CYEAT: Chapter 12

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

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

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

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

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

CYEAT: Chapter 2

Chapter 2 focuses on cognition and how the way you think affects your mood, your anxiety, your outlook on life (similar to chapter 1’s belief systems affecting your perception). It also goes into visualization, which I always find interesting.

The author talks about Coué's Law of Reversed Effort, which says (I'm paraphrasing) that when you want one thing to happen, but you are imagining or worrying about a different outcome, what you imagine will have a stronger effect than what you want. You can make it more likely something will happen by imagining/visualizing it.

Of course, that’s not always going to be true. If you want to have a safe flight and are worrying the plane will crash, you won’t make it crash. If you are worrying you will vomit, it’s very unlikely you will make yourself vomit. But you can make yourself feel “nauseous” and convinced you’re going to vomit by worrying you’re going to vomit, or even by worrying you’re going to feel nauseous.

Another example the author gives is losing a sports game because you’re imagining how awful it would be to lose, which then makes you anxious and causes you to lose your focus. Basically, your thoughts, your belief systems, your imagination, all of it, can influence your feelings and anxiety level, and that can have an effect on your behavior too.

To counteract this, it’s best to 1) tell yourself positive things and 2) visualize what you want to happen instead of what you fear might happen. Seems pretty common sense, right? Putting happy thoughts/images in your head can only have good results.

It’s difficult to do though. I spent months after my breakdown drilling affirmations into my head. I’ve gotten to the point where I can pull them out during an anxiety attack (and they are really helpful), but in general, I’m still usually thinking negative thoughts and putting myself down. It’s such a strong habit. And I hardly even know how to form a picture of what I want to happen when I’m so used to visualizing the worst outcome for every situation. The book recommends practicing these positive visualizations on a regular basis, sitting down for 5-10 minutes at a time and really fleshing out the visuals. I’m definitely going to start doing that.

dentist anxiety

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

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

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

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

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

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

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

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

movie excursion

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

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

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

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

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

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

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

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

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

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

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

emetophobia survey

Friday night of a hectic week. Sounds like a good time for a survey, followed by a lot of lying around and not working for two days. I've seen this posted a few places - not sure where it came from originally.

1. Does your family know of your Emetophobia? I don't think so. To make a long story short, we have serious communication issues in my family.

2. Do your friends know of your Emetophobia? Yeah, probably all of them do. I'm pretty open about it.

3. Would you tell a stranger that you have Emetophobia? I guess it depends. I think the only strangers I have told are doctors / dentists so that 1) they would prescribe me anti-emetics 2) they wouldn't prescribe me anything with nausea or vomiting as a main side effect. It doesn't usually come up in normal conversation for me.

4. If you are currently in a relationship, how long did you wait to tell your partner? We were friends for a while before we started dating, so she already knew all about it.

5. Are you scared to have kids? Of course. But underneath all the fear, I don't think I want kids anyway, so I'm not too concerned about it. My life is pretty stress-free compared to the average person's life, and I have a hard time handling that tiny amount of stress. I can't imagine adding the stress of raising children to that. 

6. If you are a mom who suffers from Emetophobia, how do you deal with the struggles of your kids being sick? N/A, but I'm sure I wouldn't deal with it well at all. I feel panicked even when our cat throws up and usually run to hide in the next room.
 
7. What age did you discover that you had a problem? I was around 11 and found a website describing emetophobia. I can't remember if I was actively looking for an explanation. I had recently had some problems with missing a lot of school because of "feeling sick," so maybe.
 
8. What type of methods have you tried to reach recovery? I've never really believed I could get rid of the phobia completely, but to cope better, I have tried just about everything. Exposure therapy, talk therapy, CBT, ACT, affirmations, all the basic relaxation techniques (meditation, progressive muscle relaxation, deep breathing, visualization), yoga, mindfulness, and hypnosis. Most of this I still do, because I find it all helpful. The only thing I haven't given a fair chance is long-term medication. The side effects scare me too much, so both times I tried it, I stopped after the first dose. 
 
9. When was the last time you have thrown up and why? I was nine years old, and I'm pretty sure it was just a basic stomach virus.
 
10. When was the last time you saw someone else throw up? I'm not sure I remember. I've done a really good job of avoiding seeing it, even if all I could do was shut my eyes or turn my back on it. I feel like my last "direct experience" with it was December 2007 when I went into a stall in a communal bathroom in my college dorm building and then heard the girl in the stall right next to me start throwing up. I ran out right away.

11. What type of foods do you avoid? I don't think I avoid any food all the time, it's more situational. I avoid cooking any raw meat myself, because I don't trust myself to do it right, plus I don't want to deal with that kind of "contamination" stress. I hate trying anything new, so usually I make my wife try it first, and if she doesn't get violently ill from it (she never does), I might have some. I'm afraid of restaurants I've never been to before, so I try to stick with chains. Same for groceries - I have my safe "brands" and hate buying a different brand or the generic brand. When I know I have to go out somewhere, or when I am already in public, I try to go for simple / bland foods only like sandwiches or pasta. Oh, and I always avoid alcohol. The only alcohol I've had in my life was a tiny sip of champagne when I was really young (New Year's Eve).

body visualization

I just finished reading Molecules of Emotion by Candace B. Pert, Ph.D. She's a scientist, and the book focuses mostly on her research involving peptides and receptors in the body. There was definitely much more scientific/medical jargon than I was prepared for, as I was kind of expecting a basic psychological self-help book. But I love science, and she breaks it down to the point where I could follow what she was saying most of the time, so I didn't really mind pushing through those parts. Especially because she interspersed the science with autobiographical narrative.

In the second half of the book, she started to pull it all together and talk more about health and emotions. Basically, through her research she has developed a holistic body-mind outlook: emotions are in the body and not just the mind; the mind can influence the body, and the body can influence the mind (a two-way communication); all systems tie together (immune, endocrine, nervous, etc.) and communicate with each other. I think most of these ideas would not be surprising to anyone these days. The book was written over a decade ago, so it was probably a more revolutionary message back then. But it was still interesting to read about the actual science behind it. At the very end, she tied spirituality into it too, another subject that fascinates me, so the book ended up containing almost every topic I adore: science, history, personal narrative, sexism / feminism, psychology, health, and religion / spirituality.

My original intention in reading it was to find something that might help me with my anxiety though, and on that front, there wasn't much that I didn't already know or hadn't already tried. She did inspire me with her many little anecdotes about using visualization to actually bring about changes in the body. For example, she talked about visualizing her pituitary gland releasing endorphins and how as a result of doing this, she could actually feel the endorphins being released and traveling all over her body, lifting her mood. I am a super skeptical person, and my thoughts immediately went to "maybe she just imagined this happening." But does that even make sense, saying she only "imagined" an increase in happiness? She still felt happier either way, which is the whole point. Goal achieved.

A similar story talked about a man who broke his elbow and then spent twenty minutes each day visualizing blood flowing to the site of the injury, which apparently resulted in the injury healing much faster than would normally be the case.

Since reading that, I've been experimenting a little with this kind of body visualization, focusing on my stomach / digestive area and imagining the resources of my body - blood, peptides, molecules, energy, whatever - all going to that one spot. The book describes the entire body and everything working within it as an "information network" so that I can imagine my stomach as an area that needs more research, since I usually find myself out of touch with it. Often I will find myself in the bizarre situation of knowing that I should be hungry (as a healthy person who last ate several hours ago) but not actually being able to feel that hunger. It's like my stomach is not accessible to me. I will get headaches or feelings of fatigue that alert me to my hunger without ever having passed through the stage where I felt it in my stomach.

The other morning before going out to breakfast, I tried this. I am not a morning person, and when I am tired, what's happening in my stomach is even more indecipherable to me. Then anxiety can take over and interpret the "strange" / unidentifiable feeling as fullness, or worse, nausea. But having just woken up, I know logically I must be hungry, since I haven't eaten for about twelve hours. I tried the visualization exercise, and it seemed to work after only ten to twenty minutes. I wouldn't say I was ravenous, but I began to feel like I could eat without there being any danger. I began to get a sense that the "strange" feeling was one of emptiness.

Which I find promising. In general, I am and always have been focused on the mind over the body. I loved school, and I love reading and writing and exploring ideas. I tend to see my body as an annoyance or (more frequently) as something to fear, and I really want to change this perspective. I want to learn to be aware of it in a more detached / mindful way, and I'm hoping one day I'll get to the point where enjoying my body, taking pleasure in it, is the rule rather than the exception.

celebrating progress

I am usually hard on myself. I think all the time about things I do that I shouldn't be doing, things I avoid that I shouldn't be avoiding, etc. I try to pin down every single way that I am failing to function as a "normal" person due to anxiety so that I can fix it all. I'm not doing that today.

One year ago today, I was in the hospital for almost the entire day because of panic attacks. I knew that was what was happening; I've had anxiety my whole life, so I was familiar with the symptoms. But this was different than anything I had experienced, panic attacks that were hitting me from out of nowhere - while I was sitting safely at home - and lasting for hours. I really thought I had reached the point where I was going to lose my sanity. I couldn't stop thinking about those brief biographies that are written about authors like Poe or Plath or Hemingway, the kind that paint them as people who were doomed all along to a life of insanity, and it was just a matter of waiting for that final blow, the last nervous breakdown or institutionalization.

The panic attacks didn't start from an emetophobic place, but of course they ended up there. Before I even went to the hospital, I had gotten to the point where I wasn't eating much, because I was so overwhelmed. Then that turned into (what felt like) an inability to eat anything, which lasted for about two weeks. I did eat during this time, but only because of my wife. She would bring me something and insist that I eat it. I never once felt aware of being hungry, and everything I put in my mouth, including water, made me feel so "nauseous" that I was terrified of swallowing. I remember her bringing me a small bowl of dry Cheerios one morning, and after one or two bites I started sobbing, because it felt impossible to eat the entire bowl. I was scared I would never want to eat again and couldn't imagine a lifetime of forcing myself to do it every day.

I know the anxiety set this off, and taking Ativan one day, attempting Lexapro another day, and then trying Cymbalta on another, all on a practically empty stomach, can't have helped the situation. Especially when it was my first time ever taking psychiatric medication (I didn't end up sticking with any of them). But I think what caused it to last for so long was my own inaction. I was clinging to my long-held belief that 'not eating is the best defense against feeling bad,' even though I felt absolutely horrible, and it was clear that not eating was perpetuating that.

But since I'm celebrating progress here, I'm not going to talk about how I should have handled that better and could have gotten myself accustomed to food again much faster. I'm going to talk about how I did handle it better the second time around, because about two months ago, this happened to me again. I had a few panic attacks, and once again, I felt like I couldn't eat.

I'm really glad this second bad period happened. At first, it shook me up and made me feel that in spite of all my hard work, I hadn't gotten anywhere in the past ten months. But it became obvious, from the way things played out, that I had changed. There was no hospital trip. Instead of missing about five days of work, I only missed two. I still had some Ativan, but I didn't end up taking any. I increased my focus on affirmations and practiced breathing / visualization exercises. Most importantly, I made it one of my top goals to eat as much as possible. I still wasn't consuming anywhere near the amount I should have been, but I was at least having enough every day so that I didn't get into that emetophobic cycle where it just gets worse and worse: hunger = nausea = don't eat = more intense hunger = more intense nausea = still don't eat, etc.

I was back to eating normally within a week, and it never got so bad that I was crying over a meal. I was able to drink water the whole time. Plus whenever I did eat, I actually thought about what would be the best choice, given that I was somewhat malnourished and might not be able to eat a sufficient amount. I tried to choose what had protein and actual substance, versus a year ago when I only went for "safe" carbs like crackers, toast, cereal.

So looking back over this entire year now, I feel like I've come so far. It's strange even to remember being in the hospital and how I was desperate for them to send me home with some drug, because I figured it was all over for me, and that was the only way I might possibly be able to live a normal life again. It's incredible to know that when these bad anxiety periods happen, I don't have to just fall into that state of helplessness and passivity. I have some control and can do things to reduce both the level of anxiety and the length of time I feel that way. I've been trying to convince myself of this for the past year, and I am finally at the point where I believe it most of the time. Now I just have to figure out how I can prevent these bad periods from happening in the first place.