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.                

self-healing rituals

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

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

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

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

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

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

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

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

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

accomplishments

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

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

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

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

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

blah

I haven't had that much emetophobic anxiety lately. I even went out to dinner recently and ate until I was overly full and didn't feel the slightest bit worried about it. I can't remember the last time that happened. So there's the good news.

But I've been having tons of anxiety about my health in general. I keep noticing little aches and pains and feeling like there is something wrong with me. Plus I feel low-energy. All of this could, of course, be caused by anxiety and anxiety alone. But how can I know for sure? I can't. I can't know anything for sure, and my refusal to accept this is basically the root of all my problems.

My only option really is to start up an anxiety-fighting regimen again to see if that makes me feel any better physically. I think the main area I need to focus on is exercise. But I also bought a CD player for the bedroom so that I can listen to guided meditation CDs in there, away from distractions (naughty cat, TV, noisy air conditioner).

And I'm trying to work up the courage to make a doctor's appointment. This was one of my New Year's resolutions, to get a check-up this summer, and now it's summer, but I've yet to make the appointment. It'd be nice to be officially told there is nothing wrong with me, and then I'll have that as ammunition against all these irrational thoughts.

defeating the health anxiety (again)

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

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

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

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

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

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

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

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

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

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

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

emetophobia treatment plan / exposure

I wanted to share this article, which outlines a treatment plan that was successful in curing a 12 year old girl's emetophobia.

Worrywise Kids In Session: Case Conference on Vomit Phobias and OCD

Some thoughts I have after reading it:

1) I'm pretty fascinated by the idea of a fake vomit mixture. I remember reading about the idea somewhere else a few years ago, and I thought about doing it, but I decided it would be gross and that the idea really didn't bring up that much anxiety for me. However, in this scenario they add in the elements of urgency (by running to the toilets with the mixture in their mouths) and messiness (getting some of it on the toilet seat). That makes me feel more anxious when I think about doing it, which is surprising to me.

2) Since this treatment plan is for a 12 year old, I wonder if a similar plan would be as successful for an adult. I've often wondered if I could have gotten past all this if I had just gotten therapy for it when I was really young. I'm guessing age 11 would have been the prime time for me to go into extensive phobia counseling. But maybe the only reason it's easier for a child is because they have more motivation and are more willing to take risks. She mentions at one point that other patients resist the exposure exercises more. I found myself resisting a LOT of them even though I was only thinking about them, not even being asked to do them.

I am resistant to the idea of hanging out in a nurse's (or doctor's) office with sick people, to the idea of having a normal conversation with someone who was just sick, and to the idea of going on nauseating rides like roller coasters. When I think about exposure, I think "sure, I have no problem with it, as long as I'm not doing something that legitimately makes it likely I will end up vomiting." Things like going out to restaurants, eating "high-risk" foods, and taking trips involve a certain degree of risk, obviously, but in the logical part of my mind I know it's a very small risk. Actually forcing myself to ride a roller coaster or have a conversation with a sick person seems like a very big risk.

Either I'm being irrational by thinking that it's a big risk, OR that's the idea, to take a big risk and not care. I'm not sure which it is, but I'm guessing probably the second one. I know part of exposure therapy involves going to extremes, doing things that not even a normal person would do. For example, in a book I read about OCD (Freedom from Obsessive-Compulsive Disorder, by Jonathan Grayson), part of an exposure hierarchy for someone afraid of germs was to touch the inside of a dumpster. Why? For one thing, although a normal person would not just go up to a dumpster and touch the inside (and would feel grossed out by the thought), they might take out the garbage before going out to eat without thinking about it, which is essentially the same thing. Also, going to extremes takes you even further in your recovery. Doing something as extreme as touching the inside of a dumpster makes you even more aware of how low-risk other (less extreme) activities are.

3) This particular therapist mentions that the main reason she did not have the 12 year old girl induce vomiting as part of the exposure hierarchy was because young girls have body image issues and are at risk for eating disorders. I'm assuming this means that if she was working with an adult, she would include this step.

I have mixed feelings about this. I think self-induced vomiting is dangerous. This is probably due to more irrationality on my part (my general health anxiety), since I think manipulating your body in any way, even by taking a painkiller, is dangerous. This is why I hate medication so much. Of course, I still take it, as sometimes it's necessary, but very rarely. I have read that taking the recommended dose of Ipecac (the most commonly used emetic) is not dangerous, but I'm not entirely convinced.

Then there's the "evidence" that vomiting (self-induced or not) doesn't cure emetophobia. I put "evidence" in quotes because I'm talking about stories I've read on various websites from people who have either gotten sick with a virus or have self-induced, usually through taking Ipecac. I can't really call this evidence, because I can't say for sure these stories are true, although I'm assuming they are. Most of the people who give these accounts claim that they don't feel that anxious directly following the act of vomiting, but that they are back to their usual phobic state within a day (or a few days).

On the other hand, there is the occasional account where the person says that the act of vomiting did cure them or at least made them feel considerably better. I've given this a lot of thought, wondering why it works for some when it doesn't for (it seems) most. Maybe the phobia is not as severe for these people. Maybe they have some fundamental difference in their personalities or brains that makes them good candidates for this type of treatment. What I tend to lean towards (out of hope, because it's something that I could actually control) is that it has to do with how these people react to the experience in the moment. Some people, after vomiting, are horrified and upset and scared. They are usually writing about how they "ruined their streak" or how their anti-emetics didn't work (or they didn't even have time to take them), how aware they suddenly are of how little control they have over vomiting.

Other people are excited and relieved. They write about how they felt better after vomiting, how proud they are of themselves for getting through it, how it wasn't as bad as they had always thought. I don't think this has to do with the experience itself (as in it was much worse for the people in the first, upset group). These people are making a choice to cast the experience in a positive light. It's not fun or pleasant, but they choose to downplay those parts and emphasize the triumph involved, and the fact that no terrible consequences came from vomiting.

I tend to be a negative/pessimistic person, so I would probably fall into the first group. This gave me the idea of writing a letter to myself, a letter that I would read immediately if/when I ever vomited, to remind myself that I should make every effort to see this experience as okay and even a good thing. I haven't actually written it yet. It's just something I've been mulling over.

4) The imaginal exposure parts bothered me a little, because sometimes it is actually the case that a kid gets teased for vomiting or that a parent reacts badly. I don't have any experience with the teasing, but I remember my parents always being more annoyed than concerned when I got sick (or my sisters did), because they didn't want their carpet (or the car, etc.) to get messed up. It makes me wonder what the point is of convincing yourself this is unlikely to happen, especially if you are still a child. Shouldn't the focus be more on accepting that other people might be inconsiderate/mean and that it's okay (they'll get over it)? Maybe that was part of the focus. I mean, it is a pretty short case study and obviously isn't including every detail.

5) Everything else aside, this little girl is my absolute hero.

self-diagnosing

Miranda: I've been trying to diagnose myself on the Internet.
Charlotte: You can do that?
Miranda: Sure. Just type in your symptoms, hit enter, and wait for the word cancer to appear on the screen.
- "Hot Child in the City", Sex and the City 

I seriously love this quote and know from personal experience how true it is. I am always worried about my health (general health as well as stomach-related health) and have spent so much time online looking up any physical symptoms I experience. I've been trying to stop, and I have gotten a lot better. Sometimes I can talk myself out of doing it now. But I think it was just a week or so ago that I was looking up appendicitis and thinking I might have that.

I so strongly advise against ever self-diagnosing online. Especially if you have anxiety problems of any kind. It never helps. Yes, anything you put in will come up as cancer or something equally horrible. Yes, almost every diagnosis will include nausea and vomiting as possible symptoms (just as every single medication will have them listed as possible side effects). Rarely will you put in your symptoms and have "anxiety" come up as a prominent possibility, even though anxiety can cause every possible bodily symptom or combination of symptoms. Seriously. Some websites / books talking about anxiety will tell you it can cause muscle tension, digestive problems, headaches, sweating/shaking. Those are some of the more common anxiety symptoms. But it's nowhere near what's possible. Here is a more comprehensive list. 

You will probably notice that this list also has vomiting on it, so I just want to add that I don't believe emetophobics are wired to have that particular reaction to anxiety. If it is possible to have both emetophobia and a tendency to vomit when anxious, I'm sure you would already know you were one of those people. (Also, you would be my hero for dealing with that.) Most emetophobics feel anxious frequently, often accompanied with nausea, and never get sick from it.

I'm not saying you should ignore all physical symptoms, because sometimes it will actually be something other than anxiety. If you have anxiety, it can be hard to tell when something should be ignored and when it should be checked out. These are my own personal guidelines I use to try to navigate my way through hypochondria:

-- I try really hard to avoid looking up my symptoms online. (Don't do it!)

-- I remind myself that I am an extremely anxious person, especially when it comes to my health / body, and that I have had similar worries many times before. So for me, the odds are definitely in favor of any symptoms being caused and/or magnified by anxiety.

-- I tell myself that when it comes to having a serious medical condition, the symptom won't just exist, it will also be severe. So I may feel a shooting pain in my stomach, but how much is it actually affecting me? Can I walk, can I breathe, etc.? People get random aches and pains all the time. When non-anxious people go to the doctor about them, it's because the aches and pains are impairing their ability to function.

-- If I can still walk/breathe and all that good stuff, I tell myself to wait and see if it goes away. I don't have an exact time frame in mind, but at least one or two days.

-- Usually by the time one or two days has gone by, my symptom is gone. But if it ever wasn't, and I was still really concerned about it, I would talk to someone I trusted about it (my wife, I'm sure) and maybe decide to go to a doctor, who, unlike a search engine, will probably be able to give me an accurate diagnosis instead of an exaggerated worst-case-ever one.

It's impossible to know at all times what's happening inside your body, something that is very frustrating to me, but I'm trying to learn to accept it. I don't want to spend every second of my life being vigilant about it, or get into a habit of going to the doctor over every tiny perceived thing. Better to err on the side of under-reacting and believe that if something was really wrong, I would catch it in time.