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.

tricks

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

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

So far, so good.

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

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

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

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

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

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

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

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

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

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

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

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

work tour / low blood sugar

I finally took that company tour for work. It went really well! I was pretty anxious before I left, but it wasn't affecting my stomach, even after I had breakfast. It was more just a shakiness. I sat and did some meditation and deep breathing and just tried to relax as much as possible.

When I actually got to the company, my anxiety was basically gone (other than a social insecurity / awkwardness that is always there). That tends to happen when I get around people, because I become so focused on acting normal in my interactions with them that I don't have the brain space to worry about much else. My tour guides walked me around all through the building, showing me everything involved in the manufacturing process. It was fun and interesting, and even though I don't find business or manufacturing to be that exciting, I got into it a little bit. Maybe just because it was nice to be 1) moving around and 2) interacting with people for a change.

The only problem came after the tour was over, and I went back home. I'm used to feeling MUCH better as soon as I get out of a stressful situation, but I started feeling very ill instead. Mostly it was a bad headache, but then I started feeling like it was affecting my stomach too. Of course, I thought at first that I must have picked up some virus on the tour or touched some part of the manufacturing equipment that was toxic, etc. I kept telling myself that couldn't be the case, because it was so unlikely I'd already be showing symptoms. But I felt so ill that this logic was barely keeping me together. I even took Aleve for my headache, which I hardly ever let myself do.

Nothing terrible happened. After a few hours, I finally started feeling better. I don't know exactly why I felt so bad, but my guess is that it was low blood sugar. I forced myself to eat breakfast before going, but I don't think my breakfast was large enough. Especially considering I was walking around for about three hours, when I am used to sitting down in front of a computer all day. I think my blood sugar crashed, and then, even though I ate again right when I got home, it took a while for things to normalize again.

I really need to work more on eating before I leave the house for long periods of time. I have gotten to the point where I almost always do it, but I still tend to gravitate towards smaller meals or even just little snacks. I worry about feeling overly full when I leave, and in trying to avoid that, I usually end up not even reaching the bare minimum of fullness.

weird al understands me

You know what I find really amusing about having emetophobia? The fact that the lyrics to the song "Germs" by Weird Al so closely mirror actual thoughts I've had.

 

positive self-talk / exposure hierarchy

I'm still working through the different steps of the emetophobia online study. Last night I was trying to come up with my own personal exposure hierarchy, and I started going back through the Cognitive Behavioural Therapy Workbook for Dummies, because I worked through a lot of the exercises back in 2010-2011 and knew I would get ideas there for what I tend to avoid the most. I also found a bunch of loose papers I had been keeping in there with helpful affirmations. I haven't looked at any of this stuff for a long time now, because I've been feeling so much better, so it was weird to go back and see how much trouble I was having. Some of the things I was thinking back then seem so foreign to me now, which I love, because they were awful things. But I thought I would post some of the positive information/statements that I collected or created to help during that horrible time.

I remember I looked online for new affirmations sometimes, but I usually couldn't find anything that resonated with me like the affirmations from the workbooks did. I did find this website with anxiety coping statements and information about thought stoppage, and I printed it off and had it tucked in the front cover of the book.

Then I had a list of negative statements I was constantly thinking back then and a positive rebuttal I had come up with to counter each one:

1. 

I should be able to just get over my anxiety, knowing that's all that it is and that it's in my head. What is wrong with me? 

It's not that simple. There is no quick fix. It will take time and work to overcome my anxiety, and I am working really hard at it. I should be proud of myself for what I am able to accomplish at this point, and for my ability to stay motivated at working hard on these issues.

2. 

There is no reason for me to feel anxiety in this situation. I'm getting worse (or not getting better). I'm not the same person I used to be. 

I keep thinking that my anxiety should "make sense" and should only pop up at the times that it makes sense that it would based on the past. But an anxiety disorder isn't like that - by definition, the amount of anxiety you feel with an anxiety disorder is extreme and does not make sense. I may still be going through a rough time, but that doesn't mean I haven't improved a lot in the past year, and it doesn't mean I should lose hope that I can one day be a relatively anxiety-free person.

3. 

I have a very hard time knowing what I feel or want, and that isn't normal. 

Again, I have an anxiety disorder. This causes me to feel insecure and doubtful and indecisive at all times. It doesn't mean that I am an abnormal person that has no real feelings or desires. It doesn't mean that I will never figure out what I want. There is always time to change things, and it is within my control to change them.

4. 

I never really do anything. I don't have a real life. 

I actually do many things, sometimes so many that I complain about how I am too busy. It is in my nature to want to stay home, and some people are like that. But also, some of that tendency might be coming from my anxiety problems (which, aside from this severe period, I have had to some degree all my life) and maybe once I get better at dealing with my anxiety, I will feel more like going out and doing more social/outside activities.

5. 

I know better than to expect this event to go well. I'm definitely going to have anxiety there, so I should just accept the fact that I'm going to be miserable and get through it as best I can. 

I can't predict the future. There is no way of knowing for sure how much anxiety I will have in any situation. I may not even have any. Expecting the worst will only make me more anxious, which won't help. If I tell myself I can handle this situation and go into it with confidence, I am more likely not to feel anxiety and to have a good time overall.

6. 

This feeling is unbearable. I can't stand feeling like this way anymore. 

This feeling may be unpleasant, but it is not unbearable. I have survived it many times before and can survive it again. If I tell myself I can handle the feeling, it will most likely go away faster and will not be as horrible. 

Thoughts on worrying 

Worry does not help you prepare for problems. Planning and taking constructive action in response to worries can help you solve a problem or prepare for a less than ideal situation. But worrying in itself will not help you prepare for what might come up in life. 

There is no point in practicing being unhappy. Most of the time, things turn out well, and in preparing all the time for bad things by worrying, you are just increasing the amount of time you spend feeling miserable.

---

This is the exposure hierarchy I came up with in the end (in order from least scary to most scary). I can do all these things, but I try to avoid them as much as possible, because they make me either really uncomfortable/uneasy (for the first few) or really anxious.

-- Watching vomit scenes on a cartoon
-- Watching vomit scenes in shows/movies (not animated)
-- Going to a pharmacy
-- Eating dessert (or something unhealthy) at a restaurant
-- Buying/eating something from the grocery store that I think is "high-risk" (for food poisoning)
-- Eating at a restaurant and getting something new/unfamiliar from the menu
-- Using public restroom
-- Eating a big meal before leaving the house to go somewhere
-- Eating at a restaurant, then going somewhere else (not straight back home)
-- Eating far away from home (at least a 3 hour drive back)
-- Eating at a restaurant at a busy time when it's crowded
-- Staying at a hotel overnight
-- Staying at a hotel overnight and eating out somewhere that night

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.

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!