may be settling, but that doesn't mean it dooms me to a life of unhappiness. Everyone is settling for something in their life. Like someone might have a bad ankle because of an injury when they were young. Of course it would be better if they didn't have to deal with that, but they do, and they work around it. I know from experience exactly how contained emetophobia can be. In college, it was there, but I rarely felt upset about it. I wasn't doing anything special to contain it. It was just out of luck, I guess, or maybe because I had so much going on (schoolwork, friends, events) to distract me from it.

So that's my hope for 2012, that I can get my phobia as contained as possible. With the knowledge about managing anxiety that I have now, I should be able to reach a level of containment even better than the one from college.

And if I want to be wildly optimistic, I have heard of some emetophobes who have been able to cure themselves. Plus with more research into it, maybe a cure that works for everyone will be discovered / developed. It's possible.

new year's resolutions

I know I'm overshooting here (and yet still falling short of what I actually want to be doing), but these are my health-related goals for the new year:

1) Eat four servings of fruit / vegetables a day.

2) Do yoga twice a week.

3) Exercise three days a week.

4) Get check-up / physical.

5) Limit taking temperature to once a month.

6) Limit taking anti-nausea meds or anti-emetics to once a week (except for Tums).

7) Limit asking my wife if I am sick to once a day.

8) Meditate or work with affirmations or deep breathing once a week.

9) Do actual written CBT work once a week.

10) Do something outside the house that makes me anxious at least twice a month.

caffeine free

One of the first decisions I made after my "breakdown" last year was to give up caffeine. Most books / websites talking about anxiety disorders will advise against it. Pretty common sense - we're stimulated enough, why add to that? I know chocolate has some, and I still eat that, so I'm not super strict about it. But I stopped drinking (caffeinated) coffee and Mt. Dew, both of which I love love love. Mt. Dew especially has always been the only soda I enjoy and one of my favorite drinks in general. The loss of the coffee didn't pose much of a problem, since you can find decaf everywhere you go. Apparently there is also a caffeine free version of Mt. Dew, but I never see it being sold anywhere. At some point I may order it online. I probably should wait a little bit longer so that I can be absolutely certain I've forgotten the amazing taste of the original.

It has always been pretty easy for me to give up things. I don't have much trouble subtracting the bad. It's when I need to add something (like doing yoga, which I've been neglecting yet again) that I find myself unable to succeed (so far). But still, the fact that it's been a year and I still crave Mt. Dew makes me proud of myself for not caving. I'm considering it a success.

Speaking of goals, I've already started coming up with New Year's resolutions. This is probably obvious from this blog, but I'm a little obsessed with self-improvement, so I always get really excited around the New Year and have these grand ideas of changing myself into a completely different person. I overshoot every time, so I'm trying to at least make each goal realistic this year, but the list will still be long I'm sure.

a visit to the pharmacy

I went to the pharmacy tonight to buy some "just in case" items for the trip. My prescribed anti-emetics are long expired. I have nothing to tell a doctor to convince them to prescribe me more. So I figured I would just get something over the counter in case I get some sickness while on the trip. I ended up buying Emetrol (anti-nausea), some Emergen-C (to strengthen my immune system over the next week), and seven individually wrapped toothbrushes.

I should feel better now, but I don't. I don't usually do things like this. I don't have an emetophobia kit, I don't carry medication around with me all the time, I don't even bother with immune system boosters. Because taking any of those precautions always makes me feel like this, like crap. I have way more doubts and anxiety thoughts now than before I went into the pharmacy. Shopping for an anti-emetic leads to visualizing myself in a situation where I would need it. I'm happiest when I try not to think about any of it as much as possible.

I hold myself to very high standards, and I'm embarrassed, and I guess a little ashamed, that I bought these items. It feels weak. It's a big deal to me to be mentally healthy as well as physically healthy, and letting myself indulge in these safety behaviors always makes me start worrying about the mental health side. I want to be in control of my life. I don't want to be limited. That bottle of Emetrol I bought for no good reason is just a symbol to me of a downward spiral to a point where I won't be able to live in any meaningful way.

I'm probably being too hard on myself. It's only one trip, and it's the most stressful thing I've done in over a year. I can have an emetophobia kit just this once, and it's completely irrational to think that having these things will jinx me in some way.

When we get back home though, I am done with all of this. I'm throwing it out. I don't even want it in our apartment. Thinking about that makes me feel better. I'm not going to allow this to take over my life any more than it already has. This will probably take the form of New Year's resolutions. No more anti-emetics around, no more thermometer. I don't know. I'll make a firmer list later on. 

more on road trips

The test run drive went really well. I didn't even need to get out my written affirmations. It was a quiet, non-stressful drive. Most of the time we were surrounded by farmland. On the way there, I could feel the anxiety start in my stomach at times, and I just tried to bring my attention back to the external world - the music playing, the scenery. I read somewhere (no clue where, my brain is way overloaded with self-help books and websites) about playing a game with yourself to calm down where you look for something that starts with the letter "A", then the letter "B", etc. So I used that to distract myself too.

Sometimes when I start to "feel sick" I view it as a kind of black and white transition where I've left the realm of calmness / happiness, and that's it - now there's no going back. But on this drive I happened to be able to tap into logic (for once) and realize that only a few seconds had passed between feeling absolutely fine and feeling "off" in some way. Obviously I still was absolutely fine and was able to return to feeling that way with a little effort.

I felt a little "sick" after eating in the restaurant too, but it didn't last long, maybe about five to ten minutes of the drive back home. All in all, I'm super pleased with how it went, although I do keep thinking about how tame a challenge it was compared to the much longer trip coming up. My main areas of concern are:

-- the drive itself. We'll be on the road longer, there will definitely be more traffic and crazy drivers. Plus having to eat during the drive.

-- staying in a hotel. The last time I actually threw up, I was in a hotel, on vacation with my family. I know some emetophobes have bad associations with certain foods because they were sick after eating them. That didn't happen to me, but I guess I associate hotels in general (well, they do all look alike and smell alike) with the experience and feel slightly unsafe in them.

-- I'll be meeting my nephew for the first time. He's a little over a year old. I might have to hold him. Part of me really wants to. I've loved him since the day he was born and the first pictures went up on facebook. But part of me worries he will spit up on me. Or get sick on me? At what age does it stop being called spit-up? I have no clue, but really it makes no difference to me.

-- eating in general on the trip, eating away from home, eating around other people. I need more practice with this.

We are planning to have a couple more of these "test run" trips, if we have time to fit them in. The goal for the next one is to go eat somewhere and then go out shopping instead of coming straight back home.

centaur / mind-body

I've been trying to figure out what my little blog picture should be, what image could be associated with emetophobia. I'm reading this book No Boundary: Eastern and Western Approaches to Personal Growth by Ken Wilber, and a couple nights ago I got to this part of the book that was talking about the centaur as a representation of a unified mind-and-body:

"A centaur is a legendary animal, half human and half horse, and so it well represents a perfect union and harmony of mental and physical. A centaur is not a horse rider in control of her horse, but a rider who is one with her horse. Not a psyche divorced from and in control of a soma, but a self-controlling, self-governing, psychosomatic unity."

I love this. This is the emetophobic issue. We see our bodies as "the enemy" that we have to fight and master. It's the source of what we fear, so we want to escape it, but it's not something that can be escaped. It's us.

I want to get rid of this mind-body split, and in order to do that, I really need to commit to doing more things that will relax my body. In other words, not just sitting around and reading all the time, as fun as that is. I'm going to start doing yoga again. There was a brief period of time many months ago where I was doing yoga on a regular basis, and I know it was helping me. I really can feel how doing the stretches and then releasing the tension makes my body feel better and also seems to allow me to tune in to different parts of my body in a way that is pretty foreign to me. I don't know why it is so hard for me to stick with the habit. I would love to eventually get to the point where I do it every day, but I think for now, my goal is going to be three times a week. Starting this week. Here's hoping that posting this will keep me accountable. 

restaurants / new goal

My wife and I went to a restaurant for lunch today, which didn't go quite as well as dinner the other night. I had a lot of anxiety ("nausea") in the time between finishing my meal and leaving the restaurant. Of course, the moment we walked out the door, I felt better, an experience I'm all too familiar with. It's always kind of infuriating, because part of me is thinking "this isn't anxiety, it really is something else this time" but that never turns out to be true. Being wrong is not the infuriating part. I'm happy to find out that the horrible thing I thought was happening to me is not real. What's infuriating is knowing that once again, I let anxiety bring down my enjoyment of an experience.

I used the same techniques I've been using: affirmations, deep breathing, mindfulness. In a public place it's not always possible to be completely focused on telling yourself "I am breathing in, I am breathing out" or something like that. Mindfulness in a situation like this involves focusing on your environment (instead of on your thoughts/feelings/internal state). It helps to think of the five senses (although smell and taste might be too much for an anxiety attack that is presenting itself as "nausea"). I focused on the music playing on the overhead speakers, the tennis match on the TV above the bar, the conversation I was having with my wife, the cold/wet feeling of the glass of water sitting in front of me.

In discussing my anxiety with my wife, she made me realize that I have a habit of trying to finish my meal as close to the time of us leaving as possible. Of course, this never really works out, because no waiter/waitress is going to bring the check while you still have food in front of you. But still, this is exactly the type of behavior that I am trying to eradicate from my life. I'm making a new goal to stop doing this, to eat at the pace that is normal for me and finish whenever I finish. If I have to sit in the restaurant for half an hour after I'm done, oh well. Nothing bad will happen. Emetophobia shmemetophobia! 

mindfulness

It turns out the teacher for the class I'm taking is currently out of the country and unable to get a flight back because of the nasty hurricane weather that's been traveling up the coast. She didn't show up for our first class, and I got an email letting me know that the second class is canceled too. So much for my goals for the week!

But on some level, I'm grateful it turned out this way. I felt like this class was a huge step for me, and this turned it into a smaller baby step. I did not technically attend a class, but I sat in a room with about twenty other students I didn't know for the twenty minutes before we all decided to give up on the teacher and leave. That alone was a frightening situation for me, and I "felt sick" for probably the first fifteen of those twenty minutes.

I said my four-part affirmation to myself, and it did help somewhat. But in a sense it felt like the anxiety was flooding my brain and making it hard to even focus on the words, so I switched over to a mindfulness / breathing exercise from another book I read recently, The Miracle of Mindfulness by Thich Nhat Hanh. I took deep breaths, and each time I inhaled, I would say to myself "I am breathing in" and each time I exhaled, I would say to myself "I am breathing out." Or "I am breathing in a long breath" and "I am breathing out a long breath."

I guess because the words are combined with the concentrated act of controlling my breathing, they work in a way the affirmations don't, where I'm able to replace the "flood of anxiety" feeling in my head with just the breaths and the descriptions that go with them. At this point, it's hard to sustain, because I haven't been practicing mindfulness for very long. But having seen the way affirmations became more and more helpful the longer I worked with them, I'm optimistic that mindfulness techniques will end up being incredibly useful also.

Mindfulness teaches you to be only in the present moment, not in the future or the past. This may seem like a stupid idea to an emetophobic who is feeling nauseous - why would you want to remain in that present moment rather than thinking of something else?

-Because the more you practice being in the present moment, the more relaxed you will be, in general, overall. It's easy to handle what is happening right now in the present moment, not so easy to handle the vast expanse of possibilities in the future.

-Because when you are in a situation that causes a lot of anxiety, you may think that you won't be able to remain in that situation for the length of time you need to, but you can be pretty sure that you can get through the next minute or five minutes, at least. Kind of like AA's "one day at a time." Staying in the present moment in this way, you can get through whatever scary situation you are facing. And then, having survived it once, you'll know you can do so again.

-Because as an emetophobic, when you're leaving the present moment, it's usually not to go to some happy place in your mind where you don't feel sick. You're leaving the present moment to go into a fake or feared future ("I must be getting sick" "what if I am getting sick, and what if this causes me to throw up?"), and this is obviously not helpful.

taking a class / affirmations

I am auditing a class at a nearby college, and it starts tomorrow. It will be Monday and Thursday evenings. It's been a really long time, at least a year, since I have pushed myself so far out of my comfort zone.

So my main goal for this week is to go to both of these classes. I'm betting that I will "feel sick" in the first class and that this will make me want to give up on it. And since I'm only auditing, it will be too easy to drop it.

My other goal, of course, is to bring down my anxiety if/when it occurs during the class. I have a four-part affirmation I've been using during the past year in situations where I don't feel well:

1. This feeling is temporary.
2. This feeling is not dangerous.
3. Calming down will always help.
4. Calming down is the only thing within my control.

Using affirmations in general is a pretty new concept for me. I used to dismiss them whenever I heard them as too simplistic or "lame" or something similar to that. When I first started repeating them to myself, it just felt like a useless chore. I didn't really believe any of them and would frequently come up with arguments against them. I still have trouble with this (trying to debate the affirmations, although now I'm more hoping to prove to myself that they are true), so I also have an affirmation about my affirmations that I use now: "Affirmations are meant to be repeated, not debated." This is a reminder to myself to just stop arguing with them. It took many months, but eventually they began to sink in, and now I find that they can be really helpful.

But I do want to elaborate on numbers 3 and 4 of my list, because these are the ones I had (sometimes still have) the most trouble accepting, and remembering the logic behind them is helpful to me.

Emetophobics want to believe they are in complete control of their bodies, and I have always believed that if I remain alert (aka anxious), I am better prepared to fight the possible sickness. This is not true. First of all, if someone is legitimately sick, being in a calm/relaxed state will not cloud their vision/judgment about what is happening to them. Calm is not the same thing as being unaware of reality. I tend to think things like "if I am calm, I may not notice I am about to vomit" which is completely ridiculous. Being calm will not ever make things worse.

Secondly, being calm will make things better, even for a person who is sick. Having a sickness, even a stomach virus, does not guarantee a person will vomit. The illness could cause other symptoms instead (in the case of a stomach virus, probably diarrhea). Anxiety is an emotion that easily causes an upset stomach all on its own, so having an illness and then adding loads of anxiety to it can't help matters. Of course, if a person is emetophobic, they will not be able to feel anxiety-free during illness, but there are always things they can do to feel less anxiety. It will be an extremely stressful time, and it will be difficult for them to lower their anxiety, but it is possible, and it is something that should be attempted. As a person living with a phobia, lowering anxiety is something that should always be attempted, no matter what the circumstance.

And in closing, I became familiar with affirmations (along with a bunch of other incredibly helpful anxiety-reducing techniques) through The Anxiety and Phobia Workbook by Edmund J. Bourne. I actually have the fourth edition, but I'm betting it's not that different from the newest version. The book has several pages of affirmations, and I have spent a lot of time reading and writing them over and over. I usually have one written or typed out on a sheet of paper and taped up on the wall over my computer. The one I have hanging there right now is one of my favorites:

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