help with my cbt!!

[katie-18]

hi i was just wondering if anyone can give me any advise or thoughts on my situation.

im currently coming to the end (around 5 sessions left) of my cbt. i feel like its gone well in certain parts for example:
# im not as obsessive about over-cooking meat anymore
# i have left my anti-sickess tablets with someone for over a month now - there was a time when i couldnt leave the house without them
# i have ate shellfish for the first time

however as my sessions are coming to an end, my therapist has been saying that i need to make bigger steps. as my big goal is to be able to stay calm and carry on as 'normal' when people are being sick, this week my 'homework' is to go on youtube and watch clips of people being sick.

obviously at first i was really anxious about doing this but i felt that if i could do it, it would be a massive step. however when i have come to actually do this 'homework' im really struggling to be able to do it.

i get the understanding behind why he wants me to do this - but im feeling now that it might make me worse as i will be 'facing my phobia' by watching these clips which are quite extreme to say the least.

i just dont know whether watching these clips will be a good idea or whether its going to make me worse.

if anyone has been through this with their cbt please let me know.

thanks

[KaydeeJayde]

The reasoning behind this is that we need to face our fears so that our mind sees theres no harm from seeing someone vomit. Perhaps start quite slowly with babies vomiting and work your way up?

[katie-18]

thanks kaydee jayde. my therapist did expalin the reasoning behind it and i do understand but i feel like its going to do more damage in a way.

i actually started with watching clips of babies, which i personally dont class as bad as an adult being sick, but this was still a lot more shocking than i expected

[Rebecca85]

You need to start with something quite gentle, that only makes you slightly anxious. If watching clips, even of babies, is difficult, maybe try a still picture of someone vomiting? Or even just of vomit. There is a great resource on this site somewhere for gradual exposure, it starts with just v**** and works up to videos of someone vomiting.

You don't need to rush to get things 'finished' before your CBT ends. Now you have the right tools, you can continue working on your own, so better to work up to videos gradually than rush things and set yourself back. I'm sure your therapist will understand that the homework is too hard at the moment, you did try, but you are going to take it in little steps.

[orton99]

Hi Katie, I've done this exercise as part of my CBT recently and wrote about it in two posts on the second page of my CBT thread (top of the Treatments page). They're the posts dated 18th and 23rd August. I wrote in some detail about what I watched and how I felt before, during and after.

I should point out however that I don't hold back in my descriptions of what I was watching, so you might find some parts of it a bit graphic, it depends on where you are in your recovery. For a more gentle introduction to the same thing, check out Sage's site (link below), which has a carefully graded list of pictures and clips to look at.

Overall it was a very worthwhile thing to do and I thought it helped me a lot, so I hope it does the same for you!

http://www.emetophobiahelp.org

[sage]

hi katie,

If you go to my website (link below) and click "Resources" you'll see 12 levels of gradual exposure. Perhaps you're just not ready for the higher levels of videos because you haven't yet desensitized to easier things yet. Even if you do go to videos, at least they will be in order of least to most scary. Good luck with it!

[overthere441]

Hi,

I did CBT about a year ago, which include watching videos. However, if you are not ready to do anything, you know best-when I did therapy, I was always leading -- my therapist was supportive, and encouraged me when I was doubtful about readiness to do a given exposure, but if I said no it was always accepted, and we worked on something I felt comfortable with - I feel that if I was told I needed to take bigger steps, I would have clammed up.

When I did therapy, I wouldn't move onto a more anxiety provoking situation until I had habituated to the first one. For instance, my hierarchy listening to a person v* (without the visual) was less anxiety provoking than listening to and watching a person v* (YouTube) at the same time. So I only went to listening/watching at the same time once I had habituated to listening (and watching without sound) alone.

Are you ending therapy soon because it is what you want, or because there is a time limit on the therapy for whatever reason (health insurance, your own financial status, or a very structured therapy program with a limited number of sessions)?

Good luck!

[katie-18]

thanks for your messages back everyone - its nice to know there are people who understand what im going through and who i can talk to.

rebecca85 - ive managed to watch clips of babies being sick but i just feel like there is a massive difference between that and looking at v* or watching clips of adults. i think i need to find more steps to get through before watching the videos. thanks for making me realise that i dont have to be 'cured' before i finish my cbt - i suppose i can continue with it myself.

orton99 - thanks for telling me about your thread - it will be interesting to see how our sessions compare.

sage - thank you for the link to your website - i think maybe graded pictures might be the next step for me.

overthere441 - i think my therapist has realised that we have spent too many sessions working on my safety behaviours (how i cook meat, things i wont eat incase it makes me ill, anti sickness tablets etc) and he is now going too quickly onto the next steps. whenever i have told him that i might have a problem with any of the 'homework' he says that none of this will be easy and that i need to move on to the next step. my therapy is through the NHS and he said the maximum amount of sessions he could give me was 20. i had cbt around 6-7years ago which did help to a certain point but i always felt that i didnt have enough sessions (again through the NHS) - thats why im starting to worry about that now.

[overthere441]

Hi again,

I have started CBT again (was doing well after the last CBT sessions a year ago, but then v* and lost most of my progress). I am terrified of it, but know that right now, it is the only way to improve my quality of life. Maybe if you thought of your values (my new therapist uses a combination of CBT and ACT, acceptance commitment therapy, which emphasizes personal values), and weight them against the fear, you can use your wish to be rid of the phobia to motivate you to do something you don't feel up to doing.

Of course, we all know logically what we need to do to overcome the phobia, it is just very hard to listen to the logic in the face of feared situations.

Maybe think about the short term discomfort (ie: probably a feeling of terror), in relation to the potential/probable long-term benefit. I've also found that reading about successful CBT for emetophobia (I think I have read at least one article, via google scholar) can also be motivating.

If it helps to know, when I did CBT last time, I did work up to watching videos, with sound, of people v*. It took an immense amount of will power - I had to continually tell myself that if I wanted to get better, this is what I had to do. It was almost like I was trying to trick myself to believe that watching the videos, or doing whatever was on my hierarchy was my only choice.

Also, it may hell to look at past triumphs in therapy, and to try to use those as motivation to continue. You were able to conquer other things on your hierarchy, even though those were very scary, and will be able to continue conquering other things on your hierarchy - even though they are scary.

I'll admit though, it is so much easier to give advice than to take it-as I am currently giving in to the phobia far more than actively trying to reduce it (hence needing to be back in therapy). But I wish you luck, and know how incredibly hard it is to be in CBT for this phobia. You can do it!

[katie-18]

thank you so much for your encouragement overthere441.
your right in everything that you say, but like you say it is sooo much harder actually doing it isnt it?
ive decided that im not going to look at videos on youtube just yet - i just feel like its too much of a big step right now. im going to concentrate on looking at the exposure therapy on Sage's website until my next appointment on tuesday.
you have also given me the confidence to tell my therapist if im not happy with any of is suggestions. im going to work at it at my own pace, even if that means i run out of sessions - ill do it by myself.

i have just got one question though - whenever im in a 'phobia situation' i concentrate on deep breathing to try and calm myself down and cope with the situation. my therapist has told me this is a safety behaviour (which i sort of understand) and has told me to stop doing this so i can feel the 'full force' of the situation and feel the anxiety come down. i understand this to a point but i feel that taking control of my breathing enables me to stay in the situation longer and therefore 'facing the fear' longer. what do you think about this - it is bad to deep breathe?

[katie-18]

oh and i forgot to say -good luck when you start your therapy aswell x

[overthere441]

Hi,

Thank you!

I'm glad you have more confidence to do what is right for yourself!

I have done, and still do, deep breathing in particularly anxiety-inducing situations. I remember being very frustrated with my previous therapist, because she also deemed this a safety behavior, preventing me from experiencing the full anxiety. I had your attitude, that it helped me stay in the moment longer. However, because she was my only resource at the time, I tried to comply as best as I could. I did watch videos - and as shocking as they were initially, I did habituate over time, and now can see people v* on tv or in movies without panicking.

The current therapist I see (I had 3 appts over the summer, but had to take a break due to $), has a more open-minded view to therapy for emetophobia. She is willing to incorporate more coping mechanisms, with the belief that if I can start off in a more relaxed state (via meditation or relaxation training), I will still feel the anxiety peak, and come down on its own. The difference is that I may simply be more likely to do the exposure, and might feel a greater sense of self-efficacy in the therapy. It seems somewhat contradictory, as she thinks it is necessary to feel capable of being in control, yet also to relinquish some of that control to accept my body as it is, and its reactions as they are - without trying to change anything. I'm not sure if this makes sense, but I like it.

I found an article about the incorporation of ACT into traditional CBT for phobias. It is not a scholarly article (ie: not in a recognized journal), but does cite scholarly articles. You should check it over though - I just skimmed it. Perhaps you could show it, or something similar, to your therapist?

The article: I can't post links on the forum yet, but here is how to find it:
in a google search, type: new harbinger, ACT, phobia
Click the first link, which should be titled "Phobias - New Harbinger Publications"

Even if your therapist doesn't know of ACT, or doesn't want to incorporate it, perhaps just seeing that another approach to phobia treatment exists would help him/her see your desire as more valid.

PS: before I watched videos in therapy, my exposure was (even with the first therapist) to look at pictures of v*, then of pictures of people v* (each for one week). Then I watched the videos gradually (first hearing alone, then looking alone, then combining both - over a period of weeks).

Hope this wasn't too much rambling, and good luck!

[katie-18]

thanks for that - its really good to hear of somebody elses experiences with the therapy.

i really do feel that the deep breathing helps me in so many ways -
* if i feel sick and start to panic - it helps to relax me so that i can deal with what may happen
* if im in a scary situation, it gives me the time to relax and think about what i am going to do - rather than just run away
i do feel that i need to learn to relax and calm myself if i am ever going to be able to get over this because the first thing that happens when im in a situation, is panic.

i had cbt around 6years ago and the big step that i made there was to be able to watch somebody be sick on tv programmes or films (not real). i am still ok with this and can still cope if i happen to see it. its just when its for real that i have still got a big problem with.

i have been looking at the 'resources' on sage's website and i did feel some anxiety, so i am going to take my time and work my way through them.

thanks for the link - i will have a good read of that over the next few days.