must check temperature now

I had a dentist appointment today and wasn't feeling well in the hours leading up to it. I actually drove to the pharmacy down the street just to buy some of those disposable covers for thermometers so that I could take my temperature and reassure myself I wasn't sick.

As I got out of the car and walked up to the store, it hit me how ridiculous I was being. Would someone who was sick with a fever really have the energy to run a quick errand and remember to grab a CD before they left and be singing along with the music on the way? Even if they did, they'd certainly feel worse by the time they got there, and I felt much better (I'm assuming because I was taking action to solve my non-existent problem).

On top of that, my car's "check tire pressure" light was on, and it probably would have been a better use of my time if I had added some minutes to my for-emergencies cell phone in case I had a tire problem on the very long drive to the dentist. Because let's face it, that was much more likely to happen than me getting sick during my dentist appointment.

Not my most rational moment. Luckily, I did not have any car trouble. Or a fever.

Anyway, aside from minor crazy behaviors like the above, I have been doing well. Very little anxiety. Life is good.

Hope everyone else is doing good too!    

two years

Today's the anniversary of my "breakdown." Actually, I guess it really started the night before with the first of the panic attacks, but this was the date where I was in the hospital all day, so I consider this to be The Infamous Day.

I never thought I would feel like myself again, but I do. I can now say I feel like my anxiety is under control, at least as much as it can be while still having a phobia. It's just exhilarating to know that. Two years ago I was such a mess, and I had never imagined that things could get that bad. And then I couldn't imagine that they would ever get this good again either.

In celebration of this, I'm posting the timeline of my improvement. This is pretty much how the last two years went:

September 10, 2010: I was in the hospital most of the day discussing my non-stop panic attacks with various people. Then they gave me Ativan, and I went home and took that immediately, and then one or two other times in the next few days.

September 11-19: I went to the doctor three times. The first time I was given Lexapro, which made me feel sick, so I only took it once. The second time I got my thyroid tested (problems with it can cause anxiety issues), and nothing was wrong with it. The third time I was given Cymbalta, and I only took that once too. It didn't make me feel sick, but it did have minor side effects that bothered me (like restless legs).

I missed a lot of work. I couldn't eat or drink much. Everything I ate made me feel nauseous; I was taking a lot of Zofran during this time. I couldn't sleep and basically spent every night in the living room, dozing with the TV on.

I started seeing a therapist and doing breathing exercises, and I listened to a guided meditation CD every day and tried to meditate as much as possible. It was not something I had done much in the past, but it helped immensely anyway. Just made me feel temporarily calmer.

September 26: I started working through The Anxiety & Phobia Workbook. I know I've talked about it a lot, but I'll say it again. It's an amazing book. It helped me so much.

October 5: I joined a gym and started exercising more to see if that would help. It does help, but I still have a hard time sticking with the habit, even now.

October 8: By this point I was doing word searches almost constantly, especially when I woke up in the middle of the night (which was almost every night). They really helped me calm down when I was anxious.

October 16: I wouldn't let myself watch anything (on TV or in movies), read anything, think about anything upsetting or anxiety-producing. I felt frustrated by having to hide from negativity, but now I think it was the right thing to do. It helped me get better faster, and obviously I no longer have to do it. But I still don't watch horror movies. I used to watch them all the time and now don't let myself, because they have too much of an effect on me.

October 20: I had gotten a little notebook and was writing out affirmations in it every day. I would pick one from The Anxiety & Phobia Workbook and write it out five to ten times in a row, pausing in between to reflect on what it was saying and really try to believe it. I did this at least once a day, but more if I was really anxious. It was another activity that calmed me down.

December 4: I started noticing that PMS always made my anxiety issues much worse. I began reminding myself of this every month around that time so that I wouldn't take my thoughts and feelings so seriously.

February 3, 2011: I started doing yoga. I don't do it much anymore, but it was helpful and calming at the time. 

April 30: I printed out some of my favorite affirmations and would tape one to the wall above my desk so that I'd be reminded of it frequently throughout the day. Every so often, I'd switch to a new one. 

May 9: I was still seeing that my anxiety got significantly worse and hard to deal with during PMS, so I started taking 100mg of B6 daily (on top of a multivitamin) to help with that. It seemed to work wonders (after a couple months I think). I still take it. 

July 23 - 26: I started having bad panic attacks again. It felt like a repeat of the initial "breakdown" only to a much lesser degree. But again, it was extremely difficult to eat or drink for a few days, and I felt horrible all the time. I'm not sure what caused this relapse, but I got it under control much faster than I had the first time, mostly through forcing myself to eat as much as possible, which kept me somewhat stable. This gave me hope that I was moving in the right direction. 

August 29: I started taking a class at a college nearby. This forced me out of the house on a regular basis, forced me to interact with the world again, which was something I really needed. I had gotten pretty homebound. 

September 10: I tried hypnosis for the first (and only) time. I felt slightly better for a few days after it, but I have no idea if it was the hypnosis that caused this. Or the placebo effect. Or coincidence. 

November 22: I took a trip to see my family for Thanksgiving. This was very stressful and didn't go as well as I had hoped. Again, I had problems eating, drinking, and sleeping. I felt sick almost constantly. But I did manage to get through it without any medication (psychiatric or anti-emetic). I used affirmations that I had written out on index cards and the EmWave2 I had just gotten.

February 19, 2012: I did an online emetophobia study which started around this time. It involved a lot of CBT and exposure work that was helpful.

May 1: I stopped going to therapy, because I felt pretty confident that I knew what to do when I was anxious. Most of the time I could calm myself down by countering my negative thoughts and focusing on more positive ones.

That's about it. I've been doing really well this year. Basically, the Thanksgiving trip was the last "crisis" period I had, and I am sure that if I took that trip again this November, it would go a lot better.

Speaking of trips, I am taking a small one later this month. I won't even be leaving the state, but I will be staying in a hotel in another city. I'm excited. For the first time in a long time, I feel excited about a trip. I'm not dreading it! I think it's going to go really well and be loads of fun.

doctor

I went to the doctor for a check-up last week. And survived! I was extremely nervous before and during it, but it all turned out fine. I even got a vaccination that I needed, one that supposedly can cause nausea or vomiting (a 1 in 10 chance). No problems with that either.

I was anxious that I would be part of the 10%, but I know there was no reason to be. I have never had any issues with vaccinations or medications in the past (being allergic to them, having bad reactions). Not to mention the fact that probably most of the 10% felt nauseous but didn't vomit (since the stats combined the two side effects), or they allowed themselves to vomit when they felt nauseous because they aren't afraid of it.

I'm super proud of myself for forcing myself to do this. And the best part is that now I won't have to do it again for one to two years! I'm leaning towards two. 

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.

movie scenes

I didn't write about it at the time, but a few months ago, I finally decided to sit down and force myself to watch some movie vomit scenes I usually avoid. I had seen most of them, but I tend to hide even from those I've already seen by covering my face or leaving the room, just because they make me uncomfortable. But two scenes I saw for the first time, the scene from Drop Dead Gorgeous and the scene from Bridesmaids. I had heard about how graphic these scenes were from other people before seeing the movies, so I made sure to always leave during them.

The Bridesmaids one in particular has already become a frequent mention on emetophobia forums. I've seen a bunch of threads talking about how awful it is, other people disagreeing and saying it's funny, debates starting about whether vomit should ever be shown on TV or in movies.

Of course it should. I may sit around at home and complain about it and get really angry and say it's completely unnecessary. But so is everything else in shows/movies. I'm choosing to watch, and I know what I'm getting myself into. There's no way of knowing what will pop up. I also don't particularly like excessive gore. And I hate how movies about babies almost always include some disgusting poop-related scene. Oh well. Other people like those things and think they add to the drama and/or comedy. Vomit is a somewhat extreme act that can be used for either purpose. Of course they're going to keep taking advantage of that. It's up to me to desensitize myself as much as possible.

I was pretty surprised at how nervous I was. I watched the scenes without any volume at first. Which I would highly recommend, because that made them totally manageable. Once I had seen everything that happened without having heard any of it, I watched them again with a little volume, and then a few more times with normal volume. They were definitely unpleasant. I can't say I ever enjoyed them (even the Bridesmaids one - I didn't think it was that funny), but it was easy to get to the point where I could tolerate them.

With new movies/shows, I won't be prepared. I won't know when the scene is, and I may not have heard the basics of what happens. And a lot of times they like to surprise you when it comes to vomit, to have it come out of nowhere. But I feel like this desensitization exercise has a broader effect than you would think. I haven't been flinching as much when I encounter new TV/movie vomit.

It also helps (with vomit, gore, any gross thing in movies) to remind yourself every time that it's fake. Of course you already know that, but actually thinking about how they did it takes away much of the ickiness. I don't know what they use to make movie vomit, but I'm guessing it's usually some mixture of food. This website talks about how they use a vomit machine to project tomato soup in one movie.

Plus with Drop Dead Gorgeous, Denise Richards is in it, and knowing that she has emetophobia makes me feel oddly comforted about the scene in that movie. I guess it's knowing that someone is involved who understands how I feel (although I don't think she is actually in the vomit scene). Who knows? This may be true of other actors/actresses as well, and they just haven't come forward about it yet. 

"it's different this time"

This is usually how one of my emetophobic anxiety attacks plays out.

I notice something happening in my stomach. This leads me to think/say "I don't feel well."

I try to pinpoint the cause. In fact, I want to know the exact cause, which then leads to frustration, because that's almost always impossible. If I ate three different things an hour ago, I might spend way too much time and brainpower arguing with myself about which of the three things would be the most likely to make my stomach hurt.

I start assessing how bad the unpleasant feeling is. This is where things can quickly spin out of control. It doesn't really matter how bad the feeling is - what matters is how anxious I am. If I'm not careful, if I don't do something to try to calm down, I will soon arrive at the conclusion that this feeling is somehow different than any stomach-related feeling I have ever had before in my life. It's more severe, or it's in a different part of the stomach, or it feels like there's more _____ this time (churning, bubbling, flipping, whatever).

"It's different this time" - four words that I should never say, but I say them far too frequently. Other variations: "this feels different" or "what if this is something different?"

Sometimes it's not even the feeling itself that leads me to this "conclusion." Sometimes it's that I feel I was exposed to some illness a couple days ago, so this feeling MUST be related to that and therefore, it's different, where "different" really means "the moment I'm finally going to get sick."

From looking around at emetophobia blogs and forums, I can tell this thought is not unique to me. It seems like most, if not all, emetophobics get hung up on this idea of stomach pain being "different this time."

Maybe it's not only emetophobics, but all people with anxiety. One of the main cognitive distortions an anxious person will struggle with is catastrophizing, and if you are telling yourself "it's different this time" you are catastrophizing. Instantly you have changed something that is benign/harmless to something huge and scary. You have taken something you can handle, something you are familiar with (stomach pain for emetophobics, a panic attack for those with panic disorder, etc.) and made yourself believe it is unfamiliar and unmanageable.

You're basically saying "though every other time has been fine, this time I am clearly in great danger." Even if you don't fully believe that, that's the message you are reinforcing with your words, and it will only lead to more anxiety.

It seems like emetophobics have a kind of amnesia when it comes to their stomachs. With all the times in my life I have felt "sick," and all the times I have thought or said that what I was feeling was different than anything I had felt before, it's impossible that I could be right all those times. There isn't an unlimited number of unpleasant stomach sensations. If I am able to calm down some and then reassess, it's rare that I still believe it is a brand new feeling.

I think this irrational thought is one of the most harmful for me, so I have been putting a lot of effort into correcting myself whenever I catch myself thinking or saying it.

It is not different this time.
The truth is, I have been through this many, many times before.
I have had this same feeling at some point in the past and lived through it.
I know I can handle this. I'm practically an expert.
This feeling will pass.

regressing

The person I was going to meet for dinner cancelled, as they ended up not having enough time during their vacation to make the long drive over to my area. I can't say I wasn't partially relieved. I had been stressing about it every day. But at the same time, it would have been nice to prove to myself that I could get through a situation like that.

Then last weekend a friend came to visit and stayed with us. I had so much fun hanging out with him, but my anxiety spiked. Which was both surprising (because I'm close to and comfortable with this friend) and annoying.

We went on nature walks, and because it was hot, I worried I would get heat stroke and throw up. Or I worried I was overexerting myself, and that would make me sick. We went out to eat twice. The first time (breakfast) was absolutely fine, but the second time (dinner) I wasn't hungry, probably due to anxiety, and I was anxious that this meant I was getting sick and would throw up. We did a bunch of other things too. By the end of the day I was exhausted - it was more activity than I am used to - and then I worried I was sick because I felt tired! I had to repeat affirmations in my head in order to fall asleep and then woke up in a half-asleep panic at around 2 in the morning, feeling "sick" and trying to figure out where I could go to be sick in private, if it was going to happen.

I hardly ever wake up feeling like this anymore.

I feel like I've hit some kind of wall. I don't experience much anxiety anymore, but I guess it's only because I feel safe, because I'm only hanging out on a "narrow strip" of my room, as Rilke would say. I don't expect these (pretty minor) challenges to throw me so much, because I'm feeling so great most of the time. I really need to find more things to do around here that put me in situations where I am uncomfortable. I hate to think this is as good as it gets. I want to be able to go into any situation without returning to the mess I used to be.